USHealth Program Act

USHealth Program Act - Division A: USHealth Program - Title I: Eligibility and Enrollment - Amends title XVIII (Medicare) of the Social Security Act to establish the USHealth Program (Program) for the provision of comprehensive medical care, without regard to age or disability status to: (1) U.S. citizens; (2) permanent U.S. residents; and (3) aliens who are employed with a foreign government or international organization and reside in the United States, provided an executive agreement can be arranged with such government or organization for payments into the Program. Provides for the possibility of incorporating foreign visitors into the program.

Repeals title XIX (Medicaid) of the Act and provisions of various other benefit programs rendered superfluous by the comprehensive nature of the USHealth Program. Makes conforming amendments to the Railroad Retirement Act of 1974.

Title II: Benefits and Providers - Lists Program benefits which comprise: (1) inpatient hospital and inpatient psychiatric hospital services; (2) medical and other health services; (3) comprehensive outpatient rehabilitation facility services; (4) medical care access facility services; (5) extended care services; (6) home health services; (7) hospice care; (8) long-term care for a chronically ill individual; (9) alcohol and drug abuse rehabilitation services; and (10) outpatient mental health services. Amends the Medicare program to expand covered medical and other health services to include: (1) nurse practitioner and clinical nurse specialist services; (2) periodic screening and diagnosis of individuals under age 21 to ascertain their physical or mental defects and the care necessary to correct or ameliorate discovered defects; (3) family planning services and supplies for individuals of child-bearing age; (4) private duty nursing services; (5) eyeglasses and dental services, with specified conditions; (6) prescribed drugs and prosthetic devices; (7) physical therapy; and (8) other diagnostic, preventive, and rehabilitative services. Directs the USHealth Board (Board) to review coverage limitations on mental health services and to make such changes as will improve access to such services while containing costs.

Requires the Board to report to the Congress on whether Program coverage should include services of pediatric and geriatric assessment units.

Makes the Program the primary payor where items and services provided may also be covered by a group health plan.

Sets forth certification standards for long-term care, comprehensive outpatient rehabilitation facility services, outpatient physical therapy services, and outpatient speech pathology services.

Uses funds authorized for the rural health care transition grant program under the Omnibus Budget Reconciliation Act of 1987 for the development of medical care access facilities. Defines a "medical care access facility" as a facility which: (1) provides ambulatory, primary, emergency, urgent, and surgical care; (2) provides inpatient care for from one-to-ten inpatient beds for stays not exceeding 48 hours; and (3) is located in a medically underserved area or a county with a population of less than 20,000, or serves a frontier service area. Provides Medicare coverage of facility services. Authorizes such facilities to provide dietician, pharmacist, laboratory technician, medical technologist, and radiological services on a part-time, off-site basis, and remain open for less time than Medicare hospitals. Authorizes appropriations for FY 1990 through 1992 for grants creating medical care access facilities in communities which lack hospitals and assisting hospitals in being converted into such facilites.

Directs the Secretary of Health and Human Services to establish a Medical rural health clinic demonstration program: (1) testing new payment methodologies for clinic services; (2) covering early detection procedures, health education, and health risk reduction services; (3) easing staffing requirements for clinics that have been unable to recruit physician assistants or nurse practitioners; and (4) reducing physician, physician assistant, and nurse practitioner productivity standards for sparsely populated areas.

Requires the Administrator of the Health Care Financing Administration to provide for and annually report to the Congress on additional research and demonstration projects into how the Medicare and Medicaid (title XIX of the Social Security Act) programs could be changed to better cover care for beneficiaries residing in rural areas and in central city areas of large cities.

Directs the Board to develop policies and protocols to assure the appropriate coordination in payments and identification of benefits for Medicare long-term care and acute health care services.

Title III: Payments for Services - Ties changes in the payment rate for services provided under the Program to changes in the gross national product (GNP) over a payment period, with adjustments in payments among services being made in response to changes in the utilization of such services. Limits payments for noninstitutional care provided to chronically-ill individuals. Sets forth a formula for determining the payment due to hospitals for capital-related costs which takes into account capital resource use associated with differing diagnosis-related groups as well as changes in the GNP.

