A bill to increase the availability and affordability of health care coverage for individuals and their families, to reduce paperwork and simplify the administration of health care claims, to increase access to care in rural and underserved areas, to improve quality and protect consumers from health care fraud and abuse, to promote preventive care, to make long-term care more affordable, and for other purposes.
TABLE OF CONTENTS:
Title I: Health Insurance Market Reform
Subtitle A: Insurance Market Standards
Subtitle B: Establishment and Application of Standards
Subtitle C: Definitions
Title II: Grants to States for Small Group Health Insurance
Purchasing Arrangements
Title III: Tax Incentives to Encourage the Purchase of
Health Insurance
Title IV: Incentives to Increase the Access of Rural and
Underserved Areas to Health Care
Title V: Quality and Consumer Protection
Subtitle A: Quality Improvement Foundations
Subtitle B: Administrative Simplification
Subtitle C: Privacy of Health Information
Subtitle D: Health Care Fraud Prevention
Title VI: Malpractice Reform
Title VII: Health Promotion and Disease Prevention
Title VIII: Tax Incentives for Long-Term Care
Subtitle A: Tax Treatment of Long-Term Care Insurance
Subtitle B: Standards for Long-Term Care Insurance
Subtitle C: Incentives to Encourage the Purchase of
Private Insurance
Subtitle D: Effective Date
Title IX: Budget Neutrality
Access to Affordable Health Care Act - Title I: Health Insurance Market Reform - Subtitle A: Insurance Market Standards - Prohibits discrimination by a health plan based on health status, except as specified.
(Sec. 1002) Provides for guaranteed issue and renewal in both the small and large group market, subject to the following exceptions: (1) capacity limits; (2) nonpayment of premiums; and (3) fraud or misrepresentation.
(Sec. 1003) Provides for the development of rating limitations by the National Association of Insurance Commissioners (NAIC).
(Sec. 1004) