Universal Health Benefits Empowerment and Partnership Act of 1993

TABLE OF CONTENTS:

Title I: Universal Access to Health Coverage

Title II: Medical and Health Insurance Information Reform

Title III: MEWA Enforcement Improvements

Universal Health Benefits Empowerment and Partnership Act of 1993 - Title I: Universal Access to Health Coverage - (Sec. 101) Amends the Employee Retirement Income Security Act of 1974 (ERISA) to provide for universal coverage under group health plans and statewide accessible (or State-based) health benefits systems.

Requires employers to offer coverage for eligible individuals under basic group health plans or group health payroll deduction plans.

Sets forth requirements for statewide accessible health benefit systems, including reporting, participation, benefits, contribution, reciprocity, and coverage. Directs the Secretary of Health and Human Services (HHS) to prescribe regulations for such systems.

Provides for coverage by such systems of uninsurable risks and preexisting conditions.

(Sec. 102) Allows States to establish certain State-based systems in the absence of statewide access to coverage. Provides for recognition of certain substitute basic health benefits systems.

Directs the Secretary of HHS to establish a program of grants to statewide accessible health benefits systems. Authorizes appropriations.

(Sec. 103) Declares that such statewide accessible or substitute systems satisfy certain continuation coverage requirements under ERISA and related laws.

(Sec. 104) Preempts State laws which mandate certain health benefits or restrict managed medical care under employee welfare benefit plans.

(Sec. 105) Amends the Internal Revenue Code (IRC) to remove certain restrictions on the tax-exempt status of multiple employer welfare arrangements (MEWAs) providing basic health benefits.

(Sec. 106) Amends the Public Health Service Act (PHSA) with respect to the Agency for Health Care Policy and Research and the Office of the Forum for Quality and Effectiveness in Health Care. Authorizes appropriations.

(Sec. 107) Establishes a Federal Advisory Council on Health Care Coverage and Costs. Requires the Council to study and report to the Secretary of HHS on how practice guidelines may be used in reducing medical malpractice costs.

(Sec. 108) Amends the IRC to increase the deduction for health insurance costs of self-employed individuals from 25 percent through 1995 to 50 percent in 1996 and 1997 and to 100 percent in 1998 and thereafter.

Title II: Medical and Health Insurance Information Reform - Medical and Health Insurance Information Reform Act of 1993 - (Sec. 202) Amends the Social Security Act to require the Secretary to determine whether each State is developing and implementing a health care value information program that meets specified criteria and, if it has not developed or implemented such a program, take necessary action to implement a comparable program in such State.

Requires Federal agency heads responsible for providing health insurance or health care services to individuals to develop health care value information about their programs comparing them with State program data.

Requires the Secretary to promulgate requirements for the periodic submission by insurers of health care data relevant to health care Services research.

Requires the Department of Health and Human Services to make all Medicare claim records available under the Freedom of Information Act, without regard to the consent of the physician or other item or service furnisher.

Requires the Secretary to develop model systems to facilitate the gathering and analysis of health care cost, quality, and outcomes data.

Authorizes appropriations.

Authorizes the Secretary to make grants to each State for the development and implementation of its health care value information program. Authorizes appropriations.

Preempts State laws which require medical or health insurance records to be maintained in written, rather than electronic form.

Requires the Secretary to promulgate: (1) requirements concerning health insurance information privacy and confidentiality protection for individuals; (2) standards and requirements concerning the electronic receipt and transmission of certain health insurance information if there are problems receiving and transmitting it which cause significant administrative costs; and (3) requirements for the format and content of basic health insurance claim forms.

Requires the Secretary to publish recommendations for the types and format of information used by insurers if requests for it by insurers cause administrative costs disproportionate to the benefits derived.

Requires the Secretary to: (1) promulgate rules for determining the liability of insurers when benefits are payable under two or more health insurance plans; and (2) promulgate requirements for the furnishing of health insurance information among insurers if there are problems relating to its availability which cause significant mistaken benefit payments or administrative costs.

Requires the Secretary to determine if each State has in effect standards, requirements, and rules substantially the same as those under this Act for insurers relating to health insurance information privacy and confidentiality protection, identification numbers, the receipt and transmission of health insurance information, health insurance claim forms, liability, and the furnishing of health insurance information among insurers. Applies such standards, requirements, and rules to activities of insurers in the State if the State does not have them.

Requires the Secretary to: (1) determine if the State maintains an effective enforcement mechanism for State requirements; and (2) promulgate requirements for hospitals and other providers concerning electronic medical data.

Sets forth requirements for hospitals which participate in Medicare.

Allows Federal agency heads to require any provider required to transmit certain data elements to transmit them electronically and present them in the manner prescribed under this Act.

(Sec. 204) Amends the Internal Revenue Code to impose an excise tax on: (1) insurers and administrators of self-insured employee plans who fail to comply with the standards, requirements, and rules established under this Act; and (2) insurers who fail to submit to the Secretary certain health care data for health care research purposes.

Title III: MEWA Enforcement Improvements - Multiple Employer Welfare Arrangements Enforcement Improvements Act of 1993 - Amends the Employee Retirement Income Security Act of 1974 (ERISA) with respect to multiple employer welfare arrangements (MEWAs) and other employee welfare benefit plans.

(Sec. 302) Revises the definition of employee welfare benefit plan to: (1) allow up to five percent of the aggregate number of covered individuals to be individuals who are not employees or former employees of the employer (or members or former members of the employee organization) which established or maintains the plan; and (2) include a plan, fund, or program established or maintained by a franchise network or by two or more trades or businesses that are within the same control group or were within it at any time during the preceding one-year period.

(Sec.303) Amends the definition of MEWA to: (1) limit the exclusion of collective bargaining agreements, under specified conditions; (2) exclude franchise networks; (3) exclude insurers, or health maintenance organizations licensed to do business in a State; (4) exclude trades and businesses within the same control group at any time during the preceding one-year period (as well as those currently in the same group), by deeming them a single employer; and (5) provide that single plans shall not be deemed MEWAs solely because they cover individuals who are not employees or former employees, or their beneficiaries, if the number of such individuals never exceeds five percent of the aggregate covered during the plan year.

(Sec. 304) Makes ERISA title I (Protection of Employee Benefit Rights) applicable to any MEWA engaged in commerce or in any industry or activity affecting commerce, with specified exceptions.

(Sec. 305) Requires MEWAs which provide medical care benefits to file annual registration statements with the Secretary of Labor.

(Sec. 306) Authorizes the Secretary, to assess a civil penalty for a trustee's or other responsible person's failure or refusal to file such registration statement.

Authorizes district courts to order the MEWA to cease activities and to grant additional equitable or remedial relief.

(Sec. 307) Sets forth MEWA exemption and exclusion procedures.

(Sec. 308) Provides that States may require disclosure of information from any employee welfare benefit plan (in connection with certain investigations) as to whether such plan is a MEWA or is in compliance with the MEWA exemption or 18-month exclusion.