Consumer Choice Health Security Act of 1993

TABLE OF CONTENTS:

Title I: Tax and Insurance Provisions

Subtitle A: Tax Treatment of Health Care Expenses

Subtitle B: Insurance Provisions

Subtitle C: Employer Provisions

Subtitle D: State Plan Requirements

Subtitle E: Federal Preemption

Title II: Medicare and Medicaid Reforms

Subtitle A: Medicare

Subtitle B: Medicaid

Title III: Health Care Liability Reform

Title IV: 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: Preemption of State Quill Pen Laws

Title V: Anti-Fraud

Subtitle A: Criminal Prosecution of Health Care Fraud

Subtitle B: Coordination of Health Care Anti-Fraud

and Abuse Activities

Title VI: Antitrust Provisions

Title VII: Long-Term Care

Title VIII: Welfare Restrictions for Aliens

Title IX: Increase in Assistance to Community and

Migrant Health Centers from Residual Savings

Consumer Choice Health Security Act of 1993 - Title I: Tax and Insurance Provisions - Subtitle A: Tax Treatment of Health Care Expenses - Amends the Internal Revenue Code to allow a tax credit for health care expenses based upon percentages of qualified health insurance premiums and adjusted gross income. Provides for employers to make advance payments of such credit.

(Sec. 102) Allows individuals a tax credit for a percentage of contributions made to a medical care savings account established for the benefit of an eligible individual.

Exempts such accounts from taxation.

Establishes an excise tax for excess contributions to medical care savings accounts and makes such accounts subject to the tax on prohibited transactions.

(Sec. 103) Disallows the use of a personal exemption for an uninsured individual. Terminates the medical expense deduction, the deduction for health insurance costs of self-employed individuals, and the exclusion for employer-provided health insurance.

Subtitle B: Insurance Provisions - Part I: Federally Qualified Health Insurance Plans - Sets forth requirements for federally qualified health insurance plans, including coverage for acute medical care, cost-sharing, premium rating practices, and guaranteed issuance and renewability.

Part II: Certification of Federally Qualified Health Insurance Plans - Requires States to meet standards for regulatory programs for the certification of federally qualified health insurance plans.

Subtitle C: Employer Provisions - Requires employers to: (1) withhold health insurance premiums from employee wages and remit such premiums to the employee's chosen insurer; and (2) notify each employee of their right to claim an advance refundable tax credit for such premiums.

(Sec. 122) Provides for the conversion and continuation of existing insurance plans to required coverage under this Act.

(Sec. 125) Establishes the Benefits Cash Out Commission to propose a procedure under which individuals may cash out Federal health benefits. Provides for congressional consideration of such proposal prior to its implementation.

(Sec. 126) Imposes excise taxes on employers and health insurance carriers for noncompliance with this Act.

Subtitle D: State Plan Requirements - Sets forth requirements for States to meet in order to receive Federal funds for health care programs.

Subtitle E: Federal Preemption - Preempts specified State laws concerning health insurance.

Title II: Medicare and Medicaid Reforms - Subtitle A: Medicare - Directs the Secretary to report to the Congress on the feasibility of allowing future Medicare beneficiaries to elect to receive certificates with which to purchase private health insurance coverage instead of receiving Medicare benefits.

(Sec. 202) Eliminates disproportionate share hospital payments under Medicare.

(Sec. 203) Provides for a reduction in the adjustment for indirect medical education costs under Medicare.

(Sec. 204) Imposes copayments for skilled nursing facility services provided under Medicare.

(Sec. 205) Moves payment updates to January for all payment rates under Medicare's hospital insurance program.

(Sec. 206) Accelerates the transition to prospective rates for facility costs in hospital outpatient departments.

Subtitle B: Medicaid - Places a cap on Federal payments for acute medical services furnished under a State's Medicaid program.

(Sec. 212) Provides for waivers from Medicaid requirements in order to establish acute medical services programs.

(Sec. 213) Terminates disproportionate share hospital payments under Medicaid.

