Improvements to the HealthAmerica Act of 1991

Improvements to the HealthAmerica Act of 1991 - Title I: Cost Containment - Subtitle A: Federal Health Expenditure Board - Amends the Public Health Service Act to establish as an independent agency in the executive branch the Federal Health Expenditure Board.

Amends the Public Health Service Act and, using similar language, the Social Security Act to require the Board to take specified actions, including: (1) developing national health care expenditure, access, and quality goals; (2) convening and overseeing negotiations between providers and purchasers to develop payment rates regarding those expenditure goals; (3) establishing payment levels and other measures to achieve the goals; (4) establishing measures for the allocation of capital; (5) developing State and regional goals; (6) establishing uniform billing and claim forms and mandatory reporting requirements; and (7) recommending rates, budgets, and other measures.

Mandates that the Board require negotiations regarding physician, hospital care, and pharmaceutical products. Allows the Board to require negotiations concerning other health care sectors.

Declares that the Board shall determine which individuals, organizations, and institutions are eligible for representation by negotiators. Sets forth procedures and requirements regarding approval of an organization or individual as a negotiator.

Sets forth requirements regarding payment systems adopted for hospitals or physicians.

Requires the Board, when negotiators for a sector fail to reach an agreement, to promulgate regulations recommending advisory rates and other measures to achieve the goals.

Imposes a civil monetary penalty on a provider assessing or a purchaser paying rates other than those required. Provides for temporary injunctive relief.

Requires the Board to recommend rates for all Federal programs that reimburse providers on a fee, charge, or cost basis or charge third-party providers on such basis. Exempts from that requirement: (1) with regard to the amendments to the Public Health Service Act, programs under titles XVIII (Medicare), XIX, (Medicaid), or XXI (AmeriCare) of the Social Security Act; and (2) with regard to the amendments to the Social Security Act, programs under such title XVIII.

Allows a State consortium, with the approval of the Board, to establish an alternative payment system, rates, and methods for achieving Board goals.

Requires the Board to establish a system of uniform billing and reporting to enable the Board to determine the progress in meeting the goals, enable providers and purchasers to provide and obtain efficiently provided care, and reduce administrative costs of the health care system. Directs the Secretary to develop and implement methodologies that will measure the effectiveness of the health care service provided by health care providers.

Amends Federal law to add members of the Board to the list of positions paid at levels III and IV of the Executive Schedule.

Amends the Social Security Act to require the Board to make recommendations regarding hospital and physician services.

Subtitle B: State Purchasing Consortia - Amends the Public Health Service Act to mandate establishment in each State of a consortium open to all providers and purchasers of health insurance and health care in the State. Directs the Secretary of Health and Human Services to make a grant to each State for establishment and initial operation of the consortium.

Amends the Public Health Service Act and, using similar language, the Social Security Act to list optional consortium functions, including: (1) permitting or requiring insurers with a large market share in a State to participate in the consortium; and (2) convening negotiations with providers, purchasers, and others on service availability, coverage and reimbursement levels, and claim submission and payment procedures. Exempts such negotiations, if authorized by the State, from Federal anti-trust laws.

Sets forth the mandatory consortium functions, including: (1) enrolling all small share health insurance companies in the State as consortium members; (2) establishing a claim payment fund and payment procedures, with the fund to be capitalized through public and private contributions and assessments by the consortium on such enrollees; (3) developing and using uniform billing and claim forms and procedures consistent with subtitle A of this title; and (4) attempting to reduce administrative costs and burdens on enrollees and providers through specified measures.

Declares that the Consumer Product Safety Act and other Federal consumer protection laws apply to the mandatory consortium functions.

Allows States to enter into an agreement for the establishment of a regional consortium.

Declares that a State that fails to comply with the requirements regarding consortia shall be ineligible: (1) with regard to the amendments to the Public Health Service Act, to receive assistance under that Act; and (2) with regard to the amendments to the Social Security Act, to receive payments to States under specified provisions of that Act.

Amends the Public Health Service Act to authorize appropriations to carry out provisions relating to the consortia.

