93D CONGRESS 2D SESSION

H. R. 13870

IN THE HOUSE OF REPRESENTATIVES

APRIL 2, 1974

Mr. MILLS introduced the following bill; which was referred to the Committee on Ways and Means

A BILL

To amend the Social Security Act to establish a national health insurance program for all Americans within the social security system, to improve the benefits in the medicare program including a new program of long-term care, to improve Federal programs to create the health resources needed to supply health care, to provide for the administration of the national health insurance program and the existing social security programs by a newly established independent Social Security Administration, to provide for the administration of health resource development by a semi-independent Board in the Department of Health, Education, and Welfare, and for other purposes.

1

Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 That this Act, divided into titles and sections according to the

I-O

2

1 following table of contents, may be cited as the "Compre-

2 hensive National Health Insurance Act of 1974".

Sec. 1. Short title.

TABLE OF CONTENTS

Sec. 2. Findings and declaration of purpose.

TITLE I-NATIONAL HEALTH INSURANCE PROGRAM

"Sec. 2012. Payment for outpatient drugs and biologicals.

"PART B-ELIGIBILITY FOR BENEFITS

"Sec. 2021. Eligible individuals.

"PART C-METHOD OF PAYMENT TO ELIGIBLE INDIVIDUALS

"Sec. 2031. Establishment of individual accounts.

"Sec. 2032. Payment for items and services and collection of deducti-

bles and coinsurance.

"Sec. 2033. Special waiver of or limitation on deductibles and coin-

surance for lower income families (with financing from

general revenues).

"Sec. 2034. Information and data to facilitate administration.

"PART D-ADMINISTRATION OF PROGRAM

"Sec. 2041. Conditions of and limitations on payment.

"(a) Requirement of requests and certifications.

"(b) No payments to Federal providers of services.

"(c) Payment for emergency hospital services.

"(d) Payment for inpatient hospital services prior

to notification of noneligibility.

"(e) Payment for post hospital extended care serv-
ices.

"(f) Payment for home health services.

“(g) Limitation on payment for outpatient drugs

and biologicals.

3

TABLE OF CONTENTS-Continued

"TITLE XX-NATIONAL HEALTH INSURANCE

PROGRAM-Continued

"PART D-ADMINISTRATION OF PROGRAM-Continued

"Sec. 2041. Conditions of and limitations on payment-Continued

"(h) Limitations on payment for surgery and other

specialized services.

"(i) Limitation on payment for practitioner services

furnished in nonparticipating hospital.

"(j) Limitation on payment for certain prosthetic

devices.

"(k) Payment for certain outpatient services for-
nished by nonparticipating hospital.

"(1) Collection by hospitals of customary charges

for certain outpatient services.

"Sec. 2042. Payment to providers of services; prospective determina-

tion of payment to providers; quality management pay-

ments.

"Sec. 2043. Agreements with providers of services.

"Sec. 2044. Use of public agencies or private organizations to facili-

tate payment to providers of services.

"Sec. 2045. Use of carriers for administration of noninstitutional

benefits.

"Sec. 2046. Payment to physicians and other health professionals.

"Sec. 2047. Special provisions relating to outpatient drugs and bio-

logicals.

"(a) National Health Insurance Formulary Com-

mittee.

"(b) Formulary.

"(c) Limitations on payment for charges of provid-

ers of services.

"(d) Reasonable allowance for outpatient drugs and

biologicals.

"(e) Special provisions for physicians dispensing

outpatient drugs and biologicals.

"Sec. 2048. National Health Insurance Trust Fund.

"PART E-MISCELLANEOUS PROVISIONS

"Sec. 2051. Definitions.

"(a) Inpatient hospital services.

"(b) Hospital.

"(c) Psychiatric hospital.

"(d) Tuberculosis hospital.

"(e) Physicians' services.

"(f) Physician.

"(g) Medical and other health services.

"(h) Extended care services.

"(i) Posthospital extended care services.

"(j) Skilled nursing facility.

"(k) Utilization review.