Directs the USHealth Board to establish a payment schedule for each class of covered health care services and periodically adjust such schedules to reflect GNP changes as well as regional and qualitative differences in services provision. Requires that payment rates for physicians' services and other professional services reflect the particular costs of furnishing such services and take into account the full-time coverage and low-volume of services characteristic of rural areas.

Authorizes the Board to provide for the payment of services under an alternative reimbursement system established by a State, provided the system does not increase the cost or reduce the quality of such services. Provides funding to States establishing such a system. Cuts a State's required contribution to the Program by 50 percent of the savings which result from use of the State's alternative system.

Directs the Board to establish a toll-free, telephone hotline to handle inquiries concerning Medicare payments for certified registered nurse specialist, certified nurse-midwife, nurse practitioner, and clinical nurse specialist services.

Sets forth medical care access facility payment provisions.

Prohibits providers from charging beneficiaries or third parties for services covered by this Act. Requires the Board to use insurance companies as carriers, where practicable, and strengthen utilization review by carriers.

Increases the rate of payment for each class of individuals enrolled with a health maintenance organization (HMO) to 100 percent of the cost for that class. (Currently, 95 percent of the costs are covered.) Restricts coverage to HMOs qualified under the Public Health Service Act. Requires HMOs to provide enrollees with all services covered by this Act. Directs the Board to conduct a national campaign encouraging eligible individuals to enroll with HMOs.

Title IV: Financing Program - Requires USHealth beneficiaries to pay the first $100 of payments made for covered outpatient drugs and, subject to specified maximum payment limits, 25 percent of the payments provided for custodial long-term care services and 20 percent of the payments provided for other services (in addition to nominal copayments). Waives the coinsurance requirement where such payments would place a family's income below the Federal poverty level. Provides that the failure to pay coinsurance amounts will not result in loss of benefit entitlement.

Alters the formula for determining the monthly Medicare part B (Supplementary Medical Insurance) premium for individuals age 65 or older, requiring the elimination of such premium when the individual's family income falls below the Federal poverty level. Phases-out such premium for elderly beneficiaries by the year 2005. Eliminates such premium for disabled beneficiaries. Amends the Internal Revenue Code to phase-down the supplemental premium rate so that it reaches zero by the year 2005. Indexes increases to the ceiling on such premium to increases in the per capita GNP. Reduces an individual's supplemental premium by the amount of surtax he or she paid for the coverage of excess Program costs.

Amends title II (Old Age, Survivors and Disability Insurance) (OASDI) of the Act to extend the wages on which the Hospital Insurance tax is levied to an unlimited dollar amount after 1989. Amends the Internal Revenue Code to impose an excise tax, to be paid into the USHealth Program Trust Fund (Trust Fund), on wages and self-employment income, including in such tax certain Federal, State, and church employment. Increases the Federal excise tax on cigarettes. Applies the increase to the Trust Fund. Adjusts the rate of such taxes to reflect changes in the GNP.

Amends the Medicare program to require the States to pay into the Trust Fund an amount equal to 50 percent of Program payments made to families whose income falls below the Federal poverty level.

Amends the Internal Revenue Code to impose a surtax on personal income to cover the amount by which estimated Program costs for a calendar year will exceed Program revenues.

Amends the Medicare program to establish the USHealth Program Trust Fund which is to replace the Federal Hospital Insurance Trust Fund, Federal Supplementary Medical Insurance Trust Fund, Federal Catastrophic Drug Insurance Trust Fund, and Medicare Catastrophic Account and be administered by the Board. Provides for off-budget treatment of receipts and disbursements of the Trust Fund.

Amends the Internal Revenue Code to repeal the exclusion of employer health insurance contributions from income computations.

