(1) IN GENERAL.—The National Health Board 
and its local authorities shall, not later than the ef-
fective date of health services and to the maximum 
extent feasible, establish and maintain such health 
care facilities as are necessary for the efficient and 
effective delivery to individuals of comprehensive pri-
mary health care services (defined in paragraph (2)), 
specialized health care services (defined in para-
graph (3)), special services (defined in paragraph 
(4)), and community-oriented health measures (de-
fined in paragraph (5)). Such health care facilities 
shall be established and maintained in a manner 
that, as soon as possible and to the greatest extent 
feasible, provides services in each community 
through a single comprehensive health center. 
(2) COMPREHENSIVE PRIMARY HEALTH CARE 
SERVICES DEFINED.—As used in paragraph (1), the 
term ‘‘comprehensive primary health care services’’ 
means those basic outpatient health care services 
typically needed for the promotion of health and the 
prevention and treatment of common illnesses and 
includes the following health care services— 
(A) general primary medical and dental 
care, including diagnosis and treatment, routine 
physical 
examinations, 
laboratory, 
and 
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radiologic services, and home visits by health 
workers, as appropriate; 
(B) preventive health services, including at 
least immunizations, nutrition counseling and 
consultation, and periodic screening and assess-
ment services; 
(C) children’s health services, including as-
sessment of growth and development, education 
and counseling on childrearing and child devel-
opment, and school and day care center health 
services; 
(D) obstetrical and gynecological services, 
including family planning and contraceptive 
services, pregnancy (prenatal and postnatal) 
and abortion counseling and services; 
(E) comprehensive geriatric services; 
(F) vision and hearing examinations and 
provision of eyeglasses and other visual aids 
and hearing aids; 
(G) 24-hour emergency medical services; 
(H) provision of pharmaceuticals and 
therapeutic devices, and medical appliances and 
equipment; 
(I) mental health services, including psy-
chological and psychiatric counseling; 
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(J) home health services; and 
(K) occupational safety and health serv-
ices, including screening, diagnosis, treatment, 
and education. 
(3) SPECIALIZED HEALTH CARE SERVICES DE-
FINED.—As used in paragraph (1), the term ‘‘spe-
cialized health care services’’ means those health 
care services of a specialized nature (whether deliv-
ered in an inpatient or outpatient setting) which, ap-
plying guidelines established by the National Health 
Board, may be provided most effectively and effi-
ciently in a community setting. 
(4) SPECIAL SERVICES DEFINED.—As used in 
paragraph (1), the term ‘‘special services’’ means 
supportive services and the facilities (including nurs-
ing homes and multiservice centers) in which such 
services are provided for individuals who are phys-
ically or mentally handicapped, mentally ill, infirm, 
or chronically ill, so as to promote the integration 
and functioning of such individuals within the com-
munity. 
(5) COMMUNITY-ORIENTED HEALTH MEASURES 
DEFINED.—As used in paragraph (1), the term 
‘‘community-oriented health measures’’ includes ef-
forts to focus organized community activities upon 
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the promotion of health and the prevention of illness 
and injury, support for self-help and mutual aid 
groups offering health promotion and rehabilitative 
support programs; surveillance of potential threats 
to community health, and prompt action to protect 
against such threats, and includes outreach efforts 
to ensure that all residents are aware of and able to 
utilize the health services of the Service, as needed. 
(c) ALLOCATION
OF
HOSPITALS.—The National 
Health Board, in consultation with its local authorities, 
shall periodically determine the necessity to establish and 
maintain inpatient and other specialized health care facili-
ties in particular locations. Where found appropriate, it 
shall establish and maintain— 
(1) general hospitals for the efficient and effec-
tive delivery of health care services to individuals re-
quiring inpatient diagnosis, treatment, care, and re-
habilitation for injury or illness; and 
(2) such other health care facilities as are nec-
essary, using guidelines established by the National 
Health Board to promote the efficient and effective 
delivery of health care services. 
In addition, the Board shall distribute and provide such 
health care services of a specialized nature (whether deliv-
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ered in an inpatient or outpatient setting) as may be pro-
vided most effectively and efficiently. 
(d) SPECIALIZED SERVICES.—The Board shall, not 
later than the effective date of health services, establish 
and maintain— 
(1) specialized medical facilities for the efficient 
and effective delivery of highly specialized health 
care services, using guidelines it shall establish, to 
individuals requiring highly specialized treatment, 
care, and rehabilitation for injury or illness; 
(2) health care and supplemental services for 
individuals whose health care are related to occupa-
tional or other factors, including individuals residing 
within a region on a temporary or seasonal basis (in-
cluding migratory agricultural workers) and individ-
uals confined to prisons and other correctional insti-
tutions; and 
(3) such other health care facilities as are nec-
essary to promote the efficient and effective delivery 
of health care services. 
(e) HEALTH SERVICES.—States and the National 
Health Board, through its local and regional authorities, 
shall provide the following through health care facilities 
established pursuant to this section: 
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(1) Health promotion through education on per-
sonal health matters, nutrition, the avoidance of ill-
ness, and the effective use of health care services 
with particular emphasis on the appropriate and safe 
use (discouraging the overuse) of drugs and medical 
techniques. 
(2) Maintenance and appropriate transmission 
and transferal of personal health records for each 
user of the services consistent with section 201(9). 
(3) Referral services, including referrals, where 
appropriate, to other health care facilities. 
(4) Supplemental services (described in section 
213(b)), as appropriate. 
(5) Assistance to individuals who, because of 
language or cultural differences or educational or 
other handicaps, are unable fully to utilize the serv-
ices available from and delivered by the Board. 
