S. 2346 — BasiCare Health Access and Cost Control Act

 
S 2346 IS
102d CONGRESS
2d Session
S. 2346
To provide for comprehensive health care access expansion and cost control
through standardization of private health care insurance and other means.
IN THE SENATE OF THE UNITED STATES
MARCH 12 (legislative day, JANUARY 30), 1992
Mrs. KASSEBAUM introduced the following bill; which was read twice and
referred to the Committee on Finance
A BILL
To provide for comprehensive health care access expansion and cost control
through standardization of private health care insurance and other means.
  Be it enacted by the Senate and House of Representatives of the United
  States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
  (a) SHORT TITLE- This Act may be cited as the `BasiCare Health Access and
  Cost Control Act'.
  (b) TABLE OF CONTENTS- The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
TITLE I--IMMEDIATE REFORMS
Subtitle A--Small Employer Health Insurance Market Reform
Sec. 101. General requirements.
Sec. 102. General issuance requirements.
Sec. 103. Specific contractual requirements.
Sec. 104. State compliance agreements.
Sec. 105. Definitions and other rules.
Sec. 106. Amendment to the Internal Revenue Code of 1986.
Sec. 107. Effective date.
Subtitle B--Community Health Services Expansion
Sec. 111. Establishment of grant program.
Sec. 112. Program to provide for expansion of federally qualified health
centers.
Subtitle C--Expansion of Tax Incentives for Self-Employed Individuals
Sec. 121. Permanent increase in deductible health insurance costs for
self-employed individuals.
Subtitle D--Expanding the Supply of Health Professionals in Rural Areas
Sec. 131. Expansion of National Health Service Corps.
Sec. 132. Tax incentives for practice in rural areas.
Subtitle E--Malpractice Reform
Part I--Definitions
Sec. 141. Definitions.
Part II--Tort Reform of Health Care Liability Actions
Sec. 142. Application to civil actions.
Sec. 143. Damages.
Sec. 144. Joint and several liability.
Sec. 145. Statute of limitations.
Sec. 146. Preemption.
Sec. 147. Effective date.
Part III--Alternative Dispute Resolution Systems
Sec. 148. Grants for alternative dispute resolution systems.
Sec. 149. Establishment of advisory panel.
Sec. 150. Authorization.
Part IV--Demonstration Projects For No-Fault Compensation Programs
Sec. 151. Demonstration projects for no-fault compensation programs.
Subtitle F--Joint Ventures
Sec. 161.  Amendment of the National Cooperative Research Act of 1984.
TITLE II--LONG-TERM REFORMS
Subtitle A--Establishment of Commission and Advisory Board
Sec. 201. The Commission on National Health Care Access and Reform.
Sec. 202. National Advisory Board.
Sec. 203. Authorization of appropriations.
Subtitle B--Reform and Standardization of Private Insurance
Sec. 211. Defining goals and guidelines of Commission.
Sec. 212. Development and submission of legislative proposal.
Sec. 213. Continuing duties and responsibilities of the Commission.
Sec. 214. BasiCare benefits package.
Sec. 215. Insurance responsibilities under BasiCare.
Sec. 216. BasiCare base premium rate.
Sec. 217. Employer responsibilities under BasiCare.
Sec. 218. Individual responsibilities under BasiCare.
Sec. 219. Self-insured plan requirements.
Sec. 220. Development of standards for managed care plans.
Sec. 221. Preemption of provisions relating to managed care.
Subtitle C--Low-Income Assistance
Sec. 231. Transfer from medicaid to BasiCare.
Sec. 232. Low-income assistance with costs of BasiCare insurance.
Subtitle D--Congressional Consideration of Commission Recommendation
Sec. 241. Rules governing congressional consideration.
Subtitle E--Enforcement Provisions
Sec. 251. Enforcement provisions for carriers, providers, and employers.
Sec. 252. Enforcement provision for individuals.
Subtitle F--Financial Provisions
Sec. 261. BasiCare Trust Fund.
Sec. 262. Tax treatment of costs of BasiCare insurance.
Subtitle G--Definitions
Sec. 271. Definitions.
TITLE I--IMMEDIATE REFORMS
Subtitle A--Small Employer Health Insurance Market Reform
SEC. 101. GENERAL REQUIREMENTS.
  Any person issuing an accident and health insurance contract to any small
  employer shall meet the requirements of sections 102 and 103.
SEC. 102. GENERAL ISSUANCE REQUIREMENTS.
  (a) GENERAL RULE- The requirements of this section are met if any person
  issuing an accident and health insurance contract to any small employer
  meets--
  (1) the mandatory policy requirements of subsection (b), and
  (2) the guaranteed issue requirements of subsection (c).
  (b) MANDATORY POLICY REQUIREMENTS-
  (1) IN GENERAL- The requirements of this subsection are met if any person
  issuing an accident and health insurance contract to any small employer
  makes available to such small employer an accident and health insurance
  contract which provides benefits which are identical to the core benefits
  described in subsection (d).
  (2) PRICING AND MARKETING REQUIREMENTS- The requirements of paragraph (1)
  are not met unless--
  (A) the price at which the accident and health insurance contract is made
  available is not greater than the price for such contract determined on
  the same basis as prices for other accident and health insurance contracts
  within the same class of business made available by the person to small
  employers, and
  (B) the accident and health insurance contract is made available to small
  employers using substantially the same marketing methods and other sales
  practices which are used in selling such other contracts.
  (c) GUARANTEED ISSUE-
  (1) IN GENERAL- The requirements of this subsection are met--
  (A) if the person offering accident and health insurance contracts to
  small employers issues such contracts to any small employer seeking to
  enter into such a contract, and
  (B) if the person offers a managed care arrangement in a State, or a
  geographic area within a State, to employers that are not small employers,
  the person offers such managed care arrangement to small employers in the
  State or geographic area.
  (2) FINANCIAL CAPACITY EXCEPTION- Paragraph (1)(A) shall not require any
  person to issue an accident and health insurance contract to the extent
  that the issuance of such contract would result in such person violating
  any financial solvency standards established by the State in which such
  contract is to be issued.
  (3) EXCEPTIONS FOR CERTAIN EMPLOYERS- Paragraph (1)(A) shall not apply to
  a failure to issue an accident and health insurance contract to a small
  employer if--
  (A) the small employer is unable to pay the premium for such contract, or
  (B) in the case of a small employer with fewer than 15 employees, such
  employer fails to enroll at least 60 percent of the employer's eligible
  employees for coverage under such contract.
  (4) SIZE LIMITS FOR MANAGED CARE ARRANGEMENTS- Paragraph (1)(B) shall not
  apply to any person who ceases to enroll new small employer groups in a
  managed care arrangement if it ceases to enroll any new employer groups
  in such arrangement.
  (d) BENEFITS-
  (1) CORE BENEFITS- For purposes of this section, the term `core benefits'
  means benefits which are the same benefits provided as of the date of
  the enactment of this Act under title XVIII of the Social Security Act to
  individuals entitled to benefits under part A, and enrolled for benefits
  under part B of such title.
  (2) DEDUCTIBLES AND COPAYMENTS- An accident and health insurance contract
  shall not be treated as providing the core benefits described in paragraph
  (1) unless the following requirements are met:
  (A) DEDUCTIBLE- The accident and health insurance contract does not require
  a deductible amount for any contract year in excess of $500 per individual
  or $1,000 per family with respect to the core benefits.
  (B) LIMIT ON OUT-OF-POCKET EXPENSES- The accident and health insurance
  contract does not require out-of-pocket expenses for any contract year in
  excess of $2,000 per individual or $3,000 per family for the core benefits.
  (C) CHILDREN-
  (i) NO DEDUCTIBLES OR COINSURANCE- In the case of children, there shall be
  no coinsurance, deductibles, or copayments applicable to covered benefits
  described in clause (ii).
  (ii) ADDITIONAL PREVENTIVE BENEFITS- Subject to the periodicity schedule
  established under clause (iii), benefits shall be available for children
  under the accident and health insurance contract for the following items
  and services:
  (I) Newborn and well-baby care, including normal newborn care and
  pediatrician services for high-risk deliveries.
  (II) Well-child care, including routine office visits, routine immunizations
  (including the vaccine itself), routine laboratory tests, and preventive
  dental care.
  (iii) PERIODICITY SCHEDULE- The Secretary, in consultation with the American
  Academy of Pediatrics, shall establish a schedule of periodicity which
  reflects the general, appropriate frequency with which services listed in
  clause (ii) should be provided to healthy children.
  (iv) CHILD DEFINED- For purposes of this subparagraph, the term `child'
  means an individual who has not attained age 23.
  (D) PREGNANCY-RELATED SERVICES-
  (i) NO DEDUCTIBLES OR COINSURANCE- In the case of a pregnant woman, there
  shall be no coinsurance, deductibles, or copayments applicable to covered
  benefits described in clause (ii).
  (ii) ADDITIONAL BENEFITS- Subject to the periodicity schedule established
  under clause (iii), benefits shall be available for pregnant women under the
  accident and health insurance contract for the following items and services:
  (I) Prenatal care, including care for all complications of pregnancy.
  (II) Inpatient labor and delivery services.
  (III) Postnatal care.
  (IV) Postnatal family planning services.
  (iii) PERIODICITY SCHEDULE- The Secretary, in consultation with the
  American College of Obstetrics and Gynecology, shall establish a schedule
  of periodicity which reflects the general, appropriate frequency with
  which services listed in clause (ii) should be provided to pregnant women
  without complications of pregnancy.
  (iv) PREGNANT WOMAN- For purposes of this subparagraph, the term `pregnant
  woman' means a woman who has been certified by a physician (in a manner
  specified by the Secretary) as being pregnant and such woman shall be a
  pregnant woman for the purposes of this subparagraph until the last day of
  the month in which the 60-day period beginning on the date of termination
  of the pregnancy ends.
  (3) PREEMPTION- To the extent that the laws of any State or local government
  regulate or otherwise provide any requirement relating to the benefits
  to be provided under an accident and health insurance contract which are
  inconsistent with the provisions of this Act, they are preempted.
SEC. 103. SPECIFIC CONTRACTUAL REQUIREMENTS.
  (a) GENERAL RULE- The requirements of this section are met if any person
  issuing an accident and health insurance contract to any small employer
  meets--
  (1) the coverage requirements of subsection (b), and
  (2) the rating requirements of subsection (c).
  (b) COVERAGE REQUIREMENTS-
  (1) IN GENERAL- The requirements of this subsection are met with respect
  to any accident and health contract if, under the terms and operation of
  the contract, the following requirements are met:
  (A) GUARANTEED ELIGIBILITY- No eligible employee (and the spouse or any
  dependent child (as defined in section 102(d)(2)(C)(iv)) of the employee
  eligible for coverage) may be excluded from coverage under the contract.
  (B) LIMITATIONS ON COVERAGE OF PREEXISTING CONDITIONS- Any limitation
  under the contract on any preexisting condition--
  (i) may not extend beyond the 6-month period beginning with the date an
  insured individual is first covered by the contract, and
  (ii) may only apply to preexisting conditions which manifested themselves,
  or for which medical care or advice was sought or recommended, during the
  3-month period preceding the date an insured individual is first covered
  by the contract.
  (C) GUARANTEED RENEWABILITY-
  (i) IN GENERAL- The contract must be renewed at the election of the small
  employer unless the contract is terminated for cause.
  (ii) CAUSE- For purposes of this subparagraph, the term `cause'--
  (I) includes nonpayment of premiums, fraud or misrepresentation,
  noncompliance with contract provisions (including participation
  requirements), or misuse of network provisions, but
  (II) does not include any reason related to risk characteristics.
  (2) WAITING PERIODS- Paragraph (1)(A) shall not apply to any period an
  eligible employee is excluded from coverage under the contract solely by
  reason of a requirement applicable to all employees that a minimum period
  of service with the employer is required before the employee is eligible
  for such coverage.
  (3) DETERMINATION OF PERIODS FOR RULES RELATING TO PREEXISTING CONDITIONS-
  For purposes of paragraph (1)(B), the date on which an insured individual
  is first covered by an accident and health insurance contract shall be
  the earlier of--
  (A) the date on which coverage under such contract begins, or
  (B) the first day of any continuous period--
  (i) during which the insured individual was covered under 1 or more other
  health insurance arrangements, and
  (ii) which does not end more than 120 days before the date employment for
  the employer begins.
  (4) CESSATION OF SMALL EMPLOYER HEALTH INSURANCE BUSINESS-
  (A) IN GENERAL- Except as otherwise provided in this paragraph, a person
  shall not be treated as failing to meet the requirements of paragraph
  (1)(C) if such person terminates the class of business which includes the
  accident and health insurance contract.
  (B) NOTICE REQUIREMENT- Subparagraph (A) shall apply only if the person
  gives notice of the decision to terminate at least 90 days before the
  expiration of the contract.
  (C) 5-YEAR MORATORIUM- If, within 5 years of the year in which a person
  terminates a class of business under subparagraph (A), such person
  establishes a new class of business which includes contracts within the
  class of business so terminated, the issuance of such contracts in that year
  shall be treated as a failure to meet the requirements of paragraph (1)(C).
  (D) TRANSFERS- If, upon a failure to renew a contract to which subparagraph
  (A) applies, a person transfers such contract to another class of business,
  such transfer must be made without regard to any risk characteristic.
  (c) RATING REQUIREMENTS- The requirements of this subsection are met with
  respect to any accident and health contract if the following requirements
  are met:
  (1) LIMITATION ON VARIATION OF PREMIUMS BETWEEN CLASSES OF BUSINESS-
  (A) IN GENERAL- The base premium rate for any class of business of a person
  issuing an accident and health insurance contract to a small employer may
  not exceed the base premium rate for any other class of business by more
  than 20 percent.
  (B) EXCEPTIONS- Subparagraph (A) shall not apply to a class of business
  if the applicable regulatory authority determines that--
  (i) the class is one for which the person does not reject, and never has
  rejected, small employers included within the definition of employers
  eligible for the class of business or otherwise eligible employees and
  dependents who enroll on a timely basis, based upon their claims experience,
  health status, industry, or occupation,
  (ii) the person does not transfer, and never has transferred, an accident
  and health insurance contract involuntarily into or out of the class of
  business, and
  (iii) accident and health insurance contracts offered under the class of
  business are currently available for purchase by small employers at the
  time an exception to subparagraph (A) is sought by the person.
  (2) LIMIT ON VARIATION IN PREMIUM RATES WITHIN A CLASS OF BUSINESS- For
  a class of business of a person issuing an accident and health insurance
  contract to a small employer, the highest premium rates charged during a
  rating period to small employers with similar demographic characteristics
  (including age, sex, and geography and not relating to claims experience,
  health status, industry, occupation, or duration of coverage since issue)
  for the same or similar coverage, or the highest rates which could be
  charged to such employers under the rating system for that class of
  business, shall not exceed an amount that is 1.5 times the base premium
  rate for the class of business for a rating period (or portion thereof)
  that occurs in the first 3 years in which this subsection is in effect,
  and 1.35 times the base premium rate thereafter.
  (3) CONSISTENT APPLICATION OF RATING FACTORS- In establishing premium rates
  for any accident and health insurance contract offered to small employers--
  (A) the person making adjustments with respect to age, sex, or geography
  must apply such adjustments consistently across small employers, and
  (B) no person may use a geographic area that is smaller than a county
  or smaller than an area that includes all areas in which the first three
  digits of the zip code are identical, whichever is smaller.
  (4) LIMIT ON TRANSFER OF EMPLOYERS AMONG CLASSES OF BUSINESS-
  (A) IN GENERAL- A person issuing an accident and health insurance contract
  to a small employer may not transfer a small employer from one class of
  business to another without the consent of the employer.
  (B) OFFERS TO TRANSFER- The person may not offer to transfer a small
  employer from one class of business to another unless--
  (i) the offer is made without regard to age, sex, geography, claims
  experience, health status, industry, occupation or the date on which the
  policy was issued, and
  (ii) the same offer is made to all other small employers in the same class
  of business.
  (5) LIMITS ON VARIATION IN PREMIUM INCREASES- The percentage increase
  in the premium rate charged to a small employer for a new rating period
  (determined on an annual basis) may not exceed the sum of the percentage
  change in the base premium rate plus 5 percentage points.
  (6) FULL DISCLOSURE OF RATING PRACTICES-
  (A) IN GENERAL- At the time a person offers an accident and health
  insurance contract to a small employer, the person shall fully disclose
  to the employer all of the following:
  (i) Rating practices for small employer accident and health insurance
  contracts, including rating practices for different populations and
  benefit designs.
  (ii) The extent to which premium rates for the small employer are based
  on risk characteristics and on factors other than risk characteristics.
  (iii) The provisions concerning the person's right to change premium rates,
  the extent to which premiums can be modified, and the factors which affect
  changes in premium rates.
  (iv) The class of business within which the contract falls, including a
  description of the grouping of contracts within a class of business.
  (B) NOTICE ON EXPIRATION- A person issuing accident and health insurance
  contracts to small employers shall provide for notice, at least 60 days
  before the date of expiration of the accident and health insurance contract,
  of the terms for renewal of the contract. Such notice shall include an
  explanation of the extent to which any increase in premiums is due to
  actual or expected claims experience of the individuals covered under the
  small employer's accident and health insurance contract.
  (7) ACTUARIAL CERTIFICATION- Each person issuing an accident and health
  contract to a small employer shall file annually with the applicable
  regulatory authority a written statement by a qualified health actuary
  (or other individual acceptable to such authority) that, based upon an
  examination by the individual which includes a review of the appropriate
  records and of the actuarial assumptions of the person and methods used
  by the person in establishing premium rates for small employer accident
  and health insurance contracts--
  (A) the person is in compliance with the applicable provisions of this
  subsection, and
  (B) the rating methods are actuarially sound.
  (8) RECORDKEEPING- Each person issuing an accident and health insurance
  contract to a small employer shall retain for examination at its principal
  place of business a complete and detailed description of its rating and
  renewal underwriting practices and the information on which such practices
  are based, including the statement described in paragraph (7).
SEC. 104. STATE COMPLIANCE AGREEMENTS.
  (a) AGREEMENTS- The Secretary may, in the discretion of the Secretary,
  enter into an agreement with any State--
  (1) to apply the standards set by the laws of such State for accident and
  health insurance contracts issued by any person to any small employer in
  lieu of the requirements of section 102, or
  (2) to provide for the State to make the initial determination as to
  whether a person is in compliance with the provisions of section 102.
  (b) STANDARDS- An agreement may be entered into under subsection (a)(1)
  only if--
  (1) the chief executive officer of the State requests such agreement be
  entered into,
  (2) the Secretary determines that the State standards to be applied under
  the agreement will apply to substantially all accident and health insurance
  contracts issued to small employers in such State, and
  (3) the Secretary determines that the application of the State standards
  will carry out the purposes of section 102.
  (c) LIMITATION ON WAIVER- Any agreement entered into under subsection (a)(1)
  shall not waive the mandatory policy requirements under section 102(b).
  (d) TERMINATION- The Secretary shall terminate any agreement if the
  Secretary determines that the application of State standards ceases to
  carry out the purposes of this section.
SEC. 105. DEFINITIONS AND OTHER RULES.
  For purposes of this subtitle:
  (1) ACCIDENT AND HEALTH INSURANCE CONTRACT-
  (A) IN GENERAL- The term `accident and health insurance contract'
  means a contract under which a person authorized under applicable State
  insurance laws provides a health insurance plan or arrangement to a small
  employer. Such term does not include any self-insured plan of an employer.
  (B) CERTAIN CONTRACTS NOT COVERED- The term  `accident and health insurance
  contract' does not include any contract--
  (i) which provides for accident only, dental only, or disability only
  coverage,
  (ii) which provides coverage as a supplement to liability insurance,
  (iii) which provides insurance arising out of a workmen's compensation or
  similar law, or automobile medical-payment insurance, or
  (iv) which provides insurance which is required by law to be contained
  under any self-insured plan of an employer.
  (2) BASE PREMIUM RATE- The term `base premium rate' means, for each class
  of business for each rating period, the lowest premium rate which could
  have been charged under a rating system for that class of business by the
  person issuing accident and health insurance contracts to small employers
  with similar demographic or other relevant characteristics (including age,
  sex, and geography and not relating to claims experience, health status,
  industry, occupation or duration of coverage since issue) for accident
  and health insurance contracts with the same or similar coverage.
  (3) CLASS OF BUSINESS-
  (A) IN GENERAL- Except as provided in subparagraph (B), the term `class
  of business' means, with respect to a person, all of the small employers
  with an accident and health insurance contract issued by the person.
  (B)  DISTINCT GROUPS-
  (i) IN GENERAL- Subject to clause (ii), a distinct group of small employers
  with accident and health insurance contracts issued by a person may be
  treated as a class of business by such person if all of the contracts in
  such group--
  (I) are marketed and sold through individuals and organizations that do not
  participate in the marketing or sale of other distinct groups by the person,
  (II) have been acquired from another person as a distinct group, or
  (III) are provided through an association with membership of not less than
  25 small employers that has been formed for purposes other than obtaining
  health insurance.
  (ii) EXCEPTION ALLOWED- Except as provided in subparagraph (C), a person
  may not establish more than one distinct group of small employers for each
  category specified in clause (i).
  (C) SPECIAL RULE- A person may establish up to 2 groups under each category
  in subparagraph (A) or (B) to account for differences in characteristics
  (other than differences in contract benefits) of accident and health
  insurance contracts that are expected to produce substantial variation in
  health care costs.
  (4) MANAGED HEALTH CARE ARRANGEMENT- The term `managed health care
  arrangement' means an arrangement which integrates the financing and delivery
  of health care services to covered individuals by employing the following:
  (A) Contracts with selected health care providers to furnish health care
  services to members.
  (B) The adoption of explicit standards for the selection and recertification
  of providers.
  (C) An explicit, formal program for ongoing quality assurance and
  utilization review.
  (D) Significant financial incentives for members to use the providers and
  procedures associated with the arrangement.