Title V: Quality Assurance - Amends part B (Peer Review) of title XI of the Act to establish a National Council on Quality Assurance. Directs the Director of the Congressional Office of Technology Assessment to provide for the appointment of members of the Council. States that the general functions of the Council shall be to: (1) provide oversight of the operations of the quality assurance system; and (2) make recommendations annually to the Board and the Congress for improvements in the system. Sets forth the Council's functions more specifically. Requires the Council to report annually to the Congress on the functioning and progress of the Council. Authorizes appropriations.

Requires contracts with peer review organizations to provide that: (1) at least one-half of the organizations' efforts must be on quality assurance activities; and (2) quality assurance activities shall be conducted with respect to all the different types of items and services covered by Medicare, Medicaid, or through a private payor.

Adds to the definition of the term "peer review organization" so as to require such an entity to: (1) include representatives of quality assurance activities; and (2) have a consumer advisory board. Defines a "consumer advisory board." Requires peer review organizations to review health maintenance organizations (HMOs).

Requires any peer review organization to: (1) educate USHealth beneficiaries; (2) provide for a toll-free telephone number, which shall be provided to USHealth beneficiaries for the purpose of receiving questions and complaints from USHealth beneficiaries; (3) assist in resolving any such complaints that are legitimate; (4) make available to its consumer advisory boards appropriate information received from the telephone service; and (5) train members of its consumer advisory board.

Appropriates funds, in addition to any other amounts appropriated to carry out part B of title XI, from the Trust Fund for distribution to peer review organizations.

Amends the Medicare program to impose quality assurance requirements on home health agencies and long-term care management agencies, including requirements that such agencies implement grievance review procedures, ensure that their providers receive adequate training, and develop and periodically review plans of care for their clients. Requires home health agencies and providers to provide clients with information and training concerning the use of durable medical equipment. Requires long-term care management agencies to supply their clients with a written statement of the services they will receive and a copy of the consumer bill of rights to be promulgated by the Board. Directs the Board to: (1) establish procedures for surveying home health and long-term care management agencies; (2) encourage and report on State progress in developing home health agency licensing policies and procedures; and (3) provide grants for training programs for home health agencies and providers and long-term care management agencies. Authorizes appropriations for such activities in FY 1993 and thereafter.

Requires hospitals to implement a discharge planning process which meets guidelines and standards to be established by the Board, in conjunction with the National Council on Quality Assurance, to: (1) protect against inappropriate early hospital discharges; (2) ensure a timely and smooth transition to the most appropriate type of and setting for post-hospital care; and (3) permit early initiation of the authorization process for continuing care services. Amends part B of title XI of the Act to require peer review organizations to monitor hospitals' compliance with discharge planning process requirements.

Requires health maintenance organizations (HMOs) to make outpatient mental health services available to their clients and ensure that quality assurance activities include such services.

Requires the Board to promulgate a consumers' bill of rights which includes rights: (1) facilitating consumer participation in the planning and delivery of services; (2) requiring consumer notification regarding services, charges for services, and the termination or reduction of services; (3) protecting consumer dignity, privacy, and property; and (4) ensuring service from properly trained and competent individuals.

Requires the Board to provide grants to States for the establishment of a health and long-term care ombudsman in each State. Directs each State to establish a statewide uniform reporting system and a toll-free telephone hotline for the collection and communication of complaints regarding conditions in inpatient care facilities.

Sets forth study and reporting requirements.

Title VI: Administration and Miscellaneous - Amends part B (Supplementary Medical Insurance) of title XVIII (Medicare) of the Act to replace the heading of part B with the heading, "Part B-USHealth Administration." Establishes as an independent executive agency a USHealth Administration (Administration). Provides that it shall be the duty of the Administration to administer the USHealth Program. Provides that the Administration shall be governed by a USHealth Board. Requires the Board to study and make recommendations as to the most effective methods of providing for the health care of permanent U.S. residents and as to legislation and matters of administrative policy.

