I
103D CONGRESS
1ST SESSION
H. R. 36
To direct the Secretary of Health and Human Services to establish a schedule
of preventive health care services and to provide for coverage of such
services in accordance with such schedule under private health insurance
plans and health benefit programs of the Federal Government, and
for other purposes.
IN THE HOUSE OF REPRESENTATIVES
JANUARY 5, 1993
Mr. GILMAN introduced the following bill; which was referred jointly to the
Committees on Energy and Commerce, Post Office and Civil Service, Vet-
erans’ Affairs, and Ways and Means
MAY 24, 1993
Additional sponsor: Mr. FISH
A BILL
To direct the Secretary of Health and Human Services to
establish a schedule of preventive health care services
and to provide for coverage of such services in accord-
ance with such schedule under private health insurance
plans and health benefit programs of the Federal Gov-
ernment, and for other purposes.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Comprehensive Preven-
tive Health and Promotion Act of 1993’’.
SEC. 2. ESTABLISHMENT OF SCHEDULE OF PREVENTIVE
HEALTH CARE SERVICES.
(a) INITIAL SCHEDULE.—
(1) PROPOSED SCHEDULE.—Not later than 6
months after the date of the enactment of this Act,
the Secretary of Health and Human Services, in
consultation with representatives of individuals de-
scribed in subsection (d), shall establish a proposed
initial schedule of recommended preventive health
care services. In accordance with section 553 of title
5, United States Code, the Secretary shall publish
such proposed schedule in the Federal Register and
provide for a 90-day period for receiving public com-
ment on the schedule.
(2) FINAL SCHEDULE.—The proposed schedule
of recommended preventive health care services es-
tablished under paragraph (1) shall become effective
for the first calendar year that begins 90 or more
days after the expiration of the period for receiving
public comment described in paragraph (1).
(b) ANNUAL ADJUSTMENT.—Not later than October
1 of every year (beginning with the first year for which
the schedule established under subsection (a) is in effect),
the Secretary, in consultation with representatives of indi-
viduals described in subsection (d) and in accordance with
section 553 of title 5, United States Code, may revise the
schedule of preventive health care services established
under this section for the following calendar year.
(c) USE OF SOURCES FOR ESTABLISHING SCHED-
ULE.—In establishing the initial schedule of recommended
preventive health care services under subsection (a) and
in revising the schedule for subsequent years under sub-
section (b), the Secretary shall take into consideration the
recommendations for preventive health care services con-
tained in the Guide to Clinical Preventive Services pre-
sented to the Department of Health and Human Services
by the United States Preventive Services Task Force and
the Year 2000 Health Objectives of the United States
Public Health Service.
(d) INDIVIDUALS SERVING AS CONSULTANTS.—The
individuals described in this subsection are as follows:
(1) Hospital administrators.
(2) Administrators of health benefit plans.
(3) General practice physicians.
(4) Mental health practitioners.
(5) Pediatricians.
(6) Chiropractors.
(7) Physicians practicing in medical specialty
areas.
(8) Nutritionists.
(9) Nurses.
(10) Experts in scientific research.
(11) Dentists.
(12) Representatives of manufacturers of pre-
scription drugs.
(13) Health educators.
SEC. 3. APPLICATION TO INDIVIDUALS ENROLLED IN PRI-
VATE HEALTH INSURANCE PLANS.
(a) REQUIREMENT FOR CARRIERS AND PLANS.—
(1) IN GENERAL.—Each carrier and employer
health benefit plan shall include in the services cov-
ered for each individual enrolled with the carrier or
plan the preventive health care services applicable to
the individual under the schedule of preventive
health care services established under section 2.
(2) DEFINITIONS.—In this section:
(A) The term ‘‘carrier’’ means any entity
which provides health insurance or health bene-
fits in a State, and includes a licensed insur-
ance company, a prepaid hospital or medical
service plan, a health maintenance organization,
the plan sponsor of a multiple employer welfare
arrangement or an employee benefit plan (as
defined under the Employee Retirement Income
Security Act of 1974), or any other entity pro-
viding a plan of health insurance subject to
State insurance regulation, but such term does
not include for purposes of section 103 an en-
tity that provides health insurance or health
benefits under a multiple employer welfare ar-
rangement.
