Health Care Reform bill

TABLE OF CONTENTS:

Title I: Portable and Permanent Private Health Insurance

Subtitle A: Portability

Subtitle B: Permanence

Title II: Expansion of Health Care Choices

Subtitle A: Employer-Provided Health Insurance

Subtitle B: Medical Savings Accounts

Title III: Equal Tax Treatment for Health Insurance of

Self-Employed and Uninsured

Title IV: Small Business Health Insurance Pools

Title V: Assistance to Individuals With Preexisting

Conditions in Purchasing Health Insurance

Title VI: Encourage Responsible Behavior by the

Financially Capable

Title VII: Assistance to Low-Income Workers to Purchase

Health Insurance

Title VIII: Reward Preventive Medicine and Healthy

Lifestyles

Title IX: Reform Medicaid and Expand Choices Under

Medicare

Subtitle A: Medicaid

Subtitle B: Medicare

Title X: Enhanced Efficiency Through Paperwork Reduction

Title XI: Meaningful Medical Liability Reform

Title XII: Antitrust Reforms

Title XIII: Expenditure Targets for the Medicaid and

Medicare Programs

Comprehensive Family Health Access and Savings Act - Title I: Portable and Permanent Private Insurance - Subtitle A: Portability - Amends the Internal Revenue Code to modify required continuation coverage of group health plans by allowing the offering of annual deductibles for such coverage. Terminates such continuation coverage after an individual is eligible for employer-based coverage for more than 90 days.

(Sec. 102) Allows penalty-free withdrawals from qualified retirement plans to pay for health insurance during a continuation period.

Subtitle B: Permanence - Prohibits an insurer from cancelling an individual or group health insurance plan or denying renewal of coverage except for specified reasons. Prohibits an employer from cancelling a self-insured group health plan or denying renewal of coverage except for similar reasons.

(Sec. 112) Requires individual health insurance plans and group health plans to offer insureds the option to purchase new health insurance plans after enactment of this Act.

Title II: Expansion of Health Care Choices - Subtitle A: Employer-Provided Health Insurance - Requires an employer-provided health insurance package to include one of the following options: (1) the health insurance coverage provided by the employer on the date of enactment of this Act; (2) coverage in a health maintenance organization, managed care arrangement, or preferred provider organization; or (3) a medical savings account.

Subtitle B: Medical Savings Account - Allows a deduction from gross income for medical expenses attributable to coverage under a catastrophic health insurance plan.

(Sec. 212) Allows individuals a tax deduction for contributions made to a medical care savings account established for the benefit of an eligible individual or such individual's spouse and dependents.

Allows such deduction whether or not an individual itemizes deductions.

Disallows distributions from such accounts as medical expense deductions.

Excludes employer contributions to such accounts from employment taxes.

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

Title III: Equal Tax Treatment for Health Insurance of Self-Employed and Uninsured - Allows as an exclusion from gross income such self-employed health insurance costs as do not exceed the national per employee average of the employer-provided contribution excluded from gross income.

Excludes certain health insurance costs from employment taxes.

Title IV: Small Business Health Insurance Pools - Prohibits: (1) State restrictions on groups purchasing health insurance; (2) State benefit mandates for group health plans; and (3) for five years following enactment, specified State restrictions on managed care.

Title V: Assistance to Individuals with Preexisting Conditions in Purchasing Health Insurance - Requires the Secretary to establish and administer a program providing allotments to States for the establishment of State-wide insurance risk pools to provide health insurance coverage to individuals with preexisting conditions. Authorizes appropriations.

Title VI: Encourage Responsible Behavior by the Financially Capable - Prohibits any family with an income exceeding 200 percent of the poverty line or who is eligible for a catastrophic health insurance plan as defined in title VII of this Act, but who fails to purchase a plan providing such coverage within one year of enactment from being eligible for the insurance pool program under title V of this Act.

Title VII: Assistance to Low-Income Workers to Purchase Insurance - Amends the Internal Revenue Code to allow a refundable tax credit for the cost of premiums for a catastrophic health insurance plan based upon family income and size. Allows the advance payment of such credit. Disallows the use of such credit amount as a medical expense deduction.

(Sec. 702) Allows the collection of unpaid debts for medical expenses from individuals who are eligible for such credit but fail to claim it.

Title VIII: Reward Preventive Medicine and Healthy Lifestyles - Provides that in the case of any health insurance plan, no provision of State or local law shall apply that restricts the reduction of premiums or the allowance of incentives with respect to such plans for individuals who pursue healthy lifestyles.

