Comprehensive Health and Rural Equality Act of 1993

TABLE OF CONTENTS:

Title I: Guaranteed Access to Affordable Health Care

Coverage

Title II: Small Employer Insurance Reform

Title III: Health Care Cost Containment

Subtitle A: Denial of Certain Tax Deductions and

Exclusion for Excess Benefits

Subtitle B: Medical Malpractice Reform

Subtitle C: Administrative Cost Savings

Subtitle C (sic): Estimates of Expenses Prior to

Treatment

Subtitle D: Antitrust Exemptions

Title IV: Long-Term Care

Subtitle A: Treatment of Long-Term Care Insurance Plans

Subtitle B: Treatment of Accelerated Death Benefits

Title V: Incentives for Provision of Services in Rural Areas

Comprehensive Health and Rural Equality Act of 1993 - Title I: Guaranteed Access to Affordable Health Care Coverage - Requires all citizens and lawful aliens residing in the United States who are not covered under a health insurance program to register with the Secretary of Health and Human Services and be enrolled under a MedEquality plan. Provides: (1) for the issuance of a credit certificate which can only be used to purchase a MedEquality plan to each eligible individual; and (2) that the certificate's value shall be at the maximum level for individuals and families below the poverty line and that such certificate shall have no value for individuals and families with incomes of more than 150 percent of the poverty level. Provides for payments to States with agreements to carry out this title. Requires each licensed insurance carrier in a State, to make a MedEquality plan available to residents residing in the State.

Title II: Small Employer Insurance Reform - Provides for the establishment of general standards for MedEquality plans. Requires each small employer carrier in a State to make available to each small employer a MedEquality plan. Sets forth the requirements for such a plan, including that it be designed to provide only basic hospital, medical, surgical, preventive, and diagnostic benefits so as to make it affordable to small employers. Prohibits the limitation of benefits based on a preexisting condition if: (1) the condition did not exist within six months before coverage; or (2) the limitation extends more than 12 months after coverage. Provides for the establishment of reinsurance mechanisms for high risk individuals. Preempts from insurance mandates qualified small employer purchasing groups.

Amends the Internal Revenue Code to permanently make 100 percent of the health insurance costs for self-employed individuals deductible by 1997.

Preempts the following provisions of State law: (1) restrictions on reimbursement rates or selective contracting; (2) restrictions on differential financial incentives; and (3) restrictions on utilization review.

Title III: Health Care Cost Containment - Subtitle A: Denial of Certain Tax Deductions and Exclusion for Excess Benefits - Denies an employer a deduction for any expenses incurred for employee health care that are not within the basic benefits of a MedEquality plan. Denies the exclusion to an employee from gross income of employer-provided health care coverage to the extent coverage is provided for benefits not included in a MedEquality plan.

Subtitle B: Medical Malpractice Reform - Prohibits a medical malpractice claim following the two year period beginning the date after which the injury should have been discovered, but in no event may it be brought more than four years following the injury. Provides an exception for children under six years of age.

Requires the initial resolution of a medical malpractice claim under an alternative dispute resolution (ADR) system before any such claim may be brought in a State court. Requires the use of ADR in malpractice claims brought before a Federal agency. Requires a pretrial settlement conference before beginning a medical malpractice trial. Limits the award of noneconomic and punitive damages in medical malpractice cases. Limits attorney's fees in such cases. Prohibits joint liability. Requires a defendant's actions to have been not reasonable before being found negligent in such cases. Provides a complete defense to a defendant who followed the appropriate practice guideline.

Sets forth requirements for a State's ADR system.

Permits State professional societies to participate in licensing and disciplinary activities.

Subtitle C: Administrative Cost Savings - Requires the adoption of: (1) data elements for use in paper and electronic claims processing; (2) uniform claims forms; and (3) uniform electronic transmission of the data elements.

Requires the promulgation of standards for hospitals concerning electronic medical data.

Provides for the establishment of an advisory commission concerning medical data standards.

Provides for Medicare and Medicaid magnetized identification cards.

Authorizes appropriations.

Requires each health benefit plan to use the social security number of each beneficiary as that beneficiary's personal identifier.

Provides for the coordination of benefits when benefits are payable under two or more health plans, if the Secretary determines there is a need for such coordination.

Subtitle C (sic): Estimate of Expenses Prior to Treatment - Requires every health care provider to provide an estimate of expenses before providing any item or service.

Subtitle D: Antitrust Exemptions - Permits cooperative agreements among hospitals entered into solely with respect to sharing expensive capital-intensive technology or other highly resource-intensive services.

Title IV: Long-Term Care - Subtitle A: Treatment of Long-Term Care Insurance Plans - Provides, under the Internal Revenue Code, for the treatment of qualified long-term care insurance as accident or health insurance. Excludes from gross income any benefit received through qualified long-term care insurance.

Excludes from gross income amounts withdrawn from individual retirement plans or 401(K) plans for qualified long-term care insurance. Permits the exchange of a life insurance policy for a qualified long-term care policy without recognition of gain or loss.

Subtitle B: Treatment of Accelerated Death Benefits - Excludes from gross income any amount paid under a life insurance contract on the life of a terminally ill individual or one who is permanently confined to a nursing home. Treats any reference to a life insurance contract as including a reference to a qualified accelerated death benefit rider on such contract.

Title V: Incentives for Provision of Services in Rural Areas - Permits the deduction of the medical school loan interest incurred by doctors serving in medically underserved areas.

Requires a State with a medically underserved area to develop a comprehensive health care plan for any such area.