without discrimination and with appropriate no-
tice. 
(D) HEALTH
MAINTENANCE
ORGANIZA-
TIONS.—Under this Act— 
(i) health maintenance organizations 
shall be required to reimburse physicians 
based on a salary; and 
(ii) financial incentives between such 
organizations and physicians based on uti-
lization are prohibited. 
SEC. 203. PAYMENT FOR LONG-TERM CARE. 
(a) ALLOTMENT FOR REGIONS.—The Program shall 
provide for each region a single budgetary allotment to 
cover a full array of long-term care services under this 
Act. 
(b) REGIONAL BUDGETS.—Each region shall provide 
a global budget to local long-term care providers for the 
full range of needed services, including in-home, nursing 
home, and community based care. 
(c) BASIS FOR BUDGETS.—Budgets for long-term 
care services under this section shall be based on past ex-
penditures, financial and clinical performance, utilization, 
and projected changes in service, wages, and other related 
factors. 
VerDate Nov 24 2008 
07:13 Jan 27, 2009
Jkt 079200
PO 00000
Frm 00016
Fmt 6652
Sfmt 6201
E:\BILLS\H676.IH
H676
jbell on PROD1PC69 with BILLS
(d) FAVORING NON-INSTITUTIONAL CARE.—All ef-
forts shall be made under this Act to provide long-term 
care in a home- or community-based setting, as opposed 
to institutional care. 
SEC. 204. MENTAL HEALTH SERVICES. 
(a) IN GENERAL.—The Program shall provide cov-
erage for all medically necessary mental health care on 
the same basis as the coverage for other conditions. Li-
censed mental health clinicians shall be paid in the same 
manner as specified for other health professionals, as pro-
vided for in section 202(b). 
(b) FAVORING
COMMUNITY-BASED
CARE.—The 
USNHC Program shall cover supportive residences, occu-
pational therapy, and ongoing mental health and coun-
seling services outside the hospital for patients with seri-
ous mental illness. In all cases the highest quality and 
most effective care shall be delivered, and, for some indi-
viduals, this may mean institutional care. 
SEC. 205. PAYMENT FOR PRESCRIPTION MEDICATIONS, 
MEDICAL SUPPLIES, AND MEDICALLY NEC-
ESSARY ASSISTIVE EQUIPMENT. 
(a) NEGOTIATED PRICES.—The prices to be paid 
each year under this Act for covered pharmaceuticals, 
medical supplies, and medically necessary assistive equip-
ment shall be negotiated annually by the Program. 
VerDate Nov 24 2008 
07:13 Jan 27, 2009
Jkt 079200
PO 00000
Frm 00017
Fmt 6652
Sfmt 6201
E:\BILLS\H676.IH
H676
jbell on PROD1PC69 with BILLS
(b) PRESCRIPTION DRUG FORMULARY.— 
(1) IN GENERAL.—The Program shall establish 
a prescription drug formulary system, which shall 
encourage best-practices in prescribing and discour-
age the use of ineffective, dangerous, or excessively 
costly medications when better alternatives are avail-
able. 
(2) PROMOTION OF USE OF GENERICS.—The 
formulary shall promote the use of generic medica-
tions but allow the use of brand-name and off-for-
mulary medications. 
(3) FORMULARY
UPDATES
AND
PETITION 
RIGHTS.—The formulary shall be updated frequently 
and clinicians and patients may petition their region 
or the Director to add new pharmaceuticals or to re-
move ineffective or dangerous medications from the 
formulary. 
SEC. 206. CONSULTATION IN ESTABLISHING REIMBURSE-
MENT LEVELS. 
Reimbursement levels under this subtitle shall be set 
after close consultation with regional and State Directors 
and after the annual meeting of National Board of Uni-
versal Quality and Access. 
VerDate Nov 24 2008 
07:13 Jan 27, 2009
Jkt 079200
PO 00000
Frm 00018
Fmt 6652
Sfmt 6201
E:\BILLS\H676.IH
H676
jbell on PROD1PC69 with BILLS
Subtitle B—Funding 
SEC. 211. OVERVIEW: FUNDING THE USNHC PROGRAM. 