(6) Information (A) on the rights ensured 
under this Act, (B) on the guidelines and standards 
established by the Board, and (C) on how the Board 
is implementing such rights and applying such 
guidelines and standards. 
(7) Information on the grievance mechanisms 
established pursuant to subtitle A of title IV and on 
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legal services available to pursue grievances against 
the Board. 
(8) Environmental health inspection and moni-
toring services, including investigations relating to 
the prevention of communicable diseases, in coopera-
tion with State and local authorities. 
(9) Research and data gathering on the leading 
causes of ill health and injury and on health care de-
livery, in accordance with section 421. 
(10) In the case of each inpatient health care 
facility, discharge planning and followup services (A) 
to identify patients who will need continuing care 
after discharge from the facility, and (B) to plan, 
with the patient and the patient’s family, arrange-
ments and referrals to meet such postdischarge 
needs. 
(f) AUTHORITIES.— 
(1) EFFECTIVE
DELIVERY.—In its establish-
ment of health care facilities, the National Health 
Board shall seek to minimize fragmentation and du-
plication in delivery of health care and other services 
so as to promote the effective and efficient delivery 
of such services. 
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(2) COORDINATION.—The Board shall provide 
mechanisms to coordinate care across political and 
geographic boundaries as necessary. 
(3) ASSURING
AVAILABILITY
AND
ACCESSI-
BILITY OF SERVICES.—The Board shall take what-
ever additional steps are necessary to ensure that all 
of the health services required under this title are 
available and accessible in a timely manner to 
adults, infants, children, and individuals with dis-
abilities in its region. Toward that end, it shall— 
(A) ensure that users have access to a suf-
ficient number of each category of health work-
er, including primary care providers, specialists, 
and other health care professionals, in a man-
ner so that, to the maximum extent possible, 
such providers are geographically accessible to 
all residences and workplaces within the region 
and are culturally and linguistically appro-
priate; 
(B) ensure that services are available in a 
manner which ensures continuity of care, avail-
ability within reasonable hours of operation, 
and include emergency and urgent care services 
which shall be accessible at all times; 
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(C) ensure that any process established to 
coordinate care shall ensure ongoing direct ac-
cess to relevant specialists and shall not impose 
an undue burden on users with chronic health 
conditions; 
(D) ensure that appropriate steps are 
taken to eliminate any transportation or other 
barriers to the timely receipt of services; 
(E) ensure that a user who has a severe, 
complex, or chronic condition shall have access 
to the most appropriate health care coordinator 
(as defined in paragraph (4)(A)); and 
(F) ensure that priorities in the use of 
services and facilities shall be set by the appro-
priate health care professionals using criteria of 
medical necessity and that any limitations or 
delay in access to services shall be based only 
on limits of available service personnel and 
physical facilities. 
(4) DEFINITIONS.—For purposes of this sub-
section: 
(A) HEALTH
CARE
COORDINATOR.—The 
‘‘health care coordinator’’ means a health work-
er who performs case management (as defined 
in subparagraph (B)) functions in consultation 
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with the health care team, the patient, family, 
and community. 
(B) CASE MANAGEMENT.—The term ‘‘case 
management’’ means a coordinated set of activi-
ties conducted for the management of an indi-
vidual user’s serious, complicated, protracted or 
chronic health conditions in order to ensure 
cost-effective and benefit maximizing treatment. 
(g) GUIDELINES.—The National Health Board shall 
establish guidelines for distribution and coordination of 
the delivery of health care and other services described in 
this section and shall, before the effective date of health 
services, plan and facilitate the transition to the new dis-
tribution of health care facilities and health workers to 
be effected on and after that date. 
(h) USE OF EVIDENCE-BASED CLINICAL DECISION 
CRITERIA.— 
(1) IN GENERAL.—The National Health Board 
shall authorize the National Institute of Evaluative 
Clinical Research described in section 422 to estab-
lish evidence-based clinical decision criteria, where 
feasible, that shall apply throughout the Nation. 
(2) CLINICAL DECISION CRITERIA DEFINED.— 
For purposes of this section, the term ‘‘clinical deci-
sion criteria’’ means the recorded (written or other-
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wise) screening procedures, decision abstracts, clin-
ical protocols, and practice guidelines used as an im-
portant basis to determine the necessity and appro-
priateness of health care services, in combination 
with the facts of particular cases, the judgment of 
health care professionals, and the preferences of 
users. Such criteria shall be clearly documented and 
available to all health workers and shall include a 
mechanism for periodically updating such criteria. 
(i) NOTICE
OF DETERMINATIONS.—The National 
Health Board, and its local and regional authorities, shall 
provide users with timely notice of any determination to 
provide, deny, or delay provision of a service, and informa-
tion about the relevant clinical decision criteria upon 
which such determination is based, if any. Such notifica-
tion shall include information concerning the appropriate 
procedure to appeal such decision. 
(j) ACCOUNTABILITY.—In the case that the Health 
Service fails on the effective date of health services, to sub-
stantially and materially provide health care and supple-
mental services in accordance with this section, redress 
and alternative sources of care shall be authorized by an 
independent authority accountable to Congress and State 
legislatures. Such redress may include— 
(1) requiring the provision of services; and 
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(2) providing reimbursement for the provision 
of specified health care services in accordance with 
procedures and schedules in effect under title XVIII 
of the Social Security Act immediately before the ef-
fective date of health services. 
SEC. 222. OPERATION AND INSPECTION OF HEALTH CARE 
FACILITIES. 
(a) ESTABLISHMENT OF POLICIES.— 
(1) IN
GENERAL.—Each health care facility 
shall be subject to policies and organizational plans 
consistent with this section and with parts A and C 
of title III (relating to the health labor force) for the 
operation of such facility and shall establish proce-
dures to ensure that the facility is operated in ac-
cordance with such policies and plans. 
