I
103D CONGRESS
2D SESSION
H. R. 5119
To increase access to, control the costs associated with, and improve the
quality of health care in States through health insurance reform, State
innovation, public health and medical research, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
SEPTEMBER 28, 1994
Mr. DEFAZIO introduced the following bill; which was referred jointly to the
Committees on Energy and Commerce, Ways and Means, and Education
and Labor
A BILL
To increase access to, control the costs associated with, and
improve the quality of health care in States through
health insurance reform, State innovation, public health
and medical research, and for other purposes.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Health Innovation Partnership Act of 1994’’.
(b) TABLE OF CONTENTS.—The table of contents of
this Act is as follows:
Sec. 1. Short title.
Sec. 2. Findings.
TITLE I—HEALTH INSURANCE REFORM
Sec. 1001. Establishment of standards.
Sec. 1002. Medicare select.
TITLE II—STATE INNOVATION
SUBTITLE A—STATE WAIVER AUTHORITY
Sec. 2001. State health reform projects.
SUBTITLE B—EXISTING STATE LAWS
Sec. 2101. Continuance of existing Federal law waivers.
Sec. 2102. Hawaii Prepaid Health Care Act.
Sec. 2103. Alternative State provider payment systems.
Sec. 2104. Alternative State hospital services payment systems.
Sec. 2105. Exemption from erisa preemption of certain provisions of the law of
the State of Oregon relating to health plans.
TITLE III—PUBLIC HEALTH AND RURAL AND UNDERSERVED
ACCESS IMPROVEMENT
Sec. 3001. Short title.
Sec. 3002. Establishment of new title XXVII regarding public health programs.
‘‘TITLE XXVII—PUBLIC HEALTH PROGRAMS IMPROVEMENT
‘‘SUBTITLE A—CORE FUNCTIONS OF PUBLIC HEALTH PROGRAMS
‘‘PART 1—FORMULA GRANTS TO STATES
‘‘Sec. 2711. Authorizations of appropriations from Fund.
‘‘Sec. 2712. Formula grants to States for core health functions.
‘‘Sec. 2713. Number of functions; planning.
‘‘Sec. 2714. Submission of information; reports.
‘‘Sec. 2715. Application for grant.
‘‘Sec. 2716. Determination of amount of allotment.
‘‘Sec. 2717. Allocations for certain activities.
‘‘PART 2—COMPREHENSIVE EVALUATION OF DISEASE
PREVENTION AND HEALTH PROMOTION PROGRAMS
‘‘Sec. 2718. Authorizations of appropriations from Fund.
‘‘Sec. 2719. Evaluation of programs.
‘‘SUBTITLE B—OPPORTUNITIES FOR EDUCATION AND TRAINING IN PUBLIC
HEALTH
‘‘PART 1—SCHOLARSHIP AND LOAN REPAYMENT PROGRAMS
REGARDING SERVICE IN PUBLIC HEALTH POSITIONS
‘‘Sec. 2721. Authorizations of appropriations from Fund.
‘‘Sec. 2722. Scholarship program.
‘‘Sec. 2723. Loan repayment program.
‘‘Sec. 2724. Approved public health positions.
‘‘Sec. 2725. Allocation of funds; special considerations.
‘‘PART 2—EDUCATIONAL INSTITUTIONS REGARDING PUBLIC
HEALTH
‘‘Sec. 2731. Authorizations of appropriations from Fund.
‘‘Sec. 2732. Grants for expanding capacity of institutions.
‘‘Sec. 2733. Coordination of grant activities with national priorities.
‘‘Sec. 2734. Certain requirements for grants.
‘‘PART 3—EXPANSION OF COMPETENCY IN PUBLIC HEALTH
‘‘Sec. 2736. Authorizations of appropriations from Fund.
‘‘Sec. 2737. Grants to States.
‘‘PART 4—AREA HEALTH EDUCATION CENTERS
‘‘Sec. 2738. Authorizations of appropriations from Fund.
‘‘PART 5—HEALTH EDUCATION TRAINING CENTERS
‘‘Sec. 2739. Authorizations of appropriations from Fund.
‘‘SUBTITLE C—REGIONAL POISON CONTROL CENTERS
‘‘Sec. 2741. Authorizations of appropriations from Fund.
‘‘Sec. 2742. Grants for regional centers.
‘‘Sec. 2743. Requirements regarding certification.