(a) IN GENERAL.—The USNHC Program is to be 
funded as provided in subsection (c)(1). 
(b) USNHC TRUST FUND.—There shall be estab-
lished a USNHC Trust Fund in which funds provided 
under this section are deposited and from which expendi-
tures under this Act are made. 
(c) FUNDING.— 
(1) IN GENERAL.—There are appropriated to 
the USNHC Trust Fund amounts sufficient to carry 
out this Act from the following sources: 
(A) Existing sources of Federal Govern-
ment revenues for health care. 
(B) Increasing personal income taxes on 
the top 5 percent income earners. 
(C) Instituting a modest and progressive 
excise tax on payroll and self-employment in-
come. 
(D) Instituting a small tax on stock and 
bond transactions. 
(2) SYSTEM SAVINGS AS A SOURCE OF FINANC-
ING.—Funding otherwise required for the Program 
is reduced as a result of— 
(A) vastly reducing paperwork; 
VerDate Nov 24 2008 
07:13 Jan 27, 2009
Jkt 079200
PO 00000
Frm 00019
Fmt 6652
Sfmt 6201
E:\BILLS\H676.IH
H676
jbell on PROD1PC69 with BILLS
(B) requiring a rational bulk procurement 
of medications under section 205(a); and 
(C) improved access to preventive health 
care. 
(3) ADDITIONAL ANNUAL APPROPRIATIONS TO 
USNHC PROGRAM.—Additional sums are authorized 
to be appropriated annually as needed to maintain 
maximum quality, efficiency, and access under the 
Program. 
SEC. 212. APPROPRIATIONS FOR EXISTING PROGRAMS. 
Notwithstanding any other provision of law, there are 
hereby transferred and appropriated to carry out this Act, 
amounts from the Treasury equivalent to the amounts the 
Secretary estimates would have been appropriated and ex-
pended for Federal public health care programs, including 
funds that would have been appropriated under the Medi-
care program under title XVIII of the Social Security Act, 
under the Medicaid program under title XIX of such Act, 
and under the Children’s Health Insurance Program 
under title XXI of such Act. 
VerDate Nov 24 2008 
07:13 Jan 27, 2009
Jkt 079200
PO 00000
Frm 00020
Fmt 6652
Sfmt 6201
E:\BILLS\H676.IH
H676
jbell on PROD1PC69 with BILLS
TITLE III—ADMINISTRATION 
SEC. 301. PUBLIC ADMINISTRATION; APPOINTMENT OF DI-
RECTOR. 
(a) IN GENERAL.—Except as otherwise specifically 
provided, this Act shall be administered by the Secretary 
through a Director appointed by the Secretary. 
(b) LONG-TERM CARE.—The Director shall appoint 
a director for long-term care who shall be responsible for 
administration of this Act and ensuring the availability 
and accessibility of high quality long-term care services. 
(c) MENTAL HEALTH.—The Director shall appoint a 
director for mental health who shall be responsible for ad-
ministration of this Act and ensuring the availability and 
accessibility of high quality mental health services. 
SEC. 302. OFFICE OF QUALITY CONTROL. 
The Director shall appoint a director for an Office 
of Quality Control. Such director shall, after consultation 
with state and regional directors, provide annual rec-
ommendations to Congress, the President, the Secretary, 
and other Program officials on how to ensure the highest 
quality health care service delivery. The director of the Of-
fice of Quality Control shall conduct an annual review on 
the adequacy of medically necessary services, and shall 
make recommendations of any proposed changes to the 
VerDate Nov 24 2008 
07:13 Jan 27, 2009
Jkt 079200
PO 00000
Frm 00021
Fmt 6652
Sfmt 6201
E:\BILLS\H676.IH
H676
jbell on PROD1PC69 with BILLS
Congress, the President, the Secretary, and other USNHC 
Program officials. 
SEC. 303. REGIONAL AND STATE ADMINISTRATION; EM-
PLOYMENT OF DISPLACED CLERICAL WORK-
ERS. 