  (5) CHARACTERISTICS-
  (A) IN GENERAL- The term `characteristics' means, with respect to any
  insurance rating system, the factors used in determining rates.
  (B) RISK CHARACTERISTICS- The term `risk characteristics' means factors
  related to the health risks of individuals, including health status,
  prior claims experience, the duration since the date of issue of a health
  insurance plan or arrangement, industry, and occupation.
  (C) GEOGRAPHIC FACTORS- In applying geographic location as a characteristic,
  a person may not use for purposes of this subtitle areas smaller than Census
  Bureau designations of metropolitan statistical areas and nonmetropolitan
  statistical areas.
  (6) ELIGIBLE EMPLOYEE- The term `eligible employee' means, with respect to
  an employer, any employee who normally works at least 30 hours per week
  for that employer. For purposes of this paragraph, the term `employee'
  includes a self-employed individual as defined in section 401(c)(1) of
  the Internal Revenue Code of 1986.
  (7) PERSON- The term `person' includes a licensed insurance company, a
  prepaid hospital or medical service plan, a health maintenance organization,
  or in States which have distinct insurance licensure requirements, a
  multiple employer welfare arrangement.
  (8) QUALIFIED HEALTH ACTUARY- The term `qualified health actuary' means
  a member of the American Academy of Actuaries who is qualified by reason
  of prior and continuing education and relevant experience to render the
  actuarial opinion.
  (9) SECRETARY- The term `Secretary' means the Secretary of Health and
  Human Services, or the delegate of the Secretary.
  (10) SMALL EMPLOYER- The term `small employer' means, with respect to
  a calendar year, an employer who normally employs more than 1 but less
  than 51 eligible employees on a typical business day. For purposes of the
  preceding sentence, all employers covered under the same health insurance
  plan or arrangement covered by a contract shall be treated as 1 employer.
SEC. 106. AMENDMENT TO THE INTERNAL REVENUE CODE OF 1986.
  (a) IN GENERAL- Chapter 47 of the Internal Revenue Code of 1986 (relating
  to excise taxes on qualified pension, etc. plans) is amended by adding at
  the end thereof the following new section:
`SEC. 5000A. FAILURE TO SATISFY CERTAIN STANDARDS FOR HEALTH INSURANCE.
  `(a) GENERAL RULE- In the case of any person issuing an accident and health
  insurance contract to a small employer, there is hereby imposed a tax on
  the failure of such person to meet at any time during any taxable year
  the applicable requirements of section 101 of the BasiCare Health Access
  and Cost Control Act. The Secretary of Health and Human Services shall
  determine whether any person meets the requirements of such section.
  `(b) AMOUNT OF TAX-
  `(1) IN GENERAL- The amount of tax imposed by subsection (a) by reason of
  1 or more failures during a taxable year shall be equal to 35 percent of
  the gross premiums received during such taxable year with respect to all
  accident and health insurance contracts issued to a small employer by the
  person on whom such tax is imposed.
  `(2) GROSS PREMIUMS- For purposes of paragraph (1), gross premiums shall
  include any consideration received with respect to any accident and health
  insurance contract.
  `(3) CONTROLLED GROUPS- For purposes of paragraph (1)--
  `(A) CONTROLLED GROUP OF CORPORATIONS- All corporations which are
  members of the same controlled group of corporations shall be treated as 1
  person. For purposes of the preceding sentence, the term `controlled group
  of corporations' has the meaning given to such term by section 1563(a),
  except that--
  `(i) `more than 50 percent' shall be substituted for `at least 80 percent'
  each place it appears in section 1563(a)(1), and
  `(ii) the determination shall be made without regard to subsections (a)(4)
  and (e)(3)(C) of section 1563.
  `(B) PARTNERSHIPS, PROPRIETORSHIPS, ETC., WHICH ARE UNDER COMMON CONTROL-
  Under regulations prescribed by the Secretary, all trades or business
  (whether or not incorporated) which are under common control shall be
  treated as 1 person. The regulations prescribed under this subparagraph
  shall be based on principles similar to the principles which apply in the
  case of subparagraph (A).
  `(c) LIMITATION ON TAX-
  `(1) TAX NOT TO APPLY WHERE FAILURE NOT DISCOVERED EXERCISING REASONABLE
  DILIGENCE- No tax shall be imposed by subsection (a) with respect to any
  failure for which it is established to the satisfaction of the Secretary
  that the person on whom the tax is imposed did not know, and exercising
  reasonable diligence would not have known, that such failure existed.
  `(2) TAX NOT TO APPLY WHERE FAILURES CORRECTED WITHIN 30 DAYS- No tax
  shall be imposed by subsection (a) with respect to any failure if--
  `(A) such failure was due to reasonable cause and not to willful neglect, and
  `(B) such failure is corrected during the 30-day period beginning on the
  first date any of the persons on whom the tax is imposed knew, or exercising
  reasonable diligence would have known, that such failure existed.
  `(3) WAIVER BY SECRETARY- In the case of a failure which is due to reasonable
  cause and not to willful neglect, the Secretary may waive part or all of
  the tax imposed by subsection (a) to the extent that the payment of such
  tax would be excessive relative to the failure involved.
  `(d) DEFINITIONS- For purposes of this section the terms `accident and
  health insurance contract', `small employer', `eligible employee', and
  `person' shall have the same meanings given such terms under section 105
  of the BasiCare Health Access and Cost Control Act.'.
  (b) NONDEDUCTIBILITY OF TAX- Paragraph (6) of section 275(a) of such Code
  (relating to nondeductibility of certain taxes) is amended by inserting
  `47,' after `46,'.
  (c) CLERICAL AMENDMENTS- The table of sections for such chapter 47 is
  amended by adding at the end thereof the following new item:
`Sec. 5000A. Failure to satisfy certain standards for health insurance.'.
  (d) EFFECTIVE DATES-
  (1) IN GENERAL- The amendments made by subsections (a) and (c) shall take
  effect on the date of the enactment of this Act.
  (2) NONDEDUCTIBILITY OF TAX- The amendment made by subsection (b) shall
  apply to taxable years beginning after December 31, 1992.
SEC. 107. EFFECTIVE DATE.
  (a) IN GENERAL- Except as provided in section 106 and subsection (b),
  this subtitle shall apply to contracts issued, or renewed, after the
  date of the enactment of this Act and before the effective date of the
  legislation described in section 212(a) or 213(a) of this Act.
  (b) GUARANTEED ISSUE- The provisions of section 102(c) shall apply to
  contracts which are issued, or renewed, after the date which is 12 months
  after the date of the enactment of this Act and before the effective date
  of the legislation described in section 212(a) or 213(a) of this Act.
Subtitle B--Community Health Services Expansion
SEC. 111. ESTABLISHMENT OF GRANT PROGRAM.
  Subpart I of part D of title III of the Public Health Service Act (42
  U.S.C. 254b et seq.) is amended by adding at the end thereof the following
  new section:
`SEC. 330A. COMMUNITY-BASED PRIMARY HEALTH CARE GRANT PROGRAM.
  `(a) ESTABLISHMENT- The Secretary shall establish and administer a program
  to provide allotments to States to enable such States to provide grants for
  the creation or enhancement of community-based primary health care entities
  that provide services to low-income or medically underserved populations.
  `(b) ALLOTMENTS TO STATES-
  `(1) IN GENERAL- From the amount available for allotment under subsection
  (h) for a fiscal year, the Secretary shall allot to each State an amount
  equal to the product of the grant share of the State (as determined under
  paragraph (2)) multiplied by such amount available.
  `(2) GRANT SHARE-
  `(A) IN GENERAL- For purposes of paragraph (1), the grant share of a
  State shall be the product of the need-adjusted population of the State
  (as determined under  subparagraph (B)) multiplied by the Federal matching
  percentage of the State (as determined under subparagraph (C)), expressed
  as a percentage of the sum of the products of such factors for all States.
  `(B) NEED-ADJUSTED POPULATION-
  `(i) IN GENERAL- For purposes of subparagraph (A), the need-adjusted
  population of a State shall be the product of the total population of the
  State (as estimated by the Secretary of Commerce) multiplied by the need
  index of the State (as determined under clause (ii)).
  `(ii) NEED INDEX- For purposes of clause (i), the need index of a State
  shall be the ratio of--
  `(I) the weighted sum of the geographic percentage of the State (as
  determined under clause (iii)), the poverty percentage of the State (as
  determined under clause (iv)), and the multiple grant percentage of the
  State (as determined under clause (v)); to
  `(II) the general population percentage of the State (as determined under
  clause (vi)).
  `(iii) GEOGRAPHIC PERCENTAGE-
  `(I) IN GENERAL- For purposes of clause (ii)(I), the geographic percentage
  of the State shall be the estimated population of the State that is residing
  in nonurbanized areas (as determined under subclause (II)) expressed as
  a percentage of the total nonurbanized population of all States.
  `(II) NONURBANIZED POPULATION- For purposes of subclause (I), the estimated
  population of the State that is residing in nonurbanized areas shall be
  one minus the urbanized population of the State (as determined using the
  most recent decennial census), expressed as a percentage of the total
  population of the State (as determined using the most recent decennial
  census), multiplied by the current estimated population of the State.
  `(iv) POVERTY PERCENTAGE- For purposes of clause (ii)(I), the poverty
  percentage of the State shall be the estimated number of people residing
  in the State with incomes below 200 percent of the income official poverty
  line (as determined by the Office of Management and Budget) expressed as
  a percentage of the total number of such people residing in all States.
  `(v) MULTIPLE GRANT PERCENTAGE- For purposes of clause (ii)(I), the
  multiple grant percentage of the State shall be the amount of Federal
  funding received by the State under grants awarded under sections 329, 330,
  and 340, expressed as a percentage of the total amounts received under such
  grants by all States. With respect to a State, such percentage shall not
  exceed twice the general population percentage of the State under clause
  (vi) or be less than one-half of the States general population percentage.
  `(vi) GENERAL POPULATION PERCENTAGE- For purposes of clause (ii)(II), the
  general population percentage of the State shall be the total population
  of the State (as determined by the Secretary of Commerce) expressed as a
  percentage of the total population of all States.
  `(C) FEDERAL MATCHING PERCENTAGE-
  `(i) IN GENERAL- For purposes of subparagraph (A), the Federal matching
  percentage of the State shall be equal to one, less the State matching
  percentage (as determined under clause (ii)).
  `(ii) STATE MATCHING PERCENTAGE- For purposes of clause (i), the State
  matching percentage of the State shall be 0.25 multiplied by the ratio of the
  total taxable resource percentage (as determined under clause (iii)) to the
  need-adjusted population of the State (as determined under subparagraph (B)).
  `(iii) TOTAL TAXABLE RESOURCE PERCENTAGE- For purposes of clause (ii), the
  total taxable resources percentage of the State shall be the total taxable
  resources of a State (as determined by the Secretary of the Treasury)
  expressed as a percentage of the sum of the total taxable resources of
  all States.
  `(3) ANNUAL ESTIMATES-
  `(A) IN GENERAL- If the Secretary of Commerce does not produce the annual
  estimates required under paragraph (2)(B)(iv), such estimates shall be
  determined by multiplying the percentage of the population of the State
  that is below 200 percent of the income official poverty line as determined
  using the most recent decennial census by the most recent estimate of the
  total population of the State. Except as provided in subparagraph (B), the
  calculations required under this subparagraph shall be made based on the
  most recent 3-year average of the total taxable resources of individuals
  within the State.
  `(B) DISTRICT OF COLUMBIA- Notwithstanding subparagraph (A), the calculations
  required under such subparagraph with respect to the District of Columbia
  shall be based on the most recent 3-year average of the personal income of
  individuals residing within the District as a percentage of the personal
  income for all individuals residing within the District, as determined by
  the Secretary of Commerce.
  `(4) MATCHING REQUIREMENT- A State that receives an allotment under this
  section shall make available State resources (either directly or indirectly)
  to carry out this section in an amount that shall equal the State matching
  percentage for the State (as determined under paragraph (2)(C)(ii)) divided
  by the Federal matching percentage (as determined under paragraph (2)(C)).
  `(c) APPLICATION-
  `(1) IN GENERAL- To be eligible to receive an allotment under this section,
  a State shall prepare and submit an application to the Secretary at such
  time, in such manner, and containing such information as the Secretary
  may by regulation require.
  `(2) ASSURANCES- A State application submitted under paragraph (1) shall
  contain an assurance that--
  `(A) the State will use amounts received under its allotment consistent
  with the requirements of this section; and
  `(B) the State will provide, from non-Federal sources, the amounts required
  under subsection (b)(4).
  `(d) USE OF FUNDS-
  `(1) IN GENERAL- The State shall use amounts received under this section to
  award grants to eligible public and nonprofit private entities, or consortia
  of such entities, within the State to enable such entities or consortia to
  provide services of the type described in paragraph (2) of section 329(h)
  to low-income or medically underserved populations.
  `(2) ELIGIBILITY- To be eligible to receive a grant under paragraph (1),
  an entity or consortium shall--
  `(A) prepare and submit to the administering entity of the State, an
  application at such time, in such manner, and containing such information
  as such administering entity may require, including a plan for the provision
  of services of the type described in paragraph (3);
  `(B) provide assurances that services will be provided under the grant at fee
  rates established or determined in accordance with section 330(e)(3)(F); and
  `(C) provide assurances that in the case of services provided to individuals
  with health insurance, such insurance shall be used as the primary source
  of payment for such services.
  `(3) SERVICES- The services to be provided under a grant awarded under
  paragraph (1) shall include--
  `(A) one or more of the types of primary health services described in
  section 330(b)(1);
  `(B) one or more of the types of supplemental health services described
  in section 330(b)(2); and
  `(C) any other services determined appropriate by the administering entity
  of the State.
  `(4) TARGET POPULATIONS- Entities or consortia receiving grants under
  paragraph (1) shall, in providing the services described in paragraph (3),
  substantially target populations of low-income or medically underserved
  populations within the State who reside in medically underserved or health
  professional shortage areas, areas certified as underserved under the
  rural health clinic program, or other areas determined appropriate by the
  administering entity of the State, within the State.
  `(5) PRIORITY- In awarding grants under paragraph (1), the State shall--
  `(A) give priority to entities or consortia that can demonstrate through
  the plan submitted under paragraph (2) that--
  `(i) the services provided under the grant will expand the availability
  of primary care services to the maximum number of low-income or medically
  underserved populations who have no access to such care on the date of
  the grant award; and
  `(ii) the delivery of services under the grant will be cost-effective; and
  `(B) ensure that an equitable distribution of funds is achieved among
  urban and rural entities or consortia.
  `(e) REPORTS AND AUDITS- Each State shall prepare and submit to the
  Secretary annual reports concerning the State's activities under this
  section which shall be in such form and contain such information as the
  Secretary determines appropriate. Each such State shall establish fiscal
  control and fund accounting procedures as may be necessary to assure that
  amounts received under this section are being disbursed properly and are
  accounted for, and include the results of audits conducted under such
  procedures in the reports submitted under this subsection.
  `(f) PAYMENTS-
  `(1) ENTITLEMENT- Each State for which an application has been approved by
  the Secretary under this section shall be entitled to payments under this
  section for each fiscal year in an amount not to exceed the State's allotment
  under subsection (b) to be expended by the State in accordance with the terms
  of the application for the fiscal year for which the allotment is to be made.
  `(2) METHOD OF PAYMENTS- The Secretary may make payments to a State in
  installments, and in advance or by way of reimbursement, with necessary
  adjustments on account of overpayments or underpayments, as the Secretary
  may determine.
  `(3) STATE SPENDING OF PAYMENTS- Payments to a State from the allotment
  under subsection (b) for any fiscal year must be expended by the State in
  that fiscal year or in the succeeding fiscal year.
  `(g) DEFINITION- As used in this section, the term `administering entity of
  the State' means the agency or official designated by the chief executive
  officer of the State to administer the amounts provided to the State under
  this section.
  `(h) FUNDING- Notwithstanding any other provision of law, the Secretary
  shall use 50 percent of the amounts that the Secretary is required to utilize
  under section 330B(h) in each fiscal year to carry out this section.'.
SEC. 112. PROGRAM TO PROVIDE FOR EXPANSION OF FEDERALLY QUALIFIED HEALTH
CENTERS.
  (a) IN GENERAL- Subpart I of part D of title III of the Public Health
  Service Act (42 U.S.C. 254b et seq.) (as amended by section 111) is further
  amended by adding at the end thereof the following new section:
`SEC. 330B. PROGRAM TO PROVIDE FOR EXPANSION OF FEDERALLY QUALIFIED HEALTH
CENTERS.
  `(a) ESTABLISHMENT OF HEALTH SERVICES ACCESS PROGRAM- From amounts
  appropriated under this section, the Secretary shall, acting through
  the Bureau of Health Care Delivery Assistance, award grants under this
  section to federally qualified health centers (hereafter referred to in
  this section as `FQHCs')  and other entities and organizations submitting
  applications under this section (as described in subsection (c)) for
  the purpose of providing access to services for medically underserved
  populations (as defined in section 330(b)(3)) or in high impact areas
  (as defined in section 329(a)(5)) not currently being served by a FQHC.
  `(b) ELIGIBILITY FOR GRANTS-
  `(1) IN GENERAL- The Secretary shall award grants under this section to
  entities or organizations described in this paragraph and paragraph (2)
  which have submitted a proposal to the Secretary to expand such entities or
  organizations operations (including expansions to new sites (as determined
  necessary by the Secretary)) to serve medically underserved populations
  or high impact areas not currently served by a FQHC and which--
  `(A) have as of the date of enactment of the BasiCare Health Access and
  Cost Control Act, been certified by the Secretary as a FQHC under section
  1905(l)(2)(B) of the Social Security Act;
  `(B) have submitted applications to the Secretary to qualify as FQHCs
  under section 1905(l)(2)(B) of the Social Security Act; or
  `(C) have submitted a plan to the Secretary which provides that the
  entity or organization will meet the requirements to qualify as a FQHC
  when operational.
  `(2) NON-FQHC ENTITIES-
  `(A) ELIGIBILITY- The Secretary shall also make grants under this section
  to any public or private nonprofit agency, or any health care entity or
  organization which--
  `(i) meets the requirements necessary to qualify as a FQHC, except the
  requirement that such agency, entity, or organization has a consumer
  majority governing board,
  `(ii) has submitted a proposal to the Secretary to provide those services
  provided by a FQHC as defined in section 1905(l)(2)(B) of the Social
  Security Act, and
  `(iii) is designed to promote access to primary care services or to
  reduce reliance on hospital emergency rooms or other high cost providers
  of primary health care services,
provided that the proposal described in clause (ii) is developed by the agency,
entity, or organization (or such agencies, entities, or organizations acting
in a consortium in a community) with the review and approval of the Governor
of the State in which such agency, entity, or organization is located.
  `(B) LIMITATION- The Secretary shall provide in making grants to entities
  or organizations described in this paragraph that not more than 10 percent
  of the funds provided for grants under this section shall be made available
  for grants to such entities or organizations.
  `(c) APPLICATION REQUIREMENTS-
  `(1) IN GENERAL- In order to be eligible to receive a grant under this
  section, a FQHC or other entity or organization must submit an application
  in such form and at such time as the Secretary shall prescribe and which
  meets the requirements of this subsection.
  `(2) REQUIREMENTS- An application submitted under this section must provide--
  `(A)(i) for a schedule of fees or payments for the provision of the services
  provided by the entity or organization designed to cover its reasonable
  costs of operations; and
  `(ii) for a corresponding schedule of discounts to be applied to such fees
  or payments, based upon the patient's ability to pay (determined by using
  a sliding scale formula based on the income of the patient);
  `(B) assurances that the entity or organization provides services to
  persons who are eligible for benefits under title XVIII of the Social
  Security Act, for medical assistance under title XIX of such Act, or for
  assistance for medical expenses under any other public assistance program
  or private health insurance program; and
  `(C) assurances that the entity or organization has made and will continue
  to make every reasonable effort to collect reimbursement for services--
  `(i) from persons eligible for assistance under any of the programs
  described in subparagraph (B); and
  `(ii) from patients not entitled to benefits under any such programs.
  `(d) LIMITATIONS ON USE OF FUNDS-
  `(1) IN GENERAL- From the amounts awarded to a FQHC or other entity or
  organization under this section, funds may be used for purposes of planning
  but may only be expended for the costs of--
  `(A) assessing the needs of the populations or proposed areas to be served;
  `(B) preparing a description of how the needs identified will be met; and
  `(C) development of an implementation plan that addresses--
  `(i) recruitment and training of personnel; and
  `(ii) activities necessary to achieve operational status in order to meet
  FQHC requirements under 1905(l)(2)(B) of the Social Security Act.
  `(2) RECRUITING, TRAINING, AND COMPENSATION OF STAFF- From the amounts
  awarded to an entity or organization under this section, funds may be
  used for the purposes of paying for the costs of recruiting, training,
  and compensating staff (clinical and associated administrative personnel
  (to the extent such costs are not already reimbursed under title XIX of
  the Social Security Act or any other State or Federal program)) to the
  extent necessary to allow the entity or organization to operate at new or
  expanded existing sites.
  `(3) FACILITIES AND EQUIPMENT- From the amounts awarded to an entity or
  organization under this section, funds may be expended for the purposes
  of acquiring facilities and equipment but only for the costs of--
  `(A) construction of new buildings (to the extent that new construction
  is found to be the most cost-efficient approach by the Secretary);
  `(B) acquiring, expanding, or modernizing existing facilities;
  `(C) purchasing essential (as determined by the Secretary) equipment; and
  `(D) amortization of principal and payment of interest on loans obtained
  for purposes of site construction, acquisition, modernization, or expansion,
  as well as necessary equipment.