(B)(i) Subject to clause (ii), the term ‘‘em-
ployer health benefit plan’’ means a health ben-
efit plan (including an employee welfare benefit
plan, as defined in section 3(1) of the Employee
Retirement Income Security Act of 1974) which
is offered to employees through an employer
and for which the employer provides for any
contribution to such plan or any premium for
such plan are deducted by the employer from
compensation to the employee.
(ii) A State may provide (for a plan in a
State) that the term ‘‘employer health benefit
plan’’ does not include an association plan (as
defined in clause (iii)).
(iii) For purposes of clause (ii), the term
‘‘association plan’’ means a health benefit plan
offered by an organization to its members if the
organization was formed other than for pur-
poses of purchasing insurance.
(C) The term ‘‘full-time employee’’ means,
with respect to an employer, an individual who
normally is employed for at least 30 hours per
week by the employer.
(D) The term ‘‘health benefit plan’’ means
any hospital or medical expense incurred policy
or certificate, hospital or medical service plan
contract, or health maintenance subscriber con-
tract, or a multiple employer welfare arrange-
ment or employee benefit plan (as defined
under the Employee Retirement Income Secu-
rity Act of 1974) which provides benefits with
respect to health care services, but does not in-
clude—
(i) coverage only for accident, dental,
vision, disability income, or long-term care
insurance, or any combination thereof,
(ii) medicare supplemental health in-
surance,
(iii) coverage issued as a supplement
to liability insurance,
(iv) worker’s compensation or similar
insurance, or
(v) automobile medical-payment insur-
ance,
or any combination thereof.
(E) The term ‘‘small employer carrier’’
means a carrier with respect to the issuance of
an employer health benefit plan which provides
coverage to one or more full-time employees of
an entity actively engaged in business which, on
at least 50 percent of its working days during
the preceding year, employed at least 2, but
fewer than 36, full-time employees. For pur-
poses of determining if an employer is a small
employer, rules similar to the rules of sub-
section (b) and (c) of section 414 of the Inter-
nal Revenue Code of 1986 shall apply.
(b) ENFORCEMENT THROUGH EXCISE TAX.—
(1) IN GENERAL.—Chapter 43 of the Internal
Revenue Code of 1986 (relating to qualified pension,
etc., plans) is amended by adding at the end thereof
the following new section:
‘‘SEC. 
4980C. 
FAILURE 
TO 
COMPLY 
WITH 
EMPLOYER
HEALTH 
BENEFIT 
PLAN 
STANDARDS 
RE-
GARDING PREVENTIVE HEALTH CARE.
‘‘(a) IMPOSITION OF TAX.—
‘‘(1) IN GENERAL.—There is hereby imposed a
tax on the failure of a carrier or an employer health
benefit plan to comply with section 3(a)(1) of the
Comprehensive Preventive Health and Promotion
Act of 1993.
‘‘(2) EXCEPTION.—Paragraph (1) shall not
apply to a failure by a small employer carrier or
plan in a State if the Secretary of Health and
Human Services determines that the State has in ef-
fect a regulatory enforcement mechanism that pro-
vides adequate sanctions with respect to such a fail-
ure by such a carrier or of such a plan.
‘‘(b) AMOUNT OF TAX.—
‘‘(1) IN GENERAL.—Subject to paragraph (2),
the tax imposed by subsection (a) shall be an
amount not to exceed 25 percent of the amounts re-
ceived by the carrier or under the plan for coverage
during the period such failure persists.
‘‘(2) LIMITATION IN CASE OF INDIVIDUAL FAIL-
URES.—In the case of a failure that only relates to
specified individuals or employers (and not to the
plan generally), the amount of the tax imposed by
subsection (a) shall not exceed the aggregate of
$100 for each day during which such failure persists
for each individual to which such failure relates. A
rule similar to the rule of section 4980B(b)(3) shall
apply for purposes of this section.
‘‘(c) LIABILITY FOR TAX.—The tax imposed by this
section shall be paid by the carrier.
‘‘(d) EXCEPTIONS.—
‘‘(1) CORRECTIONS WITHIN 30 DAYS.—No tax
shall be imposed by subsection (a) by reason of any
failure if—
‘‘(A) such failure was due to reasonable
cause and not to willful neglect, and
‘‘(B) such failure is corrected within the
30-day period beginning on earliest date the
carrier knew, or exercising reasonable diligence
would have known, that such failure existed.