(2) HEALTH WORKER AND USER CONTROL.— 
The National Health Board and its regional and 
local authorities shall establish policies and mecha-
nisms for control of health care facilities by health 
care workers who are employed in, and users who re-
ceive services from, the respective facility, and shall 
promulgate rules preventing a financial conflict of 
interest by decisionmaking bodies. 
(b) EMPLOYMENT RESTRICTIONS.— 
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(1) IN
GENERAL.—No individual entitled to 
make decisions regarding establishment, allocation, 
or operation of a health facility may engage in the 
private delivery of health care services. 
(2) PRIVATE
DELIVERY
OF
HEALTH
CARE 
SERVICES DEFINED.—For the purposes of this sub-
section, the term ‘‘private delivery of health care 
services’’ means the delivery of health care services 
for which an individual, group, or organization re-
ceives remuneration from any source other than the 
Health Service Trust Fund established in section 
511. 
(c) OPERATIONS OF HEALTH CARE FACILITIES.— 
(1) HOURS OF OPERATION.—Any health care 
facility which provides health care services on an 
outpatient basis shall be open during hours that will 
permit all users to make use of such services. 
(2) EFFECTIVE
DELIVERY.—In its establish-
ment of health care facilities under this section, the 
Board shall seek to minimize fragmentation and du-
plication in delivery of health care and other services 
so as to promote the effective and efficient delivery 
of such services. 
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SEC. 223. PROVISION OF HEALTH SERVICES RELATING TO 
REPRODUCTION AND CHILDBEARING. 
(a) PROVISION OF SERVICES.— 
(1) IN GENERAL.—The following services shall 
be provided: 
(A) FAMILY PLANNING.— 
(i) Complete information on contra-
ception and provision of birth control ma-
terials or medication of the individual’s 
choosing. 
(ii) Complete and effective evaluation 
and treatment of sexually transmitted dis-
eases and diseases of the reproductive or-
gans. 
(iii) Complete information and coun-
seling with respect to pregnancy, child-
bearing, and possible outcomes involving 
genetically induced anomalies. 
(B) PREGNANCY.— 
(i) Complete and effective pregnancy 
testing. 
(ii) Prenatal services, including phys-
ical examination, counseling, and instruc-
tion of expectant parents in nutrition, 
childrearing, and children’s health care 
services. 
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(iii) Safe, comfortable, and convenient 
abortion services. 
(iv) Counseling for women in conjunc-
tion with the provision of all gynecologic, 
female contraceptive, and abortion services 
and counseling for men on male fertility- 
related services. 
(2) VOLUNTARY.—The services described in 
paragraph (1) shall be delivered without coercion or 
harassment, with complete confidentiality, and with-
out prior approval of individuals other than the indi-
vidual receiving the services. 
(3) ACCOMPANIMENT.—An individual shall be 
permitted to be accompanied by a person of the indi-
vidual’s choice during the provision of the services 
described in paragraph (1) to the extent this would 
not significantly increase the medical risk to the in-
dividual. 
(b) VOLUNTARY CONSENT.—No health care provider 
may perform upon an individual a treatment or procedure 
(other than a treatment or procedure required to preserve 
the life of the individual) which could reasonably be ex-
pected to affect the individual’s capacity to reproduce chil-
dren, unless— 
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(1) the individual has given voluntary written 
consent to the treatment or procedure after being 
given complete information on the effect of the 
treatment or procedure on the individual’s reproduc-
tive capacity, and on possible alternative treatments 
and procedures, at least 30 days before beginning 
the treatment or procedure, and 
(2) the individual has, after such 30-day wait-
ing period, again given written consent to the per-
formance of the treatment or procedure, except that 
in the case of a woman who has given initial written 
consent to a sterilization she may be sterilized in 
less than 30 days following such consent (but in no 
case in less than 72 hours)— 
(A) if she had given initial written consent 
at least 30 days before her anticipated delivery 
date, she delivers before the anticipated date, 
and the sterilization is performed at the time of 
delivery; 
(B) if she undergoes emergency abdominal 
surgery within the 30-day waiting period and 
the sterilization is concurrent with the abdom-
inal surgery; or 
(C) in the case of an elective sterilization 
procedure, such as tubal ligation or vasectomy, 
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that is scheduled and performed separately 
from the act of childbirth, where prior informed 
consent is provided and the procedure is per-
formed at the next subsequent or any later 
medical visit after informed consent is obtained. 
(c) BREAST CANCER TREATMENT.—The National 
Health Board shall insure that, before a mastectomy or 
other breast cancer treatment is performed on a woman, 
the woman shall be provided with complete information 
on the complete range of medical options available for 
treatment of her condition and the risks and side effects 
of each option and an opportunity to consult individuals 
of her choice, and shall have given voluntary written con-
sent to such procedure. 
(d) BIRTHING
OPTIONS.—The National Health 
Board shall provide that a woman giving birth to an infant 
shall have the right to choose from a complete range of 
childbirth options including— 
(1) giving birth at home, in a birth center (if 
available), or in a hospital; 
(2) the presence during childbirth of a person 
or persons of her choosing; 
(3) the position for labor and delivery which she 
chooses; 
(4) caring for her infant at her bedside; 
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(5) feeding her infant according to the method 
and schedule of her choice; and 
(6) selecting the birth attendant of her own 
choice. 
She shall be provided with information on the benefits, 
risks, and side effects of each option and an opportunity 
to consult individuals and groups of her choosing for infor-
mation and assistance on these options. 
TITLE III—HEALTH LABOR 
FORCE 
Subtitle A—Job Categories and 
Certification 
SEC. 301. EFFECT OF STATE LAW. 
