(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. 
(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.— 
(i) Complete and effective pregnancy 
testing. 
(ii) Prenatal services, including phys-
ical examination, counseling, and instruc-
tion of expectant parents in nutrition, 
childrearing, and children’s health care 
services.
(iii) Safe, comfortable, and convenient 
abortion services. 
(iv) Counseling for women in conjunc-
tion with the provision of all gynecologic, 
female contraceptive, and abortion services 
and counseling for men on male fertility- 
related services. 
(2) VOLUNTARY.—The services described in 
paragraph (1) shall be delivered without coercion or 
harassment, with complete confidentiality, and with-
out prior approval of individuals other than the indi-
vidual receiving the services. 
(3) ACCOMPANIMENT.—An individual shall be 
permitted to be accompanied by a person of the indi-
vidual’s choice during the provision of the services 
described in paragraph (1) to the extent this would 
not significantly increase the medical risk to the in-
dividual. 
(b) VOLUNTARY CONSENT.—No health care provider 
may perform upon an individual a treatment or procedure 
(other than a treatment or procedure required to preserve 
the life of the individual) which could reasonably be ex-
pected to affect the individual’s capacity to reproduce chil-
dren, unless—
(1) the individual has given voluntary written 
consent to the treatment or procedure after being 
given complete information on the effect of the 
treatment or procedure on the individual’s reproduc-
tive capacity, and on possible alternative treatments 
and procedures, at least 30 days before beginning 
the treatment or procedure, and 
(2) the individual has, after such 30-day wait-
ing period, again given written consent to the per-
formance 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)— 
(A) if she had given initial written consent 
at least 30 days before her anticipated delivery 
date, she delivers before the anticipated date, 
and the sterilization is performed at the time of 
delivery; 
(B) if she undergoes emergency abdominal 
surgery within the 30-day waiting period and 
the sterilization is concurrent with the abdom-
inal surgery; or 
(C) in the case of an elective sterilization 
procedure, such as tubal ligation or vasectomy,
that is scheduled and performed separately 
from the act of childbirth, where prior informed 
consent is provided and the procedure is per-
formed at the next subsequent or any later 
medical visit after informed consent is obtained. 
(c) BREAST CANCER TREATMENT.—The National 
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 side effects 
of each option and an opportunity to consult individuals 
of her choice, and shall have given voluntary written con-
sent to such procedure. 
(d) BIRTHING
OPTIONS.—The National 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. 
TITLE III—HEALTH LABOR 
FORCE 
Subtitle A—Job Categories and 
Certification 
SEC. 301. EFFECT OF STATE LAW. 
Notwithstanding any law of a State or political sub-
division 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. 
SEC. 302. QUALIFICATIONS OF HEALTH WORKERS. 
(a) CERTIFICATION OF COMPETENCE.—The National 
Health Board shall establish procedures which will ensure 
that, except in emergency situations, any work which is 
classified under a job category established under this sub-
title is performed by a health worker who at the time of 
such work was—
(1) certified (in accordance with this subtitle) 
as competent to perform the work under such job 
category, and 
(2) authorized to perform such work by the em-
ployer of such worker. 
(b) PERIODIC ASSESSMENTS.—There shall be peri-
odic review and assessment of the competency of such 
workers to perform the work within their job category, and 
opportunities for health workers to be assessed and cer-
tified with respect to skills required for advancement to 
other job categories. 
SEC. 303. ESTABLISHMENT OF JOB CATEGORIES AND CER-
TIFICATION STANDARDS. 
(a) IN GENERAL.— 
(1) CLASSIFICATION.—The National Health 
Board shall establish such guidelines for the classi-
fication, certification, and employment of health 
workers by job category as it determines to be nec-
essary— 
(A) to ensure that health workers who per-
form work for the Service which requires spe-
cialized skills have demonstrated that they pos-
sess such skills, 
(B) to expand the roles of health workers 
to enable them to participate in health care de-
livery to the maximum extent consistent with 
their skills, and 
(C) to provide for affiliation of health 
workers with health care facilities at the com-
munity, district, and regional levels. 
These guidelines shall permit alternative approaches 
to healing, and practitioners skilled in such ap-
proaches, when these approaches have not been dem-
onstrated to be injurious to health. 