Title IX: Reform Medicaid and Expand Choices Under Medicare - Subtitle A: Medicaid - Amends title XIX (Medicaid) of the Social Security Act to place a specified formula cap on the Federal payment made each year to a State for furnishing medical assistance to eligible individuals.

(Sec. 902) Provides for waivers from Medicaid requirements in order for States to establish innovative and cost-effective programs for furnishing medical assistance to eligible individuals.

Subtitle B: Medicare - Amends title XVIII (Medicare) of the Social Security Act to allow an individual to elect health care coverage through either a private health care arrangement or an eligible organization within one year after becoming entitled to benefits under Medicare part A (Hospital Insurance) or forgoing an employer health benefit plan. Details the election process for current Medicare part A beneficiaries. Provides for payments under Medicare to individuals enrolled with such arrangements or organizations, including additional amounts from the Medicare trust funds for individuals enrolled with such arrangements.

Title X: Enhanced Efficiency Through Paperwork Reduction - Directs the Secretary of Health and Human Services to adopt standards to reduce the administrative and paperwork burdens of all Federal health care programs by 50 percent within the two-year period following the date of this Act's enactment (initial reduction), and by an additional 50 percent reduction over a subsequent three-year period (subsequent reduction), for a total reduction of 75 percent over the five-year period following such date.

Requires the Secretary, to achieve the initial reduction, to adopt standards for Federal health care programs relating to: (1) data elements for use in paper and electronic claims processing under health insurance plans, as well as for use in utilization review and management of care; (2) uniform claims forms; and (3) uniform electronic transmission of the data elements, including protections to assure the confidentiality of patient-specific information and to protect against the unauthorized use and disclosure of information.

Directs the Secretary, to achieve the subsequent reduction, to modify by regulation the standards adopted with respect to the initial reduction. Specifies that such modification may include such recommendations as reported by the Standardized Form Commission or any other provisions necessary to meet the goals for reduction in the paperwork burden of Federal health care programs.

(Sec. 1002) Requires each State, to be eligible for Federal funds in connection with any State-administered health care program, to standardize the processing of paper and electronic claims to reduce the administrative and paperwork burdens on such programs by 75 percent during the five-year period following enactment of this Act. Sets forth provisions regarding enforcement of this provision and waivers of payment reductions for noncompliance.

(Sec. 1003) Directs the Secretary to: (1) establish a Standardized Forms Commission to make recommendations on the standardization of paper and electronic claims processing to reduce the paperwork burden and enhance the efficiency and productivity of claims processing; and (2) submit recommendations to the Congress in the form of an implementing bill. Sets forth procedures for congressional consideration of such bill.

Makes a health care provider or insurer that fails to comply with any enacted recommendations of the Commission ineligible for payments of claims submitted under any provision of the Social Security Act or the Public Health Service Act.

Title XI: Meaningful Medical Liability Reform - Makes this title applicable with respect to any medical malpractice liability claim or action (such action) brought in State or Federal court, except with respect to certain claims or actions for damages arising from a vaccine-related injury or death. Sets forth provisions regarding: (1) preemption; (2) negotiated liability; (3) effect on sovereign immunity and choice of law or venue; and (4) jurisdiction.

(Sec. 1102) Prohibits such action from being initiated after the expiration of: (1) the two-year period that begins on the latter of the date the alleged injury that is the subject of the claim was discovered or the date the injury should reasonably have been discovered; and (2) the four-year period that begins on the date on which the alleged injury occurred. Makes an exception for a minor who has not attained age six.

(Sec. 1103) Provides that: (1) the liability of each defendant in such action, with respect to economic and noneconomic damages, shall be several only and not joint; (2) such a defendant shall be liable only for the amount of damages allocated to the defendant in direct proportion to such defendant's percentage of fault or responsibility for the injury; and (3) the trier of fact shall determine and assign a percentage of responsibility for each such defendant.

(Sec. 1104) Requires: (1) all requests for discovery pursuant to such action to identify the relevant portion of the complaint, answer, or other pleading to which responses to the discovery requests are expected to relate; and (2) the court, with respect to any motion for an order compelling discovery, to award the prevailing party reasonable fees and expenses incurred in bringing or defending against the motion, including reasonable attorney fees, unless the court finds that the position of the unsuccessful party with substantially justified or that special circumstances make such an award unjust.

(Sec. 1105) Limits the total amount of noneconomic damages that may be awarded to a claimant and family members to $250,000, regardless of the number of parties against whom the action is brought or the number of actions brought with respect to the injury.