Notwithstanding any law of a State or political sub-
division to the contrary, the Service, acting in accordance 
with the provisions of this Act, shall be the sole judge of 
the qualifications of its employees. 
SEC. 302. QUALIFICATIONS OF HEALTH WORKERS. 
(a) CERTIFICATION OF COMPETENCE.—The National 
Health Board shall establish procedures which will ensure 
that, except in emergency situations, any work which is 
classified under a job category established under this sub-
title is performed by a health worker who at the time of 
such work was— 
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(1) certified (in accordance with this subtitle) 
as competent to perform the work under such job 
category, and 
(2) authorized to perform such work by the em-
ployer of such worker. 
(b) PERIODIC ASSESSMENTS.—There shall be peri-
odic review and assessment of the competency of such 
workers to perform the work within their job category, and 
opportunities for health workers to be assessed and cer-
tified with respect to skills required for advancement to 
other job categories. 
SEC. 303. ESTABLISHMENT OF JOB CATEGORIES AND CER-
TIFICATION STANDARDS. 
(a) IN GENERAL.— 
(1) CLASSIFICATION.—The National Health 
Board shall establish such guidelines for the classi-
fication, certification, and employment of health 
workers by job category as it determines to be nec-
essary— 
(A) to ensure that health workers who per-
form work for the Service which requires spe-
cialized skills have demonstrated that they pos-
sess such skills, 
(B) to expand the roles of health workers 
to enable them to participate in health care de-
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livery to the maximum extent consistent with 
their skills, and 
(C) to provide for affiliation of health 
workers with health care facilities at the com-
munity, district, and regional levels. 
These guidelines shall permit alternative approaches 
to healing, and practitioners skilled in such ap-
proaches, when these approaches have not been dem-
onstrated to be injurious to health. 
(2) CONSIDERATIONS.—In establishing guide-
lines under paragraph (1), the National Health 
Board shall provide for (A) sufficient flexibility to 
permit utilization of health workers most effectively 
to meet the health needs of the region, and (B) suf-
ficient uniformity to permit mobility of health work-
ers among the regions. 
(b) CERTIFICATION STANDARDS.— 
(1) ESTABLISHMENT.—For each job category 
(other than a job category determined by the Na-
tional Health Board to involve highly specialized 
skills requiring advanced specialty training), the Na-
tional Health Board shall, taking into account the 
guidelines established under subsection (a), establish 
certification standards which shall specify— 
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(A) the functions performed by a health 
worker employed in such job category; 
(B) the skills required in the course of 
properly performing work under such job cat-
egory; 
(C) the initial and continuing training, ex-
perience, and performance which must be un-
dertaken or demonstrated by a health worker to 
achieve and maintain competency to perform 
the work within such job category; and 
(D) the curriculum which a health worker 
must follow in studies in a health team school 
(established under subtitle B) to demonstrate 
sufficient competence to satisfy the specification 
of subparagraph (C) for such job category. 
(2) SPECIFICATIONS.—For each job category 
established and determined by the National Health 
Board to involve highly specialized skills requiring 
advanced specialty training, the National Health 
Board shall make the specifications described in sub-
paragraphs (A) through (D) of paragraph (1). 
(3) PERIODIC
REVIEW.—Standards for a job 
category under this subsection shall be periodically 
reviewed to supplement, modify, or eliminate such 
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standards as will facilitate the delivery of quality 
health care services under this Act. 
(4) QUALITY PROTECTION.— 
(A) PROHIBITION
OF
DOWNGRADES
OF 
LEVELS.—No individual health facility adminis-
trator is authorized to downgrade the level of 
skill, license or certification required to perform 
duties delineated by the Board. 
(B) REVIEW.— 
(i) REVIEW OF STAFFING CHANGES.— 
Upon enactment of this Act, the Board 
shall convene a national level task force to 
review the impact on the safety and health 
of patients and workers of downgrading 
and deskilling of health care job categories 
by replacing licensed with unlicensed work-
ers during the 1990s, particularly in the 
nursing area, and to recommend remedies 
as appropriate. 
(ii) WHISTLEBLOWER PROTECTION.— 
Health care workers who report com-
promises in the quality of care shall not be 
subjected to recriminations. 
(C) WORKFORCE STAFFING LEVELS.—The 
Board may establish health workforce staffing 
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levels as it determines will promote the delivery 
of quality health care services. 
Subtitle B—Education of Health 
Workers 
SEC. 311. HEALTH TEAM SCHOOLS. 
(a) ESTABLISHMENT.— 
(1) IN GENERAL.—Except as provided in para-
graph (2), the Board shall establish a procedure for 
converting existing educational facilities for health 
services workers to create health team schools (each 
in this subtitle referred to as a ‘‘school’’) in accord-
ance with this section to provide programs of initial 
and continuing basic education in health care deliv-
ery for health workers in all job categories, and to 
provide initial continuing advanced education in 
health care specialties and health science specialty 
fields. Such schools shall be established and func-
tioning not later than 4 years after the effective date 
of health services. 
(2) USE OF FUNDS.—Schools shall be funded 
exclusively by the Service, shall not charge nor ac-
cept tuition or fees for enrollment, and shall provide 
each student with an adequate allowance for living 
expenses, educational supplies, and any child care 
expenses. 
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(b) OPERATIONAL PRINCIPLES.—Schools shall be op-
erated and maintained in accordance with the following 
principles: 
(1) The activities of each school shall be de-
signed to meet the health needs of the population. 
(2) The number of students enrolled in each 
educational program in a school shall be based on 
the needs for health workers within a given area, de-
fined by geographic and political boundaries. 
