on limits of available service personnel and 
physical facilities. 
(4) DEFINITIONS.—For purposes of this sub-
section: 
(A) HEALTH
CARE
COORDINATOR.—The 
‘‘health care coordinator’’ means a health work-
er who performs case management (as defined 
in subparagraph (B)) functions in consultation 
with the health care team, the patient, family, 
and community. 
(B) CASE MANAGEMENT.—The term ‘‘case 
management’’ means a coordinated set of activi-
ties conducted for the management of an indi-
vidual user’s serious, complicated, protracted or 
chronic health conditions in order to ensure 
cost-effective and benefit maximizing treatment. 
(g) GUIDELINES.—The National Health Board shall 
establish guidelines 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 dis-
tribution of health care facilities and health workers to 
be effected on and after that date. 
(h) USE OF EVIDENCE-BASED CLINICAL DECISION 
CRITERIA.— 
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(1) IN GENERAL.—The National Health Board 
shall authorize the National Institute of Evaluative 
Clinical Research described in section 422 to estab-
lish evidence-based clinical decision criteria, where 
feasible, that shall apply throughout the Nation. 
(2) CLINICAL DECISION CRITERIA DEFINED.— 
For purposes of this section, the term ‘‘clinical deci-
sion criteria’’ means the recorded (written or other-
wise) screening procedures, decision abstracts, clin-
ical protocols, and practice guidelines used as an im-
portant basis to determine the necessity and appro-
priateness of health care services, in combination 
with the facts of particular cases, the judgment of 
health care professionals, and the preferences of 
users. Such criteria shall be clearly documented and 
available to all health workers and shall include a 
mechanism for periodically updating such criteria. 
(i) NOTICE
OF DETERMINATIONS.—The National 
Health Board, and its local and regional authorities, shall 
provide users with timely notice of any determination to 
provide, deny, or delay provision of a service, and informa-
tion about the relevant clinical decision criteria upon 
which such determination is based, if any. Such notifica-
tion shall include information concerning the appropriate 
procedure to appeal such decision. 
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(j) ACCOUNTABILITY.—In the case that the Health 
Service fails on the effective date of health services, to sub-
stantially and materially provide health care and supple-
mental services in accordance with this section, redress 
and alternative sources of care shall be authorized by an 
independent authority accountable to Congress and State 
legislatures. Such redress may include— 
(1) requiring the provision of services; and 
(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. 
SEC. 222. OPERATION AND INSPECTION OF HEALTH CARE 
FACILITIES. 
(a) ESTABLISHMENT OF POLICIES.— 
(1) IN
GENERAL.—Each health care facility 
shall be subject to policies and organizational plans 
consistent with this section and with parts A and C 
of title III (relating to the health labor force) for the 
operation of such facility and shall establish proce-
dures to ensure that the facility is operated in ac-
cordance with such policies and plans. 
(2) HEALTH WORKER AND USER CONTROL.— 
The National Health Board and its regional and 
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local authorities shall establish policies and mecha-
nisms for control of health care facilities by health 
care workers who are employed in, and users who re-
ceive services from, the respective facility, and shall 
promulgate rules preventing a financial conflict of 
interest by decisionmaking bodies. 
(b) EMPLOYMENT RESTRICTIONS.— 
(1) IN
GENERAL.—No individual entitled to 
make decisions regarding establishment, allocation, 
or operation of a health facility may engage in the 
private delivery of health care services. 
(2) PRIVATE
DELIVERY
OF
HEALTH
CARE 
SERVICES DEFINED.—For the purposes of this sub-
section, the term ‘‘private delivery of health care 
services’’ means the delivery of health care services 
for which an individual, group, or organization re-
ceives remuneration from any source other than the 
Health Service Trust Fund established in section 
511. 
(c) OPERATIONS OF HEALTH CARE FACILITIES.— 
(1) HOURS OF OPERATION.—Any health care 
facility which provides health care services on an 
outpatient basis shall be open during hours that will 
permit all users to make use of such services. 
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(2) EFFECTIVE
DELIVERY.—In its establish-
ment of health care facilities under this section, the 
Board shall seek to minimize fragmentation and du-
plication in delivery of health care and other services 
so as to promote the effective and efficient delivery 
of such services. 
SEC. 223. PROVISION OF HEALTH SERVICES RELATING TO 
REPRODUCTION AND CHILDBEARING. 
(a) PROVISION OF SERVICES.— 
(1) IN GENERAL.—The following services shall 
be provided: 
(A) FAMILY PLANNING.— 
(i) Complete information on contra-
ception and provision of birth control ma-
terials or medication of the individual’s 
choosing. 
(ii) Complete and effective evaluation 
and treatment of sexually transmitted dis-
eases and diseases of the reproductive or-
gans. 
(iii) Complete information and coun-
seling with respect to pregnancy, child-
bearing, and possible outcomes involving 
genetically induced anomalies. 
(B) PREGNANCY.— 
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