Establishes in the Administration: (1) a USHealth Administrator; (2) a Deputy USHealth Administrator; (3) a General Counsel; (4) an Inspector General; and (5) an office of the USHealth Ombudsman, to be headed by a USHealth Ombudsman who shall represent the interests of USHealth beneficiaries within the Administration. Requires the annual report of the Board to include a description of the activities of the Ombudsman.

Requires the Board to make annual budgetary recommendations relating to the Administration. Requires that appropriations requests by the Administration for staffing and personnel be based upon a comprehensive workforce plan as established by the Board. Provides for the apportionment of administrative costs. Requires the annual report of the Board to include a section reflecting the use of budget authority provided to the Administration. Requires that authority for automated data processing procurement and facilities construction be provided in the form of contract authority covering the total cost of such acquisitions. Makes amounts needed for the liquidation of contract authority so provided available from the Trust Fund to the extent that such amounts are not needed to meet current obligations for benefit payments. Requires the Board to cause a seal of office to be made and judicial notice taken thereof. Directs the Administrator and the Board to report to the Congress within 120 days after the beginning of each regular session on their administration under this Act.

Requires the Board and the Director of the Office of Personnel Management to implement demonstration projects relating to personnel matters. Directs the Board and the Administrator of General Services to implement such projects relating to delegations from such Administrator. Specifies the authorities which are to be delegated to the Board from the Administrator of General Services and the Director. Requires the Comptroller General to report to specified congressional committees concerning such projects, including an evaluation of the Board's readiness to assume full and permanent authority.

Provides for the transfer to the Administration of all functions carried out by the Secretary of Health and Human Services with respect to the programs and activities which have been administered by the Health Care Financing Administration.

Abolishes the position of Administrator of the Health Care Financing Administration in the Department of Health and Human Services.

Directs the Secretary to conduct: (1) from five-to-ten three-year demonstration projects to determine the relative effectiveness, cost, and impact on the quality of long-term care of different models of providing and reimbursing Medicare care management services; and (2) from five-to-ten 18-month demonstration projects to assess the coverage of day health care provided to chronically ill individuals in a group-setting outside their homes on a less than 24-hour-a-day basis as long-term care. Sets forth reporting requirements.

Sets forth effective date and transitional rule provisions.

Title VII: Miscellaneous Provisions - Repeals the Medicaid program. Makes this Act inapplicable to Medicare or Medicaid services furnished before 1994.

Division B: Transition and System - Building Provisions - Title I: Medicaid Expansion to Cover the Poor - Amends the Medicaid program to extend Medicaid coverage to all children whose income is below the Federal poverty level and whose resources do not exceed twice the limit for eligibility under title XVI (Supplemental Security Income) of the Social Security Act. Phases-in Medicaid coverage, by January 1, 1992, of all individuals whose income and resources do not exceed such limits.

Title II: Private Health Insurance Deduction for Self-Employed - Amends the Internal Revenue Code to provide a tax deduction for the entire health insurance costs of the self-employed.

Title III: Rural Health Care Development - Amends the Medicaid program to require that State Medicaid payments for rural medical practices reflect the particular costs of furnishing services in rural areas. Directs the Secretary, jointly with the States, to develop an appropriate system to reduce the payment differential between urban and rural professional health personnel.

Permits rural nursing facilities to elect to receive Medicaid payments on the basis of a daily rate schedule to be established by the Secretary. Permits rural home health agencies to elect to receive payments on the basis of a per visit rate to be established by the Secretary.

Provides Medicaid coverage of medical care access facility services. Requires such facilities to participate in the program.

Amends title VII (Administration) of the Act to place the Office of Rural Health Care in the Office of the Secretary of Health and Human Services.

Amends the Public Health Service Act to authorize the Secretary to make grants to States which have submitted fiscal year plans for comprehensive State rural health access planning to assist States in such planning. Authorizes appropriations for such grant program through FY 1992.

Requires each State to submit a comprehensive rural emergency medical services plan to the Secretary for each fiscal year, beginning with FY 1990. Authorizes appropriations through FY 1992 for payments to States, which vary among States on the basis of the proportion of the nation's rural population which reside in each State, to cover the costs of planning, implementing, and monitoring the operation of trauma care systems in rural areas.

