(b) ANNUAL REPORTS.—At the beginning of each 
regular session of Congress, it shall make a full report 
to Congress of the administration of this Act, including 
a report with regard to the adequacy of its financial provi-
sions contained in this Act and of appropriations made 
pursuant thereto, the methods of allotment of funds 
among the States, and related matters. Such report shall 
include a record of consultations with the Advisory Coun-
cil, recommendations of the Advisory Council, and com-
ments thereon. 
SEC. 504. NONDISCLOSURE OF INFORMATION. 
(a) CONFIDENTIALITY.—Information concerning an 
individual, obtained from the individual or from any physi-
cian, dentist, nurse, or hospital, or from any other person 
pursuant to or as a result of the administration of this 
Act, shall be held confidential (except for statistical pur-
poses) and shall not be disclosed or be open to public in-
spection in any manner revealing the identity of the indi-
vidual or other person from whom the information was ob-
tained or to whom the information pertains, except as may 
be necessary for the proper administration of this Act or 
of other laws, State or Federal. 
(b) PENALTY.—Any person who shall violate any pro-
vision of subsection (a) shall be deemed guilty of a mis-
demeanor and, upon conviction thereof, shall be punished
by a fine not exceeding $50,000 or by imprisonment not 
exceeding one year, or both. 
SEC. 505. PROHIBITION AGAINST DISCRIMINATION. 
In carrying out the provisions of this Act there shall 
be no discrimination on account of race, creed, or color. 
Personal health services shall be made available as bene-
fits to all eligible individuals, and all persons qualified 
under title II to enter into agreements to furnish or pro-
vide such services shall be permitted to do so. 
TITLE VI—ELIGIBILITY DETER-
MINATIONS, 
COMPLAINTS, 
HEARINGS, AND JUDICIAL RE-
VIEW 
SEC. 601. DETERMINATIONS AS TO ELIGIBILITY FOR BENE-
FITS. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services through such units of the Department 
of Health and Human Services as the Secretary may de-
termine, shall upon the Secretary’s own initiative or upon 
application of any individual make determinations as to 
the eligibility of individuals for benefits under this Act. 
Whenever requested by any individual determined by the 
Secretary not to be eligible for benefits for any period, 
or by a dependent of any such individual, the Secretary 
shall give such individual or such dependent reasonable
notice and opportunity for a hearing with respect to such 
determination and on the basis of the evidence adduced 
at the hearing shall affirm, modify, or reverse the Sec-
retary’s determination. 
(b) AUTHORITY.— 
(1) IN
GENERAL.—In carrying out the Sec-
retary’s responsibility under this section, the Sec-
retary shall have all the powers and duties conferred 
upon the Secretary under sections 205 and 206 of 
the Social Security Act. Such powers and duties 
shall be subject to the same limitations and rights 
of judicial review as are contained in section 205 of 
such Act. 
(2) CIVIL
SERVICE
ELIGIBILITY
DETERMINA-
TIONS.—Eligibility for benefits under this title based 
on entitlement to an annuity under subchapter III 
(relating to civil service retirement) of chapter 83 of 
title 5, United States Code, shall be determined on 
the basis of certification by the Office of Personnel 
Management. 
(c) ROLE OF STATES.—Nothing in title IV shall be 
deemed to require or authorize any assumption by the 
State agency, designated in accordance with an approved 
State plan of operations approved under such title, of any 
of the Secretary’s responsibilities under this section, but
the Secretary may utilize existing facilities and services 
of any such agency on the basis of mutual agreements with 
such agency. 
SEC. 602. COMPLAINTS OF ELIGIBLE INDIVIDUALS AND OF 
PERSONS FURNISHING BENEFITS. 
