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PART B—HEALTH SERVICE TRUST FUND
Sec. 511. Establishment of health service trust fund.
Sec. 512. Transfer of funds to the health service trust fund.
Sec. 513. Administration of health service trust fund.
PART C—PREPARATION OF PLANS AND BUDGETS
Sec. 521. Determination of fund availability.
Sec. 522. Preparation of area plans and budgets.
PART D—ALLOCATION AND DISTRIBUTION OF FUNDS
Sec. 531. National budget.
Sec. 532. Regional budgets.
Sec. 533. District budgets.
Sec. 534. Special operating expense fund.
Sec. 535. Distribution of funds.
Sec. 536. Annual statement, records, and audits.
PART E—GENERAL PROVISIONS
Sec. 541. Issuance of obligations.
Sec. 542. Definitions.
TITLE VI—MISCELLANEOUS PROVISIONS
Sec. 601. Effective date of health services.
Sec. 602. Repeal of provisions.
Sec. 603. Transition provisions.
Sec. 604. Amendment to Budget and Accounting Act.
Sec. 605. Separability.
FINDINGS
SEC. 2. The Congress makes the following findings:
(1) The health of the Nation’s people is a foun-
dation of their well-being.
(2) High quality health care is a right of all
people.
(3) Many of the Nation’s people are unable
fully to exercise this right because of the inability of
the present health care delivery system to make high
quality health care available to all individuals re-
gardless of race, sex, age, national origin, income,
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marital status, sexual orientation, religion, political
belief, place of residence, or previous health status.
(4) The present health care system has failed to
address the basic deterioration in occupational, envi-
ronmental, and social conditions affecting the health
of the people of this Nation.
(5) Unnecessary and excessive profits and ad-
ministrative expenses have inflated the cost of health
care.
(6) The health professions have failed to control
the cost of their services and the imbalance in the
number of health workers among geographic areas
or health care specialties.
(7) The present health care system has failed to
make full and efficient use of allied health workers.
(8) A United States Health Service is the best
means to implement the right to high quality health
care and to overcome the deficiencies in the present
health care delivery system.
PURPOSES
SEC. 3. The purposes of this Act are:
(1) To create a United States Health Service to
provide without charge to all residents, regardless of
race, sex, age, national origin, income, marital sta-
tus, sexual orientation, religion, political belief, place
of residence, or previous health status, comprehen-
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sive health care services delivered by salaried health
workers and emphasizing the promotion and mainte-
nance of health as well as the treatment of illness.
(2) To establish representative and democratic
governance of the Service through community boards
chosen through community elections, district and re-
gional boards selected by the community and district
boards, respectively, and a National Health Board
selected by the regional boards, subject to the ap-
proval of the President.
(3) To provide health workers in the Service
with fair and reasonable compensation, secure em-
ployment, opportunities for full and equal participa-
tion in the governance of health facilities, and oppor-
tunities for advancement without regard to race, sex,
age, national origin, sexual orientation, religion, or
political belief.
(4) To increase the availability and continuity
of health care by linking local health care facilities
to hospitals and specialized care facilities.
(5) To implement local, regional, and national
planning for the establishing, equipping, and staffing
of health care facilities needed to overcome present
shortages and redistribute health resources, espe-
cially for currently deprived inner-city and rural pop-
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ulations, minority groups, prisoners, and occupa-
tional groups.
(6) To finance the Service through progressive
taxation of individuals and employer contributions,
and to distribute these revenues on a capitation
basis, supplemented by allocations to meet special
health care needs.
DEFINITIONS
SEC. 4. For the purposes of this Act, unless the con-
text implies otherwise:
Service
(1) The term ‘‘Service’’ means the United
States Health Service established in section 101.
National Health Board; Interim National Health
Board; Appropriate National Health Board
(2)(A) The term ‘‘National Health Board’’
means the National Health Board of the Service.
(B) The term ‘‘Interim National Health Board’’
means the Interim National Health Board, ap-
pointed under section 102, of the Service.
(C) The term ‘‘appropriate National Health
Board’’ means—
(i) the Interim National Health Board,
prior to the initial meeting of the National
Health Board under section 117, and
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(ii) the National Health Board, at and
after such meeting.
Health Board; Area Health Board
(3)(A) The term ‘‘health board’’ means the In-
terim National Health Board, National Health
Board, an interim regional health board, a regional
health board, a district health board, or a commu-
nity health board established under this Act.
(B) The term ‘‘area health board’’ means a re-
gional health board, a district health board, or a
community health board established under this Act.
Community; District; Region; Area
(4)(A) The term ‘‘community’’ means a health
care delivery community established under title I.
(B) The term ‘‘district’’ means a health care
delivery district established under title I.
(C) The term ‘‘region’’ means a health care de-
livery region established under title I.
(D) The term ‘‘area’’ means, with respect to an
area health board or an area health care facility—
(i) in the case of a community board or a
health care facility established by a community
board, the community for which such board is
established or in which the facility is located;
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(ii) in the case of a district board or a
health care facility established by a district
board, the district for which such board is es-
tablished or in which the facility is located; and
(iii) in the case of a regional board or a
health care facility established by a regional
board, the region for which such board is estab-
lished or in which the facility is located.
Interim Regional Board; Regional Board; District
Board; Community Board
(5)(A) The term ‘‘interim regional board’’
means an interim regional health board established
in accordance with section 112.
(B) The term ‘‘regional board’’ means a re-
gional health board established in accordance with
title I.
(C) The term ‘‘district board’’ means a district
health board established in accordance with title I.
(D) The term ‘‘community board’’ means a
community health board established in accordance
with title I.
Respective Regional and District Board
(6)(A) The terms ‘‘respective regional board’’
and ‘‘respective interim regional board’’ mean, with
respect to a community board or a district board,
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fined in subparagraph (E)), or a member of the im-
mediate family of such a worker or indirect provider.
(D) The term ‘‘user member’’ means, with re-
spect to a health board, an eligible user elected or
appointed by users or user members to the health
board under sections 114 through 118.
(E) The term ‘‘indirect provider of health care’’
means an individual who—
(i) receives (either directly or through his
or her spouse) more than one-tenth of his or
her gross annual income from any one or com-
bination of—
(I) fees or other compensation for
provision of, research into, or instruction
in, the provision of health care,
(II) entities engaged in the provision
of health care or in such research or in-
struction,
(III) producing or supplying drugs or
other articles for individuals or entities for
use in the provision of or in research into
or instruction in the provision of health
care, or
(IV) entities engaged in producing
drugs or such other articles;
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(ii) holds a fiduciary position with, or has
a fiduciary interest in, any entity described in
subclause (II) or (IV) of clause (i); or
(iii) is engaged in issuing any policy or
contract of individual or group health insurance
or hospital or medical service benefits.
Health Worker; Authorized Health Worker; Eligible
Health Worker; Worker Member
(8)(A) The term ‘‘health worker’’ includes—
(i) any employee of the Service; and
(ii) any individual who for remuneration
delivers, administers any program in, provides
supporting services for, teaches the subject
matter of, or performs research in, health care
services.
(B) The term ‘‘authorized health worker’’
means, with respect to a specified health care serv-
ice, an individual who is an employee of the Service
and is authorized by a health board to deliver the
service.
(C) The term ‘‘eligible area health worker’’
means, for purposes of sections 114 through 118
with respect to a community, district, or region, a
health worker who is employed by the community,
district, or regional health board (respectively) or, in
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the case of sections 114 through 117, is scheduled
to be employed by such board on the effective date
of health services.
(D) The term ‘‘worker member’’ means, with
respect to a health board, an eligible area health
worker elected or appointed by health workers or
worker members to the health board under sections
114 through 118.
Health Care Facility; Area Health Care
Facility
(9)(A) The term ‘‘health care facility’’ means
an administrative unit composed of specified staff,
equipment, and premises and established by a health
board as an appropriate unit of organization for the
delivery of specified health care or supplemental
services under this Act.
(B) The term ‘‘area health care facility’’ means,
with respect to an area health board, a health care
facility established by the area health board.
Health Care Service; Supplemental Services
(10)(A) The term ‘‘health care services’’ means
the services described in paragraphs (1) through (5)
of section 213(a).
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(B) The term ‘‘supplemental services’’ means
the services described in paragraphs (1), (2), and
(3) of section 213(b).
Number of Residents
(11) The term ‘‘number of residents’’ means
the number of residents in a health care delivery
area as determined by the most recent decennial na-
tional census.
Effective Date of Health Services
(12) The term ‘‘effective date of health serv-
ices’’ means the effective date of health services
under this Act as specified in section 601.
TITLE I—ESTABLISHMENT AND OPERATION OF
THE UNITED STATES HEALTH SERVICE
PART A—INITIAL ORGANIZATION
ESTABLISHMENT OF THE SERVICE
SEC. 101. (a) There is established, as an independent
establishment of the executive branch of the United
States, the United States Health Service.
(b)(1) The authority of the Service shall be exercised
by the appropriate National Health Board and, in accord-
ance with this Act and guidelines established by such
Board, by area health boards.
(2) The Service shall have the authority, under the
power of eminent domain, to acquire by condemnation
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under judicial process real estate for the Service for public
purposes whenever it is necessary or advantageous to do
so.
APPOINTMENT OF INTERIM NATIONAL HEALTH BOARD
SEC. 102. (a) The President shall, no later than 30
days after the date of enactment of this Act, appoint 21
individuals—
(1) who are 18 years of age or older,
(2) who are concerned about the health care
problems of the Nation,
(3) who approximate the Nation’s population by
race, sex, income, language, and region of residence,
and
(4) no more than seven of whom are or have
been health workers, indirect providers of health
care, or members of the immediate family of such
workers or indirect providers within 24 months of
the date of such nomination.
To serve as members of the Interim National Health
Board of the Service.
(b) The President shall, at the time of such appoint-
ments, designate two nominees to the Interim National
Health Board who are not and have not been health work-
ers, indirect providers of health care, or members of the
immediate family of such workers or indirect providers
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within 24 months of the date of such appointment as
chairperson and vice chairperson of such Board.
POWERS AND DUTIES OF THE INTERIM NATIONAL
HEALTH BOARD
SEC. 103. (a) The members of the Interim National
Health Board shall serve as the National Health Board
of the Service until the National Health Board holds its
initial meeting in accordance with section 117(c)(2).
(b) The Interim National Health Board shall—
(1) establish the boundaries of health care de-
livery regions, in accordance with section 111;
(2) select interim regional health boards in ac-
cordance with section 111;
(3) assist interim regional health boards in the
performance of their functions;
(4) coordinate the initial election of community
health boards, under section 114; and
(5) carry out such duties of the National
Health Board as it deems necessary and consistent
with the timetable given under this Act and the pur-
poses of the Service, except that no staff member
may be appointed and no employee may be hired by
the Interim National Health Board for a period ex-
tending beyond 90 days after the appointment of the
National Health Board under section 117.
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(c) The Interim National Health Board shall operate
in a manner consistent with the provisions of part C.
(d) The Interim National Health Board shall submit
a report to Congress on its performance under this Act
no later than 30 days after the appointment of the Na-
tional Health Board under section 117.
AUTHORIZATION
SEC. 104. There are authorized to be appropriated
to the Service $4,000,000,000 to carry out the provisions
of this Act with respect to the establishment of the Serv-
ice. Funds appropriated under this section shall remain
available until expended.
PART B—ORGANIZATION OF AREA HEALTH BOARDS
ESTABLISHMENT OF HEALTH CARE DELIVERY REGIONS
SEC. 111. (a) No later than 6 months after the ap-
pointment of members of the Interim National Health
Board, such Board shall establish, in accordance with this
section, health care delivery regions throughout the United
States.
(b) Each health care delivery region shall meet the
following requirements:
(1) The region shall be a contiguous geographic
area appropriate for the effective governance, plan-
ning, and delivery of all health care and supple-
mental services under this Act for residents of the
region.
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(2) The region shall have a population of not
less than 500,000 and of not more than 3,000,000
individuals, except that—
(A) the population of a region may be
more than 3,000,000 if the region includes a
standard metropolitan statistical area (as deter-
mined by the Office of Management and Budg-
et) with a population of more than three mil-
lion; and
(B) the population of a region may be less
than 500,000 if the Interim National Health
Board determines that this is necessary to fa-
cilitate the delivery of health care and supple-
mental services or the effective governance of
the health program within such region.
(3) The boundaries of each region shall take
into account—
(A) any economic or geographic barrier to
the receipt of health care and supplemental
services in nonmetropolitan areas, and
(B) the differences in needs between non-
metropolitan and metropolitan areas in the
planning, development, and delivery of health
care and supplemental services.
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(c) At least 60 days prior to the establishment of the
boundaries of any region, the Interim National Health
Board shall provide for—
(1) notice in the area which would be affected
by the establishment of such boundaries of the
boundaries proposed to be established, and of the
date, time, and location of the public hearing on
such establishment as provided in paragraph (2);
and
(2) a public hearing at which individuals can
speak or present written statements relating to the
establishment of such boundaries.
(d) The boundaries of regions shall be modified in
accordance with section 119.
APPOINTMENT OF INTERIM REGIONAL HEALTH BOARDS
SEC. 112. (a) No later than 60 days after the estab-
lishment of health care delivery regions under section 111,
the Interim National Health Board shall appoint an in-
terim regional board for each such region.
(b) Each interim regional board shall be composed
of nine members—
(1) who are 18 years of age or older;
(2) who are concerned about the health care
problems of their region;
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(3) who approximate the region’s population by
race, sex, income, and language; and
(4) no more than three of whom are or have
been health workers, indirect providers or health
care, or members of the immediate family of such
workers or indirect providers within 24 months of
the date of such appointment.
(c) The Interim National Health Board shall, at the
time of appointment of each interim regional board, des-
ignate two members of the board who are not and have
not been health workers, indirect providers of health care,
or members of the immediate family of such workers or
indirect providers within 24 months of the date of such
appointment as chairperson and vice chairperson of such
board.
(d) A vacancy in the membership of an interim re-
gional board shall be filled in the same manner as the
original appointment.
(e) The members of an interim regional board shall
serve until the certification of appointment of a regional
board in its region in accordance with section 116.
(f) Each interim regional board shall—
(1) establish the boundaries of health care de-
livery districts and of health care delivery commu-
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nities within its region in accordance with section
113;
(2) conduct elections for voting members of
community boards within its region, in accordance
with section 114; and
(3) carry out such functions of a regional
board, set out under this Act, as the Interim Na-
tional Health Board deems appropriate for the pur-
poses of this Act.
(g) Each interim regional board shall operate in a
manner in accordance with part C of this title.
ESTABLISHMENT OF HEALTH CARE DELIVERY DISTRICTS
AND HEALTH CARE DELIVERY COMMUNITIES
SEC. 113. (a) No later than 6 months after its ap-
pointment under section 112, each interim regional board
shall establish, in accordance with this section, health care
delivery districts and health care delivery communities
throughout its region.
(b) Each region shall be divided into three or more
health care delivery districts. Each such district shall meet
the following requirements:
(1) The district shall be a contiguous geo-
graphic area appropriate for the effective govern-
ance, planning, and delivery of all health care serv-
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ices, except for highly specialized health services, for
residents of such district.
(2) The district shall have a population of not
less than 100,000 and of not more than 500,000 in-
dividuals, except that a district may have a popu-
lation of less than 100,000 if the interim regional
board or regional board (as appropriate) determines
that a lesser population would facilitate the delivery
of health care and supplemental services or the ef-
fective governance of the health program within such
district or its region.