(3) Schools shall integrate the education of 
health workers in the different job categories (estab-
lished under subtitle A) so as to permit health work-
ers to be educated and certified for successively 
higher levels of health care work. 
(4) Each school’s admissions policies, cur-
riculum policies, faculty hiring procedures, and gov-
ernance plan shall be established and implemented 
in accordance with subsections (c) through (f), re-
spectively, and with the fullest possible participation 
of the community health workers, staff, and students 
in its region. 
(5) A school may not use individuals who are 
from low-income populations or minority groups, or 
who are women or confined in mental or penal insti-
tutions, as subjects for training or demonstration in 
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numbers that are disproportionate to their numbers 
in the population of the region, and may not use any 
individuals as subjects for training or demonstration 
in a manner beyond that required for the immediate 
purpose of the training or demonstration or without 
their explicit consent. 
The National Health Board shall establish, not later than 
one year after the effective date of health services, guide-
lines for the application of these principles and for the 
phased integration of health worker education programs, 
including medical, dental, osteopathic, and nursing school 
programs, in existence on the date of enactment of this 
Act into the schools established under this section. 
(c) ADMISSIONS POLICIES.—Admissions policies for 
education programs in schools shall— 
(1) emphasize previous health-related work ex-
perience, as evaluated by health workers (including 
peers), by individuals who have received health care 
services from the applicant, and by faculty members; 
(2) minimize the use of criteria of academic 
performance other than such criteria as have been 
shown to be significantly related to future work per-
formance; 
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(3) give preference to segments of the popu-
lation of the region underrepresented among health 
workers; 
(4) to the extent consistent with paragraph (3), 
provide for admission of individuals so that the stu-
dent body approximates the population of the region 
by race, sex, family income, and language; and 
(5) require that the applicant agree, if accepted 
into the school, to perform health care services in ac-
cordance with section 312. 
(d) CURRICULUM POLICIES.—The National Health 
Board, in consultation with its local and regional authori-
ties, shall establish and implement curriculum policies for 
educational programs in schools. Such policies shall— 
(1) give priority in study and field work to the 
leading causes of illness and death in the region, in-
cluding environmental, biological, and social deter-
minants of mortality and morbidity; 
(2) give special consideration to studying the 
social, as well as biological, causation and prevention 
of illness and disease, and to the differing health 
care needs of populations facing special health risks 
and having special cultures and lifestyles within the 
region; 
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(3) provide that all students shall take a com-
mon, initial sequence of courses and that students 
preparing for more advanced types of health work 
shall take studies that are progressively more spe-
cialized and differentiated; 
(4) emphasize work study experience in all 
types of health care facilities in the region, including 
community and workplace facilities, facilities for the 
aged, mentally ill, and mentally retarded, health care 
facilities in prisons and other correctional institu-
tions, alcohol and drug rehabilitation facilities, envi-
ronmental health facilities, and all other health care 
facilities of the Service in communities and districts 
in the region; 
(5) emphasize the appropriate and safe use, 
and discourage the overuse, of drugs and medical 
techniques; and 
(6) facilitate the development by all health 
workers of skills in decisionmaking and assessment 
of user needs in cooperation with other health work-
ers and with users. 
(e) FACULTY HIRING PROCEDURES.—Faculty hiring 
procedures in schools shall, to the maximum extent fea-
sible, create a faculty which approximates the population 
of the region by race, sex, and language. 
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(f) GOVERNANCE PLANS.—Governance plans for the 
management of a school shall give significant decision-
making powers to staff and students of the school. 
SEC. 312. SERVICE REQUIREMENT. 
(a) SERVICE REQUIREMENT.— 
(1) IN GENERAL.—No individual may be en-
rolled in a school unless the individual agrees to per-
form health care services as an employee of the 
Service in the job category for which training is 
being provided— 
(A) for a period of time equal to the period 
of such enrollment in the school but not less 
than 2 years; 
(B) beginning not later than 1 year after 
the date of the individual’s graduation from the 
school; and 
(C) for an area with the highest priority 
ranking under subsection (c) that agrees to em-
ploy the individual. 
(2) DEFERRAL.—An individual’s obligation to 
perform service under an agreement described in 
paragraph (1) shall be deferred only for a period 
during which the individual is physically or mentally 
incapable of performing such service. 
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(3) COMPLETION OF SERVICE REQUIRED.—No 
individual who has made an agreement described in 
paragraph (1) may be employed other than in ac-
cordance with subsection (c), until the individual has 
completed the period of obligated service in accord-
ance with this section. 
(4) PENALTY FOR BREACH OF AGREEMENT.— 
Except as provided in paragraph (5), if an individual 
breaches an agreement under paragraph (1) by fail-
ing (for any reason) either to begin such individual’s 
service obligation or to complete such service obliga-
tion, the Service shall be entitled to recover from the 
individual an amount determined in accordance with 
the formula A = C (1 ¥ s / (t)) in which— 
(A) ‘‘A’’ is the amount the Service is enti-
tled to recover; 
(B) ‘‘C’’ is an amount determined by the 
National Health Board to be the costs to the 
Service of the education program and allowance 
received by the individual and the interest on 
such costs which would be payable if at the 
time the costs were undertaken they were loans 
bearing interest at the maximum legal pre-
vailing rate, as determined by the Treasurer of 
the United States; 
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(C) ‘‘t’’ is the total number of months in 
the individual’s period of obligated service; and 
(D) ‘‘s’’ is the number of months of such 
period served by the individual. Any amount of 
damages which the Service is entitled to recover 
under this paragraph shall, within the 1-year 
period beginning on the date of the breach of 
the agreement, be paid to the Service. 