(Sec. 214) Directs the Secretary to provide grants to States for programs to provide health insurance coverage, acute medical services, preventive care, and disease prevention services to low-income individuals.

Title III: Health Care Liability Reform - Health Care Liability Reform Act of 1993 - Limits payments, damages, and attorney's fees in health care malpractice actions and claims.

(Sec. 304) Declares that a manufacturer or seller of a health care product shall not be strictly liable for injury from: (1) a defect in the design of the product; or (2) a failure to warn or instruct regarding a risk posed by the product that was not known or reasonably knowable.

(Sec. 305) Limits the amount of noneconomic damages that may be awarded in a health care malpractice claim or a health care product liability claim. Allows several liability for noneconomic loss and for punitive damages.

(Sec. 306) Allows punitive damages to be awarded only if the claimant establishes that the harm suffered was the result of conduct manifesting conscious, flagrant indifference to the health of those harmed by the product. Disallows punitive damges against a product approved by the Food and Drug Administration.

Title IV: Administrative Cost Savings - Subtitle A: Standardization of Claims Processing - Directs the Secretary to adopt standards relating to: (1) data elements for use in paper and electronic claims processing under health benefit plans and in utilization review and mangement of care; (2) uniform claims forms; and (3) uniform electronic transmission of the data elements.

(Sec. 402) Authorizes the Secretary, two years after standards are adopted for classes of services upon determining that a significant number of claims for benefits for such services under health benefit plans are not being submitted in accordance with such standards, to require that all providers of such services submit claims to health benefit plans in accordance with such standards.

(Sec. 403) Directs the Secretary to: (1) provide for the ongoing receipt and review of comments and suggestions for changes in the standards adopted and promulgated; (2) establish a schedule for the periodic review of such standards; and (3) revise such standards.

Subtitle B: Electronic Medical Data Standards - Directs the Secretary to promulgate standards for hospitals concerning electronic medical data, including standards for transmission of such data and confidentiality of patient-specific information. Authorizes the Secretary to periodically revise such standards.

(Sec. 412) Sets forth requirements with respect to: (1) the sharing of hospital information under Medicare; (2) waiver of such requirements; and (3) application of such requirements to hospitals of the Department of Veterans Affairs.

(Sec. 413) Authorizes the head of a Federal agency to require a provider to present and transmit a required data element electronically in accordance with applicable presentation or transmission standard.

(Sec. 414) Sets forth limitations on data requirements where standards with respect to data elements are in effect.

(Sec. 415) Directs the Secretary to establish an advisory commission on the standards established under this part and operational concerns about the implementation of such standards. Authorizes appropriations.

Subtitle C: Development and Distribution of Comparative Value Information - Directs the Secretary to determine whether each State is developing and implementing a health care value information program that meets specified criteria and a specified schedule. Authorizes the Secretary to: (1) make grants to enable each State to plan development and initiate implementation of its health care value information program; and (2) recover the amount of such a grant by offset against any other amount payable to the State under the Social Security Act under specified circumstances. Authorizes appropriations.

(Sec. 422) Directs the Secretary to take actions necessary to implement a comparable program in a State that fails to develop or implement a health care value information program in accordance with such criteria and schedule. Authorizes the Secretary to charge fees for the information materials provided pursuant to such a program.

(Sec. 423) Directs the head of each Federal agency with responsibility for the provision of health insurance or health care services to individuals to develop health care value information relating to each program that such head administers and covering the same types of data that a State program meeting such criteria would provide.

Subtitle D: Preemption of State Quill Pen Laws - Specifies that, effective January 1, 1996, no effect shall be given to any provision of State law that requires medical or health insurance records (including billing information) to be maintained in written, rather than electronic, form.

Title V: Anti-Fraud - Subtitle A: Criminal Prosecution of Health Care Fraud - Amends the Federal criminal code to impose penalties upon a health care provider that knowingly engages in any scheme or artifice to defraud a person in connection with the provision of health care.