‘‘Sec. 2744. General provisions.
‘‘SUBTITLE D—SCHOOL-RELATED HEALTH SERVICES
‘‘PART 1—PROJECTS FOR PROVISION OF SERVICES
‘‘Sec. 2746. Authorization of appropriations from Fund.
‘‘Sec. 2747. Eligibility for grants.
‘‘Sec. 2748. Preferences.
‘‘Sec. 2749. Planning and development grants.
‘‘Sec. 2750. Grants for operation of school health services.
‘‘PART 2—SCHOLARSHIP AND LOAN REPAYMENT PROGRAMS
REGARDING SCHOOL NURSES
‘‘Sec. 2751. Authorizations of appropriations from Fund.
‘‘Sec. 2752. Scholarship program regarding upgrade in skills.
‘‘Sec. 2753. Loan repayment program.
‘‘Sec. 2754. School-nurse positions.
‘‘SUBTITLE E—EXPANSION OF RURAL AND UNDERSERVED AREAS ACCESS
TO HEALTH SERVICES
‘‘PART 1—COMMUNITY AND MIGRANT HEALTH CENTERS
‘‘Sec. 2756. Authorizations of appropriations from Fund.
‘‘Sec. 2757. Grants to community and migrant health centers.
‘‘PART 2—NATIONAL HEALTH SERVICE CORPS
‘‘Sec. 2781. Authorizations of appropriations from Fund.
‘‘PART 3—SATELLITE CLINICS REGARDING PRIMARY HEALTH
CARE
‘‘Sec. 2783. Authorization of appropriations from Fund.
‘‘Sec. 2783A. Grants to States for development and operation of satellite clin-
ics.
‘‘PART 4—COMMUNITY HEALTH ADVISORS
‘‘Sec. 2784. Authorization of appropriations from Fund.
‘‘Sec. 2785. Formula grants regarding community health advisor programs.
‘‘Sec. 2786. Requirements regarding community health advisor programs.
‘‘Sec. 2787. Additional agreements.
‘‘Sec. 2788. Application for assistance; State plan.
‘‘Sec. 2789. Determination of amount of allotment.
‘‘Sec. 2790. Quality assurance; cost-effectiveness.
‘‘Sec. 2791. Evaluations; technical assistance.
‘‘Sec. 2792. Rule of construction regarding programs of Indian Health Service.
‘‘Sec. 2793. Definitions.
‘‘Sec. 2794. Effect of insufficient appropriations for minimum allotments.
‘‘SUBTITLE F—GENERAL PROVISIONS
‘‘Sec. 2798. Requirement regarding accreditation of schools, departments, and
programs.
‘‘Sec. 2799. Relation to other funds.
‘‘Sec. 2799A. Definitions.’’
TITLE IV—MEDICAL RESEARCH
Sec. 4001. Findings.
Sec. 4002. National Fund for Health Research.
TITLE V—REVENUE PROVISIONS
Sec. 5000. Amendment of 1986 code.
SUBTITLE A—FINANCING PROVISIONS
Sec. 5001. Increase in excise taxes on tobacco products.
Sec. 5002. Modifications of certain tobacco tax provisions.
Sec. 5003. Imposition of excise tax on manufacture or importation of roll-your-
own tobacco.
SUBTITLE B—HEALTH CARE REFORM TRUST FUND
Sec. 5101. Establishment of Health Care Reform Trust Fund.
SEC. 2. FINDINGS.
The Congress finds the following:
(1) Americans support universal coverage. The
people of this country agree that all Americans, rich
and poor, should be guaranteed access to affordable,
high-quality health care.
(2) Although there is common agreement on the
goal of universal coverage, there are many different
ways to achieve this goal. The States can play an
important role in achieving universal coverage for
our population, demonstrating additional health re-
forms that may be needed on a national level to en-
hance access to affordable, high-quality health care.
The States also can serve as testing grounds to iden-
tify effective alternatives for making the transition
to 
universal 
coverage, 
while 
maintaining 
the
strengths of the current health care system.
(3) Maintaining the high quality of health care
Americans expect and controlling costs are also im-
portant goals of health care reform. As payers of
health care, the States have a strong incentive to en-
sure that such States purchase high-quality, cost-ef-
fective services for the residents of such States. The
States can develop and test alternative payment and
delivery systems to ensure that these goals are
achieved.