(Sec. 1106) Specifies that a defendant may not be required to pay damages awarded for any economic losses to be incurred after the date on which the judgment is entered exceeding $100,000, in a single, lump-sum payment, but shall be permitted to make such payments periodically based on projections of the amount of damages expected to be incurred by the claimant at appropriate intervals, as determined by the court. Permits the court to require that a defendant purchase an annuity or fund a reversionary trust to make periodic payments if the court determines that a reasonable basis exists for concluding that the defendant may be unable or otherwise fail to make the required periodic payments. Specifies that a court judgment awarding such payments may not be reopened at any time to contest, amend, or modify the schedule or amount of the payments in the absence of fraud or any other basis under which a party may obtain relief from a final judgment.

(Sec. 1107) Sets forth provisions regarding costs and fees, including limitations on attorneys charging or collecting contingency fees. Establishes recordkeeping requirements as a prerequisite to the receipt of an award of attorney fees.

(Sec. 1108) Sets forth provisions regarding: (1) contribution and indemnification; and (2) collateral sources.

(Sec. 1110) Prohibits the award of noneconomic damages with respect to any medical product liability claim alleged against a medical product producer if: (1) the drug or device that is the subject of such claim was subject to specified approval or premarket approval under the Federal Food, Drug, and Cosmetic Act by the Food and Drug Administration (FDA); or (2) the drug or device is generally recognized as safe and effective pursuant to conditions established by the FDA and applicable regulations, including packaging and labeling regulations. Makes exceptions in cases of withheld information, misrepresentation, or illegal payment of FDA officials to secure approval.

(Sec. 1111) Provides that, in any medical malpractice liability action that is certified as a class action: (1) the share of damages under any final judgment or settlement that is awarded to any party serving as a representative claimant shall be calculated in the same manner as the shares awarded to all other members of the claimant class (but permits the award of reasonable compensation, costs, and expenses relating to the representation of the class); (2) if a party is represented by an attorney who has a beneficial interest in the subject of the litigation, the court shall make a determination of whether such interest constitutes a conflict of interest sufficient to disqualify the attorney; and (3) an attorney may not represent the class if the attorney has paid, or is obligated to pay, a fee to a third party who assisted the attorney in obtaining the representation of any party to the action (and bars an attorney who knowingly violates this provision from representing the party in such action or any action to which this title applies).

Title XII: Antitrust Reforms - Directs the Attorney General to promulgate guidelines under which a health care joint venture may submit an application requesting that the Attorney General provide the entities participating in the venture with an exemption under which: (1) monetary recovery on an antitrust claim brought against the entity shall be limited to actual damages if specified conditions are met; and (2) the conduct of the entity in making or performing a contract to carry out the venture shall not be deemed illegal per se.

Requires the Attorney General to approve or disapprove the application within a specified time frame and to provide a statement explaining the reasons for any disapproval.

Directs the Attorney General to approve the application if an entity participating in the venture submits to the Attorney General an application that contains: (1) the identities of the parties to the venture; (2) the nature, objectives, and planned activities of the venture; and (3) specified assurances and information.

Sets forth provisions regarding: (1) revocation and renewal of exemptions and withdrawal of an application; (2) requirements relating to notice and publication of exemptions; and (3) issuance of health care certificates of public advantage to each eligible health care joint venture that complies with specified requirements.

(Sec. 1203) Establishes the Interagency Advisory Committee on Competition, Antitrust Policy, and Health Care to: (1) discuss and evaluate competition and antitrust policy and their implications regarding the performance of health care markets; (2) analyze the effectiveness of health care joint ventures receiving exemptions in reducing costs and expanding access; and (3) make recommendations to the Congress.

Title XIII: Expenditure Targets for the Medicaid and Medicare Programs - Requires the Director of the Office of Management and Budget, not later than 30 days after the end of each fiscal year beginning with FY 1995, to determine the amount of "medicaid excess expenditures" and "medicare excess expenditures" for such fiscal year. Defines such terms for a fiscal year as the amount by which the Federal expenditures under each such program for such fiscal year exceed the target expenditures for each such program. Sets formulas for determining the target expenditures.

(Sec. 1302) Provides that if the Director determines that there are Medicaid or Medicare excess expenditures for a fiscal year, specified categories of health insurance benefits (including certain tax credits and exclusions and assistance to individuals with preexisting conditions in purchasing health insurance) that are effective in the applicable taxable or calendar year beginning after such fiscal year may be delayed until the following year. Makes such provision applicable only to so many of such categories in the order in which such categories are listed such that the savings resulting from such delay at least equal the costs of the Medicaid and Medicare excess expenditures.