Managed Competition Act of 1993

TABLE OF CONTENTS:

Title I: Managed Competition in Employer-Based Health Plans:

Incentives to Control Costs

Subtitle A: Use of Tax Incentives to Purchase

Cost-Effective Plans

Subtitle B: Health Plan Purchasing Cooperatives (HPPCs)

Subtitle C: Accountable Health Plans (AHPs)

Subtitle D: Health Care Standards Commission

Subtitle E: Managed Competition in Rural and Urban

Underserved Areas

Subtitle F: Treatment of Chronically Underserved Areas

Subtitle G: Repeal of COBRA Continuation Requirements

Subtitle H: Definitions

Title II: Low-Income Assistance for Health Coverage

Subtitle A: Low-Income Assistance

Subtitle B: Long-Term Care Phase-Down Assistance to

States

Subtitle C: Financing

Subtitle D: Repeal of Medicaid Program

Title III: Training and Education of Health Care

Professionals

Subtitle A: Reform of Federal Funding for Medical

Residency Training

Subtitle B: Other Medical Education Grants and Programs

Title IV: Preventive Health and Individual Responsibility

Subtitle A: Expansion of Public Health Programs

Subtitle B: Medicare

Title V: Malpractice Reform

Subtitle A: Findings; Purpose; Definitions

Subtitle B: Uniform Standards for Malpractice Claims

Subtitle C: Requirements for State Alternative Dispute

Resolution Systems (ADR)

Subtitle D: Grants to States for Development of Practice

Guidelines

Title VI: Paperwork Reduction and Administrative

Simplification

Title VII: Additional Benefits On a Pay-As-You-Go Basis

Managed Competition Act of 1993 - Title I: Managed Competition in Employer-Based Health Plans: Incentives to Control Costs - Subtitle A: Use of Tax Incentives to Purchase Cost-Effective Plans - Amends the Internal Revenue Code to impose a tax on the excess health plan expenses of any employer which are health plan expenses exceeding specific limits under an accountable health plan for a defined geographical area.

(Sec. 1002) Increases to 100 percent and makes permanent the deduction for health plan premium expenses of self-employed individuals.

(Sec. 1003) Permits the deduction for medical, dental, etc. expenses without regard to the limitation on such deduction with respect to amounts paid for premiums under an accountable health plan.

(Sec. 1004) Provides for the exclusion from gross income of contributions by a partnership or S corporation to a health plan covering partners or shareholders.

(Sec. 1006) Eliminates the commonality of interest and geographic location requirements with respect to group purchasing by large tax-exempt organizations.

Subtitle B: Health Plan Purchasing Cooperatives (HPPCs) - Provides for the establishment of Health Plan Purchasing Cooperatives (HPPCs). Considers each State to be a HPPC, except that a State may subdivide into HPPC areas, and that there may be interstate HPPCs, as specified. Requires HPPCs to enter into agreements with accountable health plans and small employers, offer enrollment in accountable health plans, and charge premiums.

Subtitle C: Accountable Health Plans (AHPs) - Directs the Health Care Standards Commission to provide a process whereby a health plan may be registered with the Commission by its sponsor as an accountable health plan. Sets forth requirements for a plan to be registered, including: (1) coverage for a specified uniform set of benefits, including cost-sharing for low-income individuals; (2) standard premiums for the uniform benefits; (3) grievance procedures; (4) collecting and providing specified information; (5) prohibiting discrimination in enrollment or benefits; and (6) financial solvency.

(Sec. 1208) Sets forth additional requirements for open AHPs, which is any plan which is not closed. Defines a closed plan as one limited by structure or law to one or more large employers.

(Sec. 1211) Requires each AHP to provide for payment of one percent of gross premium receipts to the National Medical Education Fund.

(Sec. 1221) Sets forth provisions concerning the preemption of State laws for AHPs.

(Sec. 1231) Directs the President to provide for the development and publication of guidelines on the application of Federal antitrust laws to AHPs.