(c) Each district shall be divided into three or more
health care delivery communities. Each such community
shall meet the following requirements:
(1) The community shall be a contiguous geo-
graphic area appropriate for the effective govern-
ance, planning, and delivery of comprehensive pri-
mary health care services, described in section
221(a)(2), for residents of such community.
(2) The residents of the community shall, to the
maximum extent feasible, have a commonality of in-
terest, language, and ethnic and racial composition
sufficient to support and maintain a community
health program under this Act.
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(3) The community shall have a population of
not less than 25,000 and of not more than 50,000
individuals, except in the case of Indian reservations
and, except that a community may have a population
of less than 25,000 if the interim regional board or
regional board (as appropriate) determines that a
lesser population would facilitate the delivery of
health care and supplemental services or the effec-
tive governance of the health program within such
community or the district in which it is located.
(d) At least 60 days prior to the establishment of the
boundaries of any district or community within its region,
the interim regional board shall provide for—
(1) notice in the district or community which
would be affected by the establishment of such
boundaries of the boundaries proposed to be estab-
lished and of the date, time, and location of the pub-
lic hearing on such establishment as provided in
paragraph (2); and
(2) a public hearing at which individuals resid-
ing within the region can speak or present written
statements relating to the establishment of such
boundaries.
(e) The boundaries of districts and communities shall
be modified in accordance with section 119.
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ELECTION OF COMMUNITY HEALTH BOARDS
SEC. 114. (a)(1) The Interim National Health Board
shall arrange with State and local governments for the ini-
tial elections for user members of each community board
to be held on a date not later than 9 months after the
appointment of interim regional boards under section 112.
(2) Elections for worker members of each community
board shall first be held as soon as possible after the selec-
tion of health workers for employment by the user mem-
bers of such community boards. Such elections shall be
held, to the extent feasible, in accordance with subsection
(c)(2)(B).
(b)(1) The number of user members to be elected in
an election in a community under subsection (a) shall be
six, plus one user member for each 5,000 individuals resid-
ing in such community in excess of 30,000 residents.
(2) The number of worker members to be elected in
an election in a community under subsection (a) shall be
three, plus one member for each 10,000 individuals resid-
ing in such community in excess of 30,000 residents.
(c)(1) The Interim National Health Board shall es-
tablish procedures for the nomination and election under
this section of user members of community boards and
worker members of area health boards. Each interim re-
gional board shall conduct and supervise such nominations
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and elections in its region in accordance with such proce-
dures.
(2)(A) Such procedures for election of user members
shall provide, except as otherwise provided in this part,
for—
(i) the nomination for election as a user mem-
ber to a community board of any eligible user, upon
presentation to the respective interim regional board
of a petition or petitions signed by at least one per-
cent of the registered users in the community;
(ii) the full disclosure by each nominee, at the
time of presentation of a petition or petitions under
clause (i), to the respective interim regional board of
any financial interest of the nominee and such nomi-
nee’s family in the delivery of health care services,
in research on health or health care services, or in
the provision of drugs or medical supplies;
(iii) the opportunity, regardless of race, sex,
language, income level, or health condition, for all
registered users in each such community to nomi-
nate eligible users for, and for all eligible users in
each such community to run for and to serve as user
members of, such users’ community board;
(iv) the right of all registered users in each
such community, regardless of race, sex, language,
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income level, or health condition, to vote in elections
for user members of such users’ community board,
and the right of registered users who are not phys-
ically or mentally capable of voting themselves to
designate other registered users to vote proxies on
their behalf;
(v) public meetings sponsored by the respective
interim regional board in each such community with-
in its region, at which all users nominated for elec-
tion to the community board in the community may
present their views;
(vi) the preparation and distribution within
each such community by the respective interim re-
gional board of literature presenting the qualifica-
tions and views of, and disclosing information de-
scribed in clause (ii) for, each nominee for election
as a user member of the community board in the
community; and
(vii) the election of the nominees receiving the
greatest number of votes.
(B) Such procedures for election of worker members
shall provide for—
(i) the nomination for election as a worker
member of an area health board of any eligible area
health worker, upon presentation to the respective
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interim regional board of a petition (or petitions)
signed by at least 1 percent of the eligible area
health workers, and
(ii) the full participation of eligible area health
workers of all job categories and skill levels in the
nomination and election process.
(d)(1) Unless an election is set aside under section
402(d)(1) (relating to grievance procedures), individuals
who have been elected to a community board for a commu-
nity under this section, including user members until
worker members have been elected, shall be certified by
the interim regional board as constituting, on the date of
such certification, the community board for the commu-
nity.
(c) With respect to each group of individuals con-
stituting a community board under paragraph (1), the re-
spective interim regional board shall select a time, date,
and location within the community of such community
board for the holding of the initial meeting of such com-
munity board, which date shall not be later than 30 days
after the date of the election, and shall notify the newly
elected and approved members of such board and the resi-
dents of such community of the time, date, and location
of such meeting.
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APPOINTMENT OF DISTRICT HEALTH BOARDS
SEC. 115. (a)(1) Not later than 60 days after the
initial meeting of each community board, called pursuant
to section 114(d)(2), the user members of each such board
shall appoint two eligible users in the community to serve
as user members of their respective district board.
(2) As soon as feasible, the worker members of each
such board shall appoint an eligible community health
worker to serve as a worker member of their respective
district board.
(3) As soon as feasible, the eligible district health
workers shall, in accordance with section 114(c)(2)(B),
elect an eligible district health worker to serve as a worker
member of their respective district board.
(4) The user and worker members of each such com-
munity board shall promptly notify their respective interim
regional board of appointments under this subsection.
(b)(1) Not later than 15 days after the date a major-
ity of the initial community boards within a district have
notified their respective interim regional board of the ap-
pointment of user members for their respective district
boards under subsection (a)(1), such interim regional
board shall certify the users so appointed as constituting,
on the date of such certification, the district board for the
district.
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(2) With respect to each district board certified under
paragraph (1), its respective interim regional board shall
select a time, date, and location within the district of such
district board for the holding of the initial meeting of such
district board, which date shall not be later than 15 days
after the date of such certification, and shall notify the
approved members of such board and the residents of such
district of the time, date, and location of such meeting.
APPOINTMENT OF REGIONAL HEALTH BOARDS
SEC. 116. (a)(1) Not later than 60 days after the
initial meeting of each district board, called pursuant to
section 115(b)(2), the user members of each such board
shall appoint two eligible users in the district to serve as
user members of their respective regional board.
(2) As soon as feasible, the worker members of each
such board shall appoint an eligible district (or commu-
nity, in the district) health worker to serve as a worker
member of their respective regional board.
(3) As soon as feasible, the eligible regional health
workers shall, in accordance with section 114(c)(2)(B),
elect an eligible regional health worker to serve as a work-
er member of their respective regional board.
(4) The user and worker members of each such dis-
trict board shall promptly notify their respective interim
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regional board and the Interim National Health Board of
such appointments.
(b) Not later than 15 days after the date a majority
of the initial certified district boards within a region have
notified their respective interim regional board of the ap-
pointment of user members for their respective regional
board under subsection (a)(1), such interim regional board
shall certify the users so appointed as constituting, on the
date of such certification, the regional board for the re-
gion.
(2) With respect to each regional board certified
under paragraph (1), the interim regional board that cer-
tified such board shall select a time, date, and location
within its region for the holding of the initial meeting of
such regional board, which date shall not be later than
15 days after the date of such certification, and shall no-
tify the appointed and approved members of such board
and the residents of its region of the time, date, and loca-
tion of such meeting.
APPOINTMENT OF THE NATIONAL HEALTH BOARD
SEC. 117. (a) The Interim National Health Board
shall, for purposes of appointing members of the National
Health Board, assign each region to one of three groups
of regions, each group having (to the extent possible) an
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equal number and balanced geographic distribution of re-
gions.
(b)(1) Not later than 60 days after the initial meeting
of each regional board, called pursuant to section
116(b)(2), each such board for a region in the first two
groups of regions (established under subsection (a)) shall
appoint (subject to the approval of the President) an eligi-
ble user in the region to serve as a user member of the
National Health Board.
(2) As soon as feasible, each such board for any other
region shall appoint (subject to approval of the President)
an eligible regional (or community or district, in the re-
gion) health worker to serve as a worker member of the
National Health Board.
(3) Each regional board shall promptly notify the In-
terim National Health Board and the President of each
appointment under this subsection. The President shall
approve or disapprove the appointment of such a member
within the 10-day period beginning on the date of his noti-
fication of the appointment; and the appointment of such
a member shall be considered as having been approved by
the President unless he disapproves the appointment of
the member within such time period.
(c)(1) No later than 15 days after the date a majority
of the appointments under subsection (b)(1) by initially
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certified regional boards have been approved by the Presi-
dent, the Interim National Health Board shall certify the
individuals so approved as constituting, on the date of
such certification, the National Health Board, and shall
promptly notify the President and the Congress of such
certification.
(2) The Interim National Health Board shall select
a time, date, and location for the holding of the initial
meeting of the National Health Board, which date shall
not be later than 15 days after the date of the certification
under paragraph (1), and shall notify appointed and ap-
proved members and the public of the time, date, and loca-
tion of such meeting.
SUBSEQUENT ELECTION AND APPOINTMENT OF
MEMBERS OF HEALTH BOARDS
SEC. 118. (a) Members of health boards elected or
appointed in accordance with sections 114 through 117
shall serve until their successors are certified in accord-
ance with this section.
(b)(1) The National Health Board shall arrange with
State and local governments for an election for user mem-
bers of each community board to be held on the date of,
and in conjunction with, each election for Members of the
United States House of Representatives that occurs after
the effective date of health services.
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(2) An election for worker members of each commu-
nity board shall be held on or about the date of each elec-
tion specified in paragraph (1) and shall be held, to the
extent feasible and consistent with section 114(c)(2)(B),
in conjunction with the election under paragraph (1).
(3) The provisions of section 114 (other than sub-
section (a) thereof) shall apply to elections of members
of community boards under this subsection, except that
for purposes of this subsection—
(A) the term of each member elected under this
subsection shall be 4 years, except that, in the case
of the elections first held under this section, the
term of half of the user members and of half of the
worker members or, in the case of an odd number
of user or worker members, the term of half plus
one of such members shall be 2 years;
(B) the individuals whose term of office does
not expire following an election, as well as individ-
uals elected in the election, are deemed to constitute
the community board under section 114(d)(1); and
(C) any reference to an interim regional board
or to the Interim National Health Board in section
114 shall be considered as a reference to a regional
board or to the National Health Board.
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(c)(1) Each regional board shall, for purposes of ap-
pointing worker members of district boards within its re-
gion, assign each community to one of two groups of com-
munities within each district, each group having (to the
extent possible) an equal number and balanced geographic
distribution of communities.
(2) Not later than 60 days after the initial meeting
of each community board (newly certified after an election
under subsection (b))—
(A) in the case of the first new certification of
such a board—
(i) user members of each such board shall
appoint two eligible users in the community,
one of whom shall serve a 4-year term as a user
member of their respective district board and
the other a 2-year term on such board; and
(ii) worker members of each such board for
a community in the first group of communities
(established under paragraph (1)) shall appoint
an eligible community health worker to serve a
4-year term as a worker member of their re-
spective district board, and worker members of
each such board for a community in the second
group of communities shall appoint an eligible
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community health worker to serve a 2-year
term on such board;
(B) in the case of a subsequent new certifi-
cation of such a board—
(i) user members of each such board shall
appoint an eligible user for a 4-year term; and
(ii) worker members of each such board for
a community in a group of communities that
did not appoint a worker member to serve a 4-
year term after the previous certification shall
appoint an eligible community health worker to
serve a 4-year term; and
(C) beginning with the first new certification of
such a board, and every 4 years thereafter, the eligi-
ble district health workers shall, in accordance with
section 114(c)(2)(B), elect an eligible district health
worker to serve a 4-year term as a worker member
of their respective district board.
The user and worker members of each such community
board shall promptly notify their respective regional board
of such appointments.
(3) Not later than 15 days after the date a majority
of the newly certified community boards within a district
have notified their respective regional board of the ap-
pointment or election of individuals for their respective
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district boards under paragraph (2), such regional board
shall certify the users and workers whose term of office
does not expire at the time of such appointments or elec-
tions, as well as individuals newly appointed or elected,
as constituting, on the date of such certification, the dis-
trict board for the district.
(4) For each district board certified under paragraph
(3), the respective regional board shall select a time, date,
and location within the district of such district board for
the holding of the initial meeting of such new board, which
date shall be not later than 15 days after the date of such
certification, and shall notify the members of such board
appointed under this subsection and the residents of the
district of the time, date, and location of such meeting.
(d)(1) The National Health Board shall, for purposes
of appointing worker members of regional boards, assign
each district to one of two groups of districts within each
region, each group having (to the extent possible) an equal
number and balanced geographic distribution of districts.
(2) Not later than 60 days after the initial meeting
of each newly certified district board (held pursuant to
subsection (c)(4))—
(A) in the case of the first new certification of
such a board—
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(i) user members of each such board shall
appoint two eligible users in the district, one of
whom shall serve a 4-year term as a user mem-
ber of their respective regional board and the
other a 2-year term on such board; and
(ii) worker members of each such board for
a district in the first group of districts (estab-
lished under paragraph (1)) shall appoint an el-
igible district (or community, within the dis-
trict) health worker to serve a 4-year term as
a worker member of their respective regional
board, and worker members of each such board
for a district in the second group of districts
shall appoint an eligible district (or community,
within the district) health worker to serve a 2-
year term on such board;
(B) in the case of a subsequent new certifi-
cation of such a board—
(i) user members of each such board shall
appoint an eligible user for a 4-year term; and
(ii) worker members of each such board for
a district in a group of districts that did not
appoint a worker member to serve a 4-year
term after the previous certification shall ap-
point an eligible district (or community, within
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the district) health worker to serve a 4-year
term; and
(C) beginning with the first new certification of
such a board, and every 4 years thereafter, the eligi-
ble regional health workers shall, in accordance with
section 114(c)(2)(B), elect an eligible regional
healthworker to serve a 4-year term as a worker
member of their respective regional board.
The user and worker members of each such district board
shall promptly notify the National Health Board of such
appointments.
(3) Not later than 15 days after the date a majority
of the newly certified district boards within a region have
notified the National Health Board of the appointment or
election of individuals for their respective regional boards
under paragraph (2), the National Health Board shall cer-
tify the users and workers whose term of office does not
expire at the time of such appointments or elections, as
well as individuals newly appointed or elected, as con-
stituting, on the date of such certification, the regional
board for the region.
(4) For each regional board newly certified under
paragraph (3), the previously certified regional board shall
select a time, date, and location within the region for the
holding of the initial meeting of such new board, which
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date shall not be later than 15 days after the date of such
certification, and shall notify the members of such board
appointed and approved under this subsection and the
residents of the region of the time, date, and location of
such meeting.
(e)(1) Not later than 60 days after the initial meeting
of each newly certified regional board, held pursuant to
subsection (d)(4)—
(A) in the case of the first new certification of
such a board—
(i) each such board for a region in the first
group of regions (established under section
117(a)) shall appoint (subject to the approval of
the President) an eligible regional (or commu-
nity or district, in the region) health worker,
and
(ii) each such board for any other region
shall appoint (subject to the approval of the
President) an eligible user in the region,
to serve a 4-year term as a member of the National
Health Board; and
(B) in the case of a subsequent new certifi-
cation of such a board occurring when the terms of
office of members of the National Health Board are
expiring—
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(i) each such board for a region in a group
of regions that has appointed an eligible user to
serve as a member of the National Board for
the previous two appointments under this sub-
section or section 117(b) shall appoint (subject
to the approval of the President) an eligible re-
gional (or community or district, in the region)
health worker, and
(ii) each such board for any other region
shall appoint (subject to the approval of the
President) an eligible user in the region,
to serve a 4-year term as a member of the National Health
Board. Each such board shall promptly notify the Na-
tional Health Board and the President of such appoint-
ment. The President shall approve or disapprove the ap-
pointment of such a member within the 10-day period be-
ginning on the date of his notification of the appointment;
and the appointment of such a member shall be considered
as having been approved by the President unless he dis-
approves the appointment of the member within such time
period.
