amounts in excess of the amounts provided under
the approved budget.
SEC. 224. PAYMENTS FROM FEDERAL GOVERNMENT TO
STATES FOR COVERED DISTRICT HEALTH
CARE SERVICES.
(a) IN GENERAL.—The Federal Health Board shall
provide for payment each fiscal year to each State Health
Board of an amount, on an annualized basis, equal to the
sum of the following:
(1) 25 percent of the product of (A) the portion
of the national per capita health care facilities rate
not attributable to nursing facility services (deter-
mined under section 221) and (B) the total number
of eligible State residents (other than native Ameri-
cans) in the State.
(2) 10 percent of the product of (A) the portion
of the national per capita health care facilities rate
attributable to nursing facility services (as deter-
mined under section 221) and (B) the total number
of eligible State residents (other than native Ameri-
cans) in the State.
(3) Subject to subsection (b), 100 percent of
the product of (A) the national per capita health
care facilities rate (as determined under section 221)
and (B) the total number of native Americans who
are eligible State residents in the State.
(b) TREATMENT OF NATIVE AMERICANS.—Instead of
the payment amounts provided under subsection (a)(3),
the Federal Health Board may pay to a State such
amounts as may be required in order to provide for full
payment of the amounts of the global budgets for district
boards established pursuant to section 112(b)(3).
(c) PERIODIC PAYMENTS.—Payments under this sec-
tion shall be made on a periodic base (not less often than
monthly).
(d) PAYMENTS FOR HEALTH EDUCATION AND PRI-
MARY HEALTH CARE PRACTITIONER TRAINING.—For
provisions relating to payments to State Health Education
Commissions for grants for health education and training
of primary health care practitioners, see section 501 of
this Act.
(e) ADDITIONAL EXPENDITURES.—Nothing in this
section shall be construed as preventing a district board
from providing for payments for health care services in
addition to the amounts provided under this section.
SEC. 225. STATE PROGRAM BUDGETS.
(a) IN GENERAL.—Each State program shall estab-
lish an annual fiscal year State program budget which pro-
vides for—
(1) the total expenditures to be made under the
State program in such fiscal year for covered district
health care services (including administrative and
associated costs), and
(2) the revenues to meet such expenditures.
(b) STATE SHARE.—
(1) IN GENERAL.—Each State program shall
cover the State share of program costs through the
use of tax revenues and other financing methods.
(2) ADDITIONS TO STATE SHARE.—Each State
shall raise the revenues necessary to cover at least
the State share of the State health budget estab-
lished by the State Health Board.
(c) ESTABLISHMENT OF ANNUAL BUDGETS UNDER
STATE PLANS.—
(1) SUBMISSION OF ESTIMATED PLAN EXPENDI-
TURES.—Not later than 3 months before the begin-
ning of each calendar year, each district board in
each State shall submit to the State Health Care
Board the estimated plan expenditures for the dis-
trict for that year.
(2) STATE PLAN BUDGET.—
(A) IN GENERAL.—The State plan budget
for a year shall be equal to the sum of the esti-
mated negotiated expenditures for all district
boards in the State submitted under paragraph
(1).
(B) PERMITTING
RETROACTIVE
ADJUST-
MENT.—The State Health Care Board may
make a retroactive adjustment to the State plan
budget for a year under subparagraph (A) to
take into account differences between the budg-
et and total amount of expenditures under the
State plan during the year.
TITLE III—MALPRACTICE
INSURANCE REFORM
SEC. 301. ELIGIBILITY REQUIREMENTS FOR FEDERAL PAY-
MENTS FOR STATE PLANS.
For purposes of section 111(e)(4), a State has en-
acted and is enforcing laws, rules, or regulations relating
to physician medical malpractice liability that meet the re-
quirements of this title if State law meets the require-
ments of sections 302 through 304.
SEC. 302. STATE-CHARTERED PRACTITIONERS ASSOCIA-
TION ASSUMPTION OF RESPONSIBILITY FOR
MALPRACTICE INSURANCE COVERAGE AND
PAYMENT OF DAMAGES.
(a) STATE-CHARTERED PRACTITIONERS ASSOCIA-
TION RESPONSIBLE FOR OBTAINING INSURANCE.—With
respect to each class of health care practitioners in a
State, the State-chartered practitioners association in the
State shall provide (either directly or through contracts
with insurance companies) medical malpractice insurance
for each practitioner member of the association.
(b) STATE-CHARTERED PRACTITIONERS ASSOCIA-
TION RESPONSIBLE
FOR PAYING DAMAGES ARISING
FROM MEDICAL MALPRACTICE CLAIMS.—Any damages
assessed with respect to any medical malpractice claim
filed in the State against a health care practitioner who
is a member of a State-chartered practitioners association
shall be assessed against the association or other entity
providing the medical malpractice insurance under sub-
section (a), and the individual or entity to whom the dam-
ages are awarded may not collect the damages from the
practitioner.
SEC. 303. PROHIBITION AGAINST PUNITIVE DAMAGES.
No punitive damages may be assessed with respect
to any medical malpractice claim filed in the State against
any provider of health care services.
SEC. 304. MEDICAL MALPRACTICE CLAIM DEFINED.
(a) IN GENERAL.—In this title, the term ‘‘medical
malpractice claim’’ means (subject to subsection (b)) any
claim relating to the provision of (or the failure to provide)
health care services without regard to the theory of liabil-
ity asserted.