Authorizes the Secretary to make grants to public and nonprofit entities for planning, constructing, equipping, supplying, and operating a rural health clinic and training the personnel at such clinic. Authorizes the Secretary to make grants to solo and small group medical practices which provide primary health services to medically underserved rural populations to assist such practices in purchasing equipment and supplies and training personnel. Sets forth grant conditions, including the requirement that such clinics and practices accept as patients Medicare and Medicaid recipients residing in their service area, and provide 24-hour-a-day emergency medical services. Authorizes appropriations through FY 1992.

Sets aside five percent of amounts appropriated to the National Center for Health Services Research and Health Care Technology Assessment for research on improving rural health care delivery systems. Directs the Secretary to conduct a study on improvements which can be made in the collection and analysis of data used in designating rural areas as medically underserved areas.

Amends the Public Health Service Act to require that a State's application for an Alcohol, Drug Abuse, and Mental Health Services Block Grant include an examination of the mental health care needs of rural residents and specify the effort that has and will be made to satisfy such needs.

Directs the Secretary to conduct research on improving rural mental health delivery systems. Authorizes appropriations for such research through FY 1992.

Title IV: Direct Reimbursement of Nurse Specialists - Amends the Medicaid program to require direct Medicaid reimbursement for certified nurse midwife, certified registered nurse anesthetist, nurse practitioner, and clinical nurse specialist services, whether or not such nurse is under the supervision of, or associated with, another health care provider, if such services would otherwise be covered if furnished by a physician or as an incident to a physician's services. Requires that such payments be equal to payments for such services under the Medicare program and not vary on the basis of the type of nurse involved.

Title V: Health Care Personnel Development - Amends the Public Health Service Act to authorize appropriations through FY 1992 under the National Health Service Corps Scholarship Program and Loan Repayment Program.

Requires the Secretary to establish a program of scholarships and loan repayments to assure an adequate supply of trained health care personnel at medical facilities which serve medically underserved populations. Requires that no less than 40 percent of the persons receiving such assistance be targeted for placement with medically underserved rural populations. Authorizes appropriations for such program through FY 1992.

Requires persons receiving Federal financial assistance under the Public Health Service Act to operate health care personnel training programs: (1) take into account the special health care conditions of rural areas; and (2) improve efforts to recruit, as students, individuals who are likely to practice in medically underserved rural areas.

Authorizes the Secretary to make grants to public or private nonprofit health or educational entities for training programs to increase the number of health care personnel and multi-competent health care technicians serving medically underserved rural populations. Authorizes appropriations for such grant programs through FY 1992.

Requires the Secretary, in entering into contracts with schools of medicine and osteopathy for area health education centers, to give priority to health education projects targeted toward health professions having an inadequate number of practitioners, either by specialty or geographic location. Makes administrative changes affecting area health education centers. Authorizes appropriations for such centers through FY 1992.

Authorizes the Secretary to make grants to and enter into contracts with public and nonprofit private entities to cover the costs of providing continuing education for nurses in rural areas through the use of satellite transmissions.

Title VI: Mental Health Care Development - Subtitle A: Amendments to Public Health Service Act - Amends the Public Health Service Act to reserve specified amounts of appropriations to the National Institute of Mental Health and to the National Institute on Aging for FY 1990 through 1992, which are in excess of FY 1989 appropriations, for research on the mental health and psycho-social well-being of elderly individuals. Amends the Older Americans Act of 1965 to authorize appropriations for FY 1990 through 1992 for research, development, and demonstration projects regarding the mental health of elderly individuals.

Requires the Secretary to enter into a contract with the Institute of Medicine of the National Academy of Sciences for the conduct of a study to determine methods for measuring and assuring the quality and effectiveness of mental health services and alcohol and drug abuse treatment services. Requires that the Institute complete such study and report to the Congress. Authorizes appropriations for FY 1990.