(a) IN GENERAL.— 
(1) FILING.—Any eligible individual aggrieved 
by reason of the individual’s failure to receive any 
personal health-service benefits to which the believes 
entitled, or dissatisfied with any service rendered the 
individual as a personal health-service benefit, and 
any person who has entered into an agreement to 
furnish services as personal health-service benefits 
and who is aggrieved by the failure or alleged failure 
of a local or other administrative officer or a local 
administrative committee to carry out the agreement 
in accordance with its terms, may make a complaint 
to the local administrative officer or local executive 
officer in the area in which the action or inaction 
complained of occurred, or to such other officer as 
may be provided in regulations. 
(2) RESPONSE.—If the officer to whom such 
complaint is made finds, after investigation, that the 
complaint is well founded, the officer shall prompt-
ly—
(A) take such steps as may be necessary 
and appropriate to correct the action or inac-
tion complained of; and 
(B) notify the individual or other person 
making the complaint of the officer’s disposition 
thereof. 
(3) HEARING.—Any such individual or other 
person dissatisfied with the action taken may in 
writing request a hearing thereon and shall be af-
forded opportunity for the same pursuant to sub-
section (b). 
(b) HEARINGS.— 
(1) IN GENERAL.—Provision shall be made for 
the establishment of necessary and sufficient impar-
tial tribunals to afford hearings to individuals and 
other persons entitled thereto under subsection (a), 
or section 207(d), and for further review of the find-
ings, conclusions, and recommendations of such tri-
bunals, in accordance with regulations made by the 
Board, after consultation with the Advisory Council. 
(2) SPECIFIC SUBJECTS.—With respect to any 
complaint involving— 
(A) matters or questions of professional 
practice or conduct, the hearing body shall con-
tain competent and disinterested professional 
representation; and 
(B) only matters or questions of profes-
sional practice or conduct, the hearing body 
shall consist exclusively of such professional 
persons. 
(c) POWERS OF BOARD.—In administering this sec-
tion in any State which has not assumed responsibility for 
the administration of benefits under this Act as provided 
in title IV, the Board (subject to the provisions of section 
501(b)) shall, insofar as they are applicable to its func-
tions under this Act, have all the powers and duties con-
ferred upon the Secretary by sections 205 and 206 of the 
Social Security Act. Such powers and duties shall be sub-
ject to the limitations and rights of judicial review con-
tained in section 205 of such Act. 
(d) JUDICIAL REVIEW.—In any State which has as-
sumed responsibility for the administration of benefits 
under this Act as provided in title IV the powers and du-
ties of the State agency shall be subject to such rights 
of judicial review in the courts of the State as the law 
of the State may provide; subject, however, to review by 
the Supreme Court of the United States in such cases and 
in such manner as is provided in section 1257 of title 28 
of the United States Code.
TITLE VII—APPLICATION OF ACT 
TO 
INDIVIDUALS 
COVERED 
UNDER MEDICARE PROGRAM 
SEC. 701. ELIGIBILITY; BENEFITS AVAILABLE. 
(a) LIMITATION TO SUPPLEMENTARY BENEFITS.— 
(1) IN GENERAL.—In the case of any individual 
who is entitled to hospital insurance benefits under 
part A of title XVIII of the Social Security Act, or 
to supplementary medical insurance benefits under 
the insurance program established by part B of such 
title, during any benefit year or part thereof in 
which the individual is otherwise eligible for benefits 
under this Act in accordance with section 104 or 
would otherwise be furnished such benefits in ac-
cordance with section 105, the personal health serv-
ices (specified in section 101) which may be made 
available to the individual as benefits under this Act 
shall be limited to those services (otherwise available 
to the individual in accordance with section 102) for 
which the individual is ineligible under part A or B 
of such title XVIII. 
