IV
103D CONGRESS
2D SESSION
H. RES. 498
Making in order, in the consideration by the House of Representatives of
H.R. 3600 (the ‘‘Health Security Act’’), an amendment providing for
an AMCARE plan that makes available a government-sponsored, fee-
for-service nationwide health plan to almost all eligible individuals not
covered under large group health plans.
IN THE HOUSE OF REPRESENTATIVES
JULY 28, 1994
Mr. SCOTT (for himself, Mr. STARK, Mr. MCDERMOTT, Mr. MILLER of Cali-
fornia, Mr. OWENS, Ms. MCKINNEY, Ms. PELOSI, Mr. FARR of Califor-
nia, Mr. TUCKER, Ms. WOOLSEY, Mr. DELLUMS, Mr. WATT, Mr.
STOKES, Mr. HILLIARD, and Mr. ROMERO-BARCELO´) submitted the fol-
lowing resolution; which was referred to the Committee on Rules
RESOLUTION
Making in order, in the consideration by the House of Rep-
resentatives of H.R. 3600 (the ‘‘Health Security Act’’),
an amendment providing for an AMCARE plan that
makes available a government-sponsored, fee-for-service
nationwide health plan to almost all eligible individuals
not covered under large group health plans.
Resolved, That in the consideration of the bill (H.R.
3600), to ensure individual and family security through
health care coverage for all Americans in a manner that
contains the rate of growth in health care costs and pro-
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motes responsible insurance practices, to promote choice
in health care, and to ensure and protect the health care
of all Americans, in the Committee of the Whole, the fol-
lowing amendment, if offered by Mr. Scott of Virginia (or
his designee), shall be made in order to the amendment-
in-the-nature-of-a-substitute to title I, as reported by the
Committee on Education and Labor and that any points
of order against this amendment are hereby waived.
At the end of subtitle E of title I, add the following
new part (and conform the table of contents of title I
accordingly):
‘‘PART 5—AMCARE PLAN
‘‘SEC. 1497. ESTABLISHMENT, ELIGIBILITY, AND ENROLL-
MENT.
‘‘(a) ESTABLISHMENT.—
‘‘(1) IN GENERAL.—The Secretary of Health
and Human Services shall establish and operate in
accordance with this part a government-sponsored
health care plan (in this part referred to as the
‘AMCARE plan’) for eligible individuals described in
subsection (b).
‘‘(2) DEADLINE FOR INITIAL OPERATION.—The
Secretary shall establish the AMCARE plan in a
manner that permits eligible individuals to first ob-
tain benefits under the plan on January 1, 1996.
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‘‘(b) ELIGIBILITY.—
‘‘(1) ELIGIBLE INDIVIDUALS.—Except as pro-
vided in paragraph (2), each eligible individual (as
defined in section 1001(c)) is eligible to enroll in the
AMCARE plan.
‘‘(2) EXCEPTION FOR CERTAIN INDIVIDUALS.—
An individual is not eligible to enroll in the
AMCARE plan if the individual—
‘‘(A) is an experience-rated individual; or
‘‘(B) resides in a State operating a State
single-payer program under subpart B of part
1 of subtitle C.
‘‘(c) ENROLLMENT PROCEDURES.—The Secretary
shall establish procedures for the enrollment of individuals
described in subsection (a) in the AMCARE plan. Such
procedures shall be based on the procedures used with re-
spect to the enrollment of community-rated individuals
under community-rated plans.
‘‘(d) TREATMENT AS COMMUNITY-RATED PLAN.—
For purposes of this Act (including titles VI and IX), ex-
cept as may otherwise be provided in this part or under
rules established by the Board—
‘‘(1) the AMCARE plan offered in a commu-
nity-rating area shall be treated as a community-
rated plan offered in such area; and
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‘‘(2) the AMCARE plan and the Secretary shall
comply with the requirements of this Act applicable
to community-rated plans and the carriers offering
such plans.
‘‘SEC. 1498. REQUIREMENTS FOR PLAN.
‘‘(a) IN GENERAL.—Except as provided in this sec-
tion, the AMCARE plan shall meet the requirements ap-
plicable for a community-rated, fee-for-service, higher cost
sharing plan.