(2) CONSIDERATIONS.—In establishing guide-
lines under paragraph (1), the National Health 
Board shall provide for (A) sufficient flexibility to 
permit utilization of health workers most effectively 
to meet the health needs of the region, and (B) suf-
ficient uniformity to permit mobility of health work-
ers among the regions. 
(b) CERTIFICATION STANDARDS.— 
(1) ESTABLISHMENT.—For each job category 
(other than a job category determined by the Na-
tional Health Board to involve highly specialized 
skills requiring advanced specialty training), the Na-
tional Health Board shall, taking into account the 
guidelines established under subsection (a), establish 
certification standards which shall specify—
(A) the functions performed by a health 
worker employed in such job category; 
(B) the skills required in the course of 
properly performing work under such job cat-
egory; 
(C) the initial and continuing training, ex-
perience, and performance which must be un-
dertaken or demonstrated by a health worker to 
achieve and maintain competency to perform 
the work within such job category; and 
(D) the curriculum which a health worker 
must follow in studies in a health team school 
(established under subtitle B) to demonstrate 
sufficient competence to satisfy the specification 
of subparagraph (C) for such job category. 
(2) SPECIFICATIONS.—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 sub-
paragraphs (A) through (D) of paragraph (1). 
(3) PERIODIC
REVIEW.—Standards for a job 
category under this subsection shall be periodically 
reviewed to supplement, modify, or eliminate such
standards as will facilitate the delivery of quality 
health care services under this Act. 
(4) QUALITY PROTECTION.— 
(A) PROHIBITION
OF
DOWNGRADES
OF 
LEVELS.—No individual health facility adminis-
trator is authorized to downgrade the level of 
skill, license or certification required to perform 
duties delineated by the Board. 
(B) REVIEW.— 
(i) REVIEW OF STAFFING CHANGES.— 
Upon enactment of this Act, the Board 
shall convene a national level task force to 
review the impact on the safety and health 
of patients and workers of downgrading 
and deskilling of health care job categories 
by replacing licensed with unlicensed work-
ers during the 1990s, particularly in the 
nursing area, and to recommend remedies 
as appropriate. 
(ii) WHISTLEBLOWER PROTECTION.— 
Health care workers who report com-
promises in the quality of care shall not be 
subjected to recriminations. 
(C) WORKFORCE STAFFING LEVELS.—The 
Board may establish health workforce staffing
levels as it determines will promote the delivery 
of quality health care services. 
Subtitle B—Education of Health 
Workers 
SEC. 311. HEALTH TEAM SCHOOLS. 
(a) ESTABLISHMENT.— 
(1) IN GENERAL.—Except as provided in para-
graph (2), the Board shall establish a procedure for 
converting existing educational facilities for health 
services workers to create health team schools (each 
in this subtitle referred to as a ‘‘school’’) in accord-
ance with this section to provide programs of initial 
and continuing basic education in health care deliv-
ery for health workers in all job categories, and to 
provide initial continuing advanced education in 
health care specialties and health science specialty 
fields. Such schools shall be established and func-
tioning not later than 4 years after the effective date 
of health services. 
(2) USE OF FUNDS.—Schools shall be funded 
exclusively by the Service, shall not charge nor ac-
cept tuition or fees for enrollment, and shall provide 
each student with an adequate allowance for living 
expenses, educational supplies, and any child care 
expenses.
(b) OPERATIONAL PRINCIPLES.—Schools shall be op-
erated and maintained in accordance with the following 
principles: 
(1) The activities of each school shall be de-
signed to meet the health needs of the population. 
(2) The number of students enrolled in each 
educational program in a school shall be based on 
the needs for health workers within a given area, de-
fined by geographic and political boundaries. 
(3) Schools shall integrate the education of 
health workers in the different job categories (estab-
lished under subtitle A) so as to permit health work-
ers to be educated and certified for successively 
higher levels of health care work. 
(4) Each school’s admissions policies, cur-
riculum policies, faculty hiring procedures, and gov-
ernance plan shall be established and implemented 
in accordance with subsections (c) through (f), re-
spectively, and with the fullest possible participation 
of the community health workers, staff, and students 
in its region. 
(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