(5) CANCELLATION.— 
(A) UPON DEATH.—Any obligation of an 
individual under this subsection for service or 
payment of damages shall be canceled upon the 
death of the individual. 
(B) EXTREME
HARDSHIP
EXCEPTION.— 
The National Health Board shall provide for 
the waiver or suspension of any obligation of 
service or payment by an individual under this 
subtitle whenever compliance by the individual 
is impossible or would involve extreme hardship 
to the individual and if enforcement of such ob-
ligation with respect to any individual would be 
unconscionable. 
(C) LIMITATION ON DISCHARGE IN BANK-
RUPTCY.—Any obligation of an individual under 
this subtitle for payment of damages may be re-
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leased by a discharge in bankruptcy under title 
11 of the United States Code only if such dis-
charge is granted after the expiration of the 5- 
year period beginning on the first date that 
payment of such damages is required. 
(b) PERIODIC REASSESSMENT
OF WORKER RA-
TIOS.—The National Health Board shall periodically as-
sess the ratio of the number of health workers employed 
by the Board in each job category (established under sub-
title A) in an area to the number of residents in the area. 
(c) WORKER MATCHES.—The National Health Board 
shall establish a program to match the locational pref-
erences of graduates of schools with the needs and pref-
erences of regions. 
SEC. 313. PAYMENT FOR CERTAIN EDUCATIONAL LOANS. 
(a) LOAN PAYMENT PROGRAM.—In the case of any 
individual who has incurred any educational loan before 
the fourth year after the effective date of health services 
and for the individual’s costs for an educational program 
in health care delivery, health care specialties, or health 
science specialty fields, the National Health Board shall 
make payments, in accordance with subsection (b), for and 
on behalf of that individual, on the principal of and inter-
est on any such loan which is outstanding on the date the 
individual begins to work for the Service. 
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(b) MAKING OF PAYMENT.—The payments described 
in subsection (a) shall be made by the National Health 
Board as follows: 
(1) Upon completion by the individual for whom 
the payments are to be made of the first year of em-
ployment with the Service, the National Health 
Board shall pay 30 percent of the principal of, and 
the interest on, each loan described in subsection (a) 
which is outstanding on the date he began such em-
ployment. 
(2) Upon completion by that individual of the 
second year of such employment, the National 
Health Board shall pay another 30 percent of the 
principal of, and the interest on, each such loan. 
(3) Upon completion by that individual of a 
third year of such employment, the National Health 
Board shall pay another 25 percent of the principal 
of, and the interest on, each such loan. 
(4) Upon completion by that individual of a 
fourth year of such employment, the National 
Health Board shall pay the remaining 15 percent of 
the principal of, and all remaining interest on, each 
such loan. 
No payment may be made under this subsection with re-
spect to a loan unless the person on whose behalf the pay-
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ment is to be made has submitted to the National Health 
Board a certified copy of the agreement under which such 
loan was made. 
(c) PAYMENT
DURING
EMPLOYMENT.—Notwith-
standing the requirement of completion of employment 
specified in subsection (b), the National Health Board 
shall on or before the due date thereof, pay any loan or 
loan installment which may fall due within the period of 
employment for which the borrower may receive payments 
under this section, upon the declaration of such borrower, 
at such times and in such manner as the National Health 
Board may prescribe (and supported by such other evi-
dence as the National Health Board may reasonably re-
quire), that the borrower is then employed as described 
in subsection (b) and that the borrower will continue to 
be so engaged for the period required (in the absence of 
this subsection) to entitle the borrower to have made the 
payments provided by this section for such period, except 
that not more than 85 percent of the principal of any such 
loan shall be paid pursuant to this subsection. 
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Subtitle 
C—Employment 
and 
Labor-Management 
Relations 
Within the Service 
SEC. 321. EMPLOYMENT, TRANSFER, PROMOTION, AND RE-
CEIPT OF FEES. 
(a) SERVICE EMPLOYEES.—The National Health 
Board shall employ, classify, and fix the salaries and bene-
fits of all employees of the Service employed in the Serv-
ice’s facilities. 
(b) POLICIES.—The National Health Board, in estab-
lishing guidelines and standards under this subtitle, shall, 
to the extent feasible and consistent with the provisions 
of this subtitle, provide for— 
(1) employment and promotion in the Service in 
the same manner as is provided for employment and 
promotion under the Federal civil service system; 
(2) meaningful opportunities for career ad-
vancement; 
(3) encouragement of health workers to use up 
to 10 percent of their work time for continuing edu-
cation under subtitle B without loss of pay or other 
job rights; and 
(4) full protection of employees’ rights by pro-
viding an opportunity for a fair hearing on adverse 
actions with representation of their own choosing. 
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(c) HIRING PREFERENCES.—The National Health 
Board, in hiring for employees to fill vacancies in newly 
created positions, shall give preference to individuals who 
were employed as health workers, or self-employed while 
delivering health services, before the date of enactment of 
this Act. The National Health Board shall ensure, through 
such steps as it deems necessary, that all such individuals 
desiring to be employed within the Service shall find ap-
propriate employment in the Service. 
(d) PROMOTION AND TRANSFER.—Employees of the 
Service shall be eligible for promotion or transfer to any 
position in the Service for which they are qualified. A job 
placement service in each region shall assist health work-
ers in its region in identifying suitable employment oppor-
tunities and in transferring between jobs. The authority 
given by this subsection shall be used to provide a max-
imum degree of career opportunities for employees and to 
ensure continued improvement of health care services. 
(e) NO UNDUE FINANCIAL INCENTIVES.—No health 
worker should benefit financially from the provision or de-
nial of services to individual patients, beyond their regular 
remuneration. 