  `(4) SERVICES- From the amounts awarded to an entity or organization under
  this section, funds may be expended for the payment of services but only
  for the costs of--
  `(A) providing or arranging for the provision of all services through the
  entity or organization necessary to qualify such entity or organization
  as a FQHC under section 1905(l)(2)(B) of the Social Security Act;
  `(B) providing or arranging for any other service that a FQHC may provide
  and be reimbursed for under title XIX of the Social Security Act; and
  `(C) providing any unreimbursed costs of providing services as described
  in section 330(a) to patients.
  `(e) PRIORITIES IN THE AWARDING OF GRANTS-
  `(1) CERTIFIED FQHCs- The Secretary shall give priority in awarding grants
  under this section to entities and organizations which have, as of the
  date of enactment of the BasiCare Health Access and Cost Control Act, been
  certified as a FQHC under section 1905(l)(2)(B) of the Social Security
  Act and which have submitted a proposal to the Secretary to expand their
  operations (including expansion to new sites) to serve medically underserved
  populations for high impact areas not currently served by a FQHC. The
  Secretary shall give first priority in awarding grants under this section
  to those FQHCs or other entities or organizations which propose to serve
  populations with the highest degree of unmet need, and which can demonstrate
  the ability to expand their operations in the most efficient manner.
  `(2) QUALIFIED FQHCs- The Secretary shall give second priority in awarding
  grants to entities and organizations which have submitted applications to
  the Secretary which demonstrate that the entities or organizations will
  qualify as FQHCs under section 1905(l)(2)(B) of the Social Security Act
  before they provide or arrange for the provision of services supported
  by funds awarded under this section, and which are serving or proposing
  to serve medically underserved populations or high impact areas which are
  not currently served (or proposed to be served) by a FQHC.
  `(3) EXPANDED SERVICES AND PROJECTS- The Secretary shall give third priority
  in awarding grants in subsequent years to those FQHCs or other entities
  or organizations which have provided for expanded services and projects
  and are able to demonstrate that such entities or organizations will incur
  significant unreimbursed costs in providing such expanded services.
  `(f) RETURN OF FUNDS TO SECRETARY FOR COSTS REIMBURSED FROM OTHER SOURCES-
  To the extent that a FQHC or other entity or organization receiving funds
  under this section is reimbursed from another source for the provision of
  services to an individual, and does not use such increased reimbursement to
  expand services furnished, to expand areas served, to compensate for costs
  of unreimbursed services provided to patients, or to promote recruitment,
  training, or retention of personnel, such excess revenues shall be returned
  to the Secretary.
  `(g) TERMINATION OF GRANTS-
  `(1) FAILURE TO MEET FQHC REQUIREMENTS-
  `(A) IN GENERAL- With respect to any entity or organization that is receiving
  funds awarded under this section and which subsequently fails to meet the
  requirements to qualify as a FQHC under section 1905(l)(2)(B) of the Social
  Security Act or is an entity or organization that is not required to meet
  the requirements to qualify as a FQHC under section 1905(l)(2)(B) of the
  Social Security Act but fails to meet the requirements of this section,
  the Secretary shall terminate the award of funds under this section to
  such entity or organization.
  `(B) NOTICE- Prior to any termination of funds under this section to an
  entity or organization, the entity or organization shall be entitled to
  60 days' prior notice of termination and, as provided by the Secretary in
  regulations, an opportunity to correct any deficiencies in order to allow
  the entity or organization to continue to receive funds under this section.
  `(2) REQUIREMENTS- Upon any termination of funding under this section,
  the Secretary may (to the extent practicable)--
  `(A) sell any property (including equipment) acquired or constructed by
  the entity or organization using funds made available under this section
  or transfer such property to another FQHC, except that the Secretary shall
  reimburse any costs which were incurred by the entity or organization in
  acquiring or constructing such property (including equipment) which were
  not supported by grants under this section; and
  `(B) recoup any funds provided to an entity or organization terminated
  under this section.
  `(h) AUTHORIZATION OF APPROPRIATIONS- There are authorized to be appropriated
  to carry out this section $600,000,000 for each of the fiscal years 1993
  through 1997.'.
  (b) EFFECTIVE DATE- The amendments made by subsection (a) shall become
  effective with respect to services furnished by a federally qualified
  health center or other qualifying entity or organization described in this
  section beginning on or after the date of enactment of this Act.
Subtitle C--Expansion of Tax Incentives for Self-Employed Individuals
SEC. 121. PERMANENT INCREASE IN DEDUCTIBLE HEALTH INSURANCE COSTS FOR
SELF-EMPLOYED INDIVIDUALS.
  (a) IN GENERAL- Paragraph (1) of section 162(l) of the Internal Revenue
  Code of 1986 (relating to special rules for health insurance costs of
  self-employed individuals) is amended by striking `25 percent' and inserting
  `100 percent'.
  (b) PERMANENT DEDUCTION- Section 162(l) of such Code is amended by striking
  paragraph (6).
  (c) EFFECTIVE DATE- The amendment made by this subsection shall apply to
  taxable years beginning after the date of enactment of this Act.
Subtitle D--Expanding the Supply of Health Professionals in Rural Areas
SEC. 131. EXPANSION OF NATIONAL HEALTH SERVICE CORPS.
  Section 338H(b) of the Public Health Service Act (42 U.S.C. 254q(b))
  is amended--
  (1) in paragraph (1), by striking `and such sums' and all that follows
  through the end thereof and inserting `$120,000,000 for each of the fiscal
  years 1992 through 1996.'; and
  (2) in paragraph (2)--
  (A) by redesignating subparagraphs (A) and (B) as subparagraphs (B) and
  (C), respectively; and
  (B) by inserting before subparagraph (B) (as so redesignated) the following
  new subparagraph:
  `(A) IN GENERAL- Of the amount appropriated under paragraph (1) for each
  fiscal year, the Secretary shall utilize 25 percent of such amount to carry
  out section 338A and 75 percent of such amount to carry out section 338B.'.
SEC. 132. TAX INCENTIVES FOR PRACTICE IN RURAL AREAS.
  (a) NONREFUNDABLE CREDIT FOR CERTAIN PRIMARY HEALTH SERVICES PROVIDERS-
  (1) IN GENERAL- Subpart A of part IV of subchapter A of chapter 1 of the
  Internal Revenue Code of 1986 (relating to nonrefundable personal credits)
  is amended by inserting after section 25 the following new section:
`SEC. 25A. PRIMARY HEALTH SERVICES PROVIDERS.
  `(a) ALLOWANCE OF CREDIT- In the case of a qualified primary health services
  provider, there is allowed as a credit against the tax imposed by this
  chapter for any taxable year in a mandatory service period an amount equal
  to the product of--
  `(1) the lesser of--
  `(A) the number of months of such period occurring in such taxable year, or
  `(B) 36 months, reduced by the number of months taken into account under
  this paragraph with respect to such provider for all preceding taxable years
  (whether or not in the same mandatory service period), multiplied by
  `(2) $1,000 ($500 in the case of a qualified primary health services
  provider who is a physician assistant or a nurse practitioner).
  `(b) QUALIFIED PRIMARY HEALTH SERVICES PROVIDER- For purposes of this
  section, the term `qualified primary health services provider' means any
  physician, physician assistant, or nurse practitioner who for any month
  during a mandatory service period is certified by the Bureau to be a
  primary health services provider who--
  `(1) is providing primary health services--
  `(A) full time, and
  `(B) to individuals at least 80 percent of whom reside in a rural health
  professional shortage area,
  `(2) is not receiving during such year a scholarship under the National
  Health Service Corps Scholarship Program or a loan repayment under the
  National Health Service Corps Loan Repayment Program,
  `(3) is not fulfilling service obligations under such Programs, and
  `(4) has not defaulted on such obligations.
  `(c) MANDATORY SERVICE PERIOD- For purposes of this section, the term
  `mandatory service period' means the period of 60 consecutive calendar
  months beginning with the first month the taxpayer is a qualified primary
  health services provider.
  `(d) DEFINITIONS AND SPECIAL RULES- For purposes of this section--
  `(1) BUREAU- The term `Bureau' means the Bureau of Health Care Delivery
  and Assistance, Health Resources and Services Administration of the United
  States Public Health Service.
  `(2) PHYSICIAN- The term `physician' has the meaning given to such term
  by section 1861(r) of the Social Security Act.
  `(3) PHYSICIAN ASSISTANT; NURSE PRACTITIONER- The terms `physician assistant'
  and `nurse practitioner' have the meanings given to such terms by section
  1861(aa)(3) of the Social Security Act.
  `(4) PRIMARY HEALTH SERVICES PROVIDER- The term `primary health services
  provider' means a provider of primary health services (as defined in
  section 330(b)(1) of the Public Health Service Act).
  `(5) RURAL HEALTH PROFESSIONAL SHORTAGE AREA- The term `rural health
  professional shortage area' means--
  `(A) a class 1 or class 2 rural health professional shortage area (as defined
  in section 332(a)(1)(A) of the Public Health Service Act) in a rural area
  (as determined under section 1886(d)(2)(D) of the Social Security Act), or
  `(B) an area which is determined by the Secretary of Health and Human
  Services as equivalent to an area described in subparagraph (A) and which
  is designated by the Bureau of the Census as not urbanized.
  `(C) a community that is certified as underserved by the Secretary for
  purposes of participation in the rural health clinic program under title
  XVIII of the Social Security Act.
  `(e) RECAPTURE OF CREDIT-
  `(1) IN GENERAL- If, during any taxable year, there is a recapture event,
  then the tax of the taxpayer under this chapter for such taxable year
  shall be increased by an amount equal to the product of--
  `(A) the applicable percentage, and
  `(B) the aggregate unrecaptured credits allowed to such taxpayer under
  this section for all prior taxable years.
  `(2) Applicable recapture percentage-
  `(A) IN GENERAL- For purposes of this subsection, the applicable recapture
  percentage shall be determined from the following table:
  `If the recapture
--The applicable recap-
   event occurs during:
--ture percentage is:
  Months 1-24
--100
  Months 25-36
--75
  Months 37-48
--50
  Months 49-60
--25
  Months 61 and thereafter
--0.
  `(B) TIMING- For purposes of subparagraph (A), month 1 shall begin on the
  first day of the mandatory service period.
  `(3) RECAPTURE EVENT DEFINED-
  `(A) IN GENERAL- For purposes of this subsection, the term `recapture event'
  means the failure of the taxpayer to be a qualified primary health services
  provider for any month during any mandatory service period.
  `(B) CESSATION OF DESIGNATION- The cessation of the designation of any
  area as a rural health professional shortage area after the beginning
  of the mandatory service period for any taxpayer shall not constitute a
  recapture event.
  `(C) SECRETARIAL WAIVER- The Secretary may waive any recapture event caused
  by extraordinary circumstances.
  `(4) NO CREDITS AGAINST TAX- Any increase in tax under this subsection
  shall not be treated as a tax imposed by this chapter for purposes of
  determining the amount of any credit under subpart A, B, or D of this part.'.
  (2) CLERICAL AMENDMENT- The table of sections for subpart A of part IV of
  subchapter A of chapter 1 of such Code is amended by inserting after the
  item relating to section 25 the following new item:
`Sec. 25A. Primary health services providers.'.
  (3) EFFECTIVE DATE- The amendments made by this subsection shall apply to
  taxable years beginning after the date of the enactment of this Act.
  (b) NATIONAL HEALTH SERVICE CORPS LOAN REPAYMENTS EXCLUDED FROM GROSS INCOME-
  (1) IN GENERAL- Part III of subchapter B of chapter 1 of the Internal Revenue
  Code of 1986 (relating to items specifically excluded from gross income)
  is amended by redesignating section 136 as section 137 and by inserting
  after section 135 the following new section:
`SEC. 136. NATIONAL HEALTH SERVICE CORPS LOAN REPAYMENTS.
  `(a) GENERAL RULE- Gross income shall not include any qualified loan
  repayment.
  `(b) QUALIFIED LOAN REPAYMENT- For purposes of this section, the term
  `qualified loan repayment' means any payment made on behalf of the taxpayer
  by the National Health Service Corps Loan Repayment Program under section
  338B(g) of the Public Health Service Act.'.
  (2) CONFORMING AMENDMENT- Paragraph (3) of section 338B(g) of the Public
  Health Service Act is amended by striking `Federal, State, or local'
  and inserting `State or local'.
  (3) CLERICAL AMENDMENT- The table of sections for part III of subchapter
  B of chapter 1 of the Internal Revenue Code of 1986 is amended by striking
  the item relating to section 136 and inserting the following:
`Sec. 136. National Health Service Corps loan repayments.
`Sec. 137. Cross references to other Acts.'.
  (4) EFFECTIVE DATE- The amendments made by this subsection shall apply
  to payments made under section 338B(g) of the Public Health Service Act
  after the date of the enactment of this Act.
  (c) EXPENSING OF MEDICAL EQUIPMENT-
  (1) IN GENERAL- Section 179 of the Internal Revenue Code of 1986 (relating
  to election to expense certain depreciable business assets) is amended--
  (A) by striking paragraph (1) of subsection (b) and inserting the following:
  `(1) DOLLAR LIMITATION-
  `(A) GENERAL RULE- The aggregate cost which may be taken into account
  under subsection (a) for any taxable year shall not exceed $10,000.
  `(B) RURAL HEALTH CARE PROPERTY- In the case of rural health care property,
  the aggregate cost which may be taken into account under subsection (a)
  for any taxable year shall not exceed $25,000, reduced by the amount
  otherwise taken into account under subsection (a) for such year.'; and
  (B) by adding at the end of subsection (d) the following new paragraph:
  `(11) RURAL HEALTH CARE PROPERTY- For purposes of this section, the
  term `rural health care property' means section 179 property used by
  a physician (as defined in section 1861(r) of the Social Security Act)
  in the active conduct of such physician's full-time trade or business of
  providing primary health services (as defined in section 330(b)(1) of the
  Public Health Service Act) in a rural health professional shortage area
  (as defined in section 25A(d)(5)).'.
  (2) EFFECTIVE DATE- The amendments made by this subsection shall apply to
  property placed in service in taxable years beginning after the date of
  enactment of this Act.
  (d) DEDUCTION FOR STUDENT LOAN PAYMENTS BY MEDICAL PROFESSIONALS PRACTICING
  IN RURAL AREAS-
  (1) INTEREST ON STUDENT LOANS NOT TREATED AS PERSONAL INTEREST- Section
  163(h)(2) of the Internal Revenue Code of 1986 (defining personal interest)
  is amended by striking `and' at the end of subparagraph (D), by striking
  the period at the end of subparagraph (E) and inserting `, and', and by
  adding at the end thereof the following new subparagraph:
  `(F) any qualified medical education interest (within the meaning of
  subsection (k)).'.
  (2) QUALIFIED MEDICAL EDUCATION INTEREST DEFINED- Section 163 of such Code
  (relating to interest expenses) is amended by redesignating subsection
  (k) as subsection (l) and by inserting after subsection (j) the following
  new subsection:
  `(k) Qualified Medical Education Interest of Medical Professionals Practicing
  in Rural Areas-
  `(1) IN GENERAL- For purposes of subsection (h)(2)(F), the term `qualified
  medical education interest' means an amount which bears the same ratio
  to the interest paid on qualified educational loans during the taxable
  year by an individual performing services under a qualified rural medical
  practice agreement as--
  `(A) the number of months during the taxable year during which such services
  were performed, bears to
  `(B) the number of months in the taxable year.
  `(2) DOLLAR LIMITATION- The aggregate amount which may be treated as
  qualified medical education interest for any taxable year with respect to
  any individual shall not exceed $5,000.
  `(3) QUALIFIED RURAL MEDICAL PRACTICE AGREEMENT- For purposes of this
  subsection--
  `(A) IN GENERAL- The term `qualified rural medical practice agreement'
  means a written agreement between an individual and an applicable rural
  community under which the individual agrees--
  `(i) in the case of a medical doctor, upon completion of the individual's
  residency (or internship if no residency is required), or
  `(ii) in the case of a registered nurse, nurse practitioner, or physician's
  assistant, upon completion of the education to which the qualified education
  loan relates,
to perform full-time services as such a medical professional in the applicable
rural community for a period of 24 consecutive months. An individual and
an applicable rural community may elect to have the agreement apply for 36
consecutive months rather than 24 months.
  `(B)  SPECIAL RULE FOR COMPUTING PERIODS- An individual shall be treated
  as meeting the 24 or 36 consecutive month requirement under subparagraph
  (A) if, during each 12-consecutive month period within either such period,
  the individual performs full-time services as a medical doctor, registered
  nurse, nurse practitioner, or physician's assistant, whichever applies, in
  the applicable rural community during 9 of the months in such 12-consecutive
  month period. For purposes of this subsection, an individual meeting the
  requirements of the preceding sentence shall be treated as performing
  services during the entire 12-month period.
  `(C) APPLICABLE RURAL COMMUNITY- The term `applicable rural community'
  means--
  `(i) any political subdivision of a State which--
  `(I) has a population of 5,000 or less, and
  `(II) has a per capita income of $15,000 or less, or
  `(ii) an Indian reservation which has a per capita income of $15,000 or less.
  `(4) QUALIFIED EDUCATIONAL LOAN- The term `qualified educational loan'
  means any indebtedness to pay qualified tuition and related expenses
  (within the meaning of section 117(b)) and reasonable living expenses--
  `(A) which are paid or incurred--
  `(i) as a candidate for a degree as a medical doctor at an educational
  institution described in section 170(b)(1)(A)(ii), or
  `(ii) in connection with courses of instruction at such an institution
  necessary for certification as a registered nurse, nurse practitioner,
  or physician's assistant, and
  `(B) which are paid or incurred within a reasonable time before or after
  such indebtedness is incurred.
  `(5) RECAPTURE- If an individual fails to carry out a qualified rural
  medical practice agreement during any taxable year, then--
  `(A) no deduction with respect to such agreement shall be allowable by
  reason of subsection (h)(2)(F) for such taxable year and any subsequent
  taxable year, and
  `(B) there shall be included in gross income for such taxable year the
  aggregate amount of the deductions allowable under this section (by reason
  of subsection (h)(2)(F)) for all preceding taxable years.
  `(6) DEFINITIONS- For purposes of this subsection, the terms `registered
  nurse', `nurse practitioner', and `physician's assistant' have the meaning
  given such terms by section 1861 of the Social Security Act.'.
  (3) DEDUCTION ALLOWED IN COMPUTING ADJUSTED GROSS INCOME- Section 62(a)
  of such Code is amended by inserting after paragraph (13) the following
  new paragraph:
  `(14) INTEREST ON STUDENT LOANS OF RURAL HEALTH PROFESSIONALS- The deduction
  allowable by reason of section 163(h)(2)(F) (relating to student loan
  payments of medical professionals practicing in rural areas).'.
  (4) EFFECTIVE DATE- The amendments made by this subsection shall apply to
  taxable years beginning after the date of the enactment of this Act.
Subtitle E--Malpractice Reform
PART I--DEFINITIONS
SEC. 141. DEFINITIONS.
  For purposes of this subtitle:
  (1) ALTERNATIVE DISPUTE RESOLUTION SYSTEM- The term `alternative dispute
  resolution system' means a system that is enacted or adopted by a State
  to resolve health care liability actions as an alternative to a judicial
  proceeding in a Federal or State court.
  (2) CONCERTED ACTION AND ACTING IN CONCERT- The terms `concerted action'
  and `acting in concert' mean the participation in joint conduct by two or
  more persons who agree to jointly participate in such conduct with actual
  knowledge of the wrongfulness of the conduct.
  (3) ECONOMIC LOSSES- The term `economic losses' means losses for health
  care provider and medical expenses, lost wages, lost employment, and other
  pecuniary losses.
  (4) HEALTH CARE LIABILITY ACTION- The term `health care liability action'
  means any civil action or proceeding in any judicial tribunal brought
  pursuant to Federal or State law against a health care provider alleging
  that injury was suffered by the claimant as a result of any act or omission
  by such provider, without regard to the theory of liability asserted in
  the action. Such term includes a claim, third-party claim, cross-claim,
  counter-claim, or contribution-claim.
  (5) HEALTH CARE PROVIDER- The term `health care provider' means--
  (A) any individual who provides health care services in a State and who
  is required by State law or regulation to be licensed or certified by the
  State to provide such services in the State; and
  (B) any organization or institution that is engaged in the delivery of
  health care services in a State and that is required by State law or
  regulation to be licensed or certified by the State to engage in the
  delivery of such services in the State.
  (6) INJURY- The term `injury' means any injury, illness, disease, or other
  harm suffered by an individual as a result of the provision of health care
  services by a health care provider.
  (7) NONECONOMIC LOSSES- The term `noneconomic losses' means losses for
  physical and emotional pain, suffering, physical impairment, mental anguish,
  disfigurement, loss of enjoyment of life, loss of companionship, consortium,
  and other nonpecuniary losses.
  (8) SECRETARY- The term `Secretary' means the Secretary of Health and
  Human Services.
  (9) STATE- The term `State' means each of the several States, the District
  of Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, and Guam.
PART II--TORT REFORM OF HEALTH CARE LIABILITY ACTIONS
SEC. 142. APPLICATION TO CIVIL ACTIONS.
  This part shall apply to any health care liability action brought in
  any Federal or State court.  This part shall not be construed to create
  or effect any cause of action or theory of liability recognized in any
  Federal or State proceeding.
SEC. 143. DAMAGES.
  (a) LIMITATION ON NONECONOMIC DAMAGES- The total amount of damages which
  may be awarded to an individual and the family members of such individual
  for noneconomic losses resulting from an injury which is the subject of a
  health care liability action may not exceed $250,000, regardless of the
  number of health care providers against whom such action is brought or
  the number of such actions brought with respect to the injury.
  (b) PAYMENTS- With respect to a health care liability action, no person
  may be required to pay more than $100,000 in a single payment for an award
  of damages for economic or noneconomic losses, but such person shall be
  permitted to make such payments on a periodic basis.  The periods for such
  payments shall be determined by the court.