(2) No later than 15 days after the date a majority
of the appointments under paragraph (1) by newly cer-
tified regional boards have been approved by the Presi-
dent, the National Health Board shall certify the individ-
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uals so approved as constituting, on the date of such cer-
tification, the National Health Board and shall promptly
notify the President and Congress of such certification.
(3) The previously certified National Health Board
shall select a time, date, and location for the holding of
the initial meeting of the new National Health Board,
which date shall not be later than 15 days after the date
of certification of such Board under paragraph (2), and
shall notify the members appointed and approved under
this subsection and the public of the time, date, and loca-
tion of such meeting.
MODIFICATION OF THE BOUNDARIES OF HEALTH CARE
DELIVERY AREAS
SEC. 119. (a) No later than 2 years after each decen-
nial national census, and at such other times as it deems
necessary, the National Health Board shall review the ap-
propriateness of the boundaries of each health care deliv-
ery region and may, in accordance with subsection (b),
modify the boundary of any region in which there has been
a substantial shift of population justifying such modifica-
tion, if such modification is approved in a referendum of
registered users residing in an area whose regional identi-
fication would be changed by making such modification.
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(b) At least 60 days before the modification by ref-
erendum of the boundary of any region, the National
Health Board shall provide for—
(1) notice in the area whose regional identifica-
tion would be changed by the modification of such
boundaries—
(A) of existing boundaries and of the pro-
posed modification, and
(B) of the date, time, and location of the
public hearing on such modification, as required
in paragraph (2), and
(2) a public hearing at which individuals can
speak or present written statements relating to the
modification of such boundaries.
(c)(1) After the establishment of regional health
boards under section 116—
(A) no later than 2 years after each decennial
national census,
(B) upon receipt of a petition for modification
of a boundary of a district or community within the
region of such board, which petition is signed by not
less than 15 percent of the registered users residing
in an area whose district or community identification
would be changed by adoption of such petition, and
(C) at such other times as it deems appropriate,
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each regional board shall review the appropriateness of the
boundaries of districts and communities within its region.
(2) Any review conducted under paragraph (1) shall
comply with the procedures of subsection (d) (relating to
open hearings and public participation).
(3) A regional board, after reviewing the boundaries
of a district or community within its region under para-
graph (1), may modify the boundary of any such district
or community if—
(A) there has been a substantial shift of popu-
lation justifying such modification, or
(B) such modification would better carry out
the purposes of this Act, and
if such modification is approved in a referendum, held
after notice and a public hearing in accordance with sub-
section (d), of registered users residing in an area whose
district or community identification would be changed by
adoption of the proposed modification.
(d) At least 60 days before the modification by ref-
erendum of the boundary of any district or community,
the respective regional board shall provide for—
(1) notice in the area whose district or commu-
nity identification would be changed by the modifica-
tion of such boundaries—
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(A) of existing boundaries and of the
boundaries proposed to be modified, and
(B) of the date, time, and location of the
public hearing on such modification, as required
in paragraph (2), and
(2) a public hearing at which individuals can
speak or present written statements relating to the
modification of such boundaries.
PART C—GENERAL PROVISIONS REGARDING HEALTH
BOARDS
DEFINITIONS
SEC. 121. As used in this part, the term ‘‘full mem-
ber’’ means, with respect to a health board, a member of
such board other than an associate member described in
section 122(a)(4).
MEMBERSHIP OF HEALTH BOARDS
SEC. 122. (a) Each health board shall be composed
of—
(1) members elected or appointed and approved
in accordance with this part B;
(2) one member—
(A) in the case of a community board, ap-
pointed by the occupational safety and health
action council established under section 412 for
such community, and
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(B) in the case of a regional board, ap-
pointed by the occupational safety and health
action council established under section 413 for
such region;
(3) such voting user members as the members
of the board described in paragraphs (1) and (2)
may determine from time to time (in consultation
with elements of the population from which the
members are being selected) to be necessary in order
to ensure that (1) the user members of the board
approximate the population within its area by race,
sex, income level, and language and (2) segments of
the population having special health needs (such as
the physically and mentally handicapped and the
aged) are appropriately represented; and
(4) such nonvoting associate members as the
members of such board may determine from time to
time to be necessary to provide appropriate rep-
resentation of appropriate units of State, territorial,
and local government and of segments of the popu-
lation having special health needs; and in the case
of the Interim National Health Board and National
Health Board, to carry out the purposes of this Act.
(b)(1) Except as provided in paragraph (2), no indi-
vidual may serve as a full member of a health board in
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a community, district, or region, or of the National Health
Board, for more than four consecutive years, exclusive of
any time that might be served as a member by election
or appointment (A) before the effective date of health serv-
ices, (B) for a 2-year term under section 118(b)(3)(A),
118(c)(2)(A), or 118(d)(2)(A), or (C) by appointment
under subsection (d) to fill a vacancy.
(2) Full members of a health board shall serve until
their successors are certified in accordance with this Act.
(c)(1)(A) Within 60 days of the date of the presen-
tation to the appropriate regional board of a petition,
signed by at least 15 percent of the number of registered
users residing in a community or of eligible area health
workers, requesting the recall of a user member or elected
worker member, respectively, of a board elected and ap-
proved in accordance with this title, such regional board
shall conduct an election on the recall of such member.
(B) The provisions of section 114 (except for sub-
section (a) thereof) and procedures established thereunder
regarding elections of user and worker members shall
apply with respect to recall elections conducted under this
paragraph, except that for the purposes of this paragraph,
any reference in such section to an interim regional board
or to the Interim National Health Board shall be consid-
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(B) in the case of a member of a district or re-
gional board, an interim regional board, or the Na-
tional Health Board, by appointment or election
and, in the case of the National Health Board, Pres-
idential approval of an eligible individual by the
health board or workers which appointed or elected
such vacating member; and
(C) in the case of a member of the Interim Na-
tional Health Board, by appointment by the Presi-
dent.
(2) Any individual appointed to fill a vacancy under
this subsection shall serve only for the unexpired term of
office of the vacating member.
(3) For the purposes of this subsection, the term ‘‘eli-
gible individual’’ means, with respect to filling the place
of a vacating member, an individual who is eligible, under
the applicable provisions of this Act, to serve on a health
board in the capacity in which the vacating member was
elected or appointed.
MEETINGS AND RECORDS OF HEALTH BOARDS
SEC. 123. (a)(1) Each full member of a health board
shall have one vote in meetings of such board.
(2) A majority of the full members of each health
board shall constitute a quorum for the transaction of the
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business of such board, and such board shall act upon the
vote of a majority of the full members present and voting.
(b)(1) Except as otherwise provided in this Act, the
full members of each health board shall, at the first meet-
ing following the certification of such board, elect a chair-
person and vice chairperson from among the full members
of such board.
(2) The chairperson of each health board shall be re-
sponsible for convening meetings of such board and for
such other duties as such board may assign. Upon the
written request of two full members of such board, the
chairperson shall convene a meeting of such board.
(3) The vice chairperson shall perform the duties of
the chairperson in the event that the chairperson is unable
to perform such functions.
(c)(1) Each health board shall provide for the record-
ing of the minutes of each of its meetings and each of
the meetings of its committees and advisory groups, and
shall make such records available to the public for inspec-
tion and copying.
(2) Meetings of each health board and each commit-
tee and advisory group thereof (except meetings that con-
cern an individual user or health worker, and such individ-
ual requests that the meeting be closed) shall be open to
the public and shall be held at such times and in such
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places as the board determines to be convenient to attend-
ance by the public.
(3) Each health board shall establish a principal of-
fice within the area it serves.
(d) Each health board shall disseminate within the
area it serves full information regarding its activities, in-
cluding the furnishing of health care and supplemental
services.
(e)(1) Each health board may establish such rules,
consistent with this Act, as it finds necessary for the effec-
tive and expeditious transaction of its duties and func-
tions.
(2) Each health board may establish such committees
and advisory groups, and appoint to them such individuals
(including health workers), as it deems necessary to carry
out its duties and functions.
(f)(1) A full member of the Interim National Health
Board or National Health Board may receive compensa-
tion at a rate not to exceed the daily equivalent of the
annual rate of basic pay in effect for grade GS–18 of the
General Schedule for each day (including traveltime) dur-
ing which the member is engaged in the actual perform-
ance of such member’s duties plus reimbursement for trav-
el, subsistence, and other necessary expenses incurred in
the performance of such member’s duties.
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(2) A full member of a health board, other than the
Interim National Health Board of the National Health
Board, may receive such amounts per diem when engaged
in the actual performance of such member’s duties, or
such annual salary, plus reimbursement for travel, subsist-
ence, and other necessary expenses incurred in the per-
formance of such member’s duties, as the appropriate Na-
tional Health Board may establish.
PROCEDURES FOR ESTABLISHMENT OF NATIONAL
GUIDELINES AND STANDARDS
SEC. 124. (a) In addition to guidelines and standards
otherwise required to be established by this Act, the Na-
tional Health Board shall establish such guidelines and
standards as will facilitate the implementation of the ob-
jectives of this Act and as will encourage innovation and
experimentation in the implementation of these objectives.
(b) The National Health Board shall submit, at least
90 days before the date of establishment of a guideline
or standard under this Act, each such guideline or stand-
ard to regional boards for their review and comments.
(c) The National Health Board and the regional
boards shall establish programs that provide orientation,
education, and technical assistance to members of area
health boards in the use and application of guidelines and
standards established by the National Health Board.
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ASSISTANCE TO AREA HEALTH BOARD MEMBERS
SEC. 125. Each regional board shall provide orienta-
tion, education, and technical assistance to members of
district and community boards in its region, and the ap-
propriate National Health Board shall provide such sup-
port to members of regional boards, to insure that such
members are prepared to perform their duties as members
of such boards with maximum effectiveness.
TITLE II—DELIVERY OF HEALTH CARE AND
SUPPLEMENTAL SERVICES
PART A—PATIENTS’ RIGHTS IN HEALTH CARE
DELIVERY
BASIC HEALTH RIGHTS
SEC. 201. The Service, in its delivery of health care
services to users, shall ensure that every such individual
is given the following basic health rights:
(1) The right to receive high quality health care
and supplemental services without charge and with-
out discrimination on account of race, sex, age, reli-
gion, language, income, marital status, sexual ori-
entation, dress, or previous health status.
(2) The right to humane, respectful, dignified,
and comforting health care, and to the reduction of
pain and distressful symptoms.
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(3) The right to have health care services deliv-
ered in a convenient and timely manner.
(4) The right to choose the health workers who
shall be responsible for, and the health facilities in
which to receive, the individual’s health care serv-
ices.
(5) The right of access to all information, in-
cluding the individual’s health records and the medi-
cal dictionary produced under section 433(b), which
promotes an understanding of health, except when a
review committee (the majority of whose members
are users) established by the area health board
maintaining the information has determined that the
provision of the specific information would be harm-
ful to the individual.
(6) The right to have all health care informa-
tion, reports, and educational materials translated
into the individual’s primary language.
(7) The right to receive, prior to the delivery of
any health care service, a careful, prompt, and intel-
ligible—
(A) explanation of the indications, diag-
noses, benefits, side-effects, and risks involved
in the delivery of such service, and a description
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of alternatives to such service (including no
treatment);
(B) answer to any question relating to
such health care service; and
(C) explanation of one’s health rights de-
scribed in this part, and
the right to have such health care service delivered
only with the individual’s prior, voluntary, written
consent.
(8) The right to refuse the initial or continuing
delivery of any health care service whenever such re-
fusal does not directly endanger the public health or,
in accordance with State law, of the individual if the
individual is dangerous to himself or herself.
(9) The right to have all individually identifi-
able information and documents treated confiden-
tially and not disclosed (except for statistical pur-
poses and for the control of communicable diseases,
drug abuse, and child abuse) without the individual’s
prior, voluntary, and written consent.
(10) The right of access at all times to individ-
uals or groups for counseling, health information,
and assistance on health matters.
(11) The right to be accompanied and visited at
any time by a friend, relative, or independent advo-
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cate of the individual’s choosing, and the right to
have routine services, such as feeding, bathing,
dressing, and bedding changes, performed by a
friend or relative, if the individual so chooses.
(12) The right, in the event of terminal illness,
to die with a maximum degree of dignity, to be pro-
vided all necessary symptom relief, to be provided
(and for the individual’s family to be provided) coun-
seling and comfort, and to be allowed (if desired) to
die at home.
(13) The right of access to a complaint and
grievance system and to legal assistance to enforce
these rights.
RIGHT TO PAID LEAVE TO RECEIVE HEALTH CARE
SERVICES
SEC. 202. (a) The Fair Labor Standards Act of 1938
is amended by inserting after section 7 (29 U.S.C. 207)
the following new section:
‘‘MINIMUM HEALTH LEAVE COMPENSATION
‘‘SEC. 7A. Each employee of any employer who in any
workweek is engaged in commerce or in the production
of goods for commerce, or is employed in an enterprise
engaged in commerce or in the production of goods for
commerce, shall be entitled to receive from the employer,
for each 35 hours he is employed by the employer (not
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counting more than 35 hours in any workweek), com-
pensation for one hour of employment at the regular rate
at which the employee is employed (as that term is used
in section 7 of this Act) for an hour (1) during the period
of 52 weeks beginning with the workweek with which the
entitlement is earned, and (2) during which the employee
is unable to work because of the need for the employee
(or a dependent of that employee) to receive necessary
health care services.’’.
(b) The Fair Labor Standards Act of 1938 is further
amended—
(1) by striking out ‘‘sections 6 and 7’’ in sec-
tion 3(o) and inserting in lieu thereof ‘‘sections 6, 7,
and 7A’’;
(2)(A) by striking out ‘‘and 7’’ in section 13(a)
before paragraph (1) and inserting in lieu thereof ‘‘,
7, and 7A’’;
(B) by striking out ‘‘sections 6 and 7’’ in sec-
tion 13(a)(3) and inserting in lieu thereof ‘‘sections
6, 7, and 7A’’;
(C) by inserting ‘‘7A,’’ in subsections (d) and
(f) of section 13 after ‘‘7,’’ each place it appears;
(3) by striking out ‘‘6 and 7’’ in section 14(d)
and inserting in lieu thereof ‘‘6, 7, and 7A’’;
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(4) by striking out ‘‘section 6 or section 7’’ in
section 15(a) and inserting in lieu thereof ‘‘section
6, 7, or 7A’’;
(5)(A) by striking out ‘‘section 6 or section 7’’
in section 16(b) and inserting in lieu thereof ‘‘sec-
tion 6, 7, or 7A’’;
(B) by striking out ‘‘or their unpaid overtime
compensation’’ in section 16(b) and inserting in lieu
thereof ‘‘their unpaid overtime compensation, or
their unpaid health leave compensation’’;
(C) by inserting ‘‘or of unpaid health leave com-
pensation’’ in section 16(b) after ‘‘amount of unpaid
overtime compensation’’;
(D) by striking out ‘‘section 6 or 7’’ in the first
sentence of section 16(c) and inserting in lieu there-
of ‘‘section 6, 7, or 7A’’;
(E) by striking out ‘‘unpaid overtime compensa-
tion’’ in the first sentence of section 16(c) and in-
serting in lieu thereof ‘‘, unpaid overtime compensa-
tion, or unpaid health leave compensation’’;
(F) by striking out ‘‘or overtime compensation’’
in the second sentence of section 16(c) and inserting
in lieu thereof ‘‘, overtime compensation, or health
leave compensation’’;
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(G) by striking out ‘‘or unpaid overtime com-
pensation under sections 6 and 7’’ in the third sen-
tence of section 16(c) and inserting in lieu thereof
‘‘, unpaid overtime compensation, or unpaid health
leave compensation under sections 6, 7, and 7A’’;
(6)(A) by inserting ‘‘or minimum health leave
compensation higher than the minimum health leave
compensation established under this Act’’ in the first
sentence of section 18(a) before ‘‘, and no provi-
sion’’; and
(B) by inserting ‘‘, or justify any employer in
reducing health leave compensation provided by him
which is in excess of the applicable minimum health
leave compensation under this Act’’ before the pe-
riod at the end of the second sentence of section
18(a).