(4) There are many health-related issues that
should be addressed at the State level before their
implementation on the national level. As with social
security and child labor protections, States can lead
the way in testing ideas for national application.
(5) The States should have the flexibility to test
alternative health reforms with the objectives of in-
creasing access to care, controlling health care costs,
and maintaining or improving the quality of health
care.
TITLE I—HEALTH INSURANCE
REFORM
SEC. 1001. ESTABLISHMENT OF STANDARDS.
(a) IN GENERAL.—The Secretary of Health and
Human Services (hereafter referred to in this Act as the
‘‘Secretary’’) shall request that the National Association
of Insurance Commissioners (hereafter referred to in this
title as the ‘‘Association’’) develop, not later than 6
months after the date of the enactment of this Act, stand-
ards for health insurance plans with respect to—
(1) the renewability of coverage under such
plans;
(2) the portability of coverage under such plans,
including—
(A) limitations on the use of pre-existing
conditions;
(B) the concept of an ‘‘amnesty period’’
during which limitations on pre-existing condi-
tions would be suspended; and
(b) REVIEW.—Not later than 30 days after receipt
of the standards developed by the Association under sub-
section (a), the Secretary shall complete a review of such
standards. If the Secretary, based on such review, ap-
proves such standards, such standards shall apply with re-
spect to all health insurance plans offered or operating
in a State on and after the effective date specified in sub-
section (d).
(c) FAILURE TO DEVELOP STANDARDS OR FAILURE
TO APPROVE.—If the Association fails to develop stand-
ards within the 6-month period referred to in subsection
(a), or the Secretary fails to approve any standards devel-
oped under such subsection, the Secretary shall develop,
not later than 15 months after the date of the enactment
of this Act, standards applicable to health insurance plans,
including standards related to the matters described in
paragraphs (1) through (8) of subsection (a) and such
standards shall apply with respect to all health insurance
plans offered or operating in a State on and after the ef-
fective date specified in subsection (d).
(d) EFFECTIVE DATE.—
(1) IN GENERAL.—Subject to paragraph (2),
the effective date specified in this subsection for a
State is the date the State adopts standards devel-
oped under this section or 1 year after the date the
Secretary first approves such standards.
(2) DELAY FOR LEGISLATION.—In the case of
a State which the Secretary identifies, in consulta-
tion with the Association, as (A) requiring State leg-
islation (other than legislation appropriating funds)
in order for health insurance policies to meet the
standards developed and approved under this sec-
tion, but (B) having a legislature which is not sched-
uled to meet in 1996 in a legislative session in which
such legislation may be considered, the date speci-
fied in this subsection is the first day of the first
calendar quarter beginning after the close of the
first legislative session of the State legislature that
begins on or after January 1, 1996. For purposes of
the previous sentence, in the case of a State that has
a 2-year legislative session, each year of such session
shall be deemed to be a separate regular session of
the State legislature.
(e) WORKING
GROUP.—In developing standards
under this section, the Association or Secretary shall con-
sult with a working group composed of representatives of
issuers of health insurance policies, consumer groups,
health insurance beneficiaries, and other qualified individ-
uals. Such representatives shall be selected in a manner
so as to assure balanced representation among the inter-
ested groups.
(f) AFFECT ON STATE LAW.—Nothing in this section
shall be construed to preempt any State law to the extent
that such State law implements more progressive reforms
than those implemented under the standards developed
under this section, as determined by the Secretary.
SEC. 1002. MEDICARE SELECT.
(a) AMENDMENTS
TO PROVISIONS RELATING
TO
MEDICARE SELECT POLICIES.—
(1) PERMITTING MEDICARE SELECT POLICIES
IN ALL STATES.—Subsection (c) of section 4358 of
the Omnibus Budget Reconciliation Act of 1990 is
hereby repealed.