  (c) MANDATORY OFFSETS FOR DAMAGES PAID BY A COLLATERAL SOURCE-
  (1) IN GENERAL- The total amount of damages received by an individual
  in connection with a health care liability action shall be reduced, in
  accordance with paragraph (2), by any other payment which has been made
  or which will be made to such individual to compensate such individual
  for an injury, including payments under--
  (A) Federal or State disability or sickness programs;
  (B) Federal, State, or private health insurance programs;
  (C) private disability insurance programs;
  (D) employer wage continuation programs; and
  (E) any other source of payment intended to compensate such individual
  for such injury.
  (2) AMOUNT OF REDUCTION- The amount by which an award of damages to an
  individual for an injury shall be reduced under paragraph (1) shall be--
  (A) the total amount of any payments (other than such award) which have
  been made or which will be made to such individual to compensate such
  individual for such injury; minus
  (B) the amount paid by such individual (or by the spouse, parent, or legal
  guardian of such individual) to secure the payments described in subparagraph
  (A).
  (d) PUNITIVE DAMAGES-
  (1) LIMITATION- With respect to a health care liability action, punitive
  damages may not exceed the sum of damages awarded for economic and
  noneconomic losses.
  (2) DETERMINATION OF AMOUNT- In determining the amount of punitive damages
  in a health care liability action, the trier of fact shall consider all
  relevant evidence, including--
  (A) the severity of the harm caused by the conduct of the defendant;
  (B) the duration of the conduct or any concealment of the conduct by
  the defendant;
  (C) awards of punitive or exemplary damages to persons similarly situated
  to the claimant; and
  (D) prospective awards of economic and noneconomic losses to persons
  similarly situated to the claimant.
  (e) ATTORNEYS' FEES- Compensation for reasonable attorneys' fees to be paid
  by each party in connection with a health care liability action shall be
  determined by the court after an evidentiary hearing and prior to final
  disposition of the action.  Attorneys' fees shall be calculated on the
  basis of an hourly rate or as a percentage of the total damages awarded
  for economic and noneconomic losses and shall not exceed an amount that
  would be considered reasonable based on the following:
  (1) The time, labor, and skill necessary to properly perform the legal
  services required by the action.
  (2) The novelty and difficulty of the questions involved in the action.
  (3) The likelihood, if apparent to the client, that the acceptance
  of employment with respect to the client's action will preclude other
  employment by the attorney.
  (4) The fee customarily charged in the locality for similar legal services.
  (5) The amount involved in the action and the results obtained.
  (6) The time limitations imposed by the client or by the circumstances of
  the action.
  (7) The nature and length of the professional relationship between the
  attorney or attorneys and the client.
  (8) The experience, reputation, and ability of the attorney or attorneys
  performing the services in connection with the action.
  (9) Whether the fee for services in connection with the action is fixed
  or contingent.
SEC. 144. JOINT AND SEVERAL LIABILITY.
  (a) IN GENERAL- With respect to a health care liability action, joint and
  several liability shall apply--
  (1) to the liability of each defendant for damages for economic losses; and
  (2) as between persons acting in concert where the concerted action
  proximately caused the injury for which one or more persons are found
  liable for damages.
  (b) NONECONOMIC DAMAGES- With respect to a health care liability action,
  joint and several liability shall not apply to the liability of each
  defendant for damages for noneconomic losses.  A person found liable for
  damages for noneconomic losses in any such action may--
  (1) be found liable, if at all, only for those damages directly attributable
  to the pro rata share of fault or responsibility of such person for the
  injury; and
  (2) not be found liable for damages attributable to the pro rata share
  of fault or responsibility of any other person (without regard to whether
  that person is a party to the action) for the injury, including any person
  bringing the action.
SEC. 145. STATUTE OF LIMITATIONS.
  (a) IN GENERAL- Except as provided in subsection (b), no health care
  liability action may be initiated after the expiration of the 2-year period
  that begins on the date on which the alleged injury should reasonably have
  been discovered, but in no event later than 4 years after the date of the
  alleged occurrence of the injury.
  (b) EXCEPTION FOR MINORS- In the case of an alleged injury suffered by
  a minor who has not attained 6 years of age, no health care liability
  action may be initiated after the expiration of the 2-year period that
  begins on the date on which the alleged injury should reasonably have
  been discovered, but in no event later than 4 years after the date of the
  alleged occurrence of the injury or the date on which the minor attains
  8 years of age, whichever is later.
SEC. 146. PREEMPTION.
  (a) IN GENERAL- This part supersedes any State law only to the extent that
  State law establishes higher payment limits, permits the recovery of a
  greater amount of damages or the awarding of a greater amount of attorneys'
  fees, or establishes a longer period during which a health care liability
  action may be initiated.
  (b) EFFECT ON SOVEREIGN IMMUNITY AND CHOICE OF LAW OR VENUE- Nothing in
  this part shall be construed to--
  (1) waive or affect any defense of sovereign immunity asserted by any
  State under any provision of law;
  (2) waive or affect any defense of sovereign immunity asserted by the
  United States;
  (3) affect the applicability of any provision of the Foreign Sovereign
  Immunities Act of 1976 (28 U.S.C. 1602 et seq.);
  (4) preempt State choice-of-law rules with respect to actions brought by
  a foreign nation or a citizen of a foreign nation; or
  (5) affect the right of any court to transfer venue or to apply the law
  of a foreign nation or to dismiss an action of a foreign nation or of a
  citizen of a foreign nation on the ground of inconvenient forum.
SEC. 147. EFFECTIVE DATE.
  This part shall apply to any health care liability action initiated after
  the expiration of the 2-year period that begins on the date of the enactment
  of this Act.
PART III--ALTERNATIVE DISPUTE RESOLUTION SYSTEMS
SEC. 148. GRANTS FOR ALTERNATIVE DISPUTE RESOLUTION SYSTEMS.
  (a) IN GENERAL- The Secretary shall make grants to States from amounts
  appropriated under section 150 for the development and implementation of
  alternative dispute resolution systems, under such terms as the Secretary
  may require.
  (b) APPLICATION-
  (1) IN GENERAL- No grant may be made under this section unless an application
  is submitted to the Secretary. Any such application shall--
  (A) be submitted to the Secretary within 1 year after the notification of
  availability of funds by the Secretary; and
  (B) either--
  (i) contain a certification by the chief executive officer of the State that,
  on the date the application is submitted, the State has enacted, adopted,
  or otherwise has in effect an alternative dispute resolution system; or
  (ii) contain a certification by the chief executive officer of the State
  that, on the date the application is submitted, the State plans to develop
  an alternative dispute resolution system.
  (2) SUPPORTING DOCUMENTATION- The certification required--
  (A) under paragraph (1)(B)(i) shall be accompanied by supporting
  documentation, including copies of relevant State statutes, rules,
  procedures, regulations, judicial decisions, and opinions of the State
  attorney general; and
  (B) under paragraph (1)(B)(ii) shall be accompanied by supporting
  documentation, including a detailed plan of the alternative dispute
  resolution system to be developed by the State.
  (c) REVIEW OF APPLICATIONS- Within 90 days after receiving an application
  under subsection (b), the Secretary shall review and approve the application
  if, in the determination of the Secretary, the application demonstrates
  that--
  (1) the State has enacted, adopted, or otherwise has in effect an alternative
  dispute resolution system; or
  (2) the State has a plan to develop an alternative dispute resolution system.
  (d) AMOUNT OF GRANT-
  (1) IN GENERAL- The amount of a grant under this section shall be an amount
  that the Secretary finds reasonable and necessary for the development and
  implementation of the alternative dispute resolution system of the State.
  (2) REDUCTIONS FOR EXPENSES OF SUPPLIES, EQUIPMENT, AND EMPLOYEE DETAIL-
  The Secretary may reduce the amount of a grant by--
  (A) the fair market value of any supplies or equipment furnished to the
  recipient by the Secretary;
  (B) the amount of pay, allowances, and travel expenses incurred by any
  officer or employee of the Federal Government when such officer or employee
  has been detailed to the recipient; and
  (C) the amount of any other costs incurred in connection with the detail
  of an officer or employee as described in subparagraph (B),
when the furnishing of such supplies or equipment or the detail of such
an officer or employee is for the convenience, and at the request, of such
recipient and for the purpose of carrying out activities under the grant.
  (3) OPTION TO REFUSE GRANT- Not later than 90 days after the Secretary
  makes a grant under this section to a State, that State may send notice to
  the Secretary that it refuses the grant. At the time the State sends such
  notice, the State shall return any amounts paid to it under such grant to
  the Secretary.
  (e) SUPPLEMENTAL GRANTS- If amounts appropriated for grants under this
  section remain available because--
  (1) a State has notified the Secretary that it refuses the grant made to
  the State;
  (2) a State has notified the Secretary that it does not intend to use the
  full amount of a grant awarded to the State; or
  (3) the amount paid to a State under a grant is reduced, offset, or repaid
  under subsection (d)(2),
the Secretary shall have the discretion to make supplemental grants to
States, to the extent such amounts are available, for the implementation of
alternative dispute resolution systems. A grant received by a State under
this subsection shall be used by the State to further implement and evaluate
the effectiveness of such a system.
  (f) RECORDS-
  (1) IN GENERAL- Each recipient of a grant under this section shall keep
  such records as the Secretary determines appropriate.
  (2) AUDIT AND EXAMINATION OF RECORDS- The Secretary and the Comptroller
  General of the United States shall have access to any books, documents,
  papers, and records of the recipient of a grant under this section, for
  the purpose of conducting audits and examinations of such recipient that
  are pertinent to such grant.
  (g) REPORTS-
  (1) REPORTS ON COMPLIANCE-
  (A) SUBMISSION OF REPORTS- Each State shall annually submit a report to
  the Secretary containing such information as the Secretary may require to
  determine whether the State is in compliance with the terms of the grant
  made under this section.
  (B) DETERMINATION OF NONCOMPLIANCE- If, after reviewing the report submitted
  under subparagraph (A), the Secretary determines that a State receiving
  a grant under this section is not in compliance with the terms of the
  grant, the Secretary shall provide the State with written notice of such
  determination. Such notice shall specify--
  (i) the reasons for the determination of the Secretary;
  (ii) that the Secretary will require the State, not later than 60 days
  after receipt of such notice, to return all funds provided to the State
  under the grant, unless the State--
  (I) takes such corrective action as may be necessary to ensure that the
  State is in compliance with the terms of the grant; or
  (II) requests a hearing under clause (iii); and
  (iii) that the State may request a hearing on the record before an
  administrative law judge under section 554 of title 5, United States Code,
  concerning the allegations set forth in the notice.
  (2) ADDITIONAL REPORTS- Each State receiving a grant under this section
  shall, not later than 2 years after the approval of its application
  for such grant and every 2 years thereafter, prepare and submit to the
  Commission on National Health Care Access and Reform established under
  section 201 (hereafter in this subtitle referred to as the `Commission'),
  the Secretary, and the appropriate committees of Congress, a report and
  evaluation concerning the alternative dispute resolution systems implemented
  by the State, including information--
  (A) on the effect of such systems on the cost of health care within
  the State;
  (B) on the impact of such systems on the access of individuals to health
  care within the State; and
  (C) on the effect of such systems on the quality of health care provided
  within the State;
SEC. 149. ESTABLISHMENT OF ADVISORY PANEL.
  (a) IN GENERAL- The Commission shall make recommendations to the Secretary
  concerning the eligibility, approval, and review requirements for alternative
  dispute resolution systems described in applications submitted under
  section 148(b).
  (b) ADVISORS- The Commission shall--
  (1) direct the National Advisory Board established under section 202 to
  assist in carrying out the Commission's activities under this section, or
  (2) establish a panel of advisors to assist in carrying out the Commission's
  activities under this section.
  (c) MEMBERS OF THE ADVISORY PANEL- If the Commission establishes an advisory
  panel under subsection (b)(2), the members of the advisory panel shall
  include representatives from each of the following:
  (1) Patient advocacy groups.
  (2) Groups representing State governments.
  (3) Health care provider groups, including organized medicine.
  (4) Health care insurers.
  (5) Health care employers.
  (6) Academic researchers from disciplines such as medicine, economics, law
  or health services, with expertise in alternative dispute resolution models.
  (d) DUTIES OF ADVISORS- The advisors appointed under paragraph (1) or (2)
  of subsection (b) shall--
  (1) assist in the development of criteria for alternative dispute resolution
  systems that States must meet to be eligible to receive grants under section
  148 and make information on such criteria available to the States to assist
  such States in preparing applications for grants;
  (2) as part of the criteria developed under paragraph (1), require that
  the alternative dispute resolution systems for which States receive grants
  under section 148--
  (A) support access to health care;
  (B) encourage improvements in the quality of care;
  (C) enhance the patient-provider relationship;
  (D) encourage innovation in health care delivery systems;
  (E) provide prompt resolution and fair compensation;
  (F) provide predictable outcomes; and
  (G) operate efficiently in terms of costs and processes;
  (3) provide advice and assistance to representatives from State governments
  concerning the establishment of alternative dispute resolution systems;
  (4) not later than 7 years after the date of enactment of this Act, submit
  to the Commission, the Secretary, and to the appropriate committees of
  Congress, a recommendation on the feasibility of a national alternative
  dispute resolution system; and
  (5) perform the duties set forth in part IV.
  (e) COMPENSATION- All members of the advisory panel established under
  subsection (b)(2) shall be reimbursed by the Commission for travel and
  per diem expenses in lieu of subsistence expenses during the performance
  of duties of the Panel in accordance with subchapter I of chapter 57 of
  title 5, United States Code.
  (f) FACA NOT APPLICABLE- The provisions of the Federal Advisory Committee
  Act shall not apply to an advisory panel established under subsection (b)(2).
  (g) PROVISION OF INFORMATION BY THE SECRETARY- The Secretary shall make
  available to the advisors appointed under paragraph (1) or (2) of subsection
  (b) any information concerning the grants made under section 148 that is
  necessary for such advisors to complete the duties set forth in subsection
  (d).
SEC. 150. AUTHORIZATION.
  (a) IN GENERAL- There are authorized to be appropriated $250,000,000 for
  each of the fiscal years 1993, 1994, and 1995, for grants under section 148.
  (b) AVAILABILITY OF FUNDS- Amounts appropriated for grants under section
  148 shall remain available until expended.
PART IV--DEMONSTRATION PROJECTS FOR NO-FAULT COMPENSATION PROGRAMS
SEC. 151. DEMONSTRATION PROJECTS FOR NO-FAULT COMPENSATION PROGRAMS.
  (a) ESTABLISHMENT- The Secretary shall establish a program to award grants
  to private entities for the development and implementation of demonstration
  no-fault compensation programs in the private sector.
  (b) APPLICATION- To be eligible to receive a grant under this section a
  private entity shall prepare and submit to the Secretary an application at
  such time, in such form, and containing such information as the Secretary
  may require including a description of the no-fault compensation program
  that the private entity intends to develop or implement.
  (c) REVIEW AND APPROVAL OF APPLICATIONS- The Secretary shall review and
  approve applications received under subsection (b) in accordance with
  recommendations made by the Commission with the advice of the advisors
  appointed under section 149(b).
  (d) AMOUNT OF GRANT- The amount of a grant to a private entity under this
  section shall be an amount that the Secretary finds reasonable and necessary
  for the development and implementation of the no-fault compensation program.
  (e) DUTIES OF ADVISORS-
  (1) IN GENERAL- The advisors appointed under section 149(b) shall--
  (A) develop criteria for no-fault compensation programs in the private
  sector that private entities must meet to be eligible to receive grants
  under this section; and
  (B) make information on such criteria available to the private entities
  to assist such entities in preparing applications for grants.
  (2) CRITERIA- As part of the criteria developed under paragraph (1), the
  advisors shall require that the no-fault compensation programs for which
  States receive grants under this section--
  (A) provide that health care providers offer their patients a no-fault
  compensation scheme in exchange for a waiver of common law tort liability
  for all injuries;
  (B) provide that patients are fully informed of the common law tort
  rights they are surrendering and the no-fault benefits they are eligible
  to receive; and
  (C) provide that the health care facility operate an effective quality
  assurance program, including measures for reporting and accountability
  for all adverse events identified through this claims process.
  (f) REPORTS AND RECOMMENDATIONS-
  (1) REPORTS BY RECIPIENTS OF GRANTS- Not later than 2 years after the
  approval of its application, each private entity that is a grant recipient
  shall prepare and submit a report to the Commission, the Secretary, and
  the appropriate committees of Congress, which contains--
  (A) an analysis of the feasibility and desirability of developing and
  implementing no-fault compensation programs; and
  (B) a recommendation for legislation on the development and implementation
  of no-fault compensation programs.
  (2) RECOMMENDATIONS- The Commission shall review the reports made by
  grant recipients pursuant to paragraph (1) and make recommendations to
  the Secretary regarding proposals for legislation to develop and implement
  national no-fault compensation programs.
  (g) AUTHORIZATION OF APPROPRIATIONS-
  (1) IN GENERAL- There are authorized to be appropriated for grants under
  this section $20,000,000 for each of the fiscal years 1993, 1994, and 1995.
  (2) AVAILABILITY OF FUNDS- Amounts appropriated for grants under this
  section shall remain available until expended.
Subtitle F--Joint Ventures
SEC. 161. AMENDMENT OF THE NATIONAL COOPERATIVE RESEARCH ACT OF 1984.
  (a) DEFINITIONS- Section 2(a) of the National Cooperative Research Act
  of 1984 (15 U.S.C. 4301(a)) is amended by adding at the end the following
  new paragraph:
  `(7) The term `joint health care provider venture' means a group of
  activities, as determined by the Commission on National Health Care Access
  and Reform (established under section 201 of the BasiCare Health Access
  and Cost Control Act), by 2 or more hospitals for the provision or delivery
  of health care services.'.
  (b) EXCLUSIONS- Section 2(b) of such Act (15 U.S.C. 4301(b)) is amended--
  (1) in the matter preceding paragraph (1) by striking `excludes' and
  inserting `and the term `joint health care provider venture' exclude'; and
  (2) in paragraph (1) by striking `conduct the research and development
  that is' and inserting `carry out'.
  (c) TECHNICAL AMENDMENTS- (1) Section 3 of such Act (15 U.S.C. 4302)
  is amended by inserting `or joint health care provider venture' after
  `joint research and development venture'.
  (2) Section 4 of such Act (15 U.S.C. 4303) is amended in subsections (a)(1),
  (b)(1), (c)(1), and (e) by inserting `or joint health care provider venture'
  after `joint research and development venture' each place it appears.
  (3) Section 5(a) of such Act (15 U.S.C. 4304(a)) is amended in the matter
  preceding paragraph (1) by inserting `or joint health care provider venture'
  after `joint research and development venture'.
  (4) Section 6 of such Act (15 U.S.C. 4305) is amended--
  (A) in the heading by striking `research and development';
  (B) in subsections (a), (d)(2), and (e) by inserting `or joint health
  care provider venture' after `joint research and development venture'
  each place it appears; and
  (C) in the first sentence of subsection (a) by inserting `(or in the case
  of a joint health care provider venture, the date of enactment  of the
  BasiCare Health Access and Cost Control Act)' after `this Act'.
TITLE II--LONG-TERM REFORMS
Subtitle A--Establishment of Commission and Advisory Board
SEC. 201. THE COMMISSION ON NATIONAL HEALTH CARE ACCESS AND REFORM.
  (a) ESTABLISHMENT- There is established an independent commission to
  be known as the Commission on National Health Care Access and Reform
  (hereinafter referred to as the `Commission').
  (b) DUTIES- The Commission shall carry out the duties specified for it in
  this title.
  (c) APPOINTMENT-
  (1) COMPOSITION-
  (A) SIZE AND MANNER OF APPOINTMENT- The Commission shall consist of--
  (i) five members to be appointed by the President, by and with the advice
  and consent of the Senate, one of whom shall, at the time of appointment,
  be designated as Chairperson of the Commission;
  (ii) two members to be appointed by the Speaker of the House of
  Representatives upon the recommendations of the Majority Leader and Minority
  Leader of the House of Representatives; and
  (iii) two members to be appointed by the President pro tempore of the
  Senate upon the recommendations of the Majority Leader and Minority Leader
  of the Senate.
  (B) POLITICAL AFFILIATION- At no time shall more than three of the members
  appointed by the President, one of the members appointed by the Speaker
  of the House of Representatives, or one of the members appointed by the
  President pro tempore of the Senate be members of the same political party.
  (C) MEMBERSHIP QUALIFICATIONS- The membership of the Commission shall
  consist of individuals who are of recognized standing and distinction and
  who possess the demonstrated capacity to discharge the duties imposed on
  the Commission, and shall include persons possessing substantial knowledge
  or expertise in health care delivery, health care insurance, or health care
  economics. No individual who is otherwise an officer or full-time employee
  of the United States shall serve as a member of the Commission. No member
  while serving on the Commission may receive financial gain from direct
  investments, employment or associations from any entity with demonstrable
  financial interest in matters over which the Commission has jurisdiction.
  (D) CHAIRPERSON- The Chairperson of the Commission shall designate a member
  of the Commission to act as Vice Chairperson of the Commission.
  (E) QUORUM- A majority of the members of the Commission shall constitute
  a quorum, but a lesser number may conduct hearings.
  (F) TERM- Members of the Commission shall be appointed for a term of 5
  years, except that with respect to the members first appointed--
  (i) the Chairperson and 2 members, 1 each appointed under clauses (ii) and
  (iii) of paragraph (1)(A), respectively, shall be appointed for a term of
  5 years;
  (ii) 3 members, 1 each appointed under clauses (i), (ii) and (iii) of
  paragraph (1)(A), respectively, shall be appointed for a term of 4 years; and
  (iii) the remaining members shall be appointed for a term of 3 years.
  (G) VACANCY- A vacancy in the Commission shall not affect its powers,
  but shall be filled in the same manner as the original appointment, but
  the individual appointed shall serve only for the unexpired portion of
  the term for which the individual's predecessor was appointed.
  (2) EFFECTIVE DATE- Appointments to the Commission shall be made no later
  than 90 days after the date of enactment of this Act.