PART B—ELIGIBILITY FOR, NATURE OF, AND SCOPE OF
SERVICES PROVIDED BY THE SERVICE
ELIGIBILITY FOR SERVICES
SEC. 211. (a) All individuals while within the United
States are eligible to receive health care and supplemental
services under this Act.
(b) For purposes of this section, the term ‘‘United
States’’ includes Indian reservations, the District of Co-
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lumbia, the Commonwealth of Puerto Rico, the Virgin Is-
lands, Guam, Samoa, and the Northern Mariana Islands.
ENTITLEMENT TO SERVICES
SEC. 212. (a) Except as provided in subsection (b),
the Service shall, on and after the effective date of health
services, provide users with all health care services and
supplemental services described in section 213 which the
Service determines, in accordance with this title, to be nec-
essary or appropriate for the promotion and enhancement
of health, for the prevention of disease, and for the diag-
nosis and treatment of, and rehabilitation following, in-
jury, disability, or disease.
(b) Services provided under this Act shall not include
personal comfort or cosmetic services unless the area
health board providing the services determines that the
services are required for health-related reasons.
PROVISION OF HEALTH CARE AND SUPPLEMENTAL
SERVICES
SEC. 213. (a) The Service shall provide in the United
States the following health care services in or through fa-
cilities established by the Service—
(1) the promotion of health and well-being
through health education programs to be carried out
in facilities of the Service as well as in workplaces,
schools, and elsewhere utilizing all appropriate
media, and by assisting other Government agencies
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in taking appropriate actions to promote health and
well-being;
(2) the prevention of illness, injury, and death
through education and advocacy addressed to the so-
cial, occupational, and environmental causes of ill-
health; through the provision of appropriate preven-
tive services including social, medical, occupational,
and environmental health services, on both an emer-
gency and sustained basis; through screening and
other early detection programs to identify and ame-
liorate the primary causes of ill-health; and, where
appropriate, through actions taken on an emergency
basis to halt environmental threats to life and
health;
(3) the diagnosis and treatment of illness and
injury, including emergency medical services, com-
prehensive outpatient and inpatient health care serv-
ices, occupational health services, mental health
services, dental care, long-term care, and home
health services;
(4) the rehabilitation of the sick and disabled,
including physical, psychological, occupational, and
other specialized therapies; and
(5) the provision of drugs, therapeutic devices,
appliances, equipment, and other medical supplies
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(including eyeglasses, other visual aids, dental aids,
hearing aids, and prosthetic devices) certified effec-
tive in the National Pharmacy and Medical Supply
Formulary (published under section 432(a)) and fur-
nished or prescribed by authorized health workers.
The Service may not provide such health care services in
a region, district, or community other than under the aus-
pices of a regional, district, or community board estab-
lished in accordance with this Act.
(b) The Service shall provide the following services
supplemental to the delivery of health care services in or
through health care facilities established by the Service—
(1) ambulance and other transportation services
to insure ready and timely access to necessary health
care;
(2) child care services for individuals who, dur-
ing the time they receive outpatient health care serv-
ices from the Service or are working in a health care
facility of the Service, are responsible for a child’s
care; and
(3) homemaking and home health services—
(A) to enable the provision of inpatient
health services at a health care facility of the
Service to an individual who has the sole re-
sponsibility for the care (i) of a child under 15
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years of age, or (ii) of a physically or mentally
handicapped individual who requires the care of
another individual, and
(B) for the bedfast or severely handicapped
individual, when provision of such services
eliminates the need for the individual to receive
inpatient services; and
(4) such counseling and social service assistance
as will avoid the unnecessary provision of health care
services.
(c) The Service shall conduct the functions, especially
those related to environmental health and the prevention
of illness, currently performed by the departments of
health of the States and localities, to the extent consistent
with Federal, State, and local law, and shall cooperate
with State and local governments in its conduct of such
functions.
(d) The Service shall provide, at rates established by
the National Health Board, for reimbursement of the cost
of emergency health care services furnished in facilities
not operated by the Service or by health workers not em-
ployed by the Service, when an injury or acute illness re-
quires immediate medical attention under circumstances
making it medically impractical for the ill or injured indi-
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vidual to receive care in a Service facility or by an em-
ployee of the Service.
PART C—HEALTH CARE FACILITIES AND DELIVERY OF
HEALTH CARE SERVICES
ESTABLISHMENT OF HEALTH CARE FACILITIES AND DIS-
TRIBUTION
OF
DELIVERY
OF
HEALTH
CARE
AND
OTHER SERVICES
SEC. 221. (a)(1) Each community board shall, not
later than the effective date of health services and to the
maximum extent feasible, establish and maintain in its
community such health care facilities as are necessary for
the efficient and effective delivery to individuals residing
in its community of comprehensive primary health care
services (defined in paragraph (2)), specialized health care
services (defined in paragraph (3)), special services (de-
fined in paragraph (4)) and community-oriented health
measures (defined in paragraph (5)). Such health care fa-
cilities shall be established and maintained in a manner
that, as soon as possible and to the greatest extent fea-
sible, provides services through a single comprehensive
health center.
(2) As used in paragraph (1), the term ‘‘comprehen-
sive primary health care services’’ means those basic out-
patient health care services typically needed for the pro-
motion of health and the prevention and treatment of com-
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mon illnesses and includes the following health care serv-
ices—
(A) general primary medical and dental care,
including diagnosis and treatment, routine physical
examinations, laboratory, and radiologic services,
and home visits by health workers, as appropriate;
(B) preventive health services, including immu-
nizations, nutrition counseling and consultation, and
periodic screening and assessment services;
(C) children’s health services, including assess-
ment of growth and development, education and
counseling on childrearing and child development,
and school and day-care center health services;
(D) obstetrical and gynecological services, in-
cluding family planning and contraceptive services,
pregnancy (prenatal and postnatal) and abortion
counseling and services;
(E) comprehensive geriatric services;
(F) vision and hearing examinations and provi-
sion of eyeglasses and other visual aids and hearing
aids;
(G) 24-hour emergency medical services;
(H) provision of pharmaceuticals and thera-
peutic devices, and medical appliances and equip-
ment;
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(I) mental health services, including psycho-
logical and psychiatric counseling;
(J) home health services; and
(K) occupational safety and health services, in-
cluding screening, diagnosis, treatment, and edu-
cation.
(3) As used in paragraph (1), the term ‘‘specialized
health care services’’ means those health care services of
a specialized nature (whether delivered in an inpatient or
outpatient setting) which, applying guidelines established
by the National Health Board and by the respective re-
gional board, may be provided most effectively and
efficently in a community setting.
(4) As used in paragraph (1), the term ‘‘special serv-
ices’’ means supportive services and the facilities (includ-
ing nursing homes and multiservice centers) in which such
services are provided for individuals who are physically or
mentally handicapped, mentally ill, infirm, or chronically
ill, so as to promote the integration and functioning of
such individuals within the community.
(5) As used in paragraph (1), the term ‘‘community-
oriented health measures’’ includes efforts to focus orga-
nized community activities upon the promotion of health
and the prevention of illness and injury, support for self-
help and mutual aid groups offering health promotion and
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rehabilitative support programs; surveillance of potential
threats to community health, and prompt action to protect
against such threats, and includes outreach efforts to en-
sure that all residents are aware of and able to utilize the
health services of the Service, as needed.
(b) Each district board shall, not later than the effec-
tive date of health services, establish and maintain in its
district—
(1) a general hospital for the efficient and ef-
fective delivery of health care services to individuals
residing in the district requiring inpatient diagnosis,
treatment, care, and rehabilitation for injury or ill-
ness; and
(2) such other health care facilities as are nec-
essary, using guidelines established by the National
Health Board and by the respective regional board,
to promote the efficient and effective delivery of
health care services within its district.
In addition, each district board shall provide such health
care services of a specialized nature (whether delivered in
an inpatient or outpatient setting) as, taking into account
guidelines established by the National Health Board and
its respective regional board, may be provided most effec-
tively and efficiently at the district level.
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(c) Each regional board shall, not later than the ef-
fective date of health services, establish and maintain in
its region—
(1) a regional medical facility for the efficient
and effective delivery of highly specialized health
care services, using guidelines established by the Na-
tional Health Board, to individuals residing in the
region requiring highly specialized treatment, care,
and rehabilitation for injury or illness;
(2) health care and supplemental services for
individuals whose health care needs otherwise cannot
be met by community or district boards because of
occupational or other factors, including individuals
residing within the region on a temporary or sea-
sonal basis (including migratory agricultural work-
ers) and individuals confined to prisons and other
correctional institutions; and
(3) such other health care facilities as are nec-
essary to promote the efficient and effective delivery
of health care services within its region.
(d) Each area health board, taking into account
guidelines established by the National Health Board, shall
provide the following through its health care facilities es-
tablished pursuant to this section:
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(1) Health promotion through education on per-
sonal health matters, nutrition, the avoidance of ill-
ness, and the effective use of health care services
with particular emphasis on the appropriate and safe
use (discouraging the overuse) of drugs and medical
techniques.
(2) Maintenance and appropriate transmission
and transferral of personal health records for each
user of the services of the board consistent with sec-
tion 201(9).
(3) Referral services, including referrals, where
appropriate, to health care facilities established by
other boards.
(4) Supplemental services (described in section
213(b)), as appropriate.
(5) Assistance to individuals who, because of
language or cultural differences or educational or
other handicaps, are unable fully to utilize the serv-
ices available from and delivered by the board.
(6) Information (A) on the rights ensured
under this Act, (B) on the guidelines and standards
established by the appropriate National Health
Board, and (C) on how the area health board is im-
plementing such rights and applying such guidelines
and standards.
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(7) Information on the grievance mechanisms
established pursuant to part A of title IV and on
legal services available to pursue grievances against
the board.
(8) Environmental health inspection and mon-
itoring services, including investigations relating to
the prevention of communicable diseases, in coopera-
tion with State and local authorities in the board’s
area.
(9) Research and data-gathering on the leading
causes of ill-health in the board’s area and on health
care delivery, in accordance with section 421.
(10) In the case of each inpatient health care
facility, discharge planning and followup services (A)
to identify patients who will need continuing care
after discharge from the facility and (B) to plan,
with the patient and the patient’s family, arrange-
ments and referrals to meet such postdischarge
needs.
(e)(1) Each area health board shall, in establishing
health care facilities under this section, hire health work-
ers (including administrative personnel) in sufficient num-
bers and with appropriate qualifications to ensure that
such facilities provide the health care and other services
described in this section.
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(2) In its establishment of health care facilities under
this section, each area health board shall purchase or lease
such premises as it deems necessary and suitable, utiliz-
ing, where appropriate, existing health facilities, including
health centers and clinics, hospitals, nursing homes, and
medical laboratories.
(3) In its establishment of health care facilities under
this section, each area health board shall seek to minimize
fragmentation and duplication in delivery of health care
and other services so as to promote the effective and effi-
cient delivery of such services.
(4) Each regional board, taking into account guide-
lines established by the National Health Board, shall pro-
vide for affiliation and coordination of the operation and
staff of the health care facilities in its region with the op-
eration and staff of other appropriate health care facilities
established within the region such board serves and within
adjacent regions.
(f) The National Health Board shall establish guide-
lines for distribution and coordination of the delivery of
health care and other services described in this section and
shall, before the effective date of health services, plan and
facilitate the transition to the new distribution of health
care facilities and health workers to be effected on and
after that date.
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(g) In the case that a community or district board
fails, on the effective date of health services, to substan-
tially and materially provide health care and supplemental
services in accordance with this section, its respective re-
gional board shall take such steps as it deems necessary,
consistent with the provisions of section 402 (relating to
grievance proceedings), to provide health care and supple-
mental services to users in the community or district af-
fected. Such steps may include, in addition to appointment
of a trustee or trustee committee under section
402(d)(3)(D)—
(1) requiring that the community or district
board in an adjacent community or district provide
such services to users residing in the community or
district affected, or
(2) providing reimbursement for the provision
of specified health care services in accordance with
procedures and schedules in effect under title XVIII
of the Social Security Act immediately before the ef-
fective date of health services (except that only users
in the affected community or district shall be consid-
ered as entitled to receive such specified services
under such title).
Paragraph (2) shall not apply on and after three years
after the effective date of health services.
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OPERATION AND INSPECTION OF HEALTH CARE
FACILITIES
SEC. 222. (a)(1) Each health board, with respect to
each health care facility it has established, shall establish
policies and organizational plans consistent with this sec-
tion and with parts A and C of title III (relating to the
health labor force) for the operation of such facility and
shall establish procedures to ensure that the facility is op-
erated in accordance with such policies and plans.
(2) In establishing, implementing, and modifying
such policies and plans, each health board shall seek the
fullest possible participation of health workers who are
employed in, and users who receive health care services
from, health care facilities affected by such policies and
plans.
(3) If a health board that has established more than
one health care facility determines that it cannot itself ef-
fectively manage the operation of all such facilities or if
a facility serves principally a population with special
health needs which is not appropriately represented on the
health board, the health board may provide for the estab-
lishment of a health care facility board or boards, com-
posed of users and health workers (or representatives of
users or workers of a facility or facilities) in an appro-
priate number and in a proportion approximating that on
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the health board, to assume the duties of the health board
with respect to the operation of the facility or facilities
involved.
(b) Such policies and plans shall provide for—
(1) the management of each facility by the
workers in such facilities through mechanisms which
provide full participation of health workers of all job
categories and skill levels employed in such facility;
(2) the elimination of dominance by health pro-
fessionals and the encouragement of cooperation and
mutual respect among all health workers; and
(3) regular accountability of the health workers
to the health board which established the facility for
the efficient and effective operation of the facility.
(c)(1) On and after 3 years after the effective date
of health services, a health board may not permit a health
care facility it has established to be used for the private
delivery of inpatient or outpatient health care services.
(2) No individual employed by a health board may
engage in the private delivery of health care services.
(3) For the purposes of this subsection, the term
‘‘private delivery of health care services’’ means the deliv-
ery of health care services for which an individual, group,
or organization receives remuneration from any source
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other than the Health Service Trust Fund established in
section 511.
(d) Each health board shall ensure that any health
care facility that it operates which provides health care
services on an outpatient basis is open during hours that
will permit all users to make use of such services.