‘‘(2) WAIVER BY SECRETARY.—In the case of a
failure which is due to reasonable cause and not to
willful neglect, the Secretary may waive part or all
of the tax imposed by subsection (a) to the extent
that payment of such tax would be excessive relative
to the failure involved.
‘‘(e) DEFINITIONS.—For purposes of this section, the
terms ‘carrier’, ‘employer health benefit plan’, and ‘small
employer carrier’ have the respective meanings given such
terms in section 3(a)(2) of the Comprehensive Preventive
Health and Promotion Act of 1993.’’
(2) CLERICAL AMENDMENT.—The table of sec-
tions for chapter 43 of such Code is amended by
adding at the end thereof the following new items:
‘‘Sec. 4980C. Failure to comply with employer health plan stand-
ards regarding preventive health care.’’.
(3) EFFECTIVE DATE.—The amendments made
by this subsection shall apply to plan years begin-
ning after December 31, 1993.
SEC. 4. COVERAGE OF PREVENTIVE HEALTH CARE SERV-
ICES UNDER MEDICARE.
(a) IN GENERAL.—Section 1861(s)(2) of the Social
Security Act (42 U.S.C. 1395x(s)(2)) is amended—
(1) by striking ‘‘and’’ at the end of subpara-
graph (O);
(2) by striking the semicolon at the end of sub-
paragraph (P) and inserting ‘‘; and’’; and
(3) by adding at the end the following new sub-
paragraph:
‘‘(Q) in the case of an individual, services appli-
cable to the individual under the schedule of preven-
tive health care services established under the Com-
prehensive Preventive Health and Promotion Act of
1993 (to the extent such services are not otherwise
covered with respect to the individual under this
title);’’.
(b) CONFORMING AMENDMENTS.—Section 1862(a)
of such Act (42 U.S.C. 1395y(a)) is amended—
(1) in paragraph (1)—
(A) in subparagraph (E), by striking
‘‘and’’ at the end,
(B) in subparagraph (F), by striking the
semicolon at the end and inserting ‘‘, and’’, and
(C) by adding at the end the following new
subparagraph:
‘‘(G) in the case of items or services described
in section 1861(s)(2)(Q), which are not provided in
accordance with the schedule of preventive health
care services established under the Comprehensive
Preventive Health and Promotion Act of 1993 ;’’;
and
(2) in paragraph (7), by striking ‘‘paragraph
(1)(B) or under paragraph (1)(F)’’ and inserting
‘‘subparagraphs (B), (F), or (G) of paragraph (1)’’.
(c) EFFECTIVE DATE.—The amendments made by
this section shall apply to services furnished on or after
January 1, 1994.
SEC. 5. COVERAGE UNDER STATE MEDICAID PLANS.
(a) IN GENERAL.—
(1) INCLUSION IN MEDICAL ASSISTANCE.—Sec-
tion 1905(a) of the Social Security Act (42 U.S.C.
1396d(a)) is amended—
(A) by striking ‘‘and’’ at the end of para-
graph (21);
(B) in paragraph (24), by striking the
comma at the end and inserting a semicolon;
(C) by redesignating paragraphs (22),
(23), and (24) as paragraphs (25), (22), and
(23), respectively, and by transferring and in-
serting paragraph (25) after paragraph (23), as
so redesignated; and
(D) by inserting after paragraph (23) the
following new paragraph:
‘‘(24) services applicable to the individual under
the schedule of preventive health care services estab-
lished under the Comprehensive Preventive Health
and Promotion Act of 1993 (to the extent such serv-
ices are not otherwise covered with respect to the in-
dividual under the State plan under this title); and’’.
(2) COVERAGE
MADE
MANDATORY.—(A) Sec-
tion 1902(a)(10)(A) of such Act (42 U.S.C.
1396a(a)(10)(A)) is amended by striking ‘‘(17) and
(21)’’ and inserting ‘‘(17), (21), and (24)’’.
(B) Section 1902(a)(10)(C)(iv) of such Act (42
U.S.C. 1396a(a)(10)(C)(iv)) is amended—
(i) by striking ‘‘(5) and (17)’’ and insert-
ing ‘‘(5), (17), and (24)’’; and
(ii) by striking ‘‘through (21)’’ and insert-
ing ‘‘through (24)’’.
(C) Section 1902(j) of such Act (42 U.S.C.
1396a(j)) is amended by striking ‘‘through (22)’’
and inserting ‘‘through (24)’’.