  (d) MEETINGS- The Commission shall meet at the call of the Chairperson, or at
  the call of a majority of the members of the Commission; but meetings shall
  not be held less frequently than once in each calendar month which begins
  after a majority of the membership of the Commission has been appointed.
  (e) HEARINGS- In carrying out its duties under this section, the Commission,
  or any duly authorized committee thereof, is authorized to hold such
  hearings, sit and act at such times and places, and take such testimony,
  with respect to matters with respect to which it has a responsibility under
  this title, as the Commission or such committee may deem advisable. The
  Chairperson of the Commission or any member authorized by the Chairperson
  may administer oaths or affirmations to witnesses appearing before the
  Commission or before any committee thereof.
  (f) PAY AND TRAVEL EXPENSES-
  (1) PAY-
  (A) MEMBERS- Each member, other than the Chairperson, shall be paid at
  a rate equal to the daily equivalent of the minimum annual rate of basic
  pay payable for level IV of the Executive Schedule under section 5315 of
  title 5, United States Code, for each day (including travel time) during
  which the member is engaged in the actual performance of duties vested in
  the Commission.
  (B) CHAIRPERSON- The Chairperson shall be paid for each day referred to in
  subparagraph (A) at a rate equal to the daily equivalent of the minimum
  annual rate of basic pay payable for level III of the Executive Schedule
  under section 5314 of title 5, United States Code.
  (2) TRAVEL EXPENSES- Members shall receive travel expenses, including per
  diem in lieu of subsistence, in accordance with sections 5702 and 5703 of
  title 5, United States Code.
  (g) STAFF-
  (1) APPOINTMENT- Subject to paragraphs (2) and (3), the Chairperson, with
  the approval of the Commission, may appoint and fix the pay of additional
  personnel.
  (2) INAPPLICABILITY OF CIVIL SERVICE LAWS- The Chairperson may make such
  appointments without regard to the provisions of title 5, United States
  Code, governing appointments in the competitive service, and any personnel
  so appointed may be paid without regard to the provisions of chapter 51
  and subchapter III of chapter 53 of that title relating to classification
  and General Schedule pay rates, except that an individual so appointed
  shall receive pay--
  (A) not less than 120 percent of the minimum rate of basic pay payable
  for GS-15 of the General Schedule, and
  (B) no greater than the rate of basic pay payable for level IV of the
  executive schedule.
  (3) DETAIL OF PERSONNEL FROM FEDERAL AGENCIES- Upon request of the
  Chairperson, the head of any Federal department or agency may detail any
  of the personnel of that department or agency to the Commission to assist
  the Commission in carrying out its duties under this title.
  (4) FEDERAL AGENCY ASSISTANCE- The Comptroller General of the United States,
  the Secretary of Health and Human Services, and the Administrator of General
  Services shall provide assistance on a reimbursable basis, including the
  detailing of employees, to the Commission in accordance with an agreement
  entered into with the Commission.
  (h) OTHER AUTHORITY-
  (1) CONSULTANT SERVICES- The Commission may procure by contract, to the
  extent funds are available, the temporary or intermittent services of experts
  or consultants pursuant to section 3109 of title 5, United States Code.
  (2) PROPERTY MATTERS- The Commission may lease space and acquire personal
  property to the extent funds are available.
SEC. 202. NATIONAL ADVISORY BOARD.
  (a) APPOINTMENT- The Commission shall provide for appointment of a National
  Advisory Board (hereinafter referred to as the `Board') to advise the
  Commission on its activities.
  (b) MEMBERSHIP- The Board shall consist of 15 members who are representatives
  of employers, unions, health care providers, health care carriers, consumer
  organizations, State health programs, and public health professionals,
  as well as the general public. Such members shall serve for terms of 3
  years, except that, in the initial appointment, 5 members shall be each
  appointed for terms of 1 year, 2 years, and 3 years.
  (c) VACANCIES-
  (1) IN GENERAL- The Commission shall fill any vacancy in the membership
  of the Board in the same manner as the original appointment. The vacancy
  shall not affect the power of the remaining members to execute the duties
  of the Board.
  (2) VACANCY APPOINTMENTS- Any member appointed to fill a vacancy shall
  serve for the remainder of the term for which the predecessor of the member
  was appointed.
  (3) REAPPOINTMENT- The Commission may reappoint an appointed member of
  the Board for a second term in the same manner as the original appointment.
  (d) CHAIRPERSON AND VICE CHAIRPERSON- The Board shall select a Chairperson
  and a Vice Chairperson from among the members of the Board.
  (e) COMPENSATION- All members of the Board and the committees established
  under subsection (h) shall be reimbursed by the Commission for travel and
  per diem in lieu of subsistence expenses during the performance of duties
  of the Board in accordance with subchapter I of chapter 57 of title 5,
  United States Code.
  (f) FACA NOT APPLICABLE- The provisions of the Federal Advisory Committee
  Act shall not apply to the Board.
  (g) DUTIES- As directed by the Commission, the Board shall undertake
  such projects as the Commission may deem necessary.  Such projects may
  include site visits and studies that are concerned with issues of access
  to health care services, utilization of health care services, consumer
  participation and satisfaction in the provision of health care services,
  education of health personnel, medical practice, medical technology, quality
  of insurance plans and health care delivery, and malpractice liability.
  The Board shall not undertake studies, visits, or projects, nor shall it
  issue recommendations, except at the request of the Commission.
  (h) COMMITTEES- The Board shall create such committees (composed of
  Commission members and others as appointed by the Chairperson) as necessary
  to enable the Board to meet its responsibilities and functions.
SEC. 203. AUTHORIZATION OF APPROPRIATIONS.
  There are authorized to be appropriated to the Commission such funds as
  are necessary to carry out its duties under this title.  Such funds shall
  remain available until expended.
Subtitle B--Reform and Standardization of Private Insurance
SEC. 211. DEFINING GOALS AND GUIDELINES OF COMMISSION.
  (a) DEFINING GOALS- In carrying out the responsibilities assigned to it
  under this Act, the Commission shall at all times seek to--
  (1) improve access to basic health coverage and services;
  (2) control the cost of health care coverage and services;
  (3) safeguard the quality of health care services;
  (4) assure equity in the availability and cost of health care coverage
  and services; and
  (5) minimize administrative complexity and duplication in the health
  care system.
  (b) GUIDELINES- In carrying out the responsibilities assigned to it under
  this Act, the Commission shall in developing or evaluating any health care
  proposal or modification be guided by the anticipated effect on--
  (1) the cost of health care to medical consumers;
  (2) the quality of health care services;
  (3) access to health care services;
  (4) the financial viability of health care providers;
  (5) the financial viability of health care carriers;
  (6) the provision of health benefits to employees by employers; and
  (7) the administrative complexity of the health care system.
  (c) CONSULTATIONS- In carrying out the responsibilities assigned to it
  under this Act, the Commission shall seek out and consider recommendations
  from a broad range of interested individuals and organizations, including
  organizations representing health care consumers, health care providers,
  health care carriers, representatives of State health programs, public
  health professionals, and the general public.
SEC. 212. DEVELOPMENT AND SUBMISSION OF LEGISLATIVE PROPOSAL.
  (a) IN GENERAL- By not later than January 1, of the 2nd year following the
  date of enactment of this Act, the Commission shall develop and submit to
  Congress a legislative proposal which provides for the following:
  (1) BASICARE BENEFITS PACKAGE- A uniform national health benefits package
  (hereinafter referred to as the `BasiCare benefits package') specifying
  minimum benefits applicable to all carriers which meets the requirements
  of section 214.
  (2) INSURANCE RESPONSIBILITIES UNDER BASICARE- A national health care
  insurance reform plan which meets the requirements of section 215 and which
  shall apply to all carriers selling health insurance in the United States.
  (3) ESTABLISHMENT OF BASICARE BASE PREMIUM RATE- A base premium rate
  (hereinafter referred to as the `BasiCare base premium rate') to apply to
  the BasiCare benefits package, which meets the requirements of section 216.
  (4) EMPLOYER RESPONSIBILITIES UNDER BASICARE- Employer responsibilities
  to offer the BasiCare health benefit plan as described in section 217.
  (5) INDIVIDUAL RESPONSIBILITIES UNDER BASICARE- Individual responsibilities
  to obtain the BasiCare health benefit plan coverage as described in
  section 218.
  (6) SELF-INSURED REQUIREMENTS- Self-insured plan requirements with respect
  to certification as described in section 219.
  (7) TREATMENT OF MANAGED CARE PLANS- Federal standards for managed care
  plans as described in section 220 and preemption of State provisions
  relating to such plans, as described in section 221.
  (8) LOW-INCOME ASSISTANCE- A program to provide low-income individuals
  and families--
  (A) an orderly transfer from medicaid program coverage under title XIX of
  the Social Security Act to BasiCare health benefit plan coverage, and
  (B) financial assistance in obtaining BasiCare health benefit plan coverage,
as specified in subtitle C.
  (b) CONSIDERATION- The legislative proposal described in subsection (a)
  shall be considered by the Congress under the procedures for consideration
  of an `approval resolution' as described in subtitle D.
  (c) EFFECTIVE DATE OF IMPLEMENTATION- The provisions of the recommendation
  shall become effective on January 1 of the year following the year of the
  date of approval of the Commission's recommendation (unless such period
  of time is less than 9 months, in which case such provisions shall become
  effective on January 1 of the second year following the date of approval
  of the Commission's recommendation).
SEC. 213. CONTINUING DUTIES AND RESPONSIBILITIES OF THE COMMISSION.
  (a) PERIOD FOR RESUBMISSION OF BASICARE PACKAGE AND BASE RATE IN CASE
  OF NONAPPROVAL- If the recommendation of the Commission submitted under
  section 212 is not approved by Congress in a year, the Commission shall
  by not later than January 1 of each year thereafter, for a period not to
  exceed 2 years (unless such recommendation is approved in a year) submit a
  new recommendation to Congress subject to the guidelines and requirements
  of this title.
  (b) CONTINUING REVIEW OF BASICARE BENEFITS PACKAGE AND BASICARE BASE
  PREMIUM RATE-
  (1) MODIFICATIONS IN BASICARE BENEFITS PACKAGE- The Commission may by
  not later than September 30 of any year following the effective date
  of implementation of the Commission's recommendation under section 212,
  subject to the guidelines and goals applicable to its initial recommendation,
  publish in the Federal Register revisions to the BasiCare benefits package,
  which revisions shall become effective on January 1 of the immediately
  following calendar year unless rescinded by Congress.
  (2) MODIFICATIONS TO VARIATIONS IN BASICARE BASE PREMIUM RATE- The Commission
  may by not later than September 30 of any year following the effective date
  of implementation of the Commission's recommendation under section 212,
  subject to the guidelines and goals applicable to its initial recommendation,
  publish in the Federal Register revisions to any variations provided in the
  BasiCare base premium rate, which revisions shall become effective on January
  1 of the immediately following calendar year unless rescinded by Congress.
  (c) ESTABLISHMENT OF ANNUAL ALLOWABLE RATES OF INCREASE IN BASICARE
  PREMIUM RATES- The Commission shall by not later than September 30 of each
  year following the effective date of implementation of the Commission's
  recommendation under section 212, subject to the guidelines and goals
  applicable to its initial recommendation, publish in the Federal Register
  a percentage figure for a single allowable rate of increase in BasiCare
  premiums to become effective on January 1 of the immediately following
  calendar year unless such percentage figure is modified or rescinded by
  Congress. Such rate of increase shall be binding on all carriers offering
  benefits covered under the BasiCare benefits package, as provided in
  section 215.
  (d) OVERSIGHT OF PROVIDER PARTICIPATION AND BILLING-
  (1) IN GENERAL- The Commission shall conduct ongoing oversight of provider
  response to the imposition of annual limits in the allowable rate of
  increase in BasiCare premiums, as provided in this Act. The findings of
  such oversight shall be expressed in annual reports to Congress.
  (2) CONSIDERATIONS- Matters to be examined in such oversight shall include,
  but are not limited to, the following:
  (A) The incidence of balance billing by providers to patients of amounts
  in excess of such payments as may be made to providers by BasiCare carriers.
  (B) The effect of any such balance billing on the accessibility of affordable
  health care services to health care consumers.
  (C) The incidence of participation (or nonparticipation) of health care
  providers in BasiCare health benefit plans.
  (D) The effect of such participation (or nonparticipation) on the
  availability and affordability of health care services to health care
  consumers.
  (E) The extent to which the incidence of provider balance billing or
  nonparticipation in BasiCare health benefit plans may vary according to
  professional specialty or region.
  (3) OPTION FOR BILLING AND PARTICIPATION REQUIREMENTS- At any time following
  the standardization of the BasiCare health benefit plan under this Act,
  the Commission may submit to Congress a legislative proposal providing
  for one or both of the following:
  (A) Such balance billing limits as the Commission may deem necessary to
  assure affordable access by health care consumers to services covered
  under the BasiCare health benefit plan.
  (B) Such participation requirements as the Commission may deem necessary to
  assure a level of provider participation in BasiCare health benefit plans
  sufficient to assure affordable access to quality health care services by
  BasiCare enrollees.
  (4) CONGRESSIONAL CONSIDERATION- Any proposal made to Congress under
  this subsection shall be considered by Congress under the procedures for
  consideration of an `approval resolution' as described in subtitle D.
  (e) OVERSIGHT OF SUPPLEMENTAL HEALTH INSURANCE MARKET-
  (1) IN GENERAL- The Commission shall, upon implementation of the Commission's
  recommendations under section 212, commence an ongoing assessment of
  the condition of the supplemental health insurance market for insurance
  benefits which are beyond the scope of the BasiCare benefits package.
  The findings of such assessment shall be transmitted in annual reports to
  the appropriate committees of Congress.
  (2) CONSIDERATIONS- Matters to be addressed in such assessment shall include,
  but not be limited to--
  (A) the rate of cost growth in the supplemental market, and the extent
  to which such growth may be contributing to growth in national health
  care expenditures;
  (B) the affordability and availability of supplemental policies to employers,
  families, and individuals;
  (C) the extent to which the terms and cost of coverage vary among
  beneficiaries based on health and claims status;
  (D) the value of supplemental policies to beneficiaries, as measured by
  loss ratios;
  (E) the extent of questionable marketing practices, such as misrepresentation
  of policy benefits or provisions, or the selling of policies that duplicate
  existing coverage; and
  (F) the extent to which State insurance regulation is addressing perceived
  problems in the supplemental market.
  (3) RECOMMENDATION TO CONGRESS- No later than January 1 of the second
  year following the effective date of implementation of the Commission's
  recommendations under this title, the Commission shall include in its annual
  report to Congress (under this subsection) a recommendation regarding the
  advisability of Federal regulation of the supplemental health insurance
  market.  If the Commission's recommendation is that such regulation is
  needed, the Commission shall prepare and submit to Congress draft legislation
  to carry out the terms of such regulation as it may deem necessary.
  (4) SUBSEQUENT RECOMMENDATIONS- At any time following submission of its
  recommendation to Congress under paragraph (3), the Commission may, based
  on the findings of its continuing assessment under paragraphs (1) and (2),
  submit additional recommendations or draft legislation to Congress regarding
  action it may consider advisable relative to the supplemental market.
  (5) CONGRESSIONAL CONSIDERATION- Proposals made to Congress under this
  subsection shall be considered by Congress under the procedures for
  consideration of an `approval resolution' as described in subtitle D.
  (f) SAFEGUARDING QUALITY OF HEALTH CARE-
  (1) ANNUAL REPORT- The Commission shall by no later than January 1 of each
  year following the date of enactment of this Act, submit an annual report
  to Congress assessing the quality of health care in the United States, and
  outlining areas of significant progress or decline in the delivery of or
  accessibility to health care.  In preparing such reports, the Commission
  shall conduct such studies, hearings, or other evaluations as it deems
  necessary to accomplish a comprehensive and continuing evaluation of health
  care quality in the United States.
  (2) CONTRACTS FOR PROVISION OF INFORMATION TO CONSUMERS REGARDING QUALITY
  OF HEALTH CARE SERVICES AND INSURANCE- The Commission shall enter into
  contracts with public or private nonprofit entities in each State for
  the collection and dissemination to consumers of information regarding
  the quality and cost-effectiveness of services provided by health care
  providers and carriers in the State.
  (3) REQUIREMENT TO CONSIDER HEALTH CARE QUALITY DATA- Information regarding
  health care quality obtained through the activities described in this
  subsection shall be considered and incorporated by the Commission in
  carrying out the other continuing duties and responsibilities assigned to
  it under this section including setting annual premium limits and other
  rates as provided in this title.
  (g) UNIFORM CLAIMS FORMS AND ELECTRONIC PROCESSING-
  (1) IN GENERAL- The Commission shall develop in consultation with entities
  offering health insurance, health care providers, and the Secretary,
  a uniform claims form to be used by both private health plans and by the
  Medicare program under title XVIII of the Social Security Act.
  (2) APPLICATION AND REVISION- The Commission shall by no later than
  1 year after the effective date of implementation of the Commission's
  recommendation under section 212, require that the uniform claims form
  developed under paragraph (1), be utilized by all carriers offering benefits
  covered under the BasiCare benefits package and under title XVIII of the
  Social Security Act.  The Commission shall revise such form, as necessary,
  to reflect changes in the health care insurance market.
  (3) UNIFORM REPORTING STANDARDS- In developing the claims form under
  paragraph (1), the Commission in consultation with the entities described
  in such paragraph, shall develop standards for uniform reporting (while
  preserving individual patient identity) concerning--
  (A) the types and amounts of required health services provided; and
  (B) the costs of such facilities providing such services.
The Commission shall periodically collect, analyze, and disseminate information
received under this paragraph.
  (4) UNIVERSAL ELECTRONIC PAYMENT AND BILLING CARD- In conjunction with
  development of the standard claims form under paragraph (1), the Commission
  shall develop, and all private and public health insurance programs shall
  be required to participate in, a program to provide a universal health
  insurance card to every individual or family which shall be accepted by
  all health care providers for purposes of payment and billing.  Such cards
  shall be imprinted electronically with necessary and appropriate information
  concerning coverage and billing, and to the maximum extent practicable,
  with information to assist in the management of a uniform system of
  computerized patient records.
  (h) LONG-TERM DISPOSITION OF MEDICAID BENEFITS AND PROGRAM-
  (1) IN GENERAL- At any time following the effective date of implementation
  of the Commission's recommendation under section 212, the Commission
  may submit to Congress a proposed plan for long-term disposition of any
  benefits of the medicaid program not covered under or subsumed by the
  BasiCare benefits package.
  (2) PROPOSED PLAN- In preparing a proposed plan described in paragraph
  (1), the Commission shall consult with representatives of State medicaid
  programs, and shall follow the goals and guidelines described in section 211.
  (3) CONGRESSIONAL CONSIDERATION- Proposals made to Congress under this
  subsection shall be considered by the Congress under the procedures for
  consideration of an `approval resolution' as described in subtitle D.
  (4) PERIOD FOR RESUBMISSION OF PROPOSAL- If the recommendation of the
  Commission submitted under this subsection is not approved by Congress
  in a year, the Commission shall by not later than January 1 of each year
  thereafter, for a period not to exceed 2 years (unless such recommendation
  is approved in a year) submit a new recommendation to Congress subject to
  the guidelines and requirements of this title.
  (i) ASSIMILATION OF MEDICARE INTO BASICARE SYSTEM-
  (1) IN GENERAL- The Commission shall by no later than January 1 of the fifth
  year following the effective date of implementation of the Commission's
  recommendation under section 212, submit to the Congress draft legislation
  providing for the assimilation of the medicare program under title XVIII
  of the Social Security Act into the BasiCare system. The Commission shall
  include with such draft legislation, an accompanying report detailing and
  explaining the provisions of such draft legislation.
  (2) CONGRESSIONAL CONSIDERATION- Proposals made to Congress under this
  subsection shall be considered by Congress under the procedures for
  consideration of an `approval resolution' as described in subtitle D.
  (3) PERIOD FOR RESUBMISSION OF PROPOSAL- If the proposal of the Commission
  submitted under this subsection is not approved by Congress in a year,
  the Commission shall by not later than January 1 of each year thereafter,
  for a period not to exceed 2 years (unless such recommendation is approved
  in a year) submit a new proposal to Congress subject to the guidelines
  and requirements of this title.
  (j) ASSIMILATION OF OTHER PROGRAMS INTO BASICARE SYSTEM-
  (1) IN GENERAL- The Commission shall by no later than January 1 of the fifth
  year following the effective date of implementation of the Commission's
  recommendation under section 212, submit to the Congress draft legislation
  providing for the assimilation of the CHAMPUS program under title 10,
  United States Code, and the Federal employees program under chapter 89 of
  title 5, United States Code, into the BasiCare system. The Commission shall
  include with such draft legislation, an accompanying report detailing and
  explaining the provisions of such draft legislation.
  (2) CONGRESSIONAL CONSIDERATION- Proposals made to Congress under this
  subsection shall be considered by Congress under the procedures for
  consideration of an `approval resolution' as described in subtitle D.
  (3) PERIOD FOR RESUBMISSION OF PROPOSAL- If the proposal of the Commission
  submitted under this subsection is not approved by Congress in a year,
  the Commission shall by not later than January 1 of each year thereafter,
  for a period not to exceed 2 years (unless such recommendation is approved
  in a year) submit a new proposal to Congress subject to the guidelines
  and requirements of this title.
  (k) OVERSIGHT OF SUCH UNCOMPENSATED CARE AS MAY REMAIN- To the extent it
  deems necessary, and to the extent practicable, the Commission may provide
  to Congress recommendations for the establishment of national or regional
  compensation pools, or other mechanisms, for the payment of providers who
  furnish BasiCare-covered services to individuals who, through choice or
  inadvertence, fail to secure BasiCare coverage as provided in this Act.
  (l) MEDICAL EDUCATION ASSISTANCE- In conjunction with the duties assigned
  to it under section 212 of this Act, and in conjunction with its proposal
  to assimilate the medicare program into BasiCare under subsection (i) of
  this section, the Commission shall consider and develop methods to assure
  support for academic health centers and the provision of quality training
  to health professionals.