(Sec. 1232) Provides for the issuance of certificates of public advantage by the Attorney General to eligible health care joint ventures which, if followed, exempt such ventures from antitrust liability.

Subtitle D: Health Care Standards Commission - Establishes, as an independent agency in the Executive Branch, a Health Care Standards Commission. Requires the Commission to transmit annually to the Congress recommendations for the uniform set of effective benefits. States that such recommendations shall apply unless the Congress passes a joint resolution of disapproval.

(Sec. 1303) Directs the Commission to provide for the initial organization, as a nonprofit corporation, of the Benefits, Evaluations, and Data Standards Board in order to make recommendations to the Commission concerning the uniform set of effective benefits and matters related to the evaluation of health care services.

(Sec. 1304) Directs the Commission to provide for the initial organization, as a nonprofit organization of the Health Plan Standards Board in order to make recommendations to the Commission concerning the standards for AHPs and concerning its assessment of risk-adjustment factors.

(Sec. 1305) Sets forth provisions concerning the registration of AHPs.

(Sec. 1306) Directs the Commission to establish rules for the process of risk-adjustment of premiums among AHPs by HPPCs.

(Sec. 1307) Directs the Commission to publish information concerning procedures, their prices, and their quality.

(Sec. 1309) Establishes, within the Department of Health and Human Services, the Agency for Clinical Evaluations which shall assume the responsibilities of the Director of the Office of Medical Applications of Research at the National Institutes of Health, the Director of the Office of Research and Demonstrations of the Health Care Financing Administration (insofar as such responsibilities relate to clinical evaluations), the Administrator for Health Care Policy and Research under title IX of the Public Health Service Act, as well as other specified responsibilities. Authorizes appropriations.

(Sec. 1311) Prohibits the Commission from establishing or enforcing any controls on health care spending.

(Sec. 1313) Authorizes appropriations for the Commission through FY 2000. Terminates the Commission on December 31, 1999.

Subtitle E: Managed Competition in Rural and Urban Underserved Areas - Authorizes the Governor of any State to designate rural and urban areas of a State as underserved areas. Permits a HPPC serving such an area to require AHPs offered by the HPPC and with a service area adjoining such area to include the area as part of their service area.

(Sec. 1411) Authorizes appropriations for: (1) technical assistance for entities seeking to establish a network plan in an underserved area; (2) financial assistance to eligible entities in order to provide for the development and implementation of AHPs in rural areas; and (3) under the Public Health Service Act, migrant health centers and community health centers.

(Sec. 1422) Provides coverage under part B of title XVIII (Medicare) of the Social Security Act for rural emergency access care hospital services.

(Sec. 1431) Directs the Secretary of Health and Human Services to make payments for transitional assistance to eligible hospitals. Requires any hospital accepting such assistance to provide a significant volume of services to persons unable to pay for services. Authorizes appropriations.

Subtitle F: Treatment of Chronically Underserved Areas - Directs the Health Care Standards Commission to develop standards for the identification of chronically underserved areas. Makes provisions for addressing health care delivery in such areas.

Subtitle G: Repeal of COBRA Continuation Requirements - Repeals the COBRA continuation requirements for group health plans and title XXII of the Public Health Service Act.

Subtitle H: Definitions - Sets forth definitions for this title and title II.

Title II: Low-Income Assistance for Health Coverage - Subtitle A:

Low-Income Assistance - Provides premium assistance for very-low income individuals and moderately low-income individuals. Provides for nominal cost-sharing for such individuals and special assistance for certain items and services.

Subtitle B: Long-Term Care Phase-Down Assistance to States - Provides for long-term care phase-down assistance to eligible States for each calendar quarter in 1995 through 1998.

Subtitle C: Financing - Amends title XVIII (Medicare) of the Social Security Act to achieve savings under such program by: (1) reducing the update for inpatient hospital services; (2) reducing the conversion factor for the physician fee schedule for non-primary care services; and (3) reducing hospital outpatient services through establishing a prospective payment system.

(Sec. 2204) Amends the Internal Revenue Code to impose a Medicare part B premium tax on higher-income individuals.

