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President at the time of their appointment, for 1, 2,
3, and 4 years.
(c) VACANCIES.—
(1) IN GENERAL.—The President shall fill any
vacancy in the membership of the Council in the
same manner as the original appointment. The va-
cancy shall not affect the power of the remaining
members to execute the duties of the Council.
(2) VACANCY
APPOINTMENTS.—Any member
appointed to fill a vacancy shall serve for the re-
mainder of the term for which the predecessor of the
member was appointed.
(3) REAPPOINTMENT.—The President may re-
appoint a member of the Council for a second term
in the same manner as the original appointment. A
member who has served for two consecutive 5-year
terms shall not be eligible for reappointment until
two years after the member has ceased to serve.
(d) CHAIR.—The President shall designate one of the
members of the Council to serve at the will of the Presi-
dent as Chair of the Council.
(e) COMPENSATION.—Members of the Council who
are not employees of the Federal Government shall be en-
titled to compensation at a level equivalent to level II of
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the Executive Schedule, in accordance with section 5313
of title 5, United States Code.
(f) GENERAL DUTIES OF THE COUNCIL.—The Coun-
cil is responsible for quality review activities under title
V. The Council shall report to the Board annually on the
conduct of activities under such title and shall report to
the Board annually specifically on findings from outcomes
research and development of practice guidelines that may
affect the Board’s determination of coverage of services
under section 401(f)(1)(G).
SEC. 405. STATE HEALTH SECURITY PROGRAMS.
(a) SUBMISSION OF PLANS.—
(1) IN GENERAL.—Each State shall submit to
the Board a plan for a State health security pro-
gram for providing for health care services to the
residents of the State in accordance with this Act.
(2) REGIONAL PROGRAMS.—A State may join
with one or more neighboring States to submit to
the Board a plan for a regional health security pro-
gram instead of separate State health security
programs.
(3) REGIONAL
PLANNING
MECHANISMS.—The
Board shall provide incentives for States to develop
regional planning mechanisms to promote the ration-
al distribution of, adequate access to, and efficient
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use of, tertiary care facilities, equipment, and
services.
(b) REVIEW AND APPROVAL OF PLANS.—
(1) IN
GENERAL.—The Board shall review
plans submitted under subsection (a) and determine
whether such plans meet the requirements for ap-
proval. The Board shall not approve such a plan un-
less it finds that the plan (or State law) provides,
consistent with the provisions of this Act, for the
following:
(A) Payment for required health services
for eligible individuals in the State in accord-
ance with this Act.
(B) Adequate administration, including the
designation of a single State agency responsible
for the administration (or supervision of the
administration) of the program.
(C) The establishment of a State health
security budget.
(D) Establishment of payment methodolo-
gies (consistent with subtitle B of title VII).
(E) Assurances that individuals have the
freedom to choose practitioners and other
health care providers for services covered under
this Act.
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(F) A procedure for carrying out long-term
regional management and planning functions
with respect to the delivery and distribution of
health care services that—
(i) ensures participation of consumers
of health services and providers of health
services, and
(ii) gives priority to the most acute
shortages and maldistributions of health
personnel and facilities and the most seri-
ous deficiencies in the delivery of covered
services and to the means for the speedy
alleviation of these shortcomings.
(G) The licensure and regulation of all
health providers and facilities to ensure compli-
ance with Federal and State laws and to
promote quality of care.
(H) Establishment of a quality review sys-
tem in accordance with section 502.
(I) Establishment of an independent om-
budsman for consumers to register complaints
about the organization and administration of
the State health security program and to help
resolve complaints and disputes between con-
sumers and providers.
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(J) Publication of an annual report on the
operation of the State health security program,
which report shall include information on cost,
progress towards achieving full enrollment, pub-
lic access to health services, quality review,
health outcomes, health professional training,
and the needs of medically underserved popu-
lations.
(K) Provision of a fraud and abuse preven-
tion and control unit that the Inspector General
determines meets the requirements of section
413(a).
(L) Provision that—
(i) all claims or requests for payment
for services shall be accompanied by the
unique provider identifier assigned under
section 414(a) to the provider and the
unique patient identifier assigned to the
individual under section 414(b);
(ii) no payment shall be made under
the program for the provision of health
care services by any provider unless the
provider has furnished the program with
the unique provider identifier assigned
under section 414(a);
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(iii) the plan shall use the unique pa-
tient identifier assigned under section
414(b) to an individual as the identifier of
the individual in the processing of claims
and other purposes (as specified by the
Board); and
(iv) 
queries 
made 
under 
section
412(c)(2) shall be made using the unique
provider identifier specified under section
414(a).
(M) Prohibit payment in cases of prohib-
ited physician referrals under section 304.
(N) Effective January 1, 2000, provide for
use of a uniform electronic data base in accord-
ance with section 504(a).
(O) Effective as of January 1, 1997, im-
plement malpractice reform provisions in ac-
cordance with section 801.
(2) CONSEQUENCES OF FAILURE TO COMPLY.—
If the Board finds that a State plan submitted
under paragraph (1) does not meet the requirements
for approval under this section or that a State
health security program or specific portion of such
program, the plan for which was previously ap-
proved, no longer meets such requirements, the