Small Business Health Care Reform Act of 1991

Small Business Health Care Reform Act of 1991 - Title I: Improvements in Health Insurance Affordability for Small Employers - Amends the Internal Revenue code to raise from 25 to 100 percent the deduction allowed to self-employed individuals for health insurance premiums and makes the deduction permanent.

Directs the Secretary of Health and Human Services (the Secretary) to make grants to up to 15 States for the establishment and operation of small employer health insurance purchasing programs. Permits grant funds to be used to finance administrative costs associated with developing and operating a group purchasing program for small employers. Authorizes appropriations.

Title II: Improvements in Health Insurance for Small Employers - Amends the Social Security Act to add a new title, Title XXI: Standards for Small Employer Health Insurance and Certification of Managed Care Plans. Directs the Secretary to develop standards concerning requirements for health insurance plans for small employers. Requires such plans to provide for: (1) guaranteed eligibility; (2) guaranteed availability; and (3) guaranteed renewability. Prohibits: (1) an insurer from refusing to renew or terminate a plan, except for nonpayment of premiums, fraud, or failure to maintain minimum participation rates; and (2) for certain services, discrimination based on health status. Sets limits controlling the variation of premium charges permitted among all small employers insured by an insurer. Requires the full disclosure of an insurer's rating practices.

Requires a health insurance plan for small employers to offer: (1) both a standard benefit package and basic benefit package; and (2) a managed care option, if the insurer also offers such an option to other employers. Provides, under both the standard and basic package, for coverage of: (1) inpatient and outpatient hospital care; (2) inpatient and outpatient physician services; (3) diagnostic tests; and (4) preventive services. Provides, in addition, under the standard plan: (1) for the coverage of certain mental health care; (2) that, except as specified, there will be no limits on the amount, scope, or duration of benefits, and (3) for specified limits on deductibles, copayment, coinsurance, and out-of-pocket expenses. Provides under the basic plan that: (1) premiums, deductibles, copayments, or other cost-sharing may be imposed; and (2) there shall be an out-of-pocket limit.

Amends the Internal Revenue Code to impose an excise tax of 25 percent of gross premiums on the issuer of any health insurance plan to a small employer if the plan does not meet the requirements of title XXI.

Sets forth study and reporting requirements.

Title III: Improvements in Portability of Private Health Insurance - Imposes an excise tax of $100 per day, with respect to a covered individual, on a group health plan for its failure to provide coverage for a preexisting condition, subject to stated exceptions.

Title IV: Health Care Cost Containment - Establishes a Health Care Cost Commission which shall report annually to the President and the Congress on national health care costs. Authorizes appropriations.

Requires the Secretary of Health and Human Services, under title XXI of the Social Security Act, to establish a process for the certification of managed care plans and of utilization review programs. Sets forth requirements for certification.

Amends the Public Health Service Act to direct the Administrator of the Agency for Health Care Policy and Research to develop outcomes research and practice parameters for mental health services, including at least the diagnosis and treatment of childhood attention deficit syndrome disorders and manic depression. Amends Part A (General Provisions) of title XI of the Social Security Act to authorize appropriations for research outcomes of health care services and procedures.

Mandates development of uniform claims forms for use by beneficiaries and health care providers in submitting claims under group health plans and titles XVIII (Medicare) and XIX (Medicaid) of the Social Security Act.

Amends the Public Health Service Act to include entities receiving Federal funds under provisions relating to migrant health centers, community health centers, or health services for the homeless, and officers, employees, or contractors of such entities who are licensed health care practitioners, in the coverage of provisions regulating civil actions for injury resulting from medical or related functions against commissioned officers or employees of the Public Health Service. Subrogates to the United States any insurance claim such an entity or person has.

Prohibits grants under provisions relating to migrant or community health centers or health services for the homeless unless the applicant has: (1) implemented policies and procedures to assure against malpractice; (2) reviewed the professional credentials, claims history, and other information regarding its licensed health care practitioners; and (3) no history of claims against it under such provisions relating to officers and employees of the Public Health Service, or has cooperated with the Attorney General in defending against such claims and has taken corrective action.

Empowers the Attorney General, if certain conditions are met, to determine that an individual practitioner shall not be deemed a Public Health Service employee for purposes of these provisions.

Prohibits hospitals from denying admitting privileges to an otherwise qualified health care provider who is an officer, employee, or contractor of such an entity.

Title V: Medicare Prevention Benefits - Amends part B (Supplementary Medical Insurance Benefits for the Aged and Disabled) of title XVIII (Medicare) of the Social Security Act to establish frequency and payment limits for screening for fecal-occult blood tests and screening flexible sigmoidoscopies.

Amends part C (Miscellaneous Provisions) of title XVIII to provide coverage for tetanus-diphtheria booster and its administration.

Provides Medicare coverage for well-child services which is to include routine office visits, immunizations, laboratory tests, and preventive dental care.

Expands the coverage of a screening mammography to provide for one such screening annually for all covered women over age 49.

Directs the Secretary to establish and provide for a series of ongoing demonstration projects which provide coverage for specified preventive services, including: (1) glaucoma screening; (2) cholesterol screening; (3) osteoporosis screening and treatment; (4) screening services for pregnant women; (5) assessments for individuals beginning at age 65 or 75; and (6) other appropriate services. Authorizes appropriations.

Directs the Director of the Office of Technology Assessment to study and report concerning the development of a process for the regular review for the consideration of coverage of preventive services under Medicare.