(Sec. 2205) Achieves additional Medicare savings through the: (1) phased-in elimination of Medicare disproportionate share adjustment payments; (2) reduction of routine cost limits for home health services; (3) reduction in routine cost limits for extended care services; and (4) reductions in payments for hospice services.

Subtitle D: Repeal of Medicaid Program - Repeals title XIX (Medicaid) of the Social Security Act.

Title III: Training and Education of Health Care Professionals - Subtitle A: Reform of Federal Funding for Medical Residency Training - Directs the Health Care Standards Commission to approve a resident training position in medical residency program for purposes of funding approved medical residency training programs under this title. Provides funding, in addition, for physician retraining. Sets forth provisions concerning: (1) the allocation of entry positions among programs; and (2) the general distribution of positions among specialties.

(Sec. 3004) Requires payment by AHPs of one percent of gross premium receipts to the National Medical Education Fund. Requires payments from the Medicare trust funds to the National Medical Education Fund.

(Sec. 3005) Establishes the National Medical Education Fund.

Subtitle B: Other Medical Education Grants and Programs - Authorizes appropriations under the Public Health Service Act for medical education programs, including: (1) the scholarship and loan repayment programs of the National Health Service Corps; (2) area education centers; (3) public health and preventive medicine; (4) family medicine; (5) general internal medicine and pediatrics; (6) physician assistants; (7) allied health projects grants and contracts; and (8) nurse practitioner and nurse midwife programs.

Title IV: Preventive Health and Individual Responsibility - Subtitle A: Expansion of Public Health Programs - Authorizes appropriations under the Public Health Service Act for the following public health programs: (1) immunizations against vaccine-preventable diseases; (2) prevention, control, and elimination of tuberculosis; (3) lead poisoning prevention; (4) preventive health measures with respect to breast and cervical cancers; (5) the Office of Disease Prevention and Health Promotion; (6) the Office of Minority Health; (7) preventive health and health services block grant; (8) categorical grants for early intervention regarding acquired immune deficiency syndrome; and (9) programs of the Centers for Disease Control regarding the smoking of tobacco products.

Directs the Office of Disease Prevention and Health Promotion to promote individual responsibility in personal health care and in the use of valuable health care resources.

Subtitle B: Medicare - Provides Medicare coverage for: (1) screening fecal-occult blood tests and screening flexible sigmoidoscopies for the purpose of the early detection of cancer; (2) tetanus-diphtheria boosters; (3) well-child services; and (4) an annual screening mammography for women over age 64.

Title V: Malpractice Reform - Subtitle A: Findings; Purpose; Definitions - Sets forth the findings, purpose, and definitions for this title.

Subtitle B: Uniform Standards for Malpractice Claims - Prohibits bringing a medical malpractice liability action in a State court unless there has been an initial resolution under an alternative dispute resolution system. Limits the total noneconomic damages in such actions to $250,000. Sets limits on attorney's fees. Makes special provision for obstetric services.

Subtitle C: Requirements for State Alternative Dispute Resolution Systems (ADR) - Establishes requirements for State alternative dispute resolution systems. Provides for grants to States to assist in implementation of such systems.

Subtitle D: Grants to States for Development of Practice Guidelines - Directs the Secretary to make grants to States for the development of medical practice guidelines for health care professionals that may be applied to resolve medical malpractice liability claims.

Title VI: Paperwork Reduction and Administrative Simplification - Preempts State quill pen laws. Ensures the confidential treatment of electronic health care information. Sets forth provisions which provide for: (1) the standardization of electronic health information; (2) uniform claims forms; (3) the liability of insurers when benefits are payable under two or more plans; and (4) the uniformity of the availability of information among health plans when benefits are payable under two or more plans.

(Sec. 6007) Amends the Internal Revenue Code to impose a tax on a health plan not in compliance with specified requirements of this title.

Title VII: Additional Benefits On a Pay-As-You-Go Basis - Expresses the sense of the Congress that additional benefits should be provided by the Federal Government to the extent that additional financing is made available on a pay-as-you-go basis.