(a) ESTABLISHMENT
OF USNHC PROGRAM RE-
GIONAL OFFICES.—The Secretary shall establish and 
maintain USNHC regional offices for the purpose of dis-
tributing funds to providers of care. Whenever possible, 
the Secretary should incorporate pre-existing Medicare in-
frastructure for this purpose. 
(b) APPOINTMENT OF REGIONAL AND STATE DIREC-
TORS.—In each such regional office there shall be— 
(1) one regional director appointed by the Di-
rector; and 
(2) for each State in the region, a deputy direc-
tor (in this Act referred to as a ‘‘State Director’’) 
appointed by the governor of that State. 
(c) REGIONAL OFFICE DUTIES.—Regional offices of 
the Program shall be responsible for— 
(1) coordinating funding to health care pro-
viders and physicians; and 
(2) coordinating billing and reimbursements 
with physicians and health care providers through a 
State-based reimbursement system. 
VerDate Nov 24 2008 
07:13 Jan 27, 2009
Jkt 079200
PO 00000
Frm 00022
Fmt 6652
Sfmt 6201
E:\BILLS\H676.IH
H676
jbell on PROD1PC69 with BILLS
(d) STATE DIRECTOR’S DUTIES.—Each State Direc-
tor shall be responsible for the following duties: 
(1) Providing an annual state health care needs 
assessment report to the National Board of Uni-
versal Quality and Access, and the regional board, 
after a thorough examination of health needs, in 
consultation with public health officials, clinicians, 
patients, and patient advocates. 
(2) Health planning, including oversight of the 
placement of new hospitals, clinics, and other health 
care delivery facilities. 
(3) Health planning, including oversight of the 
purchase and placement of new health equipment to 
ensure timely access to care and to avoid duplica-
tion. 
(4) Submitting global budgets to the regional 
director. 
(5) Recommending changes in provider reim-
bursement or payment for delivery of health services 
in the State. 
(6) Establishing a quality assurance mechanism 
in the State in order to minimize both under utiliza-
tion and over utilization and to assure that all pro-
viders meet high quality standards. 
VerDate Nov 24 2008 
07:13 Jan 27, 2009
Jkt 079200
PO 00000
Frm 00023
Fmt 6652
Sfmt 6201
E:\BILLS\H676.IH
H676
jbell on PROD1PC69 with BILLS
(7) Reviewing program disbursements on a 
quarterly basis and recommending needed adjust-
ments in fee schedules needed to achieve budgetary 
targets and assure adequate access to needed care. 
(e) FIRST
PRIORITY
IN
RETRAINING
AND
JOB 
PLACEMENT; 2 YEARS OF SALARY PARITY BENEFITS.— 
The Program shall provide that clerical, administrative, 
and billing personnel in insurance companies, doctors of-
fices, hospitals, nursing facilities, and other facilities 
whose jobs are eliminated due to reduced administration— 
(1) should have first priority in retraining and 
job placement in the new system; and 
(2) shall be eligible to receive two years of 
USNHC employment transition benefits with each 
year’s benefit equal to salary earned during the last 
12 months of employment, but shall not exceed 
$100,000 per year. 
(f) ESTABLISHMENT
OF
USNHC EMPLOYMENT 
TRANSITION FUND.—The Secretary shall establish a trust 
fund from which expenditures shall be made to recipients 
of the benefits allocated in subsection (e). 
(g) ANNUAL APPROPRIATIONS TO USNHC EMPLOY-
MENT TRANSITION FUND.—Sums are authorized to be ap-
propriated annually as needed to fund the USNHC Em-
ployment Transition Benefits. 
VerDate Nov 24 2008 
07:13 Jan 27, 2009
Jkt 079200
PO 00000
Frm 00024
Fmt 6652
Sfmt 6201
E:\BILLS\H676.IH
H676
jbell on PROD1PC69 with BILLS
(h) RETENTION OF RIGHT TO UNEMPLOYMENT BEN-
EFITS.—Nothing in this section shall be interpreted as a 
waiver of USNHC Employment Transition benefit recipi-
ents’ right to receive Federal and State unemployment 
benefits. 