(2) REQUIREMENTS
OF
MEDICARE
SELECT
POLICIES.—Section 1882(t)(1) of the Social Security
Act (42 U.S.C. 1395ss(t)(1)) is amended to read as
follows:
‘‘(1)(A) If a medicare supplemental policy meets the
requirements of the 1991 NAIC Model Regulation or 1991
Federal Regulation and otherwise complies with the re-
quirements of this section except that—
‘‘(i) the benefits under such policy are re-
stricted to items and services furnished by certain
entities (or reduced benefits are provided when items
or services are furnished by other entities), and
‘‘(ii) in the case of a policy described in sub-
paragraph (C)(i)—
‘‘(I) the benefits under such policy are not
one of the groups or packages of benefits de-
scribed in subsection (p)(2)(A),
‘‘(II) except for nominal copayments im-
posed for services covered under part B of this
title, such benefits include at least the core
group of basic benefits described in subsection
(p)(2)(B), and
‘‘(III) an enrollee’s liability under such pol-
icy for physician’s services covered under part
B of this title is limited to the nominal
copayments described in subclause (II),
the policy shall nevertheless be treated as meeting
those requirements if the policy meets the require-
ments of subparagraph (B).
‘‘(B) A policy meets the requirements of this sub-
paragraph if—
‘‘(i) full benefits are provided for items and
services furnished through a network of entities
which have entered into contracts or agreements
with the issuer of the policy,
‘‘(ii) full benefits are provided for items and
services furnished by other entities if the services are
medically necessary and immediately required be-
cause of an unforeseen illness, injury, or condition
and it is not reasonable given the circumstances to
obtain the services through the network,
‘‘(iii) the network offers sufficient access,
‘‘(iv) the issuer of the policy has arrangements
for an ongoing quality assurance program for items
and services furnished through the network,
‘‘(v)(I) the issuer of the policy provides to each
enrollee at the time of enrollment an explanation
of—
‘‘(aa) the restrictions on payment under
the policy for services furnished other than by
or through the network,
‘‘(bb) out of area coverage under the pol-
icy,
‘‘(cc) the policy’s coverage of emergency
services and urgently needed care, and
‘‘(dd) the availability of a policy through
the entity that meets the 1991 Model NAIC
Regulation or 1991 Federal Regulation without
regard to this subsection and the premium
charged for such policy, and
‘‘(II) each enrollee prior to enrollment acknowl-
edges receipt of the explanation provided under
subclause (I), and
‘‘(vi) the issuer of the policy makes available to
individuals, in addition to the policy described in this
subsection, any policy (otherwise offered by the is-
suer to individuals in the State) that meets the 1991
Model NAIC Regulation or 1991 Federal Regulation
and other requirements of this section without re-
gard to this subsection.
‘‘(C)(i) A policy described in this subparagraph—
‘‘(I) is offered by an eligible organization (as
defined in section 1876(b)),
‘‘(II) is not a policy or plan providing benefits
pursuant to a contract under section 1876 or an ap-
proved demonstration project described in section
603(c) of the Social Security Amendments of 1983,
section 2355 of the Deficit Reduction Act of 1984,
or section 9412(b) of the Omnibus Budget Reconcili-
ation Act of 1986, and
‘‘(III) provides benefits which, when combined
with benefits which are available under this title, are
substantially similar to benefits under policies of-
fered to individuals who are not entitled to benefits
under this title.
‘‘(ii) In making a determination under subclause (III)
of clause (i) as to whether certain benefits are substan-
tially similar, there shall not be taken into account, except
in the case of preventive services, benefits provided under
policies offered to individuals who are not entitled to bene-
fits under this title which are in addition to the benefits
covered by this title and which are benefits an entity must
provide in order to meet the definition of an eligible orga-
nization under section 1876(b)(1).’’.
(b) RENEWABILITY
OF MEDICARE SELECT POLI-
CIES.—Section 1882(q)(1) of such Act (42 U.S.C.
1395ss(q)(1)) is amended—
(1) by striking ‘‘(1) Each’’ and inserting
‘‘(1)(A) Except as provided in subparagraph (B),
each’’;
(2) by redesignating subparagraphs (A) and
(B) as clauses (i) and (ii), respectively; and
(3) by adding at the end the following new sub-
paragraph:
‘‘(B)(i) In the case of a policy that meets the
requirements of subsection (t), an issuer may cancel
or nonrenew such policy with respect to an individ-
ual who leaves the service area of such policy; except
that, if such individual moves to a geographic area
where such issuer, or where an affiliate of such is-
suer, is issuing medicare supplemental policies, such
individual must be permitted to enroll in any medi-
care supplemental policy offered by such issuer or
affiliate that provides benefits comparable to or less
than the benefits provided in the policy being can-
celed or nonrenewed. An individual whose coverage
is canceled or nonrenewed under this subparagraph
shall, as part of the notice of termination or
nonrenewal, be notified of the right to enroll in other
medicare supplemental policies offered by the issuer
or its affiliates.