‘‘(b) ADDITIONAL SPECIFICATIONS.—
‘‘(1) NATIONAL
COVERAGE.—The plan shall
provide coverage for the items and services covered
in the comprehensive benefit package on a nation-
wide basis.
‘‘(2) PAYMENT TO PROVIDERS.—Instead of ap-
plying an applicable fee-for-service fee schedule, the
Secretary may base payments for services furnished
under the AMCARE plan on alternative market-
based payment rates for classes and types of services
provided in various market areas.
‘‘(3) APPLICATION OF COST-SHARING REDUC-
TION PROVISIONS.—Under rules established by the
Board, the Secretary shall apply the provisions of
part 5 of subtitle C to families enrolled in the
AMCARE plan in the same manner as States apply
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such provisions to families enrolled in community-
rated plans in the State.
‘‘(4) SUPPLEMENTAL BENEFITS.—
‘‘(A) IN GENERAL.—With the approval of
the trustees of the AMCARE Trust Fund (es-
tablished under section 1499(e)), the Secretary
may offer benefits under the AMCARE plan in
addition to those provided under the com-
prehensive benefit package in the same manner
as community-rated plans may offer supple-
mental benefits to enrollees under part 3.
‘‘(B) PREMIUM CHARGED.—The premium
charged for supplemental benefits offered under
subparagraph (A) shall be in an amount suffi-
cient to cover the costs of offering such benefits
(as determined by the Secretary in consultation
with the trustees of the AMCARE Trust Fund).
‘‘(c) ADMINISTRATION.—
‘‘(1) IN GENERAL.—The Secretary shall provide
for the administration of the AMCARE plan in a
manner similar to the administration of the medi-
care program. For this purpose, the Secretary may
enter into administrative agreements and contracts
with fiscal agents (which may or may not be the
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same fiscal agents through which the Secretary ad-
ministers the medicare program).
‘‘(2) QUALITY
ASSURANCE; UTILIZATION
RE-
VIEW; CLAIMS
PROCESSING.—In administering the
AMCARE plan, the Secretary shall take such steps
as the Secretary considers necessary—
‘‘(A) to assure the quality and appropriate
utilization of the items and services furnished
under the plan, including the use of peer review
organizations described in title XI of the Social
Security Act;
‘‘(B) to assure the timely and accurate
payment of claims for items and services fur-
nished under the plan; and
‘‘(C) to otherwise assure that the plan pro-
vides high quality services in an efficient and
cost-effective manner.
‘‘(3) LIMITATION ON EXPENDITURES FOR AD-
MINISTRATION.—The percentage of expenditures
under the AMCARE plan in a year attributable to
program administration may not exceed 3 percent.
‘‘(d) OPTIONAL PRIMARY CARE CASE MANAGE-
MENT.—Nothing in this part shall be construed as pre-
venting the plan from implementing a primary care case
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management program to manage the delivery of the com-
prehensive benefit package to plan enrollees.
‘‘(e) REFERRAL
OF SUBSIDY-ELIGIBLE INDIVID-
UALS.—Under rules established by the Board, individuals
enrolled in the AMCARE plan who are provided a cost-
sharing reduction under subsection (b)(3) or a premium
discount or limitation of liability described in section
1499(b)(3) shall be referred for employment, job search,
job training, and other workforce support services as are
available to them through the Secretary or the Secretary
of Labor for development of family self-sufficiency.
‘‘SEC. 1499. FINANCING.
‘‘(a) DETERMINATION OF PREMIUM RATE.—In the
case of a family enrolled in the AMCARE plan—
‘‘(1) IN GENERAL.—Subject to paragraph (3),
the premium applicable to the individual class of en-
rollment shall be such amount that (if applied under
this Act) will result in the payment of sufficient
funds to cover the costs of the AMCARE plan, in-
cluding a reasonable contingency margin and taking
into account risk adjustment under subsection (d).
‘‘(2) FAMILY ENROLLMENT.—Subject to para-
graph (3), the premium applicable to a family class
of enrollment shall be equal to the product of—