(b) EFFECTIVE DATE.—(1) Except as provided in
paragraph (2), the amendments made by subsection (a)
shall apply to calendar quarters beginning on or after Jan-
uary 1, 1994, without regard to whether or not final regu-
lations to carry out such amendments have been promul-
gated by such date.
(2) In the case of a State plan for medical assistance
under title XIX of the Social Security Act which the Sec-
retary of Health and Human Services determines requires
State legislation (other than legislation appropriating
funds) in order for the plan to meet the additional require-
ments imposed by the amendments made by subsections
(a) and (b), the State plan shall not be regarded as failing
to comply with the requirements of such title solely on the
basis of its failure to meet these additional requirements
before the first day of the first calendar quarter beginning
after the close of the first regular session of the State leg-
islature that begins after the date of the enactment of this
Act. For purposes of the previous sentence, in the case
of a State that has a 2-year legislative session, each year
of such session shall be deemed to be a separate regular
session of the State legislature.
SEC. 6. COVERAGE OF PREVENTIVE HEALTH CARE SERV-
ICES FOR VETERANS.
(a) IN GENERAL.—Section 1701(6) of title 38, Unit-
ed States Code is amended—
(1) by striking ‘‘and’’ at the end of subpara-
graph (A);
(2) by striking the period at the end of sub-
paragraph (B) and inserting ‘‘; and’’; and
(3) by adding at the end the following new sub-
paragraph:
‘‘(C) with respect to any veteran, any preventive
care services applicable under the schedule of pre-
ventive health care services established under the
Comprehensive Preventive Health and Promotion
Act of 1993, to the extent such services are not oth-
erwise treated as medical services under this para-
graph.’’.
(b) PROVIDING SERVICES
IN OUTPATIENT SET-
TING.—Section 1712(a)(5)(A) of such title is amended—
(1) in the first sentence, by striking the period
at the end and inserting the following: ‘‘, or any
other medical services applicable to the veteran
under the schedule of preventive health care services
established under the Comprehensive Preventive
Health and Promotion Act of 1993.’’; and
(2) in the second sentence, by inserting after
‘‘admission’’ the following: ‘‘or any services applica-
ble to the veteran under the schedule of preventive
health care services established under the Com-
prehensive Preventive Health and Promotion Act of
1993 (other than services applicable under such
schedule that are reasonably necessary in prepara-
tion for hospital admission)’’.
(c) EFFECTIVE DATE.—The amendments made by
this section shall apply to services furnished on or after
January 1, 1994.
SEC. 7. COVERAGE OF PREVENTIVE HEALTH CARE SERV-
ICES UNDER FEDERAL EMPLOYEES HEALTH
BENEFIT PLANS.
(a) IN GENERAL.—Paragraphs (1) and (2) of section
8904(a) of title 5, United States Code, are each amended
by adding at the end the following new subparagraph:
‘‘(G) With respect to an individual, any
preventive health care services applicable to the
individual under the schedule of preventive
health care services established under the Com-
prehensive Preventive Health and Promotion
Act of 1993.’’.
(b) EFFECTIVE DATE.—The amendments made by
subsection (a) shall apply with respect to services fur-
nished on or after January 1, 1994.
SEC. 8. COVERAGE OF PREVENTIVE HEALTH CARE SERV-
ICES FOR DEPENDENTS OF MEMBERS OF THE
UNIFORMED SERVICES.
(a) PREVENTIVE
HEALTH
CARE
SERVICES
IN-
CLUDED IN AUTHORIZED CARE.—Section 1077(a) of title
10, United States Code, is amended by adding at the end
the following new paragraph:
‘‘(13) Any preventive care services applicable
under the schedule of preventive health care services
established under the Comprehensive Preventive
Health and Promotion Act of 1993, to the extent
such services are not otherwise authorized as health
care services under this subsection.’’.
(b) EFFECTIVE DATE.—Paragraph (13) of section
1077(a) of title 10, United States Code (as added by sub-
section (a)), shall apply with respect to health care serv-
ices furnished on or after January 1, 1994, to dependents
of members or former members of the uniformed services
authorized to receive such services.
SEC. 9. PREVENTIVE HEALTH CARE DEMONSTRATION
PROJECT.