(2) TREATMENT.—For purposes of paragraph 
(1), an individual shall be considered ineligible under 
part A or B of such title XVIII if no payment is or 
can be made to the individual or on the individual’s
behalf thereunder with respect to the item or service 
involved, whether because the individual is not enti-
tled to benefits under whichever such part is applica-
ble, because no payment is provided under either 
such part for the item or service involved, or because 
the individual has exhausted entitlement to have 
payment made thereunder for items or services of 
the type involved. An individual shall also be consid-
ered ineligible under part A or B of such title XVIII 
with respect to any item or service (for which the in-
dividual is otherwise entitled to have payment made 
thereunder) to the extent that payment is not made 
with respect to such item or service because of the 
application of the deductible and coinsurance provi-
sions of sections 1813 and 1833 of the Social Secu-
rity Act. 
(b) REGULATIONS.—The Board, after consultation 
with the Advisory Council, shall prescribe such regulations 
as may be necessary or appropriate to insure, in the case 
of individuals whose benefits under this Act are limited 
under subsection (a), that the combination of benefits 
under this Act and title XVIII of the Social Security Act 
will effectively carry out (without duplication of benefits) 
the purpose of this Act.
(c) NO IMPACT ON DEPENDENTS.—The limitation 
under subsection (a) of an individual’s benefits under this 
Act shall not be construed as affecting the eligibility of 
the individual’s dependents for such benefits in accordance 
with subsection (a)(3) or (b)(3) of section 104. 
SEC. 702. STUDY AND REPORT. 
(a) STUDY.—As soon as practicable after the date of 
the enactment of this Act, the Secretary of Health and 
Human Services shall undertake and carry out a full and 
complete study of the interrelationship of the program of 
national health insurance under this Act and the program 
of health insurance under title XVIII of the Social Secu-
rity Act, in order to determine the way in which the latter 
program may be most effectively and equitably transferred 
to and incorporated in the program under this Act. 
(b) CONSIDERATIONS.—In conducting such study, 
the Secretary shall give particular attention to the transi-
tional problems which would result from such a transfer, 
and shall consider in detail (with respect to each such pro-
gram)— 
(1) the benefits provided; 
(2) the standards of eligibility therefor; 
(3) the standards and qualifications for partici-
pation by providers of services of various types; 
(4) the methods of administration;
(5) the costs and methods of financing; and 
(6) any other matters which might assist in 
making such determination and in insuring that all 
desirable features of the program under title XVIII 
of the Social Security Act will to the maximum ex-
tent feasible be preserved with respect to the individ-
uals covered by that program (and, in appropriate 
cases, included in the program under this Act for all 
individuals who are eligible thereunder, without re-
gard to any transfer). 
(c) REPORT.—The Secretary shall submit to the 
President and the Congress, no later than one year after 
the date of the enactment of this Act, a complete report 
of the study conducted under this section together with 
the Secretary’s findings as to the most effective and equi-
table way in which the transfer under consideration could 
be effected and detailed recommendations for legislative, 
administrative, and other actions to accomplish it. 
TITLE VIII—FISCAL PROVISIONS 
SEC. 801. USE OF TRUST FUND. 
(a) AVAILABILITY OF FUNDS.—Funds in the Na-
tional Health Care Trust Fund shall be available for all 
expenditures necessary or appropriate to carry out this 
Act; except that (subject to the provisions of section 
802(g)) only so much of such funds shall be available for
salaries or other administrative expenses of any depart-
ment or agency of the United States as may be authorized 
in annual or other appropriation Acts. 
(b) DEPOSIT OF REIMBURSEMENTS.—Sums received 
as reimbursements to the National Health Care Trust 
Fund pursuant to section 104(c) or section 105, or by vir-
tue of subrogation pursuant to section 104(c), shall be de-
posited in the National Health Care Trust Fund and shall 
be available in accordance with the provisions of sub-
section (a). 
SEC. 802. ALLOTMENT OF FUNDS. 
(a) FOR CLASSES OF SERVICES.— 
(1) IN GENERAL.—The Board, after consulta-
tion with the Advisory Council, shall determine, as 
far in advance of the beginning of each fiscal year 
as is possible, the sums which shall be available from 
the Trust Fund for provision during the fiscal year 
of all classes, and of each of the five classes, of per-
sonal health-service benefits specified in section 
101(a). 