(e)(1) Each health board shall ensure that any health
care facility that it operates which provides (or is designed
to provide) substantial health care services on an inpatient
basis to individuals over a continuous period of 30 days
or longer—
(A)(i) provides comfortable living quarters for
inpatients that are clean and adequately heated,
cooled, and ventilated;
(ii) provides adequate staff for its inpatients;
(iii) provides nutritional food for its inpatients;
(iv) provides inpatients with opportunities for
creative activity and recreation;
(v) establishes and maintains a review commit-
tee in accordance with paragraph (2); and
(vi) informs an inpatient of all decisions involv-
ing the inpatient’s health and well-being and permits
the inpatient (and the review committee upon the in-
patient’s request) to participate fully in such deci-
sions;
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(B) and does not—
(i) censor or harass communication be-
tween an inpatient and others by telephone, let-
ter, or in person;
(ii) confiscate personal property of an in-
patient, unless possession of such property
would interfere with the provision of health
care;
(iii) deny an inpatient the social and sexual
life of such individual’s preference;
(iv) require that an inpatient work;
(v) pay an inpatient less than minimum
wage for work performed while receiving health
care services;
(vi) physically restrain an inpatient invol-
untarily for a period exceeding 72 hours with-
out the facility’s review committee (described in
paragraph (2)) determining, within 72 hours of
its initiation and not less often than every 2
weeks during which such restraint is continued,
that such restraint is required for the physical
safety of the inpatient or of others; or
(vii) take punitive or discriminatory action
(including transfer between or within facilities,
changes in physical comforts and diets, changes
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in opportunities for social interaction and com-
munication, or restriction of full participation in
recreational and creative activities) without the
prior approval, and renewed approval not less
often than every week thereafter, of the facili-
ty’s review committee (described in paragraph
(2)).
(2)(A) Each health board shall provide that at least
once each year the inpatients at that time of each health
care facility it operates which provides (or is designed to
provide) health care services on an inpatient basis to indi-
viduals over a continuous period of 30 days or longer shall
elect, from among themselves and any representatives of
user associations which have a demonstrated interest in
the care of such inpatients, a review committee (herein-
after in this paragraph referred to as the ‘‘committee’’)
of not less than 3 members.
(B) Any member of the committee may be recalled
by a vote of two-thirds of the number of inpatients in the
facility.
(C) In any election or recall under this paragraph any
inpatient who is not able to vote for any reason shall be
permitted to appoint another individual to vote as proxy.
(f) In order to assure that quality care is provided
in health care facilities of the Service—
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(1) each area health board shall conduct regu-
lar inspections of health care facilities it has estab-
lished,
(2) each regional board shall conduct regular
inspections of district and community health care fa-
cilities established in its region, and
(3) the National Health Board shall conduct
regular inspections of area and national health care
facilities,
and the results of such inspections of a facility shall be
reported to the appropriate area health board and users
of the facility and shall be made available to the public.
PROVISIONS OF HEALTH SERVICES RELATING TO
REPRODUCTION AND CHILDBEARING
SEC. 223. (a)(1) Area health boards, as appropriate,
shall provide the following services:
(A) Complete information on contraception and
provision of birth control materials or medication of
the individual’s choosing.
(B) Complete and effective evaluation and
treatment of venereal diseases and diseases of the
reproductive organs.
(C) Complete information and counseling with
respect to pregnancy, childbearing, and possible out-
comes involving genetically induced anomalies.
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(2) Area health boards, as appropriate, shall provide
the following services:
(A) Complete and effective pregnancy testing.
(B) Prenatal services, including physical exam-
ination, counseling, and instruction of expectant par-
ents in nutrition, childrearing, and children’s health
care services.
(C) Safe, comfortable, and convenient abortion
services.
(D) Counseling by women in conjunction with
the provision of all gynecologic, female contraceptive,
and abortion services and counseling by men for
male fertility-related services.
(3) The services described in paragraphs (1) and (2)
shall be delivered without coercion or harassment, with
complete confidentiality, and without prior approval of in-
dividuals other than the individual receiving the services.
(4) An individual shall be permitted to be accom-
panied by a person of the individual’s choice during the
provision of the services described in paragraphs (1) and
(2) to the extent this would not significantly increase the
medical risk to the individual.
(b) No area health board may perform upon an
individual a treatment or procedure (other than a treat-
ment or procedure required to preserve the life of the indi-
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vidual) which could reasonably be expected to affect the
individual’s capacity to reproduce children, unless (1) the
individual has given voluntary written consent to the treat-
ment or procedure after being given complete information
on the effect of the treatment or procedure on the individ-
ual’s reproductive capacity, and on possible alternative
treatments and procedures, at least 30 days before begin-
ning the treatment or procedure, and (2) the individual
has, after such 30-day waiting period, again given written
consent to the performance of the treatment or procedure,
except that in the case of a woman who has given initial
written consent to a sterilization she may be sterilized in
less than 30 days following such consent (but in no case
in less than 72 hours) if (A) she had given initial written
consent at least 30 days before her anticipated delivery
date, she delivers before the anticipated date, and the ster-
ilization is performed at the time of delivery, or (B) she
undergoes emergency abdominal surgery within the 30-day
waiting period and the sterilization is concurrent with the
abdominal surgery.
(c) An area health board shall insure that, before a
mastectomy or other breast cancer treatment is performed
on a woman, the woman shall be provided with complete
information on the complete range of medical options
available for treatment of her condition and the risks and
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side effects of each option and an opportunity to consult
individuals of her choice, and shall have given voluntary
written consent to such procedure.
(d) An area health board shall provide that a woman
giving birth to an infant shall have the right to choose
from a complete range of childbirth options including—
(1) giving birth at home, in a birth center (if
available), or in a hospital;
(2) the presence during childbirth of a person
or persons of her choosing;
(3) the position for labor and delivery which she
chooses;
(4) caring for her infant at her bedside;
(5) feeding her infant according to the method
and schedule of her choice; and
(6) selecting the birth attendant of her own
choice.
She shall be provided with information on the benefits,
risks, and side effects of each option and an opportunity
to consult individuals and groups of her choosing for infor-
mation and assistance on these options.
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TITLE III—HEALTH LABOR FORCE
PART A—JOB CATEGORIES AND CERTIFICATION
EFFECT OF STATE LAW
SEC. 301. Notwithstanding any law of a State or po-
litical subdivision to the contrary, the Service, acting in
accordance with the provisions of this Act, shall be the
sole judge of the qualifications of its employees.
QUALIFICATIONS OF HEALTH WORKERS
SEC. 302. (a) Each area health board shall, taking
into account guidelines established by the National Health
Board, establish procedures which will ensure that, except
in emergency situations, any work which is classified
under a job category established under this part is per-
formed by a health worker who at the time of such work
was (1) certified (in accordance with this part) as com-
petent to perform the work under such job category, and
(2) authorized to perform such work by the area health
board which employs such worker.
(b) Each area health board that employs health work-
ers who perform work classified under a job category es-
tablished under this part shall provide for the periodic re-
view and assessment of the competency of such workers
to perform the work within such job category, and shall
provide opportunities for health workers to be assessed
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and certified with respect to skills required for advance-
ment to other job categories.
(c) In order to assure that health workers provide
high quality health care services in the Service—
(1) each regional board shall provide for peri-
odic review and assessment of the performance of
health workers employed by district and community
boards in its region, and
(2) the National Health Board shall provide for
periodic review and assessment of the performance
of health workers employed by regional boards and
the National Health Board,
and the results of such examinations of health workers
shall be reported to the appropriate area health board and
the users residing in the areas in which the health workers
are employed and shall be made available to the public.
ESTABLISHMENT OF JOB CATEGORIES AND
CERTIFICATION STANDARDS
SEC. 303. (a)(1) The National Health Board shall
establish such guidelines for the classification, certifi-
cation, and employment of health workers by job category
as it determines to be necessary (A) to ensure that health
workers who perform work for the Service which requires
specialized skills have demonstrated that they possess such
skills, (B) to expand the roles of health workers to enable
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them to participate in health care delivery to the maxi-
mum extent consistent with their skills, and (C) to provide
for affiliation of health workers with health care facilities
at the community, district, and regional levels. These
guidelines shall permit alternative approaches to healing,
and practitioners skilled in such approaches, when these
approaches have not been demonstrated to be injurious
to health.
(2) In establishing guidelines under paragraph (1),
the National Health Board shall provide for (A) sufficient
flexibility to permit regional health boards to utilize health
workers most effectively to meet the health needs of the
region, and (B) sufficient uniformity to permit mobility
of health workers among the regions.
(3) In establishing guidelines under paragraph
(1)(C), and as appropriate to the job responsibilities of
the respective health workers, the National Health Board
shall require that each health worker employed by a com-
munity board must work part of the time in a health care
facility operated by the respective district or regional
board, and that each health worker (including the faculty
of health team schools) employed by a district or regional
board must work part of the time in a health care facility
operated by a community board within the district or re-
gion.
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(4) The National Health Board shall periodically
evaluate the job categories and certification practices es-
tablished by area health boards under this section and
shall make such modifications to its guidelines as it deter-
mines will promote the delivery of quality health care serv-
ices.
(5) The National Health Board shall assist regional
boards in applying the guidelines established under this
subsection.
(b)(1) For each job category (other than a job cat-
egory determined by the National Health Board to involve
highly specialized skills requiring advanced specialty train-
ing), each regional health board shall, taking into account
the guidelines established under subsection (a), establish
certification standards which shall specify—
(A) the functions performed by a healthworker
employed in such job category;
(B) the skills required in the course of properly
performing work under such job category;
(C) the initial and continuing training, experi-
ence, and performance which must be undertaken or
demonstrated by a health worker to achieve and
maintain competency to perform the work within
such job category; and
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(D) the curriculum which a health worker must
follow in studies in a health team school (established
under part B) to demonstrate sufficient competence
to satisfy the specification of subparagraph (C) for
such job category.
Each area health board within the region shall apply such
standards to all health workers employed by it. In applying
such standards, such boards shall recognize health worker
training, experience, and performance undertaken or dem-
onstrated before the establishment of health team schools
under part B, subject to such periodic review and assess-
ment and to such continuing training, experience, or per-
formance as may be required under this part.
(2) For each job category established and determined
by the National Health Board to involve highly specialized
skills requiring advanced specialty training, the National
Health Board shall make the specifications described in
subparagraphs (A) through (D) of paragraph (1), and
area health boards shall apply such certification standards
to all health workers employed by them in such job cat-
egories.
(3) A health board which establishes standards for
a job category under this subsection shall periodically re-
view such standards and shall supplement, modify, or
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eliminate such standards as it determines will facilitate
the delivery of quality health care services under this Act.
PART B—EDUCATION OF HEALTH WORKERS
HEALTH TEAM SCHOOLS
SEC. 311. (a)(1) Except as provided in paragraph
(2), each regional board, in consultation with the commu-
nity and district boards in its region, shall establish a
health team school (hereinafter in this part referred to as
a ‘‘school’’) in accordance with this section to provide pro-
grams of initial and continuing basic education in health
care delivery for health workers in all job categories, and
to provide initial continuing advanced education in health
care specialties and health science specialty fields. Each
school shall be established and functioning not later than
4 years after the effective date of health services unless
the National Health Board approves a plan, submitted by
the regional board, for the establishment of a school within
a reasonable time after such deadline.
(2) If a regional board determines, after consultation
with the community and district boards in its region, that
conducting particular educational programs within a
school in its region would be inefficient or otherwise inap-
propriate, it may collaborate with one or more regional
boards for adjacent regions conducting joint educational
programs. In the case of the establishment of such a joint
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program, all further references in this part to a region
or a regional board with respect to a school offering a joint
program shall refer to the regions included within, and
the regional boards offering, the joint program.
(3) Schools shall be funded exclusively by the Service,
shall not charge nor accept tuition or fees for enrollment,
and shall provide each student with an adequate allowance
for living expenses, educational supplies, and any child
care expenses.
(4) The National Health Board shall assist regional
boards in the establishment and maintenance of schools.
(b) Schools shall be operated and maintained in ac-
cordance with the following principles:
(1) The activities of each school shall be de-
signed to meet the health needs of the region, dis-
tricts, and communities which it serves.
(2) The number of students enrolled in each
educational program in a school shall be based on
the regional, district, and community boards’ assess-
ments of the needs for health workers within such
region, districts, and communities.
(3) Schools shall integrate the education of
health workers in the different job categories (estab-
lished under part A) so as to permit health workers
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to be educated and certified for successively higher
levels of health care work.
(4) Each school’s admissions policies, curricu-
lum policies, faculty hiring procedures, and govern-
ance plan shall be established and implemented by
the regional board in accordance with subsections (c)
through (f), respectively, and with the fullest pos-
sible participation of the community and district
boards, health workers, staff, and students in its re-
gion.
(5) A school may not use individuals who are
from low-income populations or minority groups, or
who are women or confined in mental or penal insti-
tutions, as subjects for training or demonstration in
numbers that are disproportionate to their numbers
in the population of the region, and may not use any
individuals as subjects for training or demonstration
in a manner beyond that required for the immediate
purpose of the training or demonstration.
The National Board shall establish, not later than one
year after the effective date of health services, guidelines
for the application of these principles and for the phased
integration of health worker education programs, includ-
ing medical, dental, osteopathic, and nursing school pro-
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grams, in existence on the date of enactment of this Act
into the schools established under this section.
(c) Each regional board shall establish and implement
admissions policies for education programs in its school.
Such policies shall—
(1) emphasize previous health-related work ex-
perience, as evaluated by health workers (including
peers), by individuals who have received health care
services from the applicant, and by faculty members;
(2) minimize the use of criteria of academic
performance other than such criteria as have been
shown to be significantly related to future work per-
formance;
(3) give preference to segments of the popu-
lation of the region under-represented among health
workers;
(4) to the extent consistent with paragraph (3),
provide for admission of individuals so that the stu-
dent body approximates the population of the region
by race, sex, family income, and language; and
(5) require that the applicant agree, if accepted
into the school, to perform health care services in ac-
cordance with section 312.
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(d) Each regional board shall establish and imple-
ment curriculum policies for educational programs in its
school. Such policies shall—
(1) give priority in study and field work to the
leading causes of illness and death in the region, in-
cluding environmental, biological, and social deter-
minants of mortality and morbidity;
(2) give special consideration to studying the
social, as well as biological, causation and prevention
of illness and disease, and to the differing health
care needs of populations facing special health risks
and having special cultures and lifestyles within the
region;
(3) provide that all students shall take a com-
mon, initial sequence of courses and that students
preparing for more advanced types of health work
shall take studies that are progressively more spe-
cialized and differentiated;
(4) emphasize work-study experience in all
types of health care facilities in the region, including
community and workplace facilities, facilities for the
aged, mentally ill, and mentally retarded, health care
facilities in prisons and other correctional institu-
tions, alcohol and drug rehabilitation facilities, envi-
ronmental health facilities, and all other health care
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facilities of the Service in communities and districts
in the region;
(5) emphasize the appropriate and safe use,
and discourage the overuse, of drugs and medical
techniques; and
(6) facilitate the development by all health
workers of skills in decisionmaking and assessment
of patient needs in cooperation with other health
workers and with patients.
(e) Each regional board shall establish and implement
faculty hiring procedures for its school. Such procedures
shall, to the maximum extent feasible, create a faculty
which approximates the population of the region by race,
sex, and language.
(f) Each regional board shall establish and implement
a governance plan for the management of its school. Such
plan shall give significant decisionmaking powers to staff
and students of the school.