(f) SOLE EMPLOYER.—An employee of the Service 
may not receive any fee or perquisite on account of duties 
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performed by virtue of such employment except from the 
Service. 
(g) GRANDFATHER CLAUSE.—The National Health 
Board shall support alternative procedures to assure that 
health care professionals meet required standards, par-
ticularly those currently practicing in health professional 
shortage areas in inner cities and in rural communities. 
(h) TRANSITIONAL EMPLOYMENT.—Up to 1 percent 
of the budget of the United States Health Service for each 
of its first 2 years may be expended for the retraining 
and hiring of sales, administrative, clerical, and service 
employees displaced as a result of this Act, including those 
in the health insurance industry. 
SEC. 322. APPLICABILITY OF LAWS RELATING TO FEDERAL 
EMPLOYEES. 
(a) IN GENERAL.—Chapter 75 of title 5, United 
States Code (relating to adverse actions against employ-
ees), apply to employees of the Service (other than employ-
ees serving on the personal staff of members of health 
boards) except to the extent provided— 
(1) in a collective bargaining agreement nego-
tiated on behalf of and applicable to them; or 
(2) in procedures established by the Service and 
approved by the Office of Personnel Management. 
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(b) COVERAGE UNDER WORKERS COMPENSATION.— 
Employees of the Service are covered by subchapter I of 
chapter 81 of title 5, United States Code (relating to com-
pensation for work injuries). 
(c) CIVIL SERVICE.— 
(1) APPLICATION
OF
CIVIL
SERVICE
RETIRE-
MENT.—Chapter 83 of title 5, United States Code 
(relating to civil service retirement), applies to em-
ployees of the Service except to the extent provided 
in a collective bargaining agreement negotiated on 
behalf of and applicable to them. 
(2) WITHHOLDING.—The Service shall withhold 
from pay and shall pay into the Civil Service Retire-
ment and Disability Fund the amounts specified in 
chapter 83 of title 5, United States Code, as re-
quired under paragraph (1). The Service, upon re-
quest of the Office of Personnel Management, but 
not less frequently than annually, shall pay to the 
Office the costs reasonably related to the adminis-
tration of Fund activities for employees of the Serv-
ice. 
(d) ACCRUAL OF SICK AND ANNUAL LEAVE.—Sick 
and annual leave and compensatory time of employees of 
the Service, whether accrued prior to or after the com-
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mencement of operations of the Service, shall be obliga-
tions of the Service. 
(e) APPLICATION OF CONDITIONS.— 
(1) TERMS OF EMPLOYMENT.—Compensation, 
benefits, and other terms and conditions of employ-
ment in effect on the effective date of health services 
for employees of the Federal Government performing 
functions that are provided under this Act by the 
Service, shall apply to all employees of the Service 
performing similar functions until changed by the 
Service in accordance with this Act. Subject to the 
provisions of this Act, the provisions of subchapter 
I of chapter 85 and chapter 87 of title 5, United 
States Code (relating to unemployment compensa-
tion and life insurance), apply to employees of the 
Service unless varied, added to, or substituted for in 
accordance with paragraph (2). 
(2) LIMITATION ON VARIATION.—No variation, 
addition, or substitution with respect to fringe bene-
fits shall result in a program of fringe benefits which 
on the whole is less favorable to employees of the 
Service than fringe benefits in effect for employees 
of the Federal Government on the effective date of 
health services. No variation, addition, or substi-
tution with respect to fringe benefits of employees 
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for whom there is a collective bargaining representa-
tive shall be made except by agreement between such 
representative and the Service. 
SEC. 323. APPLICABILITY OF FEDERAL LABOR-MANAGE-
MENT RELATIONS LAWS. 
(a) APPLICATION OF NLRA.— 
(1) IN GENERAL.—The provisions of the Na-
tional Labor Relations Act (42 U.S.C. 141 et seq.) 
shall apply to the Service and its employees to the 
extent, not inconsistent with subsection (b), to which 
such provisions apply to employers (as defined in 
section 2(2) of such Act), except that— 
(A) the phrase ‘‘or any individual employed 
as a supervisor’’ in section 2(3) of such Act 
shall not apply (thereby making such Act apply, 
for these purposes, to such individuals); 
(B) section 9(b)(1) of such Act (providing 
for separate treatment for professional and 
nonprofessional employees) shall not apply; 
(C) sections 206 through 210 of such Act 
(relating to national emergencies) shall, for pur-
poses of this Act, have the phrases ‘‘the Presi-
dent of the United States’’ and ‘‘the Presi-
dent’’, wherever they appear, replaced by the 
phrase ‘‘the National Health Board (or a com-
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mittee thereof to which it has delegated such 
authority)’’ and the phrase ‘‘national health or 
safety’’ replaced by the phrase ‘‘health or safety 
of the residents of any region’’; and 
(D) section 213 (providing for intervention 
in a strike or lockout by the Director of the 
Federal Mediation and Conciliation Service) 
shall not apply. 
(2) STRIKES PERMITTED.—Paragraphs (3) and 
(4) of section 7311 of title 5, United States Code 
(prohibiting participation in a strike or an organiza-
tion asserting the right to strike), shall not apply to 
employees of the Service. 
(b) NEUTRALITY
IN UNION MATTERS.—The Na-
tional Health Board shall adopt as a matter of general 
policy that governing boards at each level of the Service, 
and employers acting as agents of these boards, agree to 
determine employee preference on the subject of labor 
union representation, and to determine which one if union 
representation is preferred, by a card check procedure con-
ducted by a neutral third party in lieu of a formal election. 