SEC. 214. BASICARE BENEFITS PACKAGE.
  (a) CRITERIA- In preparing the BasiCare benefits package described in
  section 212(a)(1), the Commission shall, subject to the requirements of
  this title, develop and recommend the BasiCare benefits package as it
  deems appropriate, adhering to the goals and guidelines described in this
  subtitle. The BasiCare benefits package developed and recommended by the
  Commission shall at a minimum provide for--
  (1) basic hospitalization coverage;
  (2) basic outpatient services;
  (3) protection against catastrophic out-of-pocket costs;
  (4) coverage against extraordinary long-term care costs; and
  (5) coverage for preventive care services of significant proven and
  recognized value in averting serious and costly medical conditions.
  (b) UNIFORMITY-
  (1) IN GENERAL- Subject to the exceptions described in paragraph (2),
  the BasiCare benefits package recommended by the Commission shall provide
  for uniform national deductibles, copayments, and benefit applications
  and standards.
  (2) LIMITED VARIATION ALLOWED- In order to accommodate systems for providing
  health care in a managed system, the Commission may provide for variations
  in the structure of BasiCare cost-sharing requirements for such systems,
  but only to the extent such variations do  not significantly compromise
  the national uniformity of a single BasiCare benefits package.
  (c) FLEXIBILITY REGARDING LONG-TERM CARE-
  (1) MODIFIED BENEFIT PLAN FOR MEDICARE BENEFICIARIES- The Commission may
  include in its proposal under section 212 provisions for the establishment
  of a modified BasiCare long-term care benefits plan for persons currently
  enrolled in the medicare program under title XVIII of the Social Security
  Act.  If the Commission includes such a plan, the plan shall--
  (A) consist only of long-term care benefits included in the BasiCare
  benefits package, and
  (B) be subject to the rules and requirements applicable to the BasiCare
  health benefit plan under this title, except as may be modified by the
  Commission in its proposal to Congress under section 212.
  (2) CONTINUITY OF LONG-TERM CARE COVERAGE- The Commission may include
  in its proposal under section 212 such special provisions as it may deem
  necessary to assure portability of coverage consistent with the requirements
  of section 215.
  (3) INTERACTION WITH OTHER PROGRAMS- The Commission may include such
  provisions as it deems necessary to coordinate BasiCare long-term care
  coverage with coverage provided under the medicare program under title XVIII
  of the Social Security Act, and with coverage provided by the medicaid
  program under title XIX of the Social Security Act, as modified by the
  terms of this Act.
  (d) PREFERENCE FOR COPAYMENTS IN COST-SHARING- To the extent practicable,
  the Commission shall employ copayments rather than deductibles in providing
  for such cost-sharing requirements as may be included in the BasiCare
  benefits package under this section.
SEC. 215. INSURANCE RESPONSIBILITIES UNDER BASICARE.
  (a) IN GENERAL- In developing the legislative proposal described in
  section 212(a)(2), the Commission shall provide that the requirements of
  this section are incorporated as part of its recommendation for national
  health care insurance reform.
  (b) GENERAL REQUIREMENT- Each carrier shall offer the BasiCare health
  benefit plan as specified in this section.
  (c) PREEMPTION OF STATE MANDATED BENEFIT LAWS- To the extent that laws of
  any State or local government regulate or otherwise provide any requirement
  relating to the benefits to be provided under contracts or policies of
  insurance issued to, or under, a BasiCare health benefit plan, such laws
  are preempted.
  (d) NONDUPLICATION OF BASICARE- Health benefit plans may be issued
  for benefits other than those covered by the BasiCare benefits package
  described in section 214, but no health benefit plans may be offered by
  any carrier in any State which duplicate, either in whole or in part,
  the benefits described in the BasiCare benefits package.
  (e) NONDISCRIMINATION BASED ON HEALTH STATUS-
  (1) IN GENERAL- BasiCare health benefit plans offered by carriers may not
  deny, limit, or condition the coverage under (or benefits of) the plan
  based on the health status, claims experience, receipt of health care,
  medical history, or lack of evidence of insurability, of an individual.
  (2) TREATMENT OF PREEXISTING CONDITION EXCLUSIONS FOR ALL SERVICES- BasiCare
  health benefit plans provided by carriers may not exclude or otherwise
  discourage coverage with respect to services related to treatment of a
  preexisting condition.
  (f) REGISTRATION WITH APPLICABLE REGULATORY AUTHORITY-
  (1) IN GENERAL- Each carrier shall register with the applicable regulatory
  authority for each State in which it issues or offers health benefit plans.
  (2) NO PREEMPTION OF STATE INFORMATION REQUIREMENTS- Nothing in paragraph
  (1) shall be construed as preventing the applicable regulatory authority
  from requiring, in the case of BasiCare carriers that are not self-insurance
  carriers, such additional information in conjunction with, or apart from,
  the registration required under paragraph (1) as the applicable regulatory
  authority may be authorized to require under State law.
  (g) GUARANTEED ISSUE-
  (1) IN GENERAL- Subject to the succeeding provisions of this subsection, a
  carrier that offers a BasiCare health benefit plan (including a reinsurance
  plan) to groups or individuals located in a community must offer the same
  plan to any other group or individual located in the community, and shall
  participate in a program developed by the Commission for assigning high-risk
  groups or individuals among all such carriers.
  (2) TREATMENT OF HEALTH MAINTENANCE ORGANIZATIONS-
  (A) GEOGRAPHIC LIMITATIONS- A health maintenance organization may deny
  coverage under a BasiCare health benefit plan to an individual or group
  whose members are located outside the service area of the organization,
  but only if such denial is applied uniformly without regard to health
  status or insurability.
  (B) SIZE LIMITS- A health maintenance organization may apply to the
  applicable regulatory authority to cease enrolling new groups or individuals
  in its BasiCare health benefit plan (or in a geographic area served by the
  plan) if it can demonstrate that its financial or administrative capacity to
  serve previously enrolled groups and individuals (and additional individuals
  who will be expected to enroll because of affiliation with such previously
  enrolled groups) will be impaired if it is required to enroll new groups
  or individuals.
  (3) GROUNDS FOR REFUSAL TO ISSUE OR RENEW-
  (A) IN GENERAL- A carrier may refuse to issue or renew or terminate a
  BasiCare health benefit plan under this part only for--
  (i) nonpayment of premiums,
  (ii) fraud or misrepresentation, and
  (iii) failure to meet minimum participation rates (consistent with
  subparagraph (B)).
  (B) MINIMUM PARTICIPATION RATES- A carrier may require, with respect to
  an employment-related group BasiCare health benefit plan, that a minimum
  percentage of full-time employees eligible to enroll under the plan
  be enrolled, so long as such percentage is enforced uniformly for all
  employment groups of comparable size.
  (h) MINIMUM PLAN PERIOD- A carrier may not offer, or issue a BasiCare
  health benefit plan with a term of less than 12 months.
  (i) GUARANTEED RENEWABILITY-
  (1) IN GENERAL-
  (A) GENERAL RULE- Subject to the succeeding provisions of this subsection,
  a carrier shall ensure that a BasiCare health benefit plan issued to a
  group or individual be renewed, at the option of the policyholder, unless
  the plan is terminated for the reasons specified in subsection (h)(3)
  (A) or  under subparagraph (B).
  (B) TERMINATION OF BUSINESS- A carrier need not renew a BasiCare health
  benefit plan with respect to such a policyholder if the carrier--
  (i) is terminating provision of all health insurance in the community; and
  (ii) provides notice to the policyholder covered under the plan of such
  termination at least 90 days before the date of expiration of the plan.
In the case of such a termination, the carrier may not provide for issuance of
any health benefit plan in such community during the 5-year period beginning
on the date of termination of such block of business.
  (C) CONSTRUCTION RESPECTING ADDITIONAL STATE DISCLOSURE REQUIREMENTS-
  Subparagraph (B)(ii) shall not be construed as preventing the applicable
  regulatory authority from specifying the information to be included in the
  notice under such subparagraph or in requiring such notice to be provided
  at an earlier date.
  (2) NOTICE AND SPECIFICATION OF RATES AND ADMINISTRATIVE CHANGES-
  (A) NOTICE- A carrier offering BasiCare health benefit plans shall provide
  for notice, at least 30 days before the date of expiration of the health
  benefit plan, of the terms for renewal of the plan. Except with respect to
  rates and administrative changes, the terms of renewal (including benefits)
  shall be the same as the terms of issuance.
  (B) RENEWAL RATES SAME AS ISSUANCE RATES- The carrier may change the
  terms for such renewal, but the premium rates charged with respect to such
  renewal shall be the same as that for a new issue.
  (C) RATES CANNOT CHANGE MORE OFTEN THAN MONTHLY-
  (i) IN GENERAL- A carrier may not change the premium rates established
  with respect to BasiCare health benefit plans in a community more often
  than monthly.
  (ii) APPLICATION OF NEW RATES- A carrier that offers BasiCare health
  benefit plans which become effective in a month, shall ensure that the
  premium rates established under clause (i) for that month shall apply to
  all months during the 12-month period beginning with that month. In the
  case of a plan renewal which is effective for a 12-month period beginning
  with a month, the premium rates established under clause (i) with respect
  to that month shall apply to all months during 12-month renewal period.
  (3) PERIOD OF RENEWAL- The period of renewal of each health benefit plan
  offered by a carrier shall be for a period of not less than 12 months.
  (j) COMMUNITY RATING-
  (1) IN GENERAL- A carrier may not charge premium rates for BasiCare health
  benefit plans in excess of the average per capita cost of providing such
  coverage to all individuals covered under BasiCare policies issued by that
  carrier in a community. A BasiCare health benefit plan meeting such criteria
  will be considered `actuarially certified' for purposes of this subsection.
  (2) ACTUARIALLY CERTIFIED DEFINED- A BasiCare health benefit plan is
  considered to be `actuarially certified' if there is a written statement by
  a member of the American Academy of Actuaries or other individual acceptable
  to the applicable regulatory authority that a carrier is in compliance with
  this section, based upon the individual's examination, including a review
  of the appropriate records and of the actuarial assumptions and methods
  utilized by the carrier in establishing premium rates for applicable health
  benefit plans.
  (k) ADJUSTMENTS TO COMMUNITY RATING-
  (1) IN GENERAL- A BasiCare health benefit plan offered by a carrier to a
  group or individual may provide for an adjustment to the average community
  rate based on the age of covered individuals. Any such adjustment shall
  be applied by the carrier consistently to all policyholders, and no other
  adjustments shall be permitted.
  (2) LIMITATION ON ADJUSTMENT-
  (A) IN GENERAL- The adjustment under paragraph (1) may not result, with
  respect to BasiCare health benefit plans offered by carriers to groups and
  individuals in the same community, in a premium rate for the most expensive
  age group exceeding the average community rate by more than the applicable
  percent (as defined in subparagraph (B)).
  (B) APPLICABLE PERCENT DEFINED- In subparagraph (A), the term `applicable
  percent' means--
  (i) for the first effective year, 50 percent,
  (ii) for the second effective year, 40 percent,
  (iii) for the third effective year, 30 percent, and
  (iv) for any subsequent year, 20 percent.
  (l) APPLICATION OF STANDARDS TO REINSURANCE POLICIES- The requirements
  of this section shall apply to all reinsurance policies sold by an entity
  to a carrier offering BasiCare health benefit plans through self-insured
  employment-related health benefit plans.
  (m) APPLICATION OF BASICARE BASE PREMIUM RATE- For the first year of
  standardization of the BasiCare health benefit plan under this Act,
  premiums charged for BasiCare health benefit plans may not exceed the
  BasiCare base premium rate, as provided in section 216.
  (n) APPLICATION OF ALLOWED RATE OF INCREASE-
  (1) IN GENERAL- A carrier may not charge premiums with respect to BasiCare
  health benefit plans in any calendar year which exceed the greater of--
  (A) the previous year's rate plus the annual allowable percentage rate of
  increase for the year as provided in section 213; or
  (B) the applicable base premium rate, as provided in section 213, plus
  amounts corresponding to the cumulative total of annual allowable percentage
  rates of increase up to the current year.
  (2) EXCEPTION- Notwithstanding paragraph (1)(B), in any single calendar
  year a carrier may not increase its premium with respect to a BasiCare
  health benefit plan by an amount exceeding 120 percent of the national
  annual allowable percentage rate of increase for that year, as provided
  in section 213.
  (o) TREATMENT OF CERTAIN CARRIERS- In preparing its recommendation to
  Congress under section 212 of this Act, the Commission may, as it deems
  necessary, provide for limited and temporary adjustments in the requirements
  under subsection (k) of this section for carriers who can demonstrate a
  continued and significantly disproportionate share of high-risk insureds
  among its policyholders.
SEC. 216. BASICARE BASE PREMIUM RATE.
  (a) CRITERIA- In developing the legislative proposal described in section
  212(a)(3), the BasiCare base premium rate established and recommended by
  the Commission shall be based on the anticipated average cost of providing
  the BasiCare benefits package to an average group of beneficiaries (as
  determined by the Commission in consultation with the Board).
  (b) LIMITED VARIATION ALLOWED- In establishing the BasiCare base premium
  rate, the Commission may propose limited variations in such rate to
  accommodate geographic variables, or other variables as described in
  paragraphs (1) and (2).
  (1) GEOGRAPHIC VARIABLES- In order to accommodate differences in costs in
  delivering health care in different geographical areas, the Commission may
  provide for limited geographical variations in the BasiCare base premium
  rate to the extent such variations are--
  (A) based on statistically verifiable differences in the cost of providing
  the BasiCare benefits package, and
  (B) not provided for geographic areas smaller than areas that encompass
  at least--
  (i) one or more adjacent metropolitan statistical areas (as defined by
  the Commission, in consultation with the Bureau of the Census); or
  (ii) the total remaining area within a State not otherwise included in a
  geographic area described under clause (i).
  (2) OTHER VARIABLES- If the Commission has provided for variation in
  the BasiCare benefits package under paragraph (2) of section 214(b), the
  Commission may provide for variations in the BasiCare base premium rate
  to reflect such variations in the benefit package, to the extent such
  variations meet the criteria for allowing variations under paragraph (2)
  of such section. Also, to the extent that adjustments to community rating
  of BasiCare health benefit plans are permitted under section 215(k), the
  Commission may provide for corresponding variation in the BasiCare base
  premium rate to reflect such permitted adjustments. If variations are
  provided for in the BasiCare base premium rate, such variations shall
  be expressed in terms of percentage variation from a single standard
  national rate.
SEC. 217. EMPLOYER RESPONSIBILITIES UNDER BASICARE.
  (a) NO DISCRIMINATION BASED ON HEALTH STATUS FOR CERTAIN SERVICES- An
  employment-related BasiCare health benefit plan may not deny, limit, or
  condition coverage based on the health status, claims experience, receipt
  of health care, medical history, or lack of evidence of insurability,
  of an individual.
  (b) TREATMENT OF PREEXISTING CONDITION EXCLUSIONS- An employment-related
  BasiCare health benefit plan may not exclude or otherwise discourage coverage
  with respect to services related to treatment of a preexisting condition.
  (c) TREATMENT OF WAITING PERIODS- An employment-related BasiCare health
  benefit plan may not impose waiting periods of any length.
  (d) NO DISCRIMINATION BASED ON INCOME LEVEL- An employment-related BasiCare
  health benefit plan shall apply equally to employees of all income levels.
  (e) EQUAL CONTRIBUTION LEVELS- The total amount of an employer's
  contribution to the cost of coverage under an employment-related BasiCare
  health benefit plan for employees with incomes less than 200 percent of
  the income official poverty line (as described in section 232(g)(1)) shall
  equal or exceed such total amount for employees with incomes greater than
  200 percent of such income official poverty line.
SEC. 218. INDIVIDUAL RESPONSIBILITIES UNDER BASICARE.
  Subject to the provisions of subsections (h) and (i) of section 213,
  in  developing the legislative proposal described in section 212(a)(5),
  the Commission shall require that to be eligible for benefits under a
  Federal program, an individual seeking benefits under such program shall
  certify to the administrator of such program that such individual and the
  dependents of such individual possess BasiCare health insurance coverage
  that meets the applicable minimum standards under this title. Except as
  may be provided by the Commission under section 214(c)(1), this section
  shall not apply to persons eligible for enrollment in the medicare program.
SEC. 219. SELF-INSURED PLAN REQUIREMENTS.
  (a) IN GENERAL- In developing the legislative proposal described in section
  212(a)(6), the Commission shall require that no self-insured BasiCare health
  benefit plan may be offered on or after the effective date of implementation
  of the Commission's recommendation under this title, unless the plan has
  been certified by the Commission (in accordance with such procedures as the
  Commission establishes) as qualifying as a BasiCare health benefit plan.
  The Commission may enter into an agreement with the Secretary of Health
  and Human Services in providing for administration of certification under
  this subsection.
  (b) LOOK-BEHIND AUTHORITY- If the BasiCare Commission determines that a
  self-insured health benefit plan does not qualify on or after the effective
  date specified in subsection(a), no coverage may be provided under the plan
  to individuals not enrolled as of the date of the determination, and the
  plan may not be continued for plan years beginning after the date of such
  determination until the Commission determines that such plan so qualifies.
  (c) CERTIFICATION REQUIREMENTS-
  (1) IN GENERAL- In order to obtain certification as a BasiCare health
  benefit plan as provided in this section, a self-insured health benefit
  plan must demonstrate to the satisfaction of the Commission that--
  (A) the benefits and conditions of such plan (including copayments and
  deductibles) are substantially equivalent to those of a BasiCare health
  benefit plan as provided under this Act;
  (B) the self-insuring entity is adhering to nondiscrimination standards
  substantially equivalent to those provided for carriers in section 215
  (insurance reform requirements) and described in paragraph (2);
  (C) the average per capita cost of providing BasiCare equivalent benefits
  to enrollees in the self-insured plan differs no more than 10 percent
  (either above or below) from the average per capita cost of providing
  BasiCare benefits package to non-self-insured beneficiaries in the community
  (or communities) in which the self-insured group is located; and
  (D) the self-insuring entity possesses adequate financial reserves,
  as determined by the Commission, to assure the immediate and long-term
  solvency of the entity and the benefits of individuals receiving coverage
  through such entity.
  (2) STANDARDS DESCRIBED- Standards described in this paragraph shall include
  (but are not limited to) the following:
  (A) NO DISCRIMINATION BASED ON HEALTH STATUS- No self-insured BasiCare
  health benefit plan may deny, limit, or condition the coverage under (or
  benefits of) the plan with respect to health status, claims experience,
  receipt of health care, medical history, or lack of evidence of insurability,
  of an individual or group.
  (B) TREATMENT OF PREEXISTING CONDITIONS- No self-insured BasiCare health
  benefit plan may exclude or otherwise discourage coverage with respect to
  services related to treatment of a preexisting condition.
  (C) WAITING PERIODS- No self-insured BasiCare health benefit plan may
  impose waiting periods of any length.
  (d) NONAPPLICATION TO SUPPLEMENTAL INSURANCE- The provisions described in
  this section shall apply only to coverage for benefit equivalent to the
  BasiCare health benefit plan and do not apply to other health benefits.
SEC. 220. DEVELOPMENT OF STANDARDS FOR MANAGED CARE PLANS.
  (a) IN GENERAL- In preparing the legislative proposal described in section
  212(a)(7), the Commission, taking into account recommendations of the
  Managed Care Advisory Committee (as described in subsection (b)), shall
  develop recommended standards that carriers offering managed care plans
  should meet with respect to the benefits, coverage, and delivery systems
  provided under such plans. Such standards shall encompass the standards
  by which managed care entities operate.
  (b) MANAGED CARE ADVISORY COMMITTEE-
  (1) ESTABLISHMENT- There shall be established a Managed Care Advisory
  Committee (hereinafter referred to as the `Committee').
  (2) MEMBERSHIP- The Committee shall be composed of 5 members appointed
  by the Chairperson of the Commission, each member representing 1 of the
  following areas:
  (A) Health care professionals.
  (B) Managed care industry.
  (C) Academia (with specific expertise in managed care plans).
  (D) Business management.
  (E) Organized labor.
  (3) COMPENSATION-
  (A) IN GENERAL- Members of the Committee shall serve without compensation.
  (B) EXPENSES, ETC., REIMBURSED- While away from their homes or regular
  places of business on the business of the Committee, the members may be
  allowed travel expenses, including per diem in lieu of subsistence, as
  authorized by section 5703 of title 5, United States Code, for persons
  employed intermittently in Government service.
  (C) APPLICATION OF ACT- The provisions of the Federal Advisory Committee
  Act (5 U.S.C. App.) shall not apply with respect to the Committee.
  (D) SUPPORT- The Commission shall supply such necessary office facilities,
  office supplies, support services, and related expenses as necessary to
  carry out the functions of the Committee.
SEC. 221. PREEMPTION OF PROVISIONS RELATING TO MANAGED CARE.
  In developing the legislative proposal described in section 212(a)(7), the
  Commission shall provide that in the case of a managed care plan meeting
  the recommended standards under section 220 that is offered by a carrier,
  the following provisions of State law are preempted and may not be enforced
  against the managed care plan with respect to a carrier offering such plan:
  (1) RESTRICTIONS ON REIMBURSEMENT RATES OR SELECTIVE CONTRACTING- Any law
  that restricts the ability of the carrier to negotiate reimbursement rates
  with health care providers or to contract selectively with one provider
  or a limited number of providers.
  (2) RESTRICTIONS ON DIFFERENTIAL FINANCIAL INCENTIVES- Any law that limits
  the financial incentives that the managed care plan may require a beneficiary
  to pay when a non-plan provider is used on a non-emergency basis.