SERVICE REQUIREMENT
SEC. 312. (a)(1) No individual may be enrolled by
a regional board in a school unless the individual agrees
to perform health care services as an employee of the Serv-
ice in the job category for which training is being provided
(A) for a period of time equal to the period of such
enrollement in the school but not less than 2 years, (B)
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beginning not later than 1 year after the date of the indi-
vidual’s graduation from the school, and (C) for an area
health board with the highest priority ranking under sub-
section (c) that agrees to employ the individual.
(2) An individual’s obligation to perform service
under an agreement described in paragraph (1) shall be
deferred only for a period during which the individual is
physically or mentally incapable of performing such serv-
ice.
(3) No health board may employ an individual who
has made an agreement described in paragraph (1), other
than in accordance with subsection (c), until the individual
has completed the period of obligated service in accordance
with this section.
(4) Except as provided in paragraph (5), if an indi-
vidual breaches an agreement under paragraph (1) by fail-
ing (for any reason) either to begin such individual’s serv-
ice obligation or to complete such service obligation, the
Service shall be entitled to recover from the individual an
amount determined in accordance with the formula
A=φ + 1¥
s
,
t
.
in which ‘‘A’’ is the amount the Service is entitled to re-
cover; ‘‘φ’’ is an amount determined by the National
Health Board to be the costs to the Service of the edu-
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cation program and allowance received by the individual
and the interest on such costs which would be payable if
at the time the costs were undertaken they were loans
bearing interest at the maximum legal prevailing rate, as
determined by the Treasurer of the United States; ‘‘t’’ is
the total number of months in the individual’s period of
obligated service; and ‘‘s’’ is the number of months of such
period served by the individual. Any amount of damages
which the Service is entitled to recover under this para-
graph shall, within the 1-year period beginning on the date
of the breach of the agreement, be paid to the Service.
(5)(A) Any obligation of an individual under this sub-
section for service or payment of damages shall be can-
celed upon the death of the individual.
(B) The National Health Board shall provide for the
waiver or suspension of any obligation of service or pay-
ment by an individual under this part whenever compli-
ance by the individual is impossible or would involve ex-
treme hardship to the individual and if enforcement of
such obligation with respect to any individual would be
unconscionable.
(C) Any obligation of an individual under this part
for payment of damages may be released by a discharge
in bankruptcy under title 11 of the United States code
only if such discharge is granted after the expiration of
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the 5-year period beginning on the first date that payment
of such damages is required.
(b) Each area health board shall periodically assess
the ratio of the number of health workers employed by
the board in each job category (established under part A)
to the number of residents in the area.
(c)(1) With respect to an individual obligated to per-
form service under this section as a result of completion
of an educational program for a job category in a school,
the priority ranking (referred to in subsection (a)(1)(C))
of area health boards for hiring the individual is as fol-
lows:
(A) The regional board for the region, or a dis-
trict or community board for a district or commu-
nity in the region, in which the program was com-
pleted, if the region, district, or community is a
health worker shortage area (as defined in para-
graph (2)) with respect to the job category for which
the individual received training.
(B) A regional, district, or community board
(other than one described in subparagraph (A)) for
a region, district, or community which is a health
worker shortage area with respect to the job cat-
egory for which the individual received training.
(C) Any other area health board.
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(2) For the purposes of paragraph (1), the term
‘‘health worker shortage area’’ means, with respect to a
job category for which an individual has received training
in a school, a region, district, or community which—
(A) has a ratio of the number of health workers
in the job category employed by the regional, district
or community board, respectively, to the number of
residents in the region, district, or community
(whichever is applicable) which is less than two-
thirds of the ratio of the total number of health
workers in the job category employed by all the re-
gional, district, or community boards, respectively, in
the Nation to the number of residents in the Nation,
and
(B) has plans and a budget which provide for
the hiring of an individual in the job category.
(3) The National Health board shall establish a pro-
gram to match the locational preferences of graduates of
schools with the needs and preferences of regional, dis-
trict, and community boards.
PAYMENT FOR CERTAIN EDUCATIONAL LOANS
SEC. 313. (a) In the case of any individual who has
incurred any educational loan before the fourth year after
the effective date of health services and for the individual’s
costs for an educational program in health care delivery,
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health care specialties, or health science specialty fields,
the National Health Board shall make payments, in ac-
cordance with subsection (b), for and on behalf of that
individual, on the principal of and interest on any such
loan which is outstanding on the date the individual begins
to work for the Service.
(b) The payments described in subsection (a) shall
be made by the National Health Board as follows:
(1) Upon completion by the individual for whom
the payments are to be made of the first year of em-
ployment with the Service, the National Health
Board shall pay 30 percent of the principal of, and
the interest on, each loan described in subsection (a)
which is outstanding on the date he began such em-
ployment.
(2) Upon completion by that individual of the
second year of such employment, the National
Health Board shall pay another 30 percent of the
principal of, and the interest on, each such loan.
(3) Upon completion by that individual of a
third year of such employment, the National Health
Board shall pay another 25 percent of the principal
of, and the interest on, each such loan.
(4) Upon completion by that individual of a
fourth year of such employment, the National
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Health Board shall pay the remaining 15 percent of
the principal of, and all remaining interest on, each
such loan.
No payment may be made under this subsection with re-
spect to a loan unless the person on whose behalf the pay-
ment is to be made has submitted to the National Health
Board a certified copy of the agreement under which such
loan was made.
(c) Notwithstanding the requirement of completion of
employment specified in subsection (b), the National
Health Board shall on or before the due date thereof, pay
any loan or loan installment which may fall due within
the period of employment for which the borrower may re-
ceive payments under this section, upon the declaration
of such borrower, at such times and in such manner as
the National Health Board may prescribe (and supported
by such other evidence as the National Health Board may
reasonably require), that the borrower is then employed
as described in subsection (b) and that the borrower will
continue to be so engaged for the period required (in the
absence of this subsection) to entitle the borrower to have
made the payments provided by this section for such pe-
riod, except that not more than 85 percent of the principal
of any such loan shall be paid pursuant to this subsection.
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PART C—EMPLOYMENT AND LABOR-MANAGEMENT
RELATIONS WITHIN THE SERVICE
EMPLOYMENT, TRANSFER, PROMOTION, AND RECEIPT OF
FEES
SEC. 321. (a) Health boards shall, in accordance with
this Act and taking into account guidelines and standards
established by the appropriate National Health Board,
employ, classify, and fix the salaries and benefits of all
employees of the Service employed in the Service’s facili-
ties.
(b) The appropriate National Health Board, in estab-
lishing guidelines and standards under this part, shall, to
the extent feasible and consistent with the provisions of
this part, provide for—
(1) employment and promotion in the Service in
the same manner as is provided for employment and
promotion under the Federal civil service system;
(2) meaningful opportunities for career ad-
vancement;
(3) encouragement of health workers to use up
to 10 percent of their work time for continuing edu-
cation under part B without loss of pay or other job
rights; and
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(4) full protection of employees’ rights by pro-
viding an opportunity for a fair hearing on adverse
actions with representation of their own choosing.
(c) Health boards, in hiring employees to fill vacan-
cies in newly created positions, shall give preference to in-
dividuals who were employed as health workers, or self-
employed while delivering health services, before the date
of enactment of this Act. The National Health Board shall
ensure, through such steps as it deems necessary, that all
such individuals desiring to be employed within the Service
shall find appropriate employment in the Service.
(d) Employees of the Service shall be eligible for pro-
motion or transfer to any position in the Service for which
they are qualified. Each regional board shall establish and
maintain a job placement service to assist health workers
in its region in identifying suitable employment opportuni-
ties and in transferring between jobs with different area
health boards in the region. The authority given by this
subsection shall be used to provide a maximum degree of
career opportunities for employees and to ensure contin-
ued improvement of health care services.
(e) A community or district board may not hire an
individual to fill a job vacancy that is classified under part
A in a job category if—
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(1) the community or district board, respec-
tively, has a ratio of the number of health workers
in the job category employed by such board to the
number of residents in the community or district
(whichever is applicable) which is greater than four-
thirds of the ratio of the total number of health
workers in the job category employed by all the com-
munity or district boards, respectively, in its region
to the number of residents in such region; and
(2) there is a community or district within its
region which is a health worker shortage area (as
defined in section 312(c)(2)) with respect to the job
category.
(f) An employee of the Service may not receive any
fee or perquisite on account of duties performed by virtue
of such employment, except from a health board estab-
lished under this Act.
APPLICABILITY OF LAWS RELATING TO FEDERAL
EMPLOYEES
SEC. 322. (a) Chapter 75 of title 5, United States
Code (relating to adverse actions against employees),
apply to employees of the Service (other than employees
serving on the personal staff of members of health boards)
except to the extent provided—
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(1) in a collective-bargaining agreement negoti-
ated on behalf of and applicable to them; or
(2) in procedures established by the Service and
approved by the Office of Personnel Management.
(b) Employees of the Service are covered by sub-
chapter I of chapter 81 of title 5, United States Code (re-
lating to compensation for work injuries).
(c)(1) Chapter 83 of title 5, United States Code (re-
lating to civil service retirement), applies to employees of
the Service except to the extent provided in a collective-
bargaining agreement negotiated on behalf of and applica-
ble to them.
(2) The Service shall withhold from pay and shall pay
into the Civil Service Retirement and Disability Fund the
amounts specified in chapter 83 of title 5, United States
Code, as required under paragraph (1). The Service, upon
request of the Office of Personnel Management, but not
less frequently than annually, shall pay to the Office the
costs reasonably related to the administration of Fund ac-
tivities for employees of the Service.
(d) Sick and annual leave and compensatory time of
employees of the Service, whether accrued prior to or after
the commencement of operations of the Service, shall be
obligations of the Service.
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(e)(1) Compensation, benefits, and other terms and
conditions of employment in effect on the effective date
of health services for employees of the Federal Govern-
ment performing functions that are provided under this
Act by the Service, shall apply to all employees of the
Service performing similar functions until changed by the
Service in accordance with this Act. Subject to the provi-
sions of this Act, the provisions of subchapter I of chapter
85 and chapter 87 of title 5, United States Code (relating
to unemployment compensation and life insurance), apply
to employees of the Service unless varied, added to, or sub-
stituted for in accordance with paragraph (2).
(2) No variation, addition, or substitution with re-
spect to fringe benefits shall result in a program of fringe
benefits which on the whole is less favorable to employees
of the Service than fringe benefits in effect for employees
of the Federal Government on the effective date of health
services. No variation, addition, or substitution with re-
spect to fringe benefits of employees for whom there is
a collective-bargaining representative shall be made except
by agreement between such representative and the Service.
APPLICABILITY OF FEDERAL LABOR-MANAGEMENT
RELATIONS LAWS
SEC. 323. (a)(1) The provisions of the National
Labor Relations Act (42 U.S.C. 141 et seq.) shall apply
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to the Service and its employees to the extent, not incon-
sistent with subsection (b), to which such provisions apply
to employers (as defined in section 2(2) of such Act), ex-
cept that—
(A) the phrase ‘‘or any individual employed as
a supervisor’’ in section 2(3) of such Act shall not
apply (thereby making such Act apply, for these pur-
poses, to such individuals);
(B) section 9(b)(1) of such Act (providing for
separate treatment for professional and nonprofes-
sional employees) shall not apply;
(C) sections 206 through 210 of such Act (re-
lating to national emergencies) shall, for purposes of
this Act, have the phrases ‘‘the President of the
United States’’ and ‘‘the President’’, wherever they
appear, replaced by the phrase ‘‘the National Health
Board (or a committee thereof to which it has dele-
gated such authority)’’ and the phrase ‘‘national
health or safety’’ replaced by the phrase ‘‘health or
safety of the residents of any region’’; and
(D) section 213 (providing for intervention in a
strike or lockout by the Director of the Federal Me-
diation and Conciliation Service) shall not apply.
(2) Paragraphs (3) and (4) of section 7311 of title
5, United States Code (prohibiting participation in a
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strike or an organization asserting the right to strike),
shall not apply to employees of the Service.
(b)(1) Collective-bargaining agreements between area
health boards and duly recognized bargaining representa-
tives of employees of the Service may include procedures
for resolution by the parties of grievances and adverse ac-
tions arising under the agreement, including procedures
culminating in binding third-party arbitration.
(2) Area health boards and duly recognized bargain-
ing representatives of employees of the Service may by
mutual agreement adopt procedures for the resolution by
the parties (A) of grievances and adverse actions arising
under collective-bargaining agreements, and (B) of dis-
putes or impasses arising in the negotiation of such agree-
ments.
(c) Section 3(e) of the Labor-Management Reporting
and Disclosure Act of 1959 (42 U.S.C. 402(e)) is amended
by inserting ‘‘the United States Health Service and’’ after
‘‘and includes’’.
DEFENSE OF CERTAIN MALPRACTICE AND NEGLIGENCE
SUITS
SEC. 324. (a) The remedy against the United States
provided by sections 1346(b) and 2672 of title 28, United
States Code, or by alternative benefits provided by the
United States where the availability of such benefits pre-
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cludes a remedy under section 1346(b) of such title, for
damage for personal injury, including death, resulting
from the performance of medical, surgical, dental, or relat-
ed functions, including the conduct of clinical studies or
investigations, by any employee of the Service while acting
within the scope of the employee’s employment, shall be
exclusive of any other civil action or proceeding by reason
of the same subject matter against the employee (or the
employee’s estate) whose act or omission gave rise to the
claim.
(b) The Attorney General shall defend any civil action
or proceeding brought in any court against any person re-
ferred to in subsection (a) (or the person’s estate) for any
such damage or injury. Any such person against whom
such civil action or proceeding is brought shall deliver
within such time after date of service or knowledge of serv-
ice as determined by the Attorney General, all process
served upon the person or an attested true copy thereof
to the person’s immediate superior or to whomever was
designated by the appropriate National Health Board to
receive such papers and such person shall promptly fur-
nish copies of the pleading and process therein to the
United States attorney for the district embracing the place
wherein the proceeding is brought, to the Attorney Gen-
eral, and to the appropriate National Health Board.
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(c)(1) Upon a certification by the Attorney General
that the defendant was acting in the scope of employment
at the time of the incident out of which the suit arose,
any such civil action or proceeding commenced in a State
court shall be removed without bond at any time before
trial by the Attorney General to the district court of the
United States of the district and division embracing the
place wherein it is pending and the proceeding deemed a
tort action brought against the United States under the
provision of title 28, United States Code, and all ref-
erences thereto.
(2) If a United States district court determines on
a hearing on a motion to remand held before a trial on
the merits that the case so removed is one in which a rem-
edy by suit within the meaning of subsection (a) is not
available against the United States, the case shall be re-
manded to the State court.
(3) Where a remedy by suit within the meaning of
subsection (a) is not available because of the availability
of a remedy through proceedings for compensation or
other benefits from the United States as provided by any
other law, the case shall be dismissed, but in the event
the running of any limitation of time for commencing, or
filing an application or claim in, such proceedings for com-
pensation or other benefits shall be deemed to have been
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suspended during the pendency of the civil action or pro-
ceeding under this section.
(d) The Attorney General may compromise or settle
any claim asserted in such civil action or proceeding in
the manner provided in section 2677 of title 28, United
States Code, and with the same effect.
(e) For purposes of this section, the provisions of sec-
tion 2680(h) of title 28, United States Code, shall not
apply to assault or battery arising out of negligence in
the performance of medical, surgical, dental, or related
functions, including the conduct of clinical studies or in-
vestigations.