(a) ESTABLISHMENT.—There is hereby established a
demonstration project to demonstrate the effectiveness in
providing preventive health care services in improving the
health of individuals and reducing the aggregate costs of
providing health care, under which the Secretary of Health
and Human Services shall—
(1) make grants over a 5-year period to 50 eli-
gible counties to assist the counties in providing pre-
ventive health care services (in accordance with sub-
section (b)) to individuals who would otherwise be
unable to pay (or have payment made on their be-
half) for such services;
(2) conduct the study described in subsection
(c); and
(3) carry out the educational program described
in subsection (d).
(b) GRANTS TO COUNTIES.—
(1) SERVICES DESCRIBED.—A county receiving
a grant under subsection (a)(1) shall provide preven-
tive health care services to individuals at clinics in
accordance with the schedule of preventive health
care services established under the Comprehensive
Preventive Health and Promotion Act of 1993, ex-
cept that—
(A) the county may furnish services to in-
dividuals residing in rural areas at locations
other than clinics if no clinics that are able to
provide such services are located in the area;
and
(B) the Secretary may revise the schedule
of services otherwise required to be provided to
take into account the special needs of a partici-
pating county.
(2) ELIGIBILITY OF COUNTIES.—A county is el-
igible to receive a grant under subsection (a)(1) if
it submits to the Secretary, at such time and in such
form as the Secretary may require, an application
containing such information and assurances as the
Secretary may require.
(3) GEOGRAPHIC
BALANCE
AMONG
COUNTIES
SELECTED.—In selecting counties to receive grants
under subsection (a)(1), the Secretary shall consider
the need to select counties representing urban, rural,
and suburban areas and counties representing var-
ious geographic regions of the United States.
(c) STUDY OF STATE PREVENTIVE CARE REQUIRE-
MENTS.—
(1) STUDY.—The Secretary shall conduct a
study of the requirements regarding preventive
health care services that are imposed by each State
on health benefit plans offered to individuals resid-
ing in the State.
(2) REPORT.—Not later than 1 year after the
date of the enactment of this Act, the Secretary
shall submit a report to Congress on the study con-
ducted under paragraph (1).
(d) DISSEMINATION OF INFORMATION ON PREVEN-
TIVE HEALTH CARE.—Not later than 2 years after the
date of the enactment of this Act, the Secretary, in con-
sultation with experts in preventive medicine and rep-
resentatives of providers of health care services, shall pub-
lish and disseminate information on the benefits of prac-
ticing preventive health care, the importance of under-
going periodic health examinations, and the need to estab-
lish and maintain a family medical history to businesses,
providers of health care services, and other appropriate
groups and individuals.
(e) STATE DEFINED.—In this section, the term
‘‘State’’ means each of the 50 States and the District of
Columbia.
SEC. 10. PROGRAMS TO ESTABLISH ON-SITE WORKSHOPS
ON HEALTH PROMOTION.
(a) GRANTS TO BUSINESSES.—
(1) IN GENERAL.—The Secretary of Health and
Human Services shall establish a program under
which the Secretary shall make grants over a 5-year
period to 30 eligible employers to establish and con-
duct on-site workshops on health care promotion for
employees.
(2) ELIGIBILITY.—An employer is eligible to re-
ceive a grant under paragraph (1) if the employer
submits an application (at such time and in such
form as the Secretary may require) containing such
information and assurances as the Secretary may re-
quire, including assurances that the employer shall
use funds received under the grant only to provide
services that the employer does not otherwise pro-
vide (either directly or through a carrier) to its em-
ployees.
(3) INFORMATION AND SERVICES PROVIDED.—
On-site workshops on health care promotion con-
ducted with grants received under paragraph (1)
shall include the presentation of such information
and the provision of such services as the Secretary
considers appropriate, including counseling on nutri-
tion and weight management, clinical sessions on
avoiding back injury, programs on smoking ces-
sation, and information on stress management.
(b) ESTABLISHMENT OF PROGRAMS FOR FEDERAL
EMPLOYEES.—The Secretary of Labor shall establish a
program under which the Secretary shall conduct on-site
workshops on health care promotion for employees of the
Federal Government, and shall include in such workshops
the presentation of such information and the provision of
such services as the Secretary (in consultation with the
Secretary of Health and Human Services) considers ap-
propriate, including counseling on nutrition and weight
management, clinical sessions on avoiding back injury,
programs on smoking cessation, and information on stress
management.
Æ
HR 36 SC——2