Health Care Choice and Access Improvement Act of 1993

TABLE OF CONTENTS:

Title I: Family Health and Wellness Savings Plan

Title II: Tax Treatment of Long-Term Care Insurance and Plans

Subtitle A: Treatment of Long-Term Care Insurance

Subtitle B: Employer Funding of Medical Benefits

Subtitle C: Reverse Mortgage Insurance for Older

Americans

Subtitle D: Income Tax Credits

Subtitle E: Treatment of Accelerated Death Benefits

Subtitle F: Federal National Long-Term Care Reinsurance

Corporation

Title III: Malpractice Liability Reform

Title IV: Working Americans Access To Health Care

Subtitle A: Increase in Small Employer Access to

Affordable Health Insurance

Subtitle B: Equalization of Tax Benefits for

Self-Employed Persons Under Certain Plans

Subtitle C: Managed Care Rights

Subtitle D: Study and Report

Title V: Administrative Cost Savings

Subtitle A: Standardization of Claims Processing

Subtitle B: Electronic Medical Data Standards

Subtitle C: Development and Distribution of Comparative

Value Information

Subtitle D: Additional Standards and Requirements;

Research and Demonstrations

Health Care Choice and Access Improvement Act of 1993 - Title I: Family Health and Wellness Savings Plan - (Sec. 101) Amends the Internal Revenue Code to allow individuals a tax deduction for contributions made to a medical care savings account established for the benefit of an eligible individual. Defines an eligible individual as one who: (1) is not covered by an employer-provided group health plan; or (2) is covered by a qualified employer-provided catastrophic coverage health plan but not by any other health plan.

Allows such deduction in arriving at adjusted gross income.

Includes any non-medical distributions from such an account in gross income and assesses an additional tax.

Establishes an excise tax for excess contributions to medical care savings accounts.

(Sec. 102) Allows the transfer of unused amounts in flexible spending accounts of cafeteria plans to medical savings accounts.

(Sec. 103) Allows the full deduction for medical, dental, etc., expenses for amounts paid for qualified catastrophic coverage health plans.

Title II: Tax Treatment of Long-Term Care Insurance and Plans - (Sec. 201) Provides for the treatment of long-term care insurance as: (1) accident and health insurance for life insurance company taxation; and (2) a tax-free fringe benefit.

(Sec. 203) Excludes from gross income amounts withdrawn from individual retirement accounts or qualified pension plans for such insurance.

(Sec. 204) Permits the non-taxable exchange of life insurance policies for long-term care insurance by individuals over age 59 1/2.

(Sec. 211) Revises provisions governing retiree medical benefits. Authorizes employer health benefit account contribution deductions.

(Sec. 212) Imposes a medical benefits early distribution penalty and an excise tax on allocated assets not used to provide retiree benefits.

(Sec. 221) Amends the National Housing Act to limit insurance of elderly homeowner home equity conversion mortgages.

(Sec. 231) Allows credits for: (1) households including relatives or dependents requiring custodial care; and (2) the long-term care expenses of independent persons.

(Sec. 241) Allows accelerated death benefits to be: (1) paid to certain individuals; and (2) treated as life insurance.

(Sec. 251) Authorizes incorporation of the Federal National Long-Term Care Reinsurance Corporation.

Title III: Malpractice Liability Reform - (Sec. 302) Declares that a State meets the requirements of these provisions if it has enacted laws or regulations: (1) regarding health care liability actions, allowing several but not joint liability for noneconomic damages, limiting the dollar amount of noneconomic damages, mandating offsets for collateral source payments, regulating the treatment of payments for future economic losses, limiting attorney's fees, and providing special rules for certain obstetric services; (2) implementing at least one mediation or pretrial screening panel; and (3) taking specified steps regarding quality assurance reform.

(Sec. 305) Amends titles XVIII (Medicare) and XIX (Medicaid) of the Social Security Act to reduce payments to hospitals (regarding Medicare) and States (regarding Medicaid) in States not in compliance. Makes additional hospital payments in States in compliance.

(Sec. 306) Amends Federal law relating to tort claims against the United States to set forth special rules similar to the State health care liability reform requirements under this title.

Title IV: Working Americans Access to Health Care - (Sec. 401) Provides for model standards regarding requirements of this title. Allows more stringent State standards.

(Sec. 402) Preempts certain State laws concerning small employer health benefit plans.

(Sec. 403) Requires small employer carriers to offer MedEquity plans, defined as: (1) providing only basic benefits; (2) guaranteeing issue; (3) meeting writing, premium increase, and market reentry standards; and (4) providing for cost containment. Requires each plan to accept every small employer applicant and enroll every full time employee applicant. Provides for cost containment models.

(Sec. 404) Sets forth requirements regarding pre-existing conditions, premiums, rating practices, actuarial certification, registration, minimum participation, renewability, premium increases, and market reentry.

(Sec. 406) Provides for reinsurance models, requiring establishment of mechanisms in each State.

(Sec. 409) Sets forth requirements for being considered a small employer purchasing group. Preempts State laws, with regard to such groups, regarding health plans, premium taxes, and managed care.

(Sec. 411) Amends the Internal Revenue Code to increase and make permanent health insurance deductions for self-employed individuals.

(Sec. 421) Preempts State laws relating to reimbursement rates, selective contracting, differential financial incentives, and utilization review methods.

Title V: Administrative Cost Savings - (Sec. 501) Provides for standards regarding medical data elements, uniform claims forms and data transmission.

(Sec. 512) Requires electronic maintenance or transmittal by: (1) Medicare-participating and veterans' hospitals; and (2) providers required under a Federal program to transmit data.

(Sec. 514) Prohibits benefit plans from requiring data elements not in the standards.

(Sec. 515) Establishes a standards advisory commission. Authorizes appropriations.

(Sec. 521) Authorizes grants for comparative value information systems covering service prices and quality and outcomes data. Authorizes appropriations. Mandates similar Federal information.

(Sec. 524) Mandates model systems for such information. Authorizes standards and appropriations.

(Sec. 531) Provides for magnetized Medicare and Medicaid cards. Mandates a system on plans that are primary Medicare and Medicaid payors. Authorizes appropriations.

(Sec. 532) Preempts State laws requiring written records.

(Sec. 533) Requires benefit plans to use social security number identifiers.

(Sec. 534) Provides for standards regarding coordination of benefits.

(Sec. 535) Mandates grants regarding patient care application of information systems. Authorizes appropriations.

Authorizes grants regarding: (1) communications between plan and provider systems; (2) regional or community-based clinical information systems; and (3) developing data elements. Authorizes appropriations.