Directs the Secretary to provide for and report to the Congress by January 1, 1991, on additional studies: (1) comparing mental health services under prepaid health plans and in settings other than prepaid health plans; (2) examining mechanisms for ensuring the quality of, and access to, mental health services delivered by State, local, and independent mental health facilities; (3) examining minority access to community mental health centers; (4) examining the adequacy and optimal utilization of mental health manpower; and (5) examining the adequacy of minority mental health manpower and training. Authorizes the Secretary to conduct demonstration projects to determine methods of increasing minority access to community mental health centers. Authorizes appropriations for such studies and projects.

Subtitle B: Changes in Medicare and Medicaid Programs - Amends the Medicaid program to require Medicaid coverage of outpatient mental health services which would otherwise be covered if furnished by a physician.

Amends the Medicaid program to define an institution for mental diseases as an institution that has more than 16 beds and: (1) is under the jurisdiction of the State mental health authority; (2) advertises itself as primarily specializing in treating individuals with mental disease; or (3) is made up, for the most part, of patients who do not have a physical condition which in itself requires the level of services provided in a skilled nursing facility.

Amends the Medicare and Medicaid programs to require nursing facilities to provide access to medically necessary mental health services.

Amends part A (General Provisions) of title XI of the Act to impose additional conditions on mental health providers' participation in the Medicare and Medicaid programs. Includes among such conditions the requirements that each provider: (1) comply with the consumer bill of rights; (2) provide each consumer with written grievance procedures and written notice of the services to be provided; (3) have the capacity to identify potential clients, provide mental health services, and coordinate their services with those provided by others; and (4) engage in consumer needs assessment and care and discharge planning activities. Requires health maintenance organizations to ensure access to, and the quality of, the Medicaid outpatient mental health services they provide.

Requires peer review organization review of the mental health services for which payment is made under the Medicare or Medicaid program.

Directs the Secretary to ensure the reasonableness of Medicare reimbursement for nursing facility mental health services.

Title VII: Alzheimer's Assistance Development- Subtitle A: Grants to States for Alzheimers Disease Programs - Amends the Public Health Service Act to direct the Secretary to make grants to States to plan, establish, and operate programs to provide specified services regarding Alzheimer's or related disorders. Specifies purposes for which grant funds may not be used. Limits grants to three years, subject to annual evaluation by the Secretary. Limits the amount of a grant and its portion of the costs of the program for which it is made. Directs the Secretary to annually evaluate the grant programs. Authorizes the Secretary to contract with private entities to conduct the evaluation. Authorizes appropriations for FY 1990 through 1992.

Subtitle B: Improvement of Services Under Medicare and Medicaid Programs - Directs the Secretary of Health and Human Services to review the levels of Medicare reimbursement provided for home health services, extended care services, and inpatient hospital services relating to an advanced stage of Alzheimer's or a related disorder and adjust the levels to accurately reflect the reasonable amount required to provide adequately for services furnished.

Requires each State plan approved under title XIX (Medicaid) of the Social Security Act to report to the Secretary on how the levels of reimbursement under the plan for home health services, nursing facility services, inpatient hospital services, and community-based care take into account special needs regarding an advanced stage of Alzheimer's or a related disorder.

Directs the Secretary to modify contracts with utilization and quality control peer review organizations under part B (Peer Review) of title XI of the Social Security Act to ensure that the organizations conduct adequate and representative quality of care reviews on patients who require intensive home health services or extended care services.

Requires States, as a condition of approval of a State plan under Medicaid, to provide assurances that the State is providing for the conduct of adequate and representative quality of care reviews on patients who require intensive home health services, nursing facility services, or other long-term care services.

Directs the Secretary to review and report to the Congress regarding whether specified types of facilities participating under the Medicare or Medicaid program limit or restrict the services they provide to individuals with Alzheimer's or a related disorder.

Title VIII: Community and Migrant Health Centers Expansion - Amends the Public Health Service Act to authorize appropriations through FY 1991 for grants to migrant health centers and community health centers.