(Sec. 502) Authorizes the Attorney General to pay a reward of up to $10,000 to a person who furnishes information unknown to the Government relating to a possible prosecution for health care fraud, with exceptions.

Subtitle B: Coordination of Health Care Anti-Fraud and Abuse Activities - Amends the Social Security Act to provide for: (1) the application of Federal health anti-fraud and abuse sanctions to all fraud and abuse against any health insurance plan; and (2) treble damages for making or causing to be made false statements or representations involving Medicare or State health care programs, for illegal remuneration, and for false statements or representations with respect to the condition or operation of health care institutions.

Directs the Secretary of Health and Human Services, in consultation with State and local health care officials, to: (1) identify opportunities for the satisfaction of community service obligations that a court may impose upon the conviction of a criminal offense involving Medicare or State health care programs; and (2) make information concerning such opportunities available to Federal and State law enforcement officers and State and local health care officials.

Title VI: Antitrust Provisions - Exempts from the antitrust laws specified "safe harbor" activities related to the provision of health care services. Sets forth provision regarding the award of attorney fees and costs of suit to the prevailing party in an action based on a claim involving activity found to be exempt.

(Sec. 602) Lists as safe harbors specified: (1) activities relating to health care services of combinations of health care providers with market share below a specified threshold; (2) activities of medical self-regulatory entities relating to standard setting or enforcement activities not conducted for purposes of financial gain; (3) participation of a health care provider in a written survey of the prices of services, reimbursement levels, or the compensation and benefits of employees and personnel; (4) activities relating to health care joint ventures for high technology and costly equipment and services; (5) activities relating to hospital mergers; (6) joint purchasing arrangements; and (7) negotiations.

(Sec. 603) Directs the Attorney General to publish a notice in the Federal Register soliciting proposals for additional safe harbors and to review and report to the Congress on proposed safe harbors. Sets forth criteria in establishing safe harbors, including: (1) the extent to which a competitive or collaborative activity will accomplish an increase in health care access and quality, the establishment of cost efficiencies, and increased ability of health care facilities to provide services in medically underserved areas or to underserved populations; and (2) whether designation as a safe harbor will result in specified desirable outcomes.

(Sec. 604) Directs the Attorney General to issue certificates of review for providers of health care services and to assist persons in applying for such certificates. Sets forth provisions regarding applications for, revocation of, and review of determinations regarding such certificates. Limits the disclosure of information.

(Sec. 605) Sets forth provisions regarding notifications providing for a reduction in certain penalties under the antitrust laws for health care cooperative ventures.

(Sec. 606) Directs the Attorney General to: (1) review the safe harbors and certificates of review periodically; and (2) promulgate such rules, regulations, and guidelines as necessary to carry out provisions of this title.

Title VII: Long-Term Care - Amends the Internal Revenue Code to exclude from gross income certain amounts withdrawn from individual retirement accounts and certain employer cash or deferred arrangements to pay long-term care premiums.

(Sec. 702) Provides for the nonrecognition of gain or loss on the exchange of any life insurance contract or an endowment or annuity contract for a long-term care insurance contract.

(Sec. 703) Provides for the exclusion as a death benefit of any amount paid or advanced to an individual under a life insurance contract because such individual is terminally ill, or chronically ill and has been permanently confined to a qualified facility.

Title VIII: Welfare Restrictions for Aliens - Makes aliens ineligible for programs of public welfare assistance, other than medical assistance with respect to emergency services.

(Sec. 802) Amends the Social Security Act to require State agencies to provide the Immigration and Naturalization Service with identifying information on individuals unlawfully in the United States whose children are citizens for purposes of the Aid to Families with Dependent Children program.

Title IX: Increase in Assistance to Community and Migrant Health Centers from Residual Savings - Directs the Secretary of Health and Human Services to provide for a program of grants to migrant and community health centers to promote primary health care services for underserved individuals. Authorizes appropriations with limitations. Requires a report to the Congress on such program.