  (3) RESTRICTIONS ON UTILIZATION REVIEW METHODS-
  (A) IN GENERAL- Any law that--
  (i) prohibits utilization review of any or all treatments and conditions;
  (ii) requires that such review be made by a resident of the State in which
  the treatment is to be offered or by an individual licensed in such State,
  or by a physician in any particular specialty or with any board certified
  specialty of the same medical specialty as the provider whose services
  are being rendered;
  (iii) requires the use of specified standards of health care practice in
  such review or requires the disclosure of the specific criteria used in
  such review;
  (iv) requires payments to providers for the expenses of responding to
  utilization review requests; or
  (v) imposes liability for delays in performing such review.
  (B) CONSTRUCTION- Nothing in subparagraph (A)(ii) shall be construed as
  prohibiting a State from requiring that utilization review be conducted
  by a licensed health care professional, or requiring that any appeal from
  such a review be made by a licensed physician or by a licensed physician
  in any particular specialty or with any board certified specialty of the
  same medical specialty as the provider whose services are being rendered.
  (4) RESTRICTIONS ON BENEFITS- Any law that mandates benefits under the
  managed care plan that are greater than the benefits recommended under
  the standards developed under section 220.
Subtitle C--Low-Income Assistance
SEC. 231. TRANSFER FROM MEDICAID TO BASICARE.
  (a) IN GENERAL- In developing the legislative proposal described in section
  212(a)(8)(A), the Commission shall provide for the orderly termination
  of medicaid program coverage under title XIX of the Social Security Act,
  to the extent that such coverage duplicates the BasiCare benefits package.
  (b) TRANSFER OF COVERED INDIVIDUALS FROM MEDICAID TO BASICARE- Such proposal
  shall require each State--
  (1) to notify medicaid beneficiaries of the impending transfer of coverage
  of such beneficiaries to the BasiCare program not later than 1 year prior
  to the date of transfer from medicaid to the BasiCare program; and
  (2) to provide such information and assistance as may be necessary to
  assure the enrollment of all medicaid beneficiaries in BasiCare health
  benefit plans upon the establishment of such plans.
  (c) PROVISIONAL TREATMENT OF MEDICAID BENEFITS NOT COVERED BY BASICARE-
  Such proposal shall require--
  (1) that for a period of 5 years following the termination of medicaid
  benefits that duplicate the BasiCare benefits package, the medicaid program
  shall continue to operate with respect to the provision of any existing
  benefits which are not covered under the BasiCare benefits package; and
  (2) Federal rules and regulations regarding the medicaid program shall
  remain in effect during a transition period subject to such adjustments
  deemed necessary by the Commission to carry out the medicaid-to-BasiCare
  transfer described in this section.
  (d) FINAL DISPOSITION OF MEDICAID BENEFITS- Upon expiration of the 5-year
  transition period described in subsection (c)(1), Federal funding for
  any existing medicaid benefits which are not covered under the BasiCare
  benefits package shall be discontinued, unless Congress has approved a
  plan for alternate disposition of such benefits, as provided in section 213.
SEC. 232. LOW-INCOME ASSISTANCE WITH COSTS OF BASICARE INSURANCE.
  (a) IN GENERAL- In developing the legislative proposal described in section
  212(a)(8)(B), the Commission shall provide for a BasiCare public assistance
  program (hereafter in this section referred to as `BasiCare Assist')
  which, at a minimum, meets the requirements of the following subsections
  of this section.
  (b) ASSISTANCE FOR UNDER-POVERTY FAMILIES- In the case of an individual
  who is a member of an under-poverty family, BasiCare Assist shall provide
  for payment of--
  (1) premiums charged the individual for coverage under a BasiCare health
  benefit plan in which the individual is enrolled; and
  (2) deductibles and other cost-sharing imposed on the individual under such
  plan, other than a per service copayment, not to exceed $5 per service,
  as determined by the Commission.
  (c) ASSISTANCE FOR NEAR-POVERTY FAMILIES-
  (1) IN GENERAL- In the case of an individual who is a member of a
  near-poverty family, BasiCare Assist shall provide for payment of the
  applicable percentage of any premiums, deductibles, and other cost-sharing
  charged the individual for coverage under a BasiCare health benefit plan
  in which the individual is enrolled.
  (2) APPLICABLE PERCENTAGE- For purposes of paragraph (1), the term
  `applicable percentage' means 100 percent reduced (but not below zero
  percent) by 10 percentage points for each 10 percentage point bracket
  (or portion thereof) such family's income equals or exceeds 100 percent of
  the income official poverty line (as defined by the Office of Management
  and Budget, and revised annually in accordance with section 673(2) of the
  Omnibus Budget Reconciliation Act of 1981) applicable to a family of the
  size involved.
  (d) ADJUSTMENT OF ASSISTANCE- The Commission shall provide for appropriate
  adjustments to any assistance under this section to reflect partial family
  coverage under an employment-related BasiCare health benefit plan.
  (e) APPLICATION FOR ASSISTANCE- BasiCare Assist shall use a standard Federal
  application which shall be as simple in form as possible and understandable
  to the average individual, and shall require attachment of such documentation
  as deemed necessary by the Commission in order to ensure eligibility for
  assistance. Such application shall be available to any individual or family,
  may be filed at any time, and as provided in subsection (f), may initiate
  coverage under a BasiCare health benefit plan. The Commission shall use,
  as deemed practicable by the Commission, any existing forms employed for
  Federal income tax filings as an application for BasiCare Assist.
  (f) ENROLLMENT AT POINT OF APPLICATION- To the extent practicable, the
  Commission shall provide for the option of enrollment in a BasiCare
  health benefit plan as part of the application and approval process
  for assistance under this section. In providing for such an option,
  the Commission may require carriers of BasiCare health benefit plans to
  provide such information and assistance as may be necessary.
  (g) PAYMENT OF PREMIUMS, DEDUCTIBLES, AND OTHER COST-SHARING- BasiCare Assist
  shall provide to an individual a voucher for the applicable percentage
  of BasiCare premiums, deductibles, and other cost-sharing for which such
  individual qualifies under subsection (b) or (c). Such voucher shall be
  remitted by the individual to the carrier of BasiCare health benefit plans
  (or, in the case of an employment-related BasiCare health benefit plan, to
  the individual's employer) for payment by BasiCare Assist. Such carrier shall
  make proper adjustments in billing statements to reflect such individual's
  remaining premium obligations, deductibles, and other cost-sharing (if any).
  (h) DOCUMENTATION OF ELIGIBILITY-
  (1) REQUIREMENT FOR FILING OF INCOME STATEMENT- In the case of a family
  which is receiving assistance under BasiCare Assist for any month in a
  year, a member of the family shall file a statement with the Commission,
  at such intervals during such year as the Commission deems necessary,
  and by not later than April 15 of the following year. Such a statement
  shall provide information necessary to determine the family income and
  the number of family members in the family during the year.
  (2) RECONCILIATION OF ASSISTANCE BASED ON ACTUAL INCOME- Based on and using
  the income reported in the statement filed under paragraph (1) with respect
  to a family, the Commission shall compute the amount of assistance that
  should have been provided under BasiCare Assist with respect to the family
  in the year involved and make proper adjustments in future assistance. If
  the amount of such assistance computed is--
  (A) greater than the amount of assistance provided, the Commission shall
  provide for payment to the family involved of an amount equal to the amount
  of the deficit, or
  (B) less than the amount of assistance provided, the Commission shall
  require the family to pay to the Federal Government (to the credit of
  BasiCare Assist) an amount equal to the amount of the excess payment.
  (3) DISQUALIFICATION FOR FAILURE TO FILE- In the case of any family that
  is required to file an information statement under paragraph (1) for a
  year and that fails to file such a statement by the deadline specified by
  the Commission, no member of the family shall be eligible for assistance
  under this section after such deadline. The Commission shall waive the
  application of this paragraph if the family establishes, to the satisfaction
  of the Commission, good cause for the failure to file the statement on a
  timely basis.
  (4) PENALTIES FOR FALSE INFORMATION-
  (A) INTEREST FOR UNDERSTATEMENTS- Each individual who knowingly understates
  income reported in an application for assistance under BasiCare Assist or
  any statement described in paragraph (1), or otherwise makes a material
  misrepresentation of information in such an application or statement shall
  be liable to the Federal Government for excess payments made based on
  such understatement or misrepresentation, and for interest on such excess
  payments at a rate specified by the Commission.
  (B) PENALTIES FOR MISREPRESENTATION- Each individual who knowingly
  misrepresents material information in an application for assistance under
  BasiCare Assist or any statement described in paragraph (1) shall be liable
  to the Federal Government for $1,000 or, if greater, 3 times the excess
  payments made based on such misrepresentation.
  (5) NOTICE OF REQUIREMENT- The Commission shall provide for written notice,
  in March of each year, of the requirement of paragraph (1) to each family
  which received assistance under BasiCare Assist in any month during the
  preceding year and to which such requirement applies.
  (6) TRANSMITTAL OF INFORMATION- The Secretary of the Treasury shall transmit
  annually to the Commission such information relating to the total income
  of individuals and families for the taxable year ending in the previous
  year as may be necessary to verify the reconciliation of assistance under
  BasiCare Assist.
  (i) DEFINITIONS AND SPECIAL RULES- For purposes of this section--
  (1) UNDER-POVERTY FAMILY- The term `under-poverty family' means a family
  whose income is less than 100 percent of the income official poverty line
  (as defined by the Office of Management and Budget, and revised annually
  in accordance with section 673(2) of the Omnibus Budget Reconciliation
  Act of 1981) applicable to a family of the size involved.
  (2) NEAR-POVERTY FAMILY- The term `near-poverty family' means a family
  whose income equals or exceeds 100 percent of the income official poverty
  line (as described in paragraph (1)), but is less than 200 percent of such
  income official poverty line.
  (3) DETERMINATIONS OF INCOME-
  (A) IN GENERAL- The term `income' means--
  (i) adjusted gross income (as defined in section 62(a) of the Internal
  Revenue Code of 1986), determined without the application of paragraphs
  (6) and (7) of such section and without the application of section 162(l)
  of such Code, plus
  (ii) the amount of social security benefits (described in section 86(d)
  of such Code) which is not includable in gross income under section 86 of
  such Code.
  (B) FAMILY INCOME- The term `family income' means, with respect to an
  individual, the sum of the income for the individual and all the other
  family members.
  (C) FAMILY SIZE- The family size to be applied under this section, with
  respect to family income, is the number of individuals included in the
  family for purposes of coverage of a BasiCare health benefit plan.
  (D) TIMING OF DETERMINATION- Income shall be determined in accordance with
  one of the following methods, at the option of the applicant, for coverage
  under this section:
  (i) Multiplying by a factor of 4 the family income of the applicant for
  the 3-month period immediately preceding the month in which the application
  for assistance under BasiCare is made.
  (ii) Determining the family income of the applicant for the month in which
  the application for such assistance is made.
  (j) EFFECTIVE DATE- The provisions of this section shall take effect on
  the effective date of the legislation described in section 212(a) or 213(a)
  of this Act.
Subtitle D--Congressional Consideration of Commission Recommendation
SEC. 241. RULES GOVERNING CONGRESSIONAL CONSIDERATION.
  (a) RULES OF HOUSE OF REPRESENTATIVES AND SENATE- This section is enacted
  by the Congress--
  (1) as an exercise of the rulemaking power of the House of Representatives
  and the Senate, respectively, and as such is deemed a part of the rules of
  each House, respectively, but applicable only with respect to the procedure
  to be followed in that House in the case of approval resolutions described
  in subsection (b), and supersedes other rules only to the extent that such
  rules are inconsistent therewith; and
  (2) with full recognition of the constitutional right of either House
  to change the rules (so far as relating to the procedure of that House)
  at any time, in the same manner and to the same extent as in the case of
  any other rule of that House.
  (b) TERMS OF THE RESOLUTION- For purposes of section 212(b), the term
  `approval resolution' means only a joint resolution of the two Houses of
  the Congress, providing in--
  (1) the matter after the resolving clause of which is as follows: `That the
  Congress approves the recommendations of the Commission on National Health
  Care Access and Reform as submitted by the Commission on XXXXXXXXXXXXXX',
  the blank space being filled in with the appropriate date; and
  (2) the title of which is as follows: `Joint Resolution approving the
  recommendation of the Commission on National Health Care Access and Reform'.
  (c) INTRODUCTION AND REFERRAL- On the day on which the recommendation
  of the Commission is transmitted to the House of Representatives and the
  Senate, an approval resolution with respect to such recommendation shall
  be introduced (by request) in the House of Representatives by the Majority
  Leader of the House, for himself and the Minority Leader of the House, or
  by Members of the House designated by the Majority Leader of the House,
  for himself and the Minority Leader of the House, or by Members of the
  House designated by the Majority Leader and Minority Leader of the House;
  and shall be introduced (by request) in the Senate by the Majority Leader
  of the Senate, for himself and the Minority Leader of the Senate, or by
  Members of the Senate designated by the Majority Leader and Minority Leader
  of the Senate. If either House is not in session on the day on which such
  recommendation is transmitted, the approval resolution with respect to
  such recommendation shall be introduced in the House, as provided in the
  preceding sentence, on the first day thereafter on which the House is in
  session. The approval resolution introduced in the House of Representatives
  and the Senate shall be referred to the appropriate committees of each House.
  (d) AMENDMENTS PROHIBITED- No amendment to an approval resolution shall
  be in order in either the House of Representatives or the Senate; and no
  motion to suspend the application of this subsection shall be in order in
  either House, nor shall it be in order in either House for the Presiding
  Officer to entertain a request to suspend the application of this subsection
  by unanimous consent.
  (e) PERIOD FOR COMMITTEE AND FLOOR CONSIDERATION-
  (1) IN GENERAL- Except as provided in paragraph (2), if the committee or
  committees of either House to which an approval resolution has been referred
  have not reported it at the close of the 45th day after its introduction,
  such committee or committees shall be automatically discharged from further
  consideration of the approval resolution and it shall be placed on the
  appropriation calendar. A vote on final passage of the approval resolution
  shall be taken in each House on or before the close of the 45th day after
  the approval resolution is reported by the committees or committee of that
  House to which it was referred, or after such committee or committees have
  been discharged from further consideration of the approval resolution. If
  prior to the passage by one House of an approval resolution of that House,
  that House receives the same approval resolution from the other House then--
  (A) the procedure in that House shall be the same as if no approval
  resolution had been received from the other House; but
  (B) the vote on final passage shall be on the approval resolution of the
  other House.
  (2) COMPUTATION OF DAYS- For purposes of paragraph (1), in computing a
  number of days in either House, there shall be excluded any day on which
  the House is not in session.
  (f) FLOOR CONSIDERATION IN THE HOUSE OF REPRESENTATIVES-
  (1) MOTION TO PROCEED- A motion in the House of Representatives to proceed
  to the consideration of an approval resolution shall be highly privileged
  and not debatable. An amendment to the motion shall not be in order, nor
  shall it be in order to move to reconsider the vote by which the motion
  is agreed to or disagreed to.
  (2) DEBATE- Debate in the House of Representatives on an approval resolution
  shall be limited to not more than 20 hours, which shall be divided equally
  between those favoring and those opposing the bill or resolution. A motion
  further to limit debate shall not be debatable. It shall not be in order
  to move to recommit an approval resolution or to move to reconsider the
  vote by which an approval resolution is agreed to or disagreed to.
  (3) MOTION TO POSTPONE- Motions to postpone, made in the House of
  Representatives with respect to the consideration of an approval resolution,
  and motions to proceed to the consideration of other business, shall be
  decided without debate.
  (4) APPEALS- All appeals from the decisions of the Chair relating to the
  application of the Rules of the House of Representatives to the procedure
  relating to an approval resolution shall be decided without debate.
  (5) GENERAL RULES APPLY- Except to the extent specifically provided in
  the preceding provisions of this subsection, consideration of an approval
  resolution shall be governed by the Rules of the House of Representatives
  applicable to other bills and resolutions in similar circumstances.
  (g) FLOOR CONSIDERATION IN THE SENATE-
  (1) MOTION TO PROCEED- A motion in the Senate to proceed to the consideration
  of an approval resolution shall be privileged and not debatable. An amendment
  to the motion shall not be in order, nor shall it be in order to move to
  reconsider the vote by which the motion is agreed to or disagreed to.
  (2) GENERAL DEBATE- Debate in the Senate on an approval resolution,
  and all debatable motions and appeals in connection therewith, shall
  be limited to not more than 20 hours. The time shall be equally divided
  between, and controlled by, the Majority Leader and the Minority Leader
  or their designees.
  (3) DEBATE OF MOTIONS AND APPEALS- Debate in the Senate on any debatable
  motion or appeal in connection with an approval resolution shall be limited
  to not more than 1 hour, to be equally divided between, and controlled
  by, the mover and the manager of the approval resolution, except that in
  the event the manager of the approval resolution is in favor of any such
  motion or appeal, the time in opposition thereto, shall be controlled by
  the Minority Leader or his designee. Such leaders, or either of them, may,
  from time under their control on the passage of an approval resolution,
  allot additional time to any Senator during the consideration of any
  debatable motion or appeal.
  (4) OTHER MOTIONS- A motion in the Senate to further limit debate is not
  debatable. A motion to recommit an approval resolution is not in order.
  (h) POINT OF ORDER REQUIRING SUPERMAJORITY FOR MODIFICATIONS TO
  RECOMMENDATION ONCE APPROVED-
  (1) IN GENERAL- It shall not be in order in the House of Representatives
  or the Senate to consider any amendment to the provisions of the BasiCare
  Health Access and Reform Act except as provided in paragraph (2).
  (2) WAIVER- The point of order described in paragraph (1) may be waived
  or suspended in the House of Representatives or the Senate only, by the
  affirmative vote of three-fifths of the Members duly chosen and sworn.
Subtitle E--Enforcement Provisions
SEC. 251. ENFORCEMENT PROVISIONS FOR CARRIERS, PROVIDERS, AND EMPLOYERS.
  (a) IN GENERAL- Chapter 47 of the Internal Revenue Code of 1986 (relating
  to excise taxes on qualified pension, etc. plans) is amended by striking
  section 5000 and section 5000A (as added by section 106) and inserting
  the following new sections:
`SEC. 5000. FAILURE OF CARRIERS WITH RESPECT TO BASICARE INSURANCE.
  `(a) GENERAL RULE- In the case of any carrier offering any health benefit
  plan, there is hereby imposed a tax on such carrier if such plan fails to
  qualify as a Basicare health benefit plan.
  `(b) AMOUNT OF TAX-
  `(1) IN GENERAL- The amount of tax imposed by subsection (a) by reason of
  1 or more failures during a taxable year shall be equal to 50 percent of
  the gross premiums received during such taxable year with respect to all
  health benefit plans issued by the carrier on whom such tax is imposed.
  `(2) GROSS PREMIUMS- For purposes of paragraph (1), gross premiums shall
  include any consideration received with respect to any health benefit
  contract.
  `(3) CONTROLLED GROUPS- For purposes of paragraph (1)--
  `(A) CONTROLLED GROUP OF CORPORATIONS- All corporations which are
  members of the same controlled group of corporations shall be treated as 1
  carrier. For purposes of the preceding sentence, the term `controlled group
  of corporations' has the meaning given to such term by section 1563(a),
  except that--
  `(i) `more than 50 percent' shall be substituted for `at least 80 percent'
  each place it appears in section 1563(a)(1), and
  `(ii) the determination shall be made without regard to subsections (a)(4)
  and (e)(3)(C) of section 1563.
  `(B) PARTNERSHIPS, PROPRIETORSHIPS, ETC., WHICH ARE UNDER COMMON CONTROL-
  Under regulations prescribed by the Secretary, all trades or businesses
  (whether or not incorporated) which are under common control shall be
  treated as 1 carrier. The regulations prescribed under this subparagraph
  shall be based on principles similar to the principles which apply in the
  case of subparagraph (A).
  `(c) LIMITATION ON TAX-
  `(1) TAX NOT TO APPLY WHERE FAILURE NOT DISCOVERED EXERCISING REASONABLE
  DILIGENCE- No tax shall be imposed by subsection (a) with respect to any
  failure for which it is established to the satisfaction of the Secretary
  that the carrier on whom the tax is imposed did not know, and exercising
  reasonable diligence would not have known, that such failure existed.
  `(2) TAX NOT TO APPLY WHERE FAILURES CORRECTED WITHIN 30 DAYS- No tax
  shall be imposed by subsection (a) with respect to any failure if--
  `(A) such failure was due to reasonable cause and not to willful neglect, and
  `(B) such failure is corrected during the 30-day period beginning on the
  1st date any of the carriers on whom the tax is imposed knew, or exercising
  reasonable diligence would have known, that such failure existed.
  `(3) WAIVER BY SECRETARY- In the case of a failure which is due to reasonable
  cause and not to willful neglect, the Secretary may waive part or all of
  the tax imposed by subsection (a) to the extent that the payment of such
  tax would be excessive relative to the failure involved.
  `(d) COMPLIANCE DETERMINATION-
  `(1) IN GENERAL- The Commission on National Health Care Access and Reform
  (hereafter in this subsection referred to as the `Commission' shall determine
  whether any health benefit plan qualifies as a BasiCare health benefit plan.
  `(2) STATE AGREEMENTS-
  `(A) IN GENERAL- The Commission may, in its discretion, enter into an
  agreement with any State to provide for the State to make the initial
  determination described in paragraph (1).
  `(B) STANDARDS- An agreement may be entered into under subparagraph (A)
  only if--
  `(i) the chief executive officer of the State requests such agreement be
  entered into,
  `(ii) the Commission determines that the State agreement will apply to
  substantially all health benefit plans issued in such State, and
  `(iii) the Commission determines that the application of the State agreement
  will carry out the purposes of this section.
  `(3) TERMINATION- The Commission shall terminate any agreement if the
  Commission determines that the application of the State agreement ceases
  to carry out the purposes of this section.
  `(e) DEFINITIONS- For purposes of this section the terms `health benefit
  plan', `BasiCare health benefit plan', and `carrier' shall have the same
  meanings given such terms under section 271 of the BasiCare Health Access
  and Cost Control Act.