‘‘(ii) For purposes of this subparagraph, the
term ‘affiliate’ shall have the meaning given such
term by the 1991 NAIC Model Regulation.’’.
(c) CIVIL PENALTY.—Section 1882(t)(2) of such Act
(42 U.S.C. 1395ss(t)(2)) is amended—
(1) by striking ‘‘(2)’’ and inserting ‘‘(2)(A)’’;
(2) by redesignating subparagraphs (A), (B),
(C), and (D) as clauses (i), (ii), (iii), and (iv), re-
spectively;
(3) in clause (iv), as redesignated—
(A) by striking ‘‘paragraph (1)(E)(i)’’ and
inserting ‘‘paragraph (1)(B)(v)(I); and
(B) by striking ‘‘paragraph (1)(E)(ii)’’ and
inserting ‘‘paragraph (1)(B)(v)(II)’’;
(4) by striking ‘‘the previous sentence’’ and in-
serting ‘‘this subparagraph’’; and
(5) by adding at the end the following new sub-
paragraph:
‘‘(B) If the Secretary determines that an issuer of
a policy approved under paragraph (1) has made a mis-
representation to the Secretary or has provided the Sec-
retary with false information regarding such policy, the
issuer is subject to a civil money penalty in an amount
not to exceed $100,000 for each such determination. The
provisions of section 1128A (other than the first sentence
of subsection (a) and other than subsection (b)) shall
apply to a civil money penalty under this subparagraph
in the same manner as such provisions apply to a penalty
or proceeding under section 1128A(a).’’.
(d) EFFECTIVE DATES.—
(1) NAIC STANDARDS.—If, within 9 months
after the date of the enactment of this Act, the Na-
tional Association of Insurance Commissioners
makes changes in the 1991 NAIC Model Regulation
(as defined in section 1882(p)(1)(A) of the Social
Security Act) to incorporate the additional require-
ments imposed by the amendments made by this sec-
tion, section 1882(g)(2)(A) of such Act shall be ap-
plied in each State, effective for policies issued to
policyholders on and after the date specified in para-
graph (3), as if the reference to the Model Regula-
tion adopted on June 6, 1979, were a reference to
the 1991 NAIC Model Regulation (as so defined) as
changed under this paragraph (such changed Regu-
lation referred to in this subsection as the ‘‘1995
NAIC Model Regulation’’).
(2) SECRETARY STANDARDS.—If the Associa-
tion does not make changes in the 1991 NAIC
Model Regulation (as so defined) within the 9-month
period specified in paragraph (1), the Secretary shall
promulgate a regulation and section 1882(g)(2)(A)
of the Social Security Act shall be applied in each
State, effective for policies issued to policyholders on
and after the date specified in paragraph (3), as if
the reference to the Model Regulation adopted on
June 6, 1979, were a reference to the 1991 NAIC
Model Regulation (as so defined) as changed by the
Secretary under this paragraph (such changed Regu-
lation referred to in this subsection as the ‘‘1995
Federal Regulation’’).
(3) DATE SPECIFIED.—
(A) IN
GENERAL.—Subject to subpara-
graph (B), the date specified in this paragraph
for a State is the earlier of—
(i) the date the State adopts the 1995
NAIC Model Regulation or the 1995 Fed-
eral Regulation, or
(ii) 1 year after the date the Associa-
tion or the Secretary first adopts such reg-
ulations.
(B) ADDITIONAL LEGISLATIVE ACTION RE-
QUIRED.—In the case of a State which the Sec-
retary identifies, in consultation with the Asso-
ciation, as—
(i) requiring State legislation (other
than legislation appropriating funds) in
order for medicare supplemental policies to
meet the 1995 NAIC Model Regulation or
the 1995 Federal Regulation, but
(ii) having a legislature which is not
scheduled to meet in 1995 in a legislative
session in which such legislation may be
considered,
the date specified in this paragraph is the first
day of the first calendar quarter beginning after
the close of the first legislative session of the
State legislature that begins on or after Janu-
ary 1, 1996. For purposes of the previous sen-
tence, in the case of a State that has a 2-year
legislative session, each year of such session
shall be deemed to be a separate regular session
of the State legislature.
TITLE II—STATE INNOVATION
Subtitle A—State Waiver Authority
SEC. 2001. STATE HEALTH REFORM PROJECTS.