(f) The appropriate National Health Board may, to
the extent it deems appropriate, hold harmless or provide
liability insurance for any employee of the Service for
damage for personal injury, including death, negligently
caused by such employee while acting within the scope of
employment and as a result of the performance of medical,
surgical, dental, or related functions, including the con-
duct of clinical studies or investigations, if the employee
is assigned to a foreign country or detailed to a State or
political subdivision thereof or to a nonprofit institution,
and if the circumstances are such as are likely to preclude
the remedies of third persons against the United States
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described in section 2679(b) of title 28, United States
Code, for such damage or injury.
TITLE IV—OTHER FUNCTIONS OF HEALTH
BOARDS
PART A—ADVOCACY, GRIEVANCE PROCEDURES, AND
TRUSTEESHIPS
ADVOCACY AND LEGAL SERVICES PROGRAM
SEC. 401. (a) Each area health board shall establish
a program of health advocacy to ensure the full realization
of the patient rights enumerated in part A of title II. Such
a program shall include—
(1) the employment of individuals having basic
legal knowledge and skills as health advocates;
(2) the presence of health advocates (A) in in-
patient health care facilities at all times, and (B) in
other health care facilities during the provision of
health care services;
(3) provision for health advocates to (A) in-
form, on an ongoing basis, users and health workers
of such patient rights and (B) report to the area
health board any infraction of such rights which is
not promptly corrected;
(4) provision for regular meetings between
health workers and health advocates, users, and any
user representatives to discuss ways of ensuring the
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fulfillment of such rights through affirmative action
of such workers and the area health board; and
(5) appropriate action by the area health board
to ensure that infractions of such rights are prompt-
ly and sufficiently corrected.
(b)(1) The National Health Board shall establish a
health rights legal services program and shall provide such
program with sufficient legal and administrative person-
nel, funding, and facilities (A) to ensure that users and
health workers receive, free of charge, high quality legal
services (including representation in grievance proceedings
commenced under section 402) for legal problems related
to health rights and health care services, and (B) to im-
prove, through litigation and other activities, the health
care system and expand the rights of users and health
workers.
(2) The health rights legal services program shall
provide directly, by contract with the Legal Services Cor-
poration, or by contract with members of the private bar,
for—
(A) establishment of a legal services office in
each region to provide representation (other than
representation provided under subparagraph (B)) of
users, health workers, and voluntary associations
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having a demonstrated interest in health care in pro-
ceedings and hearings under section 402; and
(B) establishment of legal services offices in
such communities and districts as are determined, in
accordance with guidelines established by the Na-
tional Health Board, to have inadequate legal serv-
ices to provide the legal services described in para-
graph (1)(A).
(3) The National Health Board may carry out the
functions described in paragraph (1)(B) directly, by con-
tract, or otherwise.
GRIEVANCE PROCEDURES AND TRUSTEESHIPS
SEC. 402. (a)(1) Each regional and interim regional
board shall provide, in accordance with this section, that
any user, health worker, or any user association having
a demonstrated interest in health care may commence a
grievance proceeding before such board (or a person or
committee designated by such board) with respect to an
alleged violation of this Act by a district or community
board within its region. Each regional and interim re-
gional board may commence a grievance proceeding before
itself (or a person or committee designated by such board)
with respect to an alleged violation of this Act by a district
or community board within its region.
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(2) The appropriate National Health Board shall pro-
vide, in accordance with this section, that any user, health
worker, or any user association having a demonstrated in-
terest in health care may commence a grievance proceed-
ing before such Board (or a person or committee des-
ignated by such Board) with respect to an alleged violation
of this Act by a regional or interim regional board. The
appropriate National Health Board may commence a
grievance proceeding before itself (or a person or commit-
tee designated by such Board) with respect to an alleged
violation of this Act by a regional or interim regional
board.
(b)(1) The appropriate National Health Board shall
provide, subject to paragraphs (3) and (4), for its review
(or a review by a person or committee designated by the
Board), by appeal to the Board by any party to a proceed-
ing described in subsection (a)(1) or on its own initiative,
of an adverse decision by a regional or interim regional
board in the proceeding.
(2) On and after the date a suit with respect to an
adverse determination in a grievance proceeding or review
proceeding is filed under subsection (e), no review proceed-
ing respecting such proceeding may be commenced by ap-
peal to the Board under paragraph (1), and any such re-
view proceeding which was commenced by appeal to the
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Board under such paragraph before the date of filing of
such suit and is pending on such date shall promptly be
discontinued.
(3) No review of an adverse administrative decision
may be made by appeal or by initiative under this sub-
section unless the appeal is filed or notice of the initiative
is published (as the case may be) not later than 15 days
after the publication of the decision.
(c)(1) Whenever a grievance proceeding is com-
menced under subsection (a), the entity before which the
proceeding is held shall investigate the grievance.
(2) An entity before which a proceeding or review
proceeding is commenced under subsection (a) or (b)—
(A) shall conduct a full and open public hearing
on the grievance as part of such proceeding—
(i) if the grievance is supported by a peti-
tion signed by a minimal number of residents
(as defined in paragraph (4)); or
(ii) before the entity (or the body which
designated it) may set aside an election or
transfer any functions of a health board under
subsection (d); and
(B) may conduct such a hearing if the entity
determines that such hearing is in the public inter-
est.
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(3) The entity that conducts a hearing under para-
graph (2) shall provide for timely notice to, and oppor-
tunity to be heard by, any party with a direct interest in
the grievance for which the hearing is conducted.
(4) As used in paragraph (1), the term ‘‘minimal
number of residents’’ means, with respect to a grievance
which concerns a health board which is—
(A) a community board, 100 individuals,
(B) a district board, 300 individuals, and
(C) a regional or interim regional board, 1,000
individuals,
who are 18 years of age or older and who reside in the
area served by the board.
(d)(1) With respect to a grievance proceeding begun
under subsection (a) relating to the conduct of an election
of a community board, if the entity before which such pro-
ceeding is commenced under such subsection, or is re-
viewed under subsection (b), determines that the election
(A) was not conducted substantially in compliance with
this Act or (B) has revealed the systematic failure of the
user members of such community board to approximate
the population of the community by race, sex, language,
and income level, the entity shall set aside the election
and, unless such determination is reviewed under sub-
section (b), the entity shall require that another election
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for members of the community board be conducted, in ac-
cordance with this Act, not later than 60 days after the
date of such determination. If such election is conducted
because of a determination under clause (B), the election
shall be conducted (and subsequent elections may be con-
ducted) in such a manner, including the use of geographic
or other subdivisions for electoral purposes, as will facili-
tate the representation of significant elements of the popu-
lation of a community by race, sex, language, and income
level.
(2) With respect to a grievance proceeding begun
under subsection (a) relating to a grievance other than
the conduct of an election of a community board, if the
entity before which such proceeding is commenced under
such subsection, or is reviewed under subsection (b), deter-
mines that the grievance represents—
(A) a failure by a health board to comply sub-
stantially and materially with this Act, the entity
shall require that a new election or appointment, in
accordance with this Act, of members of the health
board be conducted or made within 60 days of the
date of such determination; or
(B) a failure by a health board to comply, but
not substantially and materially, with this Act, the
entity may require that a new election or appoint-
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ment, in accordance with this Act, of members of
the health board be conducted or made if such fail-
ure is not corrected within a reasonable period of
time (specified by the entity) of the date of such
determination.
(3)(A) If an entity determines under paragraph (1)
or (2) that a community or district board has failed to
comply with this Act, the entity shall transfer to the re-
gional (or interim regional) board for such community or
district such functions of the community or district board
as it determines necessary to carry out this Act until a
new election or appointment is conducted or made.
(B) If an entity determines under paragraph (2) that
a regional or interim regional board has failed to comply
with this Act, the entity shall transfer to the appropriate
National Health Board such functions of the regional or
interim regional board as it determines necessary to carry
out this Act until a new regional or interim regional board
is appointed.
(C) If a health board is transferred the functions of
another health board under this paragraph, until a new
election or appointment of the other health board has been
certified, (i) the health board shall have the powers of the
other health board to conduct such functions, (ii) the
health board may appoint a trustee (or trustee committee)
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to have such powers and carry out such functions, and
(iii) any expenses that are certified by the health board
(or by the trustee or trustee committee appointed by it)
as having been incurred by it in discharging the functions
transferred to it under this paragraph shall be paid from
funds allocated to the other health board.
(e) Any party to a grievance proceeding or review pro-
ceeding commenced under this section may bring suit in
the United States district court for the judicial district
in which such proceeding, or review proceeding, was
brought, for the review of an adverse determination in
such proceeding or review proceeding. Such court shall af-
firm such determination unless it finds that such deter-
mination is not supported by substantial evidence or is ar-
bitrary and capricious.
PART B—OCCUPATIONAL SAFETY AND HEALTH
PROGRAMS
FUNCTIONS OF THE NATIONAL HEALTH BOARD
SEC. 411. (a) On and after the effective date of
health services, the National Health Board shall oversee
occupational safety and health programs conducted at the
regional level, and shall participate in the establishment
and administration of occupational safety and health
standards under the Occupational Safety and Health Act
of 1970.
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(b) In its participation in the establishment and ad-
ministration of occupational safety and health standards
under the Occupational Safety and Health Act of 1970,
the National Health Board shall seek the advice and com-
ments of regional occupational safety and health action
councils established under section 413.
(c)(1) To provide for participation of the National
Health Board in the establishment and administration of
occupational safety and health standards, the Occupa-
tional Safety and Health Act of 1970 (29 U.S.C. 651 et
seq.) is amended—
(A) by adding at the end of section 3 the fol-
lowing new paragraph:
‘‘(15) The term ‘National Health Board’ means
the National Health Board of the United States
Health Services.’’;
(B) by striking out ‘‘Secretary of Health and
Human Services’’ each place it appears (other than
in section 22(b)) and inserting in lieu thereof ‘‘Na-
tional Health Board’’;
(C) by inserting ‘‘shall request the National
Health Board and’’ in the first sentence of section
6(b)(1) before ‘‘may request’’;
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(D) by inserting ‘‘the Board and’’ in the second
sentence of section 6(b)(1) after ‘‘The Secretary
shall provide’’;
(E) by striking out ‘‘An’’ in the third sentence
of section 6(b)(1) and inserting in lieu thereof ‘‘The
Board and an’’;
(F) by striking out ‘‘its’’ each place it appears
in the third sentence of section 6(b)(1) and inserting
in lieu thereof ‘‘their’’;
(G) by inserting ‘‘after consultation with the
National Health Board and’’ in the fourth sentence
of section 6(b)(6)(A) after ‘‘may be granted only’’;
(H) by inserting ‘‘after consultation with the
National Health Board and’’ in the third sentence of
section 6(d) before ‘‘after opportunity for’’;
(I) by striking out ‘‘The Secretary’’ and all that
follows through ‘‘shall each’’ in section 8(g)(2) and
inserting in lieu thereof ‘‘The Secretary shall’’;
(J) by striking out ‘‘their’’ in section 8(g)(2)
and inserting in lieu thereof ‘‘his’’;
(K) by inserting ‘‘after consultation with the
National Health Board and’’ in section 16 before
‘‘after notice and opportunity’’;
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(L) by inserting ‘‘(after consultation with the
National Health Board)’’ in section 18(c) after ‘‘in
his judgment’’;
(M) by inserting ‘‘and the National Health
Board’’ in section 19(d) after ‘‘Secretary’’ each
place it appears; and
(N) by striking out the first sentence of para-
graph (5) of section 20(a).
(2) The amendments made by paragraph (1) shall
take effect on the effective date of health services.
(f) The National Health Board shall establish guide-
lines—
(1) for its participation in the establishment
and administration of occupational safety and health
standards under the Occupational Safety and Health
Act of 1970;
(2) for the election of community occupational
safety and health action councils under section 412;
(3) for the establishment of regional occupa-
tional safety and health programs under section 413;
(4) for the establishment and operation of
workplace health facilities under section 414; and
(5) for the provision of assistance by regional
and community boards to regional and community
occupational safety and health councils, respectively,
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and to workplace safety and health committees es-
tablished under section 415.
COMMUNITY OCCUPATIONAL SAFETY AND HEALTH
ACTIVITIES
SEC. 412. (a)(1) Each community board shall cooper-
ate with the appropriate regional board in the establish-
ment and implementation of an occupational safety and
health program for its region.
(2) Each community board shall provide for the orga-
nization and operation (including staff and support) in its
community of a community occupational safety and health
action council (hereinafter in this part referred to as a
‘‘COSHAC’’) in accordance with this section.
(b) The members of a COSHAC shall be elected by
individuals employed in the community as follows:
(1) Employees of each workplace in the commu-
nity which has 500 or more employees shall be enti-
tled to elect one member for each 500 such employ-
ees in such workplace.
(2) Employees of workplaces in the community
which have fewer than 500 employees shall be enti-
tled to vote in community-wide elections for a num-
ber of members equal to (A) the total number of em-
ployees in such workplaces divided by 500, (B)
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rounded (if necessary) to the next highest whole
number.
The elections of COSHAC members shall be conducted by
the community board for such COSHAC under guidelines
established by the National Board.
(c) Each COSHAC shall—
(1) appoint one individual to serve, at its pleas-
ure, as a member of the community board for such
COSHAC;
(2) appoint one individual to serve, at its pleas-
ure, as a member of the regional occupational safety
and health action council for its region;
(3) advise the community board on, and over-
see, occupational safety and health programs in the
community;
(4) promote and assist in the establishment of
workplace occupational safety and health committees
in workplaces in the community, and advise and fa-
cilitate such committees’ actions relating to safety
and health hazards in workplaces in the community;
and
(5) assist employees in determining methods of,
and requirements for, inspections of workplaces in
the community for safety and health hazards.
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REGIONAL OCCUPATIONAL SAFETY AND HEALTH
PROGRAMS
SEC. 413. (a)(1) Each regional board shall establish
an occupational health and safety program for its region
in accordance with this subsection and under guidelines
established by the National Health Board.
(2) A regional occupational health and safety pro-
gram shall, to the maximum extent feasible, use the facili-
ties and resources of community boards in the region
and shall include—
(A) training programs to enhance the ability of
employees in the region to monitor safety and health
conditions in their workplaces and to assist safety
and health inspectors in the conduct of workplace
inspections;
(B) facilitating communication among workers
employed in similar industries in the region and the
Nation with respect to occupational health and safe-
ty hazards they face in common;
(C) baseline and periodic biologic screening of
employees in the region;
(D) development and maintenance of environ-
mental monitoring programs to identify and isolate
hazardous workplaces and work areas in the region;
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(E) the analysis of employment-related injuries
and illnesses occurring in the region; and
(F) staff and support for the operation of the
regional occupational safety and health action coun-
cil (hereinafter in this part referred to as the
‘‘ROSHAC’’) established in the region under this
section.
(b) Each ROSHAC shall—
(1) appoint one individual to serve, at its pleas-
ure, as a member of the regional board for such
ROSHAC;
(2) advise the regional board on, and oversee,
occupational safety and health programs in the re-
gion; and
(3) advise the National Health Board on the es-
tablishment and administration of occupational safe-
ty and health standards under the Occupational
Safety and Health Act of 1970.
WORKPLACE HEALTH FACILITIES
SEC. 414. (a) The employer in each workplace shall
establish and maintain a health facility in or near the
workplace to provide occupational and emergency health
care services to individuals employed in the workplace in
accordance with this section and guidelines and standards
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for such facilities established by the National Health
Board.