`SEC. 5000A. FAILURE OF PROVIDERS WITH RESPECT TO BASICARE INSURANCE.
  `(a) GENERAL RULE- There is hereby imposed a tax on the failure of any
  person who provides any service under a BasiCare health benefit plan to
  comply with the requirements of section 213(d)(3) of the BasiCare Health
  Access and Cost Control Act.
  `(b) AMOUNT OF TAX-
  `(1) IN GENERAL- The amount of tax imposed by subsection (a) by reason
  of 1 or more failures during a taxable year shall be equal to 50 percent
  of the gross income received during such taxable year with respect to all
  services provided by the person on whom such tax is imposed.
  `(2) CONTROLLED GROUPS- For purposes of paragraph (1)--
  `(A) CONTROLLED GROUP OF CORPORATIONS- All corporations which are
  members of the same controlled group of corporations shall be treated as 1
  person. For purposes of the preceding sentence, the term `controlled group
  of corporations' has the meaning given to such term by section 1563(a),
  except that--
  `(i) `more than 50 percent' shall be substituted for `at least 80 percent'
  each place it appears in section 1563(a)(1), and
  `(ii) the determination shall be made without regard to subsections (a)(4)
  and (e)(3)(C) of section 1563.
  `(B) PARTNERSHIPS, PROPRIETORSHIPS, ETC., WHICH ARE UNDER COMMON CONTROL-
  Under regulations prescribed by the Secretary, all trades or business
  (whether or not incorporated) which are under common control shall be
  treated as 1 person. The regulations prescribed under this subparagraph
  shall be based on principles similar to the principles which apply in the
  case of subparagraph (A).
  `(c) LIMITATION ON TAX-
  `(1) TAX NOT TO APPLY WHERE FAILURE NOT DISCOVERED EXERCISING REASONABLE
  DILIGENCE- No tax shall be imposed by subsection (a) with respect to any
  failure for which it is established to the satisfaction of the Secretary
  that the person on whom the tax is imposed did not know, and exercising
  reasonable diligence would not have known, that such failure existed.
  `(2) TAX NOT TO APPLY WHERE FAILURES CORRECTED WITHIN 30 DAYS- No tax
  shall be imposed by subsection (a) with respect to any failure if--
  `(A) such failure was due to reasonable cause and not to willful neglect, and
  `(B) such failure is corrected during the 30-day period beginning on the
  1st date any of the persons on whom the tax is imposed knew, or exercising
  reasonable diligence would have known, that such failure existed.
  `(3) WAIVER BY SECRETARY- In the case of a failure which is due to reasonable
  cause and not to willful neglect, the Secretary may waive part or all of
  the tax imposed by subsection (a) to the extent that the payment of such
  tax would be excessive relative to the failure involved.
  `(d) COMPLIANCE DETERMINATION-
  `(1) IN GENERAL- The Commission on National Health Care Access and Reform
  (hereafter in this subsection referred to as the `Commission' shall
  determine compliance with the requirements of section 217 of the BasiCare
  Health Access and Cost Control Act.
  `(2) STATE AGREEMENTS-
  `(A) IN GENERAL- The Commission may, in its discretion, enter into an
  agreement with any State to provide for the State to make the initial
  determination described in paragraph (1).
  `(B) STANDARDS- An agreement may be entered into under subparagraph (A)
  only if--
  `(i) the chief executive officer of the State requests such agreement be
  entered into,
  `(ii) the Commission determines that the State agreement will apply to
  substantially all providers of services under health benefit plans issued
  in such State, and
  `(iii) the Commission determines that the application of the State agreement
  will carry out the purposes of this section.
  `(3) TERMINATION- The Commission shall terminate any agreement if the
  Commission determines that the application of the State agreement ceases
  to carry out the purposes of this section.
  `(e) DEFINITIONS- For purposes of this section the terms `health benefit
  plan' and `BasiCare health benefit plan' shall have the same meanings
  given such terms under section 271 of the BasiCare Health Access and Cost
  Control Act.
`SEC. 5000B. FAILURE OF EMPLOYERS WITH RESPECT TO BASICARE INSURANCE.
  `(a) GENERAL RULE- There is hereby imposed a tax on the failure of any
  person to comply with the requirements of sections 217 and 219 of the
  BasiCare Health Access and Cost Control Act with respect to any full-time
  employee of the person.
  `(b) AMOUNT OF TAX-
  `(1) IN GENERAL- The amount of the tax imposed by subsection (a) on any
  failure with respect to a full-time employee shall be $50 for each day in
  the noncompliance period with respect to such failure.
  `(2) NONCOMPLIANCE PERIOD- For purposes of this section, the term
  `noncompliance period' means, with respect to any failure, the period--
  `(A) beginning on the date such failure first occurs, and
  `(B) ending on the date such failure is corrected.
  `(3) CORRECTION- A failure of a person to comply with the requirements of
  sections 217 and 219 of the BasiCare Health Access and Cost Control Act
  with respect to any full-time employee of the person shall be treated as
  corrected if--
  `(A) such failure is retroactively undone to the extent possible, and
  `(B) the employee is placed in a financial position which is as good as
  such employee would have been in had such failure not occurred.
For purposes of applying subparagraph (B), the employee shall be treated
as if the employee had elected the most favorable coverage in light of the
expenses incurred since the failure first occurred.
  `(c) LIMITATIONS ON AMOUNT OF TAX-
  `(1) TAX NOT TO APPLY WHERE FAILURE NOT DISCOVERED EXERCISING REASONABLE
  DILIGENCE- No tax shall be imposed by subsection (a) on any failure during
  any period for which it is established to the satisfaction of the Secretary
  that none of the persons referred to in subsection (d) knew, or exercising
  reasonable diligence would have known, that such failure existed.
  `(2) TAX NOT TO APPLY TO FAILURES CORRECTED WITHIN 30 DAYS- No tax shall
  be imposed by subsection (a) on any failure if--
  `(A) such failure was due to reasonable cause and not to willful neglect, and
  `(B) such failure is corrected during the 30-day period beginning on
  the first date any of the persons referred to in subsection (d) knew, or
  exercising reasonable diligence would have known, that such failure existed.
  `(3) WAIVER BY SECRETARY- In the case of a failure which is due to reasonable
  cause and not to willful neglect, the Secretary may waive part or all of
  the tax imposed by subsection (a) to the extent that the payment of such
  tax would be excessive relative to the failure involved.
  `(d) LIABILITY FOR TAX-
  `(1) IN GENERAL- Except as otherwise provided in this subsection, the
  following shall be liable for the tax imposed by subsection (a) on a failure:
  `(A) In the case of a BasiCare health benefit plan other than a multiemployer
  plan, the employer.
  `(B) In the case of a multiemployer plan, the plan.
  `(C) Each person who is responsible (other than in a capacity as an
  employee) for administering or providing benefits under the BasiCare health
  benefit plan and whose act or failure to act caused (in whole or in part)
  the failure.
  `(2) SPECIAL RULES FOR PERSONS DESCRIBED IN PARAGRAPH (1)(C)- A person
  described in subparagraph (C) (and not in subparagraphs (A) and (B))
  of paragraph (1) shall be liable for the tax imposed by subsection (a)
  on any failure only if such person assumed (under a legally enforceable
  written agreement) responsibility for the performance of the act to which
  the failure relates.
  `(e) DEFINITIONS- For purposes of this section, the terms `BasiCare
  health benefit plan' and `full-time employee' shall have the same meanings
  given such terms under section 271 of the BasiCare Health Access and Cost
  Control Act.'.
  (b) CLERICAL AMENDMENTS- The table of sections for such chapter 47 is
  amended by adding at the end thereof the following new items:
`Sec. 5000. Failure of carriers with respect to BasiCare insurance.
`Sec. 5000A. Failure of providers with respect to BasiCare insurance.
`Sec. 5000B. Failure of employers with respect to BasiCare insurance.'.
  (c) EFFECTIVE DATE- The amendments made by this section shall take effect on
  the effective date of the legislation described in section 212(a) or 213(a)
  of this Act.
SEC. 252. ENFORCEMENT PROVISION FOR INDIVIDUALS.
  (a) IN GENERAL- Subsection (d) of section 151 of the Internal Revenue
  Code of 1986 (relating to allowance of deductions for personal exemptions)
  is amended by adding at the end thereof the following new paragraph:
  `(5) EXEMPTION AMOUNT DISALLOWED FOR UNINSURED INDIVIDUALS- The exemption
  amount for any individual for such individual's taxable year shall be zero,
  unless the policy number of the BasiCare health benefit plan (as defined
  in section 271 of the BasiCare Health Access and Cost Control Act) for
  such individual is included in the return claiming such exemption amount
  for such individual.'.
  (b) EFFECTIVE DATE- The amendment made by this section shall take effect on
  the effective date of the legislation described in section 212(a) or 213(a)
  of this Act.
Subtitle F--Financial Provisions
SEC. 261. BASICARE TRUST FUND.
  (a) TRUST FUND ESTABLISHED- There is hereby created on the books of the
  Treasury of the United States a trust fund to be known as the BasiCare
  Trust Fund (hereafter in this section referred to as the `Trust Fund'). The
  Trust Fund shall consist of such gifts and bequests as may be made and
  such amounts as may be deposited in, appropriated to, or credited to such
  Trust Fund as provided in this section.
  (b) TRANSFER OF AMOUNTS EQUIVALENT TO CERTAIN TAXES-
  (1) IN GENERAL- There are hereby appropriated to the Trust Fund amounts
  equivalent to 100 percent of--
  (A) 1 percent of the wages (as defined in section 3121 of the Internal
  Revenue Code of 1986) paid on or after the first day of the calendar
  year following the date of the enactment of this Act, and reported to the
  Secretary of the Treasury or the Secretary's delegate pursuant to subtitle
  F of the Internal Revenue Code of 1986, and
  (B) 1 percent of the amount of self-employment income (as defined in section
  1402 of the Internal Revenue Code of 1986) reported to the Secretary of
  the Treasury or the Secretary's delegate on tax returns under subtitle F
  of the Internal Revenue Code of 1986 for any taxable year beginning on
  or after the first day of the calendar year following the date of the
  enactment of this Act.
  (2) PENALTIES- There are hereby appropriated to the Trust Fund amounts
  equivalent to 100 percent of the taxes imposed under sections 5000, 5000A,
  and 5000B of the Internal Revenue Code of 1986.
  (3) ADDITIONAL REVENUES- There are hereby appropriated to the Trust Fund
  amounts equivalent to the additional revenues received in the Treasury as
  the result of the amendments made by section 262 of this Act.
  (4) TRANSFERS BASED ON ESTIMATES- The amounts appropriated by paragraphs (1)
  , (2), and (3) shall be transferred from time to time (not less frequently
  than monthly) from the general fund in the Treasury to the Trust Fund,
  such amounts to be determined on the basis of estimates by the Secretary
  of the Treasury of the taxes, specified in such subparagraphs, paid to
  or deposited into the Treasury; and proper adjustments shall be made in
  amounts subsequently transferred to the extent prior estimates were in
  excess of or were less than the taxes specified in such subparagraphs.
  (c) TRANSFER OF ADDITIONAL FUNDS-
  (1) STATE SHARE OF MEDICAID FUNDING-
  (A) IN GENERAL- On a fiscal year basis, each State shall remit to the
  Trust Fund the State's medicaid share for that fiscal year.
  (B) STATE'S MEDICAID SHARE-
  (i) IN GENERAL- With respect to any fiscal year beginning after the
  applicable effective date of the legislation described in section 212(a)
  or 213(a) of this Act, a State's medicaid share shall equal the amount
  such State expended under title XIX of the Social Security Act for the
  fiscal year preceding such applicable effective date for benefits equal
  to the BasiCare benefits package, as determined by the Commission, in
  consultation with the Secretary of Health and Human Services and State
  medicaid authorities. Such amount shall be adjusted each fiscal year by
  the increase in the Consumer Price Index (as determined by the Department
  of Labor) for the previous fiscal year.
  (ii) AMOUNT UPON COMPLETE ASSIMILATION OF MEDICAID- The amount otherwise
  determined under clause (i) for the fiscal year beginning after the
  applicable effective date of the legislation described in section 213(h)
  of this Act shall be increased by the amount such State expended under
  title XIX of the Social Security Act for the fiscal year preceding such
  applicable effective date.
  (C) COMPLIANCE- The requirements of this paragraph shall be subject to
  the provisions of section 1904 of the Social Security Act.
  (2) FEDERAL SHARE OF MEDICAID FUNDING- There are hereby appropriated for
  each fiscal year described in paragraph (1) the comparable Federal share
  expended under title XIX of the Social Security Act for such fiscal year,
  as adjusted under paragraph (1)(B)(i).
  (3) MEDICARE FUNDS- All amounts, not otherwise obligated, that remain in
  the Federal Hospital Insurance Trust Fund and the Federal Supplemental
  Medical Insurance Trust Fund on the applicable effective date of the
  legislation described in section 213(i) of this Act shall be transferred
  to the Trust Fund.
  (4) ADDITIONAL FEDERAL FUNDS- There are hereby appropriated to the Trust Fund
  for each fiscal year beginning after the applicable effective date of the
  legislation described in 213(j) of this Act, amounts equal to the amounts
  appropriated with respect to section 1079 of title 10, United States Code
  (CHAMPUS) and chapter 89 of title 5, United States Code, as in effect on
  the day before such applicable effective date, as adjusted under paragraph
  (1)(B)(i).
  (5) APPROPRIATION OF ADDITIONAL SUMS- There are hereby authorized to be
  appropriated to the Trust Fund such additional sums as may be required to
  make expenditures referred to in subsection (e).
  (e) Expenditures-
  (1) LOW-INCOME ASSISTANCE- There are hereby authorized and appropriated
  such sums as are necessary in each fiscal year for the expenses of the
  program described in section 241.
  (2) ADMINISTRATIVE EXPENSES- There are hereby appropriated such sums as
  are authorized under section 203 for the administrative and other expenses
  of the Commission for each fiscal year.
  (3) TITLE I EXPENDITURES- Amounts in the Trust Fund shall be available,
  as provided in appropriation Acts, for authorized expenditures described in--
  (A) sections 330A(h) and 330B(h) of the Public Health Service Act, as
  added by sections 111 and 112 of this Act, and
  (B) sections 150 and 151(g) of this Act.
  (e) INVESTMENT OF TRUST FUND-
  (1) IN GENERAL- It shall be the duty of the Secretary of the Treasury
  to invest such portion of the Trust Fund as is not, in the Secretary's
  judgment, required to meet current withdrawals. Such investments may be
  made only in interest-bearing obligations  of the United States or in
  obligations guaranteed as to both principal and interest by the United
  States. For such purpose, such obligations may be acquired--
  (A) on original issue at the issue price, or
  (B) by purchase of outstanding obligations at the market price.
The purposes for which obligations of the United States may be issued under
chapter 31 of title 31, of the United States Code, are hereby extended to
authorize the issuance at par of special obligations exclusively to the Trust
Fund. Such special obligations shall bear interest at a rate equal to the
average rate of interest, computed as to the end of the calendar month next
preceding the date of such issue, borne by all marketable interest-bearing
obligations of the United States then forming a part of the Public Debt; except
that where such average rate is not a multiple of one-eighth of 1 percent,
the rate of interest of such special obligations shall be the multiple of
one-eighth of 1 percent next lower than such average rate. Such special
obligations shall be issued only if the Secretary of the Treasury determines
that the purchase of other interest-bearing obligations of the United States,
or of obligations guaranteed as to both principal and interest by the United
States on original issue or at the market price, is not in the public interest.
  (2) SALE OF OBLIGATION- Any obligation acquired by the Trust Fund (except
  special obligations issued exclusively to the Trust Fund) may be sold
  by the Secretary of the Treasury at the market price, and such special
  obligations may be redeemed at par plus accrued interest.
  (3) CREDITS TO TRUST FUND- The interest on, and the proceeds from the sale
  or redemption of, any obligations held in the Trust Fund shall be credited
  to and form a part of the Trust Fund.
  (f) REPORT TO CONGRESS- It shall be the duty of the Secretary of the Treasury
  to hold the Trust Fund, and (after consultation with the Commission)
  to report to the Congress each year on the financial condition and the
  results of the operations of the Trust Fund during the preceding fiscal
  year and on its expected condition and operations during the next fiscal
  year. Such report shall be printed as both a House and Senate document of
  the session of the Congress to which the report is made.
  (g) CONFORMING AMENDMENT- Paragraph (4) of section 201(a) of the Social
  Security Act (42 U.S.C. 401(a)) is amended by inserting `and section
  261(1)(1) of the BasiCare Health Access and Cost Control Act' before the
  end period.
SEC. 262. TAX TREATMENT OF COSTS OF BASICARE INSURANCE.
  (a) TAX EXCLUSIONS FOR EMPLOYER-PROVIDED HEALTH INSURANCE- Section 106 of
  the Internal Revenue Code of 1986 (relating to contributions by employer
  to accident and health plans) is amended by striking `an accident or health
  plan' and inserting `a BasiCare health benefit plan (as defined in section
  271(1) of the BasiCare Health Access and Cost Control Act)'.
  (b) BUSINESS EXPENSE DEDUCTION FOR HEALTH INSURANCE- Section 162 of the
  Internal Revenue Code of 1986 (relating to trade or business expenses) is
  amended by redesignating subsection (m) as subsection (n) and by inserting
  after subsection (l) the following new subsection:
  `(m) GROUP HEALTH PLANS- The expenses paid or incurred by an employer for
  a group health plan shall not be allowed as a deduction under this section
  unless the plan qualifies as a BasiCare health benefit plan (as defined
  in section 271(1) of the BasiCare Health Access and Cost Control Act).'.
  (c) RULES RELATING TO DEDUCTIONS FOR INDIVIDUALS- Subparagraph (C) of section
  213(g)(1) of such Code (defining medical care) is amended by striking `for
  insurance' and inserting `for a Basicare health benefit plan (as defined
  in section 271(1) of the BasiCare Health Access and Cost Control Act).'.
  (d) EFFECTIVE DATE- The amendments made by this section shall apply with
  respect to any taxable year beginning after the applicable effective date
  of the legislation described in section 212(a) or 213(a) of this Act.
Subtitle G--Definitions
SEC. 271. DEFINITIONS.
  For purposes of this title:
  (1) BASICARE HEALTH BENEFIT PLAN- The term `BasiCare health benefit plan'
  means a health benefit plan which--
  (A) offers the BasiCare benefits package described in section 214;
  (B) applies the BasiCare base premium rate described in section 216; and
  (C) meets the requirements of this title.
  (2) HEALTH BENEFIT PLAN AND OTHER DEFINITIONS RELATING TO HEALTH PLANS-
  For purposes of this section:
  (A) HEALTH BENEFIT PLAN-
  (i) IN GENERAL- The term `health benefit plan' means any hospital or medical
  expense incurred policy or certificate, hospital or medical service plan
  contract, health maintenance subscriber contract, other employee welfare
  plan (as defined in the Employee Retirement Income Security Act of 1964),
  or any other health insurance arrangement, and includes an employment-related
  reinsurance plan (as defined in paragraph (3)).
  (ii) EXCLUSIONS- The term `health benefit plan' does not include--
  (I) accident-only, credit, dental, or disability income insurance,
  (II) coverage issued as a supplement to liability insurance,
  (III) worker's compensation or similar insurance, or
  (IV) automobile medical-payment insurance;
that is offered by a carrier.
  (B) REINSURANCE PLAN- The term `reinsurance plan' means any reinsurance
  or similar mechanism that underwrites a portion of the risk for a health
  benefit plan.
  (C) SELF-INSURED HEALTH BENEFIT PLAN- The term `self-insured health benefit
  plan' means a health benefit plan in which an employment-related group
  assumes the underwriting risk for the plan (whether or not there is any
  reinsurance or similar mechanism to underwrite a portion of that risk).
  (3) CARRIER; HEALTH MAINTENANCE ORGANIZATION; AND OTHER DEFINITIONS RELATING
  TO CARRIERS- For purposes of this title:
  (A) CARRIER- The term `carrier' means any person that offers a health
  benefit plan, whether through insurance or otherwise, including a licensed
  insurance company, a prepaid hospital or medical service plan, a health
  maintenance organization, a self-insurer carrier, a reinsurance carrier,
  and a multiple small employer welfare arrangement (a combination of small
  employers associated for the purpose of providing health benefit plan
  coverage for their employees).
  (B) HEALTH MAINTENANCE ORGANIZATION- The term `health maintenance
  organization' has the meaning given the term `eligible organization' in
  section 1876(b) of the Social Security Act, as in effect on the date of
  enactment of this Act.
  (C) REINSURANCE CARRIER- The term `reinsurance carrier' means the entity
  assuming responsibility for underwriting under an employment-related
  reinsurance plan, but does not include a carrier insofar as it directly
  offers a health benefit plan.
  (D) SELF-INSURER CARRIER- The term `self-insurer carrier' means a carrier
  that is not a licensed insurance company, a prepaid hospital or medical
  service plan, or a health maintenance organization, that offers a health
  benefit plan directly with respect to an employment-related group.
  (4) GENERAL DEFINITIONS- For purposes of this title:
  (A) APPLICABLE REGULATORY AUTHORITY- The term `applicable regulatory
  authority' means, with respect to a health benefit plan offered in a
  State, the State commissioner or superintendent of insurance or other
  State authority responsible for regulation of health insurance.
  (B) COMMUNITY- The term `community' means a geographic area that encompasses
  at least--
  (i) one or more adjacent metropolitan statistical areas (as defined by
  the Commission, in consultation with the Bureau of the Census); or
  (ii) the total remaining area within a State not otherwise included in a
  geographic area described under clause (i).
  (C) FULL-TIME EMPLOYEE- The term `full-time employee' means, with respect
  to an employer, an employee who normally performs on a monthly basis at
  least 30 hours of service per week for such employer.
BasiCare Health Access and Cost Control Act

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