(c) COLLECTIVE BARGAINING.— 
(1) IN GENERAL.—Collective bargaining agree-
ments between the National Health Board and duly 
recognized bargaining representatives of employees 
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of the Service may include procedures for resolution 
by the parties of grievances and adverse actions aris-
ing under the agreement, including procedures cul-
minating in binding third party arbitration. 
(2) ALTERNATIVE PROCEDURES.—The National 
Health Board and duly recognized bargaining rep-
resentatives of employees of the Service may by mu-
tual agreement adopt procedures for the resolution 
by the parties— 
(A) of grievances and adverse actions aris-
ing under collective bargaining agreements, and 
(B) of disputes or impasses arising in the 
negotiation of such agreements. 
(d) CONFORMING AMENDMENT.—Section 3(e) of the 
Labor-Management Reporting and Disclosure Act of 1959 
(42 U.S.C. 402(e)) is amended by inserting ‘‘the United 
States Health Service and’’ after ‘‘and includes’’. 
SEC. 324. DEFENSE OF CERTAIN MALPRACTICE AND NEG-
LIGENCE SUITS. 
(a) EXCLUSIVE REMEDY.—The remedy against the 
United States provided by sections 1346(b) and 2672 of 
title 28, United States Code, or by alternative benefits 
provided by the United States where the availability of 
such benefits precludes a remedy under section 1346(b) 
of such title, for damage for personal injury, including 
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death, resulting from the performance of medical, surgical, 
dental, or related functions, including the conduct of clin-
ical studies or investigations, by any employee of the Serv-
ice while acting within the scope of the employee’s employ-
ment, shall be exclusive of any other civil action or pro-
ceeding by reason of the same subject matter against the 
employee (or the employee’s estate) whose act or omission 
gave rise to the claim. 
(b) DEFENSE.—The Attorney General shall defend 
any civil action or proceeding brought in any court against 
any person referred to in subsection (a) (or the person’s 
estate) for any such damage or injury. Any such person 
against whom such civil action or proceeding is brought 
shall deliver within such time after date of service or 
knowledge of service as determined by the Attorney Gen-
eral, all process served upon the person or an attested true 
copy thereof to the person’s immediate superior or to 
whomever was designated by the appropriate National 
Health Board to receive such papers and such person shall 
promptly furnish copies of the pleading and process there-
in to the United States attorney for the district embracing 
the place wherein the proceeding is brought, to the Attor-
ney General, and to the National Health Board. 
(c) PROCEDURE.— 
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(1) REMOVAL FROM STATE COURTS.—Upon a 
certification by the Attorney General that the de-
fendant was acting in the scope of employment at 
the time of the incident out of which the suit arose, 
any such civil action or proceeding commenced in a 
State court shall be removed without bond at any 
time before trial by the Attorney General to the dis-
trict court of the United States of the district and 
division embracing the place wherein it is pending 
and the proceeding deemed a tort action brought 
against the United States under the provision of 
title 28, United States Code, and all references 
thereto. 
(2) MOTIONS TO REMAND.—If a United States 
district court determines on a hearing on a motion 
to remand held before a trial on the merits that the 
case so removed is one in which a remedy by suit 
within the meaning of subsection (a) is not available 
against the United States, the case shall be re-
manded to the State court. 
(3) EFFECT
OF
ALTERNATIVE
REMEDIES.— 
Where a remedy by suit within the meaning of sub-
section (a) is not available because of the availability 
of a remedy through proceedings for compensation 
or other benefits from the United States as provided 
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by any other law, the case shall be dismissed, but in 
the event the running of any limitation of time for 
commencing, or filing an application or claim in, 
such proceedings for compensation or other benefits 
shall be deemed to have been suspended during the 
pendency of the civil action or proceeding under this 
section. 
(d) SETTLEMENT.—The Attorney General may com-
promise or settle any claim asserted in such civil action 
or proceeding in the manner provided in section 2677 of 
title 28, United States Code, and with the same effect. 
(e) LIMITATION.—For purposes of this section, the 
provisions of section 2680(h) of title 28, United States 
Code, shall not apply to assault or battery arising out of 
negligence in the performance of medical, surgical, dental, 
or related functions, including the conduct of clinical stud-
ies or investigations. 
(f) LIABILITY INSURANCE.—The appropriate Na-
tional Health Board may, to the extent it deems appro-
priate, hold harmless or provide liability insurance for any 
employee of the Service for damage for personal injury, 
including death, negligently caused by such employee while 
acting within the scope of employment and as a result of 
the performance of medical, surgical, dental, or related 
functions, including the conduct of clinical studies or in-
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133 
section (a) and shall determine how the Service shall 
carry out the purposes of such programs. 
(2) INITIAL REPORT.—Not later than one year 
after the effective date of health services, the Na-
tional Health Board shall report to the President 
and to the Congress on how the Service is carrying 
out the purposes of the programs authorized to be 
conducted under provisions of law which are re-
pealed by subsection (a) (other than paragraph 
(1)(B) thereof). 
(3) LATER REPORT.—Not later than 5 years 
after the effective date of health services, the Na-
tional Health Board shall report to the President 
and to the Congress on how the Service is carrying 
out the purposes of programs described in subsection 
(a)(1)(B). 
(d) CODIFICATION PROPOSAL.—Not later than 2 
years after the effective date of health services, the Na-
tional Health Board shall transmit to Congress a proposed 
codification of all the provisions of law which contain func-
tions that are transferred or relate to the Service. 
SEC. 603. TRANSITION PROVISIONS. 
(a) TRANSFER OF APPROPRIATIONS.—Amounts ap-
propriated to carry out the purposes of any provisions of 
law repealed by this Act and available on the effective date 
VerDate Nov 24 2008 
01:37 Jun 25, 2009
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tjames on PRODPC75 with BILLS