(b) Each workplace health facility established pursu-
ant to subsection (a) shall, taking into account guidelines
established by the National Health Board—
(1) be organized in a manner so as to provide
an appropriate number of appropriately skilled
health workers to meet occupational and emergency
health care needs of employees in the workplace; and
(2) be operated by the community board for the
community in which the workplace is predominantly
located, or, where such board deems appropriate, by
the employer, with the cost in either case borne by
the employer in each workplace.
EMPLOYEE RIGHTS RELATING TO OCCUPATIONAL SAFETY
AND HEALTH
SEC. 415. (a)(1) Employees in each workplace having
25 or more employees shall have the right to establish
workplace occupational safety and health committees
(hereinafter in this subsection referred to as ‘‘commit-
tees’’) with members of their choosing.
(2) Members of committees (composed of the greater
of 3 members or one member for each 100 employees in
the workplace) shall, without any loss of pay or other job
rights—
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(A) be permitted to spend eight hours of each
month inspecting their workplace and conducting
such other functions relating to occupational safety
and health as are determined by the employees in
the workplace; and
(B) be permitted to accompany any safety and
health inspectors during inspections of the work-
place.
(b) Employees in each workplace shall have the right,
without any loss of pay or other job rights—
(1) to monitor safety and health conditions in
their workplace whenever they reasonably deem it
necessary and with whatever reasonable scientific in-
struments and expert assistance they choose; and
(2) to remove themselves from the site of any
hazard to their safety or health until an authorized
inspector has certified that the hazard has been
eliminated.
(c) Employers shall adopt all feasible engineering
measures that will minimize occupational safety and
health hazards in the workplace. Where such measures are
not adequate to protect employees from such hazards, em-
ployers shall furnish their employees with, or reimburse
their employees for the reasonable cost of, equipment and
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clothing needed to protect an employee from any residual
occupational safety and health hazards in the workplace.
(d) Employees or their duly chosen representatives
shall have the right to inspect all medical records main-
tained by their employers on the condition of their health,
and shall have the right to be assisted during such inspec-
tions by persons of their choosing.
(e) Employers shall provide their employees with cop-
ies of all reports, studies, and data concerning conditions
affecting the health and safety of employees within their
workplaces, with annual reports on the morbidity and
mortality experience of present and former employees, and
with timely notification of the presence within the work-
place of any materials, agents, or conditions which may
have a deleterious effect on the safety and health of their
employees, along with relevant information on hazards and
precautions, symptoms, remedies, and antidotes.
(f) Employees shall have the right to seek, through
collective bargaining, occupational safety and health
standards, including standards relating to physical and
mental stress and speed of work, more restrictive than
such standards established under the Occupational Safety
and Health Act of 1970.
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DEFINITIONS
SEC. 416. (a) For purposes of this part, the term
‘‘workplace’’ means the regular location where work is per-
formed by one or more employees of an employer.
(b) For the purposes of sections 414 and 415, the
terms ‘‘employer’’ and ‘‘employee’’ have the same mean-
ings those terms have in section 3 of the Occupational
Safety and Health Act of 1970 (42 U.S.C. 653).
PART C—HEALTH AND HEALTH CARE DELIVERY
RESEARCH
PRINCIPLES AND GUIDELINES FOR RESEARCH
SEC. 421. (a) On and after the effective date of
health services, the Service shall conduct a program of re-
search concerning health and health care delivery. On and
after 2 years after such date, such research program shall
conform to the following principles:
(1) The research shall, to the maximum extent
possible, be performed under the direction of, and in
association with, community, district, and regional
boards.
(2) No research shall be conducted within, or
using the resources of, an area health facility until
it has been reviewed and approved by the area
health board responsible for such facility.
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(3) Priority shall be given in health research to
the prevention and correction of the leading causes
of illness and death, particularly environmental, oc-
cupational, nutritional, social, and economic causes.
(4) Priority shall be given in health care deliv-
ery research to improvement of the effectiveness and
efficiency of ambulatory and primary health care de-
livery, including research on alternative systems of
health care delivery and alternative conceptions of
health and health care.
(5) No experimentation to evaluate new preven-
tive, diagnostic, or therapeutic methods or agents
shall be undertaken upon human subjects until all
animal research which may effectively contribute to
evaluating such methods or agents has been under-
taken.
(6) No research shall be conducted on a human
subject without the subject’s informed written con-
sent.
(7) No research shall be conducted on a human
subject while the subject is involuntarily confined to
an institution.
(8) Each health board, in planning and con-
ducting research under the program, shall cooperate
with appropriate officials conducting related re-
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search in the Department of Health and Human
Services, the Environmental Protection Agency,
other Federal Government agencies, and agencies
and departments of State, territorial, and local gov-
ernments.
(9) The results of research shall be dissemi-
nated to the public and to area health boards in a
manner that will most readily permit the use of such
results to improve the health of users and the deliv-
ery of health care services.
(b) The National Health Board shall establish guide-
lines for the conduct of research in conformance with the
principles described in subsection (a).
ESTABLISHMENT OF INSTITUTES
SEC. 422. On the effective date of health services, the
National Institutes of Health (established under title IV
of the Public Health Service Act) are transferred to the
National Health Board. In addition, the National Health
Board shall establish the following institutes:
(1) A National Institute of Epidemiology, which
shall—
(A) gather and analyze disease-related statistics
collected by the Service;
(B) plan, conduct, support, and assist in epi-
demiologic research conducted by the Service;
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(C) conduct and support research on epidemio-
logic methodology and experimental epidemiology;
(D) establish and maintain an early warning
system for the detection of new diseases and
epidemics; and
(E) assist in the formulation of policies to
eliminate or reduce the causes of illness and injury
and to prevent and curtail epidemics of these condi-
tions.
(2) A National Institute of Evaluative Clinical Re-
search, which shall—
(A) gather and analyze all evidence collected by
the Service dealing with the effectiveness of preven-
tive, diagnostic, and therapeutic measures and the
occurrence of iatrogenic illnesses;
(B) analyze evidence on newly-discovered or
proposed preventive, diagnostic, and therapeutic
methods and agents;
(C) plan and conduct clinical trials, in conform-
ance with the limitations of part A of title II; and
(D) assist the National Health Board, in co-
operation with other bodies, including the National
Institute of Pharmacy and Medical Supply, in devel-
oping guidelines and standards for the introduction
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of new methods of prevention, diagnosis, and treat-
ment.
(3) A National Institute of Health Care Services,
which shall—
(A) analyze data and statistics on the health
care resources and needs of the Nation and on the
quality of present services;
(B) conduct comparative studies of health care
services in the various regions of the Nation, and
make recommendations for the improvement of
health care services in areas with inferior quality of
health care services;
(C) plan and conduct research on alternative
methods of health care delivery, on the functions,
tasks, performance and work relationships of various
kinds and categories of health workers, on patterns
of organization of health care, and on the effective-
ness and benefits of health care in relation to costs;
and
(D) assist the National Health Board in formu-
lating national policies to improve the quality of
health care services.
(4) A National Institute of Pharmacy and Medical
Supply, which shall—
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(A) recommend to the National Health Board
standards regarding the quality, distribution, and
price of all drugs, therapeutic devices, appliances
and equipment to be used by the Service;
(B) certify drugs, therapeutic devices, appli-
ances, and equipment for use in the health facilities
of the Service, and for furnishing to users of such
health facilities;
(C) assist the National Health Board in issuing
a National Pharmacy and Medical Supply For-
mulary; and
(D) conduct a comprehensive program of phar-
maceutical and medical supply research and utiliza-
tion education using, to the maximum extent pos-
sible, regional facilities operated in association with
the respective regional health boards.
(5) A National Institute of Sociology of Health and
Health Care, which shall—
(A) conduct ongoing analyses of the basic epis-
temological assumptions of health and health care;
(B) assess critically the effects of scientific
medicine and of divisions in institutional and tech-
nical skills in health care;
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(C) evaluate the effects of health care measures
and policies upon population groups and subgroups
in the Nation;
(D) identify and analyze the social, occupa-
tional, and environmental factors in modern society
affecting health and well-being;
(E) analyze alternative, holistic approaches to
the human body, health, and causality of ill health
and the lack of social and psychological well-being;
and
(F) assist the National Health Board in formu-
lating national policies relating to the promotion of
health and the provision of health care.
PART D—HEALTH PLANNING, DISTRIBUTION OF DRUGS
AND OTHER MEDICAL SUPPLIES, AND MISCELLANE-
OUS FUNCTIONS
HEALTH PLANNING AND BUDGETING
SEC. 431. (a) Each area health board shall, under
guidelines established by the National Health Board, col-
lect data on the supply of and demand for health workers
in facilities under its supervision, and on the delivery of
health care and supplemental services in health care facili-
ties under its supervision, shall evaluate such data in rela-
tion to the health care needs of their respective area, and
shall transmit such data and evaluation—
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(1) to its respective regional board, in the case
of a district or community board, and
(2) to the National Health Board, in the case
of a regional board,
and shall make available such data and evaluations to resi-
dents of its area.
(b) Each regional board shall coordinate the planning
and administration of the delivery of health care services,
health worker education, and health research in its region,
and shall facilitate the planning and administration of
such programs by district and community boards in its
region.
(c) The National Health Board shall formulate a 1-
year and 5-year national health plan and budget, taking
into account the area plans and budgets prepared in ac-
cordance with section 522, to provide guidance and direc-
tion to area health boards.
DISTRIBUTION OF DRUGS AND OTHER MEDICAL SUPPLIES
SEC. 432. (a)(1) The National Health Board, after
consultation with the regional boards, shall, not later than
the effective date of health services, publish and dissemi-
nate to area health boards a National Pharmacy and Med-
ical Supply Formulary (hereinafter in this section referred
to as the ‘‘Formulary’’).
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(2) The Formulary shall contain a listing of drugs,
therapeutic devices, appliances, equipment, and other
medical supplies (including eyeglasses, other visual aids,
hearing aids, and prosthetic devices) (hereinafter in this
section referred to as ‘‘drugs and other medical supplies’’).
For each item on such listing the Formulary shall contain
(A) the standards of quality for the production of such
item, (B) the medical conditions for which the item is cer-
tified as effective for purposes of the provision of health
care services under this Act, and (C) such other informa-
tion on such item as the National Health Board deter-
mines to be appropriate for the effective and efficient de-
livery of health care services under this Act.
(3) The National Health Board shall, at regular in-
tervals, update the contents of the Formulary and publish
a price list for items listed in the Formulary, which prices
shall reflect the actual costs of manufacture.
(b)(1) Each regional board shall establish a program,
in accordance with this subsection and under guidelines
established by the National Health Board, for the pur-
chase and distribution of drugs and other medical supplies
for use in health care facilities established by such board
or by a community or district board within its region.
(2) Such program shall provide for the purchase of
each drug or other medical supply item only (A) following
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competitive bidding on such item or (B) based on the price
listed for such item in the price list published under sub-
section (a)(3).
(3) Such program shall provide for the distribution
of drugs (and their dispensing by community and district
boards in its region) under their generic names.
(4) For purposes of paragraph (3), the term ‘‘generic
names’’ means the established names, as defined in section
502(e)(2) of the Federal Food, Drug, and Cosmetic Act
(21 U.S.C. 352(e)(2)).
(c) The National Health Board is authorized to es-
tablish and operate drug and medical supply manufactur-
ing facilities, if it determines that such operation will re-
sult in reduced expenditures by the Service.
MISCELLANEOUS FUNCTIONS OF THE NATIONAL HEALTH
BOARD
SEC. 433. (a) The appropriate National Health
Board shall publish, not later than December 31 of each
year, a report presenting and evaluating operations of the
Service during the fiscal year ending in such year and sur-
veying the future health needs of the Nation and plans
the Board has for the Service to meet such needs.
(b) The National Health Board shall, not later than
the effective date of health services, prepare and dissemi-
nate to area health boards, for use by users, a comprehen-
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sive dictionary of terms used in health care records and
services maintained or provided by the Service. Such dic-
tionary shall explain terms related to symptoms, signs, di-
agnoses, etiologic agents and conditions, diagnostic proce-
dures, and the treatment and prevention of, and rehabili-
tation following, illnesses, and shall include extensive cita-
tions of lay and professional sources which a user might
consult for additional information on such terms.
TITLE V—FINANCING OF THE SERVICE
PART A—HEALTH SERVICE TAXES
INDIVIDUAL AND CORPORATE INCOME TAXES
SEC. 501. (a)(1) Subchapter A of chapter 1 of the
Internal Revenue Code of 1954 (relating to normal taxes
and surtaxes) is amended by adding at the end thereof
the following new part:
‘‘PART VII—HEALTH SERVICE TAXES
‘‘Sec. 59. Tax imposed.
‘‘SEC. 59. TAX IMPOSED.
‘‘(a) INDIVIDUALS, ESTATES, AND TRUSTS.—In ad-
dition to other taxes, there is hereby imposed for each tax-
able year on the taxable income of every individual and
of every estate and trust taxable under section 1(d), a tax
in an amount equal to 10 percent of the total amount of
the normal tax and surtax imposed by section 11 for such
taxable year.’’.
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‘‘(b) CORPORATION.—In addition to the other taxes,
there is hereby imposed for each taxable year on the tax-
able income of every corporation, a tax in an amount equal
to 90 percent of the total amount of the normal tax and
surtax imposed by section 11 for such taxable year.’’.
(2) The table of parts of such subchapter A is amend-
ed by adding after the item relating to part VI the follow-
ing new item:
‘‘Part VII. Health service taxes.’’.
(b) Subsection (a) of section 3402 of the Internal
Revenue Code of 1954 (relating to income tax collected
at source) is amended by inserting after the third sentence
thereof the following sentence: ‘‘With respect to wages
paid on and after the effective date of health services
under the Health Service Act (as established in section
601 of such Act), the Secretary shall prescribe new tables
which shall be the same as the tables prescribed under
the previous sentence, except that such tables shall be
modified to the extent necessary to reflect the amendment
made to subchapter A of chapter 1 by section 501(a)(1)
of the Health Service Act.’’.
(c) The amendments made in this section shall apply
to taxable years beginning on or after the effective date
of health services.
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OTHER CHANGES IN THE INTERNAL REVENUE CODE OF
1954
SEC. 502. (a) DENIAL OF EXCLUSION FROM GROSS
INCOME FOR AMOUNTS PAID BY THIRD PARTIES FOR
MEDICAL CARE.—Section 105 of the Internal Revenue
Code of 1954 (relating to amounts received under accident
and health plans) is amended by striking out subsection
(b).
(b) DENIAL OF EXCLUSION FROM GROSS INCOME OF
CERTAIN
CONTRIBUTIONS
BY
THE
EMPLOYER
TO
HEALTH PLANS.—Section 106 of such Code (relating to
contributions by employer to accident and health plans)
is amended to read as follows:
‘‘SEC. 106. CONTRIBUTIONS BY EMPLOYERS TO ACCIDENT
AND HEALTH PLANS.
‘‘Gross income does not include contributions by the
employer to accident or health plans for compensation
(through insurance or otherwise) to his employees for per-
sonal injuries or sickness to the extent that such contribu-
tions do not provide for health care and supplemental serv-
ices available to such employees under the Health Service
Act.’’
(c) DENIAL OF DEDUCTION OF HEALTH CARE EX-
PENSES AS TRADE OR BUSINESS EXPENSES.—Section
162 of such Code (relating to trade or business expenses)
174
HR 1374 IH
SEPARABILITY
SEC. 605. If any provision of this Act, or the applica-
tion of such provision to any person or circumstance, shall
be held invalid, the remainder of this Act, or the applica-
tion of such provision to persons or circumstances other
than those as to which it is held invalid, shall not be af-
fected thereby.
Æ