4

TABLE OF CONTENTS-Continued

"TITLE XX-NATIONAL HEALTH INSURANCE

PROGRAM-Continued

"PART E-MISCELLANEOUS PROVISIONS Continued

"Sec. 2051. Definitions-Continued

"(1) Agreements for transfer between skilled nursing

facilities and hospitals.

"(m) Home health services.

"(n) Home health agency.

“(o) Outpatient physical therapy services.

"(p) Drugs and biologicals.

"(q) Outpatient drugs and biologicals.

"(r) Routine dental services.

"(s) Dentist.

“(t) Eyeglasses.

"(u) Eye and vision examination.

"(v) Hearing aids and examinations.

"(w) Physician extender services.

"(x) Carrier.

"(y) Arrangements for certain services.

"(z) State and United States.

"(aa) Provider of services.

"(bb) Participating pharmacy.

"(cc) Well-child care.

"Sec. 2052. Consultation with State agencies and other organizations

to develop conditions of participation for providers of

services.

"Sec. 2053. Use of State agencies to determine compliance by pro-
viders of services with conditions of participation.

"Sec. 2054. Effect of accreditation.

"Sec. 2055. Determinations; appeals.

"Sec. 2056. Overpayments on behalf of individuals and settlement of

claims for benefits on behalf of deceased individuals.

"Sec. 2057. Application of certain provisions of title II.

"Sec. 2058. Designation of organization or publication by name.

"Sec. 2059. Penalties.

"Sec. 2060. Provider Reimbursement Review Board.

"Sec. 2061. National Health Insurance Benefits Advisory Council.

"Sec. 2062. Regulations.".

Sec. 102. Taxes and coverage for health insurance purposes.

Sec. 103. Tax refunds for certain servicemen.

Sec. 104. Professional standards review.

Sec. 105. Repeal of medicaid program.

TITLE II-CHANGES IN MEDICARE PROGRAM

Sec. 201. Establishment of medicare long-term care program.

"PART D-LONG-TERM CARE SERVICES PROGRAM

"Sec. 1881. Establishment of program.

"Sec. 1882. Eligibility for long-term care service benefits.

"Sec. 1883. Scope of benefits.

5

TABLE OF CONTENTS-Continued

TITLE II-CHANGES IN MEDICARE PROGRAM-Continued

"PART D-LONG-TERM CARE SERVICES PROGRAM-Continued

"Sec. 1884. State long-term care agency.

"Sec. 1885. Payment of premiums.

"Sec. 1886. Federal Long-Term Care Trust Fund.

"Sec. 1887. Functions of community long-term care centers.

"Sec. 1888. Payment to States for reimbursement of community long-

term care centers.

"Sec. 1889. Definition of terms used in this part.

"(a) Community long-term care center.

"(b) Governing board.

"(c) Nutrition services.

"(d) Homemaker services.

"(e) Institutional services.

"(f) Home health services.

"(g) Day care; foster home care.

"(h) Community mental health center outpatient

services.

"(i) Intermediate care facility.

"Sec. 1890. Payment method for community long-term care centers.

"Sec. 1891. Miscellaneous provisions.

"Sec. 1892. Determinations and appeals."

Sec. 202. Coverage of prescription drugs.

Sec. 203. Termination of deductible and coinsurance obligation in cases

of catastrophic illness or injury.

Sec. 204. Elimination of posthospital requirement for home health serv-

ices under part A of medicare.

Sec. 205. Elimination of durational limits on inpatient hospital services.

Sec. 206. Elimination of blood deductibles.

Sec. 207. Changes in payment procedures and administrative mechanisms

under medicare program.

TITLE III-INDEPENDENT SOCIAL SECURITY

ADMINISTRATION

Sec. 301. Declaration of purpose.

Sec. 302. Social Security Administration.

Sec. 303. Transitional provisions.

Sec. 304. Miscellaneous and conforming amendments.

Sec. 305. Amendments to Budget and Accounting Act.

Sec. 306. Amendments to title 5, United States Code.

Sec. 307. Effective date.

TITLE IV-AMENDMENT TO PUBLIC HEALTH SERVICE

Sec. 401. Purpose.

ACT

Sec. 402. Health Resources Development Board.