SEC. 304. CONFIDENTIAL ELECTRONIC PATIENT RECORD 
SYSTEM. 
(a) IN GENERAL.—The Secretary shall create a 
standardized, confidential electronic patient record system 
in accordance with laws and regulations to maintain accu-
rate patient records and to simplify the billing process, 
thereby reducing medical errors and bureaucracy. 
(b) PATIENT OPTION.—Notwithstanding that all bill-
ing shall be preformed electronically, patients shall have 
the option of keeping any portion of their medical records 
separate from their electronic medical record. 
SEC. 305. NATIONAL BOARD OF UNIVERSAL QUALITY AND 
ACCESS. 
(a) ESTABLISHMENT.— 
(1) IN GENERAL.—There is established a Na-
tional Board of Universal Quality and Access (in 
this section referred to as the ‘‘Board’’) consisting 
of 15 members appointed by the President, by and 
with the advice and consent of the Senate. 
VerDate Nov 24 2008 
07:13 Jan 27, 2009
Jkt 079200
PO 00000
Frm 00025
Fmt 6652
Sfmt 6201
E:\BILLS\H676.IH
H676
jbell on PROD1PC69 with BILLS
(2) QUALIFICATIONS.—The appointed members 
of the Board shall include at least one of each of the 
following: 
(A) Health care professionals. 
(B) Representatives of institutional pro-
viders of health care. 
(C) Representatives of health care advo-
cacy groups. 
(D) Representatives of labor unions. 
(E) Citizen patient advocates. 
(3) TERMS.—Each member shall be appointed 
for a term of 6 years, except that the President shall 
stagger the terms of members initially appointed so 
that the term of no more than 3 members expires 
in any year. 
(4) PROHIBITION
ON
CONFLICTS
OF
INTER-
EST.—No member of the Board shall have a finan-
cial conflict of interest with the duties before the 
Board. 
(b) DUTIES.— 
(1) IN
GENERAL.—The Board shall meet at 
least twice per year and shall advise the Secretary 
and the Director on a regular basis to ensure qual-
ity, access, and affordability. 
VerDate Nov 24 2008 
07:13 Jan 27, 2009
Jkt 079200
PO 00000
Frm 00026
Fmt 6652
Sfmt 6201
E:\BILLS\H676.IH
H676
jbell on PROD1PC69 with BILLS
(2) SPECIFIC ISSUES.—The Board shall specifi-
cally address the following issues: 
(A) Access to care. 
(B) Quality improvement. 
(C) Efficiency of administration. 
(D) Adequacy of budget and funding. 
(E) Appropriateness of reimbursement lev-
els of physicians and other providers. 
(F) Capital expenditure needs. 
(G) Long-term care. 
(H) Mental health and substance abuse 
services. 
(I) Staffing levels and working conditions 
in health care delivery facilities. 
(3) ESTABLISHMENT
OF
UNIVERSAL, 
BEST 
QUALITY
STANDARD
OF
CARE.—The Board shall 
specifically establish a universal, best quality of 
standard of care with respect to— 
(A) appropriate staffing levels; 
(B) appropriate medical technology; 
(C) design and scope of work in the health 
workplace; 
(D) best practices; and 
VerDate Nov 24 2008 
07:13 Jan 27, 2009
Jkt 079200
PO 00000
Frm 00027
Fmt 6652
Sfmt 6201
E:\BILLS\H676.IH
H676
jbell on PROD1PC69 with BILLS
care to all individuals regardless of race, ethnicity, sexual 
orientation, or language. 
TITLE V—EFFECTIVE DATE 
SEC. 501. EFFECTIVE DATE. 
Except as otherwise specifically provided, this Act 
shall take effect on the first day of the first year that be-
gins more than 1 year after the date of the enactment 
of this Act, and shall apply to items and services furnished 
on or after such date. 
Æ 
VerDate Nov 24 2008 
07:13 Jan 27, 2009
Jkt 079200
PO 00000
Frm 00030
Fmt 6652
Sfmt 6301
E:\BILLS\H676.IH
H676
jbell on PROD1PC69 with BILLS