(2) CONSIDERATIONS.—Such sums shall be de-
termined, after taking into consideration the esti-
mated amount which will be in the Trust Fund at 
the beginning of the fiscal year and the anticipated
income of the National Health Care Trust Fund 
thereafter, with a view— 
(A) to maintaining as nearly as practicable 
a uniform rate of expenditure for personal 
health-service benefits in successive fiscal years, 
except for appropriated allowance on account of 
anticipated increase in the personnel and facili-
ties available to furnish personal health-service 
benefits and on account of reduction or with-
drawal of restrictions or limitations pursuant to 
section 102(b); and 
(B) to establishing and maintaining a re-
serve in the Trust Fund adequate to meet 
emergency demands in accordance with sub-
section (d) and adequate to maintain the rate 
of expenditure or to permit its gradual reduc-
tion if the income of the Trust Fund should fall 
below the income which had been anticipated. 
(b) INITIAL STATE ALLOTMENTS.— 
(1) IN GENERAL.—In accordance with regula-
tions prescribed after consultation with the State 
agencies, the Board, prior to the beginning of each 
fiscal year shall allot to the several States, for the 
fiscal years 2006, 2007, and 2008, 90 percent, and
for each fiscal year thereafter 95 percent of each 
sum determined pursuant to subsection (a). 
(2) BASIS OF ALLOTMENTS.—Such regulations 
shall provide for allotments on the basis of— 
(A) the population in the several States eli-
gible for benefits under this Act; 
(B) professional and other personnel, hos-
pitals, and other facilities, and supplies and 
commodities, to be available in the several 
States in the provision of such benefits; and 
(C) the cost of reasonable and equitable 
compensation to such personnel and facilities 
and for such supplies and commodities. 
(3) OPERATION OF ALLOTMENTS.—Such allot-
ments shall operate, to the maximum extent pos-
sible, both to assure provision to eligible individuals 
of adequate personal health-service benefits in all 
States and all local health-service areas, and also to 
increase the adequacy of services where personnel 
and facilities are below the national average. 
(c) ALLOTMENT OF REMAINDER TO STATES.— 
(1) IN GENERAL.—From time to time during 
each fiscal year, the Board shall allot to the several 
States the remaining 10 percent or the remaining 5
percent, as the case may be, of each sum determined 
pursuant to subsection (a). 
(2) CONSIDERATIONS.—In making allotments 
under this subsection, the Board shall take into con-
sideration the factors specified in subsection (b), but 
shall, in addition, give special consideration to the 
extent of which allotments under subsection (b) have 
proved to be insufficient to permit provision of rea-
sonably adequate benefits under this Act. 
(d) EMERGENCY ALLOTMENTS.—In addition to the 
sums determined pursuant to subsection (a) to be avail-
able for the provision of personal health-service benefits, 
the Board, after consultation with the Advisory Council, 
is authorized to make emergency allotments from the Na-
tional Health Care Trust Fund if it finds that a disaster, 
epidemic, or other cause has substantially increased the 
volume of personal health-service benefits required in any 
part of the United States over the volume anticipated 
when the determinations pursuant to subsection (a) were 
made. Allotments pursuant to this subsection shall be 
made to such State or States, for such class or classes 
of personal health-service benefits, and in such amounts, 
as the Board may find necessary to meet the emergency. 
(e) PAYMENT FROM ALLOTMENTS.—The Board shall 
from time to time determine the amounts to be paid to
each State from its allotments under this section, and 
shall certify to the Secretary of the Treasury the amounts 
so determined. The Secretary shall thereupon, and prior 
to audit or settlement by the General Accounting Office, 
pay to the State the amounts so certified. 
(f) USE OF FUNDS.— 
(1) IN GENERAL.—Funds paid to a State for 
any class of personal health-service benefits shall be 
used exclusively for the provision of benefits of that 
class, except that the administrative costs of the 
State in administering personal health-service bene-
fits under this Act may be met from the allotments 
to the State. 
