SEC. 104. PROHIBITION AGAINST DUPLICATING COVERAGE. 
(a) IN GENERAL.—It is unlawful for a private health 
insurer to sell health insurance coverage that duplicates 
the benefits provided under this Act. 
(b) CONSTRUCTION.—Nothing in this Act shall be 
construed as prohibiting the sale of health insurance cov-
erage for any additional benefits not covered by this Act, 
such as for cosmetic surgery or other services and items 
that are not medically necessary. 
TITLE II—FINANCES 
Subtitle A—Budgeting and 
Payments 
SEC. 201. BUDGETING PROCESS. 
(a) ESTABLISHMENT OF OPERATING BUDGET AND 
CAPITAL EXPENDITURES BUDGET.—
(1) IN GENERAL.—To carry out this Act there 
are established on an annual basis consistent with 
this title—
(A) an operating budget; 
(B) a capital expenditures budget; 
(C) reimbursement levels for providers con-
sistent with subtitle B; and 
(D) a health professional education budget, 
including amounts for the continued funding of 
resident physician training programs.
(2) REGIONAL
ALLOCATION.—After Congress 
appropriates amounts for the annual budget for the 
USNHI Program, the Director shall provide the re-
gional offices with an annual funding allotment to 
cover the costs of each region’s expenditures. Such 
allotment shall cover global budgets, reimbursements 
to clinicians, and capital expenditures. Regional of-
fices may receive additional funds from the national 
program at the discretion of the Director. 
(b) OPERATING BUDGET.—The operating budget 
shall be used for—
(1) payment for services rendered by physicians 
and other clinicians; 
(2) global budgets for institutional providers; 
(3) capitation payments for capitated groups; 
and 
(4) administration of the Program. 
(c) CAPITAL EXPENDITURES BUDGET.—The capital 
expenditures budget shall be used for funds needed for—
(1) the construction or renovation of health fa-
cilities; and 
(2) for major equipment purchases. 
(d) PROHIBITION AGAINST CO-MINGLING OPER-
ATIONS AND CAPITAL IMPROVEMENT FUNDS.—It is pro-
hibited to use funds under this Act that are earmarked—
(1) for operations for capital expenditures; or 
(2) for capital expenditures for operations. 
SEC. 202. PAYMENT OF PROVIDERS AND HEALTH CARE CLI-
NICIANS. 
(a) ESTABLISHING GLOBAL BUDGETS; MONTHLY 
LUMP SUM.—
(1) IN
GENERAL.—The USNHI Program, 
through its regional offices, shall pay each hospital, 
nursing home, community or migrant health center, 
home care agencies, or other institutional provider 
or pre-paid group practice a monthly lump sum to 
cover all operating expenses under a global budget. 
(2) ESTABLISHMENT OF GLOBAL BUDGETS.—
The global budget of a provider shall be set through 
negotiations between providers and regional direc-
tors, but are subject to the approval of the Director. 
The budget shall be negotiated annually, based on 
past expenditures, projected changes in levels of 
services, wages and input, costs, and proposed new 
and innovative programs. 
(b) THREE PAYMENT OPTIONS FOR PHYSICIANS AND 
CERTAIN OTHER HEALTH PROFESSIONALS.—
(1) IN GENERAL.—The Program shall pay phy-
sicians, dentists, doctors of osteopathy, psycholo-
gists, chiropractors, doctors of optometry, nurse
practitioners, nurse midwives, physicians’ assistants, 
and other advanced practice clinicians as licensed 
and regulated by the States by the following pay-
ment methods: 
(A) Fee for service payment under para-
graph (2). 
(B) Salaried positions in institutions re-
ceiving global budgets under paragraph (3). 
(C) Salaried positions within group prac-
tices or non-profit health maintenance organiza-
tions receiving capitation payments under para-
graph (4). 
(2) FEE FOR SERVICE.—
(A) IN GENERAL.—The Program shall ne-
gotiate a simplified fee schedule with clinician 
representatives, after close consultation with the 
National Board of Universal Quality and Access 
and regional and State directors. 
(B) 
CONSIDERATIONS.—In 
establishing 
such schedule, the Director shall take into con-
sideration regional differences in reimburse-
ment, but strive for a uniform national stand-
ard.
(C) FINAL GUIDELINES.—The regional di-
rectors shall be responsible for promulgating 
final guidelines to all providers. 
(D) BILLING.—Under the Act physicians 
shall submit bills to the regional director on a 
simple form, or via computer. Interest shall be 
paid to providers whose bills are not paid within 
30 days of submission. 
(E) 
NO
BALANCE
BILLING.—Licensed 
health care clinicians who accept any payment 
from the USNHI Program may not bill any pa-
tient for any covered service. 
(F) UNIFORM
COMPUTER
ELECTRONIC 
BILLING SYSTEM.—The Director shall make a 
good faith effort to create a uniform computer-
ized electronic billing system, including in those 
areas of the United States where electronic bill-
ing is not yet established. 
(3) SALARIES WITHIN INSTITUTIONS RECEIVING 
GLOBAL BUDGETS.—
(A) IN GENERAL.—In the case of an insti-
tution, such as a hospital, health center, group 
practice, community and migrant health center, 
or a home care agency that elects to be paid a 
monthly global budget for the delivery of health
care as well as for education and prevention 
programs, physicians employed by such institu-
tions shall be reimbursed through a salary in-
cluded as part of such a budget. 
(B) SALARY RANGES.—Salary ranges for 
health care providers shall be determined in the 
same way as fee schedules under paragraph (2). 
(4) SALARIES WITHIN CAPITATED GROUPS.—
(A) IN GENERAL.—Health maintenance or-
ganizations, group practices, and other institu-
tions may elect to be paid capitation premiums 
to cover all outpatient, physician, and medical 
home care provided to individuals enrolled to 
receive benefits through the organization or en-
tity. 
(B) SCOPE.—Such capitation may include 
the costs of services of licensed physicians and 
other licensed, independent practitioners pro-
vided to inpatients. Other costs of inpatient and 
institutional care shall be excluded from capita-
tion payments, and shall be covered under insti-
tutions’ global budgets. 
(C) PROHIBITION OF SELECTIVE ENROLL-
MENT.—Selective enrollment policies are pro-
hibited, and patients shall be permitted to en-