Title II: State Single Payer Option - Authorizes a State to establish a universal health care system for its residents, supported by revenues generated from State tax assessments, if the system provides for universal health care coverage for all State residents at least as comprehensive as the coverage required by this Act and its amendments. Provides for matching Federal contributions in an amount equal to what the Federal contributions would have been had the State established an AmeriCare program under the HealthAmerica Act. Requires a State establishing a State system to establish a cost containment program approved by the Board.

Authorizes the Secretary of Health and Human Services such sums as necessary to make three-year grants to two States establishing such a system.

Title III: Coverage of Early Retirees, Strikers and Individuals Whose Employers' Businesses Have Failed - Directs the Secretary of Health and Human Services, subject to changes to finance this provision, to promulgate regulations to expand coverage under Medicare to provide full coverage to retired individuals at a younger age than currently covered. Requires that early retirees who are not eligible for Medicare, individuals on strike, and individuals who are unemployed as a result of the failure of their previous employer's business be eligible for coverage under the AmeriCare program in the State of their residence. Provides for premiums and cost sharing.

Title IV: Accelerated Implementation of Certain Provisions - Requires that the requirements of specified provisions of the HealthAmerica Act and their amendments apply to all employers on January 1 of the second full year after enactment of this Act.

Title V: Insurance Reform - Amends the Employee Retirement Income Security Act of 1974 (ERISA) to declare that certain provisions of ERISA supersede any State law relating to benefits under provisions of the Public Health Service Act added by title I of this Act. Includes benefit plans under that title in the ERISA definitions of "employee welfare benefit plan" and "welfare plan."

Amends the Public Health Service Act to prohibit issuing a health benefit plan in a State, or offering a new contract under such a plan with respect to a small employer (defined as having fewer than 100 employees), unless the plan meets certain standards under this Act.

Provides for: (1) complaints by individuals and entities respecting potential violations of certain requirements; (2) investigations and related procedures; and (3) enforcement, including cease and desist orders, civil monetary penalties, and orders to take other corrective action. Requires penalties collected to be credited to the AmeriCare Trust Fund.

Directs the Secretary to develop standards to implement requirements of these provisions.

Requires establishment of a toll-free telephone number to: (1) handle consumer complaints or inquiries; and (2) provide information to small employers and consumers about carriers that offer plans in the area.

Mandates periodic audits of State regulatory programs by the Comptroller General to determine compliance with these provisions.

Requires carriers offering a plan to small employers to offer the same plan to any other small employer in the community. Allows: (1) health maintenance organizations (HMOs) to have geographic and size limitations; and (2) carriers to require participation by a minimum percentage of employees. Requires, at the option of the business, plan renewability under the same terms as for issuance, except for rates and administrative changes. Regulates rate changes.

Requires premiums for plans offered to small employers to be based on a single cohesive rating system applied consistently for all small employer groups and designed not to treat groups, after the fourth year after enactment of this Act, differently based on health or risk status. Requires the lowest rate for plans with similar benefits within a block of business to be the same for all small employers. Limits the percentage by which the premium rate for the most expensive block of business may exceed the rate for the least expensive block of business. Allows limited variation in premium rates for: (1) different age and gender groups; and (2) employers who elect, under provisions of this Act, reimbursement under Medicare.

Requires plans offered to small employers to permit enrollment and compute premiums based on four specified beneficiary classes.

Requires plans offered to small employers to: (1) cover all basic health services specified in certain provisions; and (2) not impose cost-sharing in excess of that permitted by those provisions. Requires the carrier, except HMOs, to offer to the small employer a plan that only provides basic services and maximum cost-sharing. Requires a carrier (other than an HMO or a reinsurance carrier) which offers a managed care plan to an employer that is not a small employer to make a managed care plan available to small employers in the same community.

Requires the Secretary to develop a model to standardize benefits offered to small employers to promote consumer understanding and comparison among plans.

Sets forth miscellaneous disclosure and recordkeeping requirements for health benefit plans offered to small employers.

Requires each small business insurer to offer certain types of plans. Allows each such insurer to offer additional types. Directs the Secretary to publish a description of the plans offered in each State to facilitate comparison. Requires: (1) the description to include an enrollment form; and (2) insurers to enroll eligible persons submitting that form.