Community Health Care Act of 1991

Community Health Care Act of 1991 - Title I: Establishment Of Federal-State Partnership For The Provision Of Universal Health Insurance - Amends the Social Security Act to add a new title XXI under which is created a national health insurance program (the program) to be administered in each State through local health care districts established below. Entitles U.S. citizens and permanent U.S. residents residing in each local health care district to enroll in the State health care plan for that district which shall provide for a variety of specified standard benefits and services as well as preventive and long-term care services, services for pregnant women and children, and, at the option of the State, other benefits and services which the State Health Care Board established below determines are appropriate. Requires providers of such services to meet State certification standards similar to those under Medicare (title XVIII of the Social Security Act) for furnishing such services and other applicable safety standards as well in order to receive payment for plan services. Places limitations on the amount, duration, and scope of benefits and services to be provided under State plans, with exceptions for certain experimental services.

Details administrative provisions. Establishes within the Department of Health and Human Services the National Health Care Board which shall be responsible for the general administration of the program at the Federal level. Requires each State to establish a State Health Care Board which shall designate, according to specified criteria, geographic regions of the State to serve as local health care districts, unless the State demonstrates to the satisfaction of the National Board that such local districts are unnecessary in which case the program shall be under State administration. Provides for the use of area agencies on aging to administer long-term care benefits under the program in States without local health care districts. Establishes with respect to each local health care district a district health care board which shall establish payment rates for plan benefits and services and, at the option of the State, either serve as the single community insurer with overall responsibility for administering the State plan in that district or enter into agreements for the administration of the State plan in partnership with eligible private health benefit plans.

Requires each district board to establish a mechanism for enrolling in the State plan all eligible individuals residing in the local health care district.

Sets forth provisions governing the establishment by district boards of payment rates for plan services and the payment by district boards of service providers for services provided to district residents enrolled in the program, with payments made in advance on the basis of average per capita rates for individuals enrolled with private plans who are furnished benefits and services under the State plan.

Places restrictions on out-of-pocket expenses for plan benefits and services.

Provides for the establishment of annual budgets under State plans.

Establishes limitations on total payments under State plans.

Creates in the Treasury the Federal Health Care Trust Fund (trust fund) to receive funds generated from revenues dedicated to the support of the program.

Outlines provisions governing payments from the trust fund to the States for plan services, with reduced payments for States for which the National Board has established and is administering a State plan. Provides for adjustments to such Federal payments to reflect differences in the costs incurred by States under State plans.

Establishes the National Commission on Quality Assurance. Makes it the purpose of the Commission to enhance the quality, appropriateness, and effectiveness of health care services.

Delineates specific Commission duties. Includes as a duty the establishment of national minimum standards for health care providers to assure the quality of medical services. Requires the consideration of specified criteria in establishing such standards. Requires each State Health Care Board to provide for the appointment of a State Commission on Quality Assurance to: (1) facilitate the transfer of information to and from the National Commission; (2) gather information on medical practices in the State; (3) monitor the establishment of local health care district quality assurance boards in each health care district and develop rules and procedures for the operations of these district quality assurance review boards; and (4) hear appeals from and perform periodic reviews of quality review procedures conducted by local health care district quality assurance review boards.

Requires each district board to establish a local health care district quality assurance review board to: (1) review the performance of individuals and entities providing services in the district; (2) ensure the compliance of such individuals and entities with the minimum standards discussed above; (3) receive and hear complaints on service quality; (4) impose sanctions on individuals and entities that it finds to be out of compliance with such standards; and (5) provide technical assistance to such individuals and entities.

Sets forth requirements for State laws relating to medical malpractice liability.

Requires the National Board to make grants to eligible States for medical malpractice liability reform programs. Authorizes appropriations.

Requires State development of practice profiles with respect to practitioner services.

Discusses the assumption of State responsibilities by the National Board in cases of States without State plans.

Terminates specified Federal health benefit programs rendered superfluous by the enactment of this Act.

Title II: Financing Provisions - Amends the Internal Revenue Code to increase individual and top corporate income tax rates and excise taxes on cigarettes and distilled spirits as well as to make changes in social security taxes (including an increase in hospital insurance tax rates) to generate revenues to support the program established under title I. Directs the National Health Care Board to recommend to the Congress increases in other excise taxes resulting in additional specified annual revenues.