(a) OBJECTIVES.—The objectives of the waiver pro-
grams approved under this section shall include, but not
be limited to—
(1) achieving the goals of increased health cov-
erage and access;
(2) containing the annual rate of growth in
public and private health care expenditures;
(3) ensuring that patients receive high-quality,
appropriate health care; and
(4) testing alternative reforms, such as building
on the private health insurance system or creating
new systems, to achieve the objectives of this Act.
(b) STATE HEALTH REFORM APPLICATIONS.—
(1) IN GENERAL.—A State may apply for—
(A) an alternative State health program
waiver under paragraph (2); or
(B) a limited State health care waiver
under paragraph (3).
(2) ALTERNATIVE
STATE
HEALTH
PROGRAM
WAIVERS.—
(A) IN GENERAL.—In accordance with this
paragraph, each State desiring to implement an
alternative State health program may submit
an application for waiver to the Secretary for
approval.
(B) WAIVER REQUIREMENTS SPECIFIED.—
A State that desires to receive a program waiv-
er under this paragraph shall prepare and sub-
mit to the Secretary, as part of the application,
a State health care plan that shall—
(i) provide and describe the manner in
which the State will ensure that individuals
residing within the State have expanded
access to health care coverage;
(ii) describe the number and percent-
age of current uninsured individuals who
will achieve coverage under the alternative
State health program;
(iii) describe the benefits package that
will be provided to all classes of bene-
ficiaries under the alternative State health
program;
(iv) identify Federal, State, or local
programs that currently provide health
care services in the State and describe how
such programs could be incorporated into
or coordinated with the alternative State
health program, to the extent practicable;
(v) provide that the State will develop
and implement health care cost contain-
ment procedures;
(vi) describe the public and private
sector financing to be provided for the al-
ternative State health program;
(vii) estimate the amount of Federal,
State, and local expenditures, as well as,
the costs to business and individuals under
the alternative State health program;
(viii) describe how the State plan will
ensure the financial solvency of the alter-
native State health program;
(ix) describe any changes in eligibility
for public subsidies;
(x) provide assurances that Federal
expenditures under the alternative State
health program shall not exceed the Fed-
eral expenditures which would otherwise be
made in the aggregate for the entire pro-
gram period;
(xi) provide quality control assurances
and agreements as required by the Sec-
retary;
(xii) provide for the development and
implementation of a State health care de-
livery system that provides increased ac-
cess to care in areas of the State where
there is an inadequate supply of health
care providers;
(xiii) identify all Federal law waivers
required to implement the alternative State
health program, including such waivers
necessary to achieve the access, cost con-
tainment, and quality goals of this Act and
the alternative State health program; and
(xiv) provide that the State will pre-
pare and submit the Secretary such re-
ports as the Secretary may require to carry
out program evaluations.
(C) PROJECT WAIVERS.—
(i) CRITERIA FOR SELECTION.—In se-
lecting from among the applications for al-
ternative State health program waivers,
the Secretary shall be satisfied that each
approved State alternative State health
program—
(I) will not have a negative effect
on quality of care;
(II) will increase coverage of or
access for the State’s population; and
(III) will—
(aa) provide quality of care
and premium comparisons di-
rectly to employers and individ-
uals in an easy-to-use format,
(bb) contract with an exter-
nal peer review organization to
monitor the quality of health care
plans, and
(cc) establish a mechanism
within the State’s grievance proc-
ess that allows members of a
health plan to disenroll at any
time if it can be shown that such
members were provided erroneous
information that biased their
health plan selection.
(ii) WAIVER
APPROVAL.—The Sec-
retary shall approve applications submitted
by States that meet the access, cost con-
tainment, and quality goals established in
this Act and shall waive to the extent nec-
essary to conduct each alternative State
health program any of the requirements of
this Act, including, but not limited to, eli-
gibility requirements; alternative data col-
lection systems and sampling designs that
focus on measuring health status, patient
treatment outcomes, and patient satisfac-
tion with health plans, rather than on the
collection of 100 percent of patient encoun-
ters; and benefit designs; and any provi-
sions of Federal law contained in the fol-
lowing:
(I) Titles V, XVIII, XIX, and
XX of the Social Security Act.
(II) The Public Health Service
Act.
(III) Any other Federal law au-
thorizing a Federal health care pro-
gram that the Secretary identifies as