recognized Indian tribe or otherwise qualifies under regu-
lations promulgated by the Federal Health Board (in con-
sultation with the Secretary of the Interior)—
(1) the individual is entitled to a 100 percent
reduction in the premium rates charged under sub-
section (a), and
(2) the issuer of the policy is entitled to pay-
ment by the Federal Health Board of an amount
equal to the amount of such reduction.
A reduction and payment under this subsection for such
an individual shall be instead of any reduction or payment
otherwise provided under subsection (b).
(e) EXPANSION OF TAX DEDUCTIBILITY OF PRE-
MIUMS.—For provision making payment of premiums
under this section fully tax deductible, see title VI of this
Act.
SEC. 204. USE OF STANDARDIZED FORMS.
Each approved health insurance policy shall provide
for the use of such standardized claims forms as the Fed-
eral Health Board specifies, after consultation with State
Health Boards and other interested parties.
SEC. 205. PAYMENTS TO PRACTITIONERS.
(a) IN GENERAL.—Each approved health insurance
policy shall provide for payment for health care practi-
tioner services based on the fee schedules established
under part 1 of subtitle B.
(b) MANDATORY ASSIGNMENT.—Payment for health
care practitioner services may only be made to the practi-
tioner furnishing the services and only if the practitioner
agrees to accept payment of such fee schedule amounts
as payment in full for the services.
Subtitle B—Payment Amounts for
Health Care Practitioner Serv-
ices and for Covered District
Health Care Services
PART 1—HEALTH CARE PRACTITIONER SERVICES
SEC. 211. STATE-CHARTERED PRACTITIONERS ASSOCIA-
TIONS.
Each State shall provide for the chartering of practi-
tioner associations—
(1) to represent licensed members of the dis-
cipline in the establishment of fee schedules in the
State under this part, and
(2) to provide medical malpractice insurance
under section 302.
SEC. 212. ESTABLISHMENT OF FEE SCHEDULES.
(a) IN GENERAL.—Each State Health Board, in con-
junction with State-chartered practitioners associations
provided for under section 211, shall develop fee schedules
of amounts that may be paid for health care practitioner
services by approved health insurance policies under sub-
title A. The Board shall provide for the review and revision
(if appropriate) of the structure of such schedules not less
often than once every 10 years.
(b) BASIS.—Such schedules may take into consider-
ation regional cost variations, practitioner expertise, out-
come-based measures, and any other factors deemed rel-
evant by the Board.
(c) NEGOTIATIONS.—Each State Health Board shall
provide for annual negotiations with State-chartered prac-
titioners associations regarding the changes in the
amounts specified in fee schedules developed under this
section. Such negotiations shall consider changes in the
cost of living, the cost of supplies, and other elements
which affect the costs of delivering health care services by
the practitioners.
(d) SPECIAL NONPHYSICIAN PRACTITIONER PROVI-
SIONS.—In the establishment of fee schedule amounts for
nonphysician practitioners, in the case of health care prac-
titioner services which may be provided by nonphysician
practitioners and physicians, basic reimbursement rates
for those same services shall be the same regardless of
the type of practitioner providing such services.
PART 2—PAYMENTS FOR COVERED DISTRICT HEALTH
CARE SERVICES
SEC. 221. ESTABLISHMENT OF ANNUAL PER CAPITA RATES.
(a) IN GENERAL.—The Federal Health Board, using
data from State Health Boards and Health Care District
Boards, shall determine an annual per capita rate for
costs of covered district health care services provided by
such Boards.
(b) DIVISION OF RATE.—The Federal Health Board
shall specify the portion of the annual per capita rate
under subsection (a) that is attributable to nursing facility
services and the portion not attributable to such services.
Such portions shall reflect the average of approved State
budgets under section 222 which are attributable to the
different services.
SEC. 
222. 
STATE 
BUDGETS 
FOR 
COVERED 
DISTRICT
HEALTH CARE SERVICES.
(a) DEVELOPMENT.—
(1) IN GENERAL.—Each State Health Board
shall develop and approve a State budget for covered
district health care services for all districts in the
State. Such budget shall be the sum of the district
budgets submitted to and approved by the Board
under section 223.
(2) DEVELOPMENT OF SEPARATE OPERATING
AND CAPITAL BUDGETS.—The State budget under
this subsection may consist of separate components
for operating and capital expenditures under guide-
lines established by the Federal Health Board.
(b) PAYMENTS TO DISTRICT BOARDS.—
(1) IN GENERAL.—Each State Health Board
shall establish procedures for payment of each dis-
trict board of amounts under its approved budget in
a manner that provides for an adequate cash flow to
allow the timely payment of obligations for the pro-
vision of covered district health care services.
(2) TREATMENT
OF
NATIVE
AMERICANS.—
Under guidelines established by the Federal Health
Board, State Health Boards shall establish such pro-
cedures as assure full payment of amounts due to
Native American districts established under section
112(a)(4).
SEC. 223. DISTRICT BUDGETS FOR COVERED DISTRICT
HEALTH CARE SERVICES.
(a) DEVELOPMENT AND SUBMISSION.—
(1) GLOBAL BUDGETS.—Each health care dis-
trict board shall develop and submit to the State
Health Board, in a manner and at a time consistent
with guidelines developed by the appropriate State