(2) LIMITATION ON ADMINISTRATIVE COSTS.— 
Such administrative costs, which in any fiscal year 
shall not exceed 5 percent of the aggregate allot-
ments to the State for such fiscal year, shall be ap-
portioned as between the several allotments in ac-
cordance with the costs of administering the respec-
tive classes of benefits. Such apportionment may be 
made in such manner, and by such sampling, statis-
tical, or other methods, as may be agreed upon be-
tween the Board and the State agency. 
(g) BOARD ASSUMPTION OF RESPONSIBILITY.—In 
any case in which the Board has assumed responsibility
for the administration in a State of benefits under this 
Act in accordance with section 402 (d) or (e), all allot-
ments or balances of allotments to such State shall be 
available for expenditure by the Board for the provision 
of personal health-service benefits in that State, and (until 
the Congress shall make funds available therefor pursuant 
to section 801(a)) for the costs of administration of such 
benefits in such State. Expenditures authorized pursuant 
to section 801(a) for such costs of administration shall 
be charged against allotments to such State. 
SEC. 803. GRANTS-IN-AID FOR TRAINING AND EDUCATION. 
(a) AUTHORITY.—For the purpose of increasing the 
availability of training and education for professional and 
technical personnel engaged or undertaking to engage in 
the provision or administration of personal health services 
as benefits under this Act, and to carry out the policies 
of section 209(a), the Board is authorized to make 
grants— 
(1) to public or nonprofit institutions or agen-
cies engaging in undergraduate or postgraduate pro-
fessional, technical, or administration education or 
training, for the cost (in whole or in part) of courses 
or projects which the Board finds, after consultation 
with the Advisory Council and appropriate Federal 
departments and agencies, (A) cannot be carried out
without financial assistance under this section, and 
(B) show promise of making valuable contributions 
to the education, training, or retraining of profes-
sional or technical personnel engaged or undertaking 
to engage in the provision or administration of bene-
fits, or 
(2) to individuals who are professional or tech-
nical persons engaged or who undertake to engage 
in the provision of personal health-service benefits, 
or who are engaged or undertake to engage in the 
administration of such benefits, for maintenance (in 
whole or in part) while in attendance at courses or 
projects assisted under paragraph (1) or approved 
by the Board for similar training or education, and 
for costs of necessary travel. 
(b) PAYMENT UNDER GRANTS.—Such grants, in 
such amounts and for payment at such times as are ap-
proved by the Board, shall be certified for payment to the 
Secretary of the Treasury, who shall pay them from the 
National Health Care Trust Fund to the designated indi-
viduals, institutions, or agencies. 
(c) AVAILABILITY OF FUNDS.—For the purposes of 
this section there shall be available for the fiscal year 2006 
the sum of $5,000,000, for the fiscal year 2006 the sum 
of $5,000,000, and for each fiscal year thereafter an
amount not to exceed one-half of 1 percent of the amount 
expended for benefits under this Act in the last preceding 
calendar year. 
TITLE IX—MISCELLANEOUS 
PROVISIONS 
SEC. 901. DEFINITIONS. 
As used in this Act: 
(1) WAGES.—The term ‘‘wages’’ means the 
sum of the following items, excluding any amount in 
excess of the applicable contribution and benefit 
base (as determined under section 230 of the Social 
Security Act with respect to the hospital insurance 
tax) which is received (or, in the case of income 
from self-employment, accrued) by any individual 
during any calendar year— 
(A) all remuneration for employment, in-
cluding the cash value of all remuneration paid 
in any medium other than cash; except that 
such term does not include— 
(i) the amount of any payment made 
to, or on behalf of, an employee under a 
plan or system established by an employer 
which makes provision for the employer’s 
employees generally or for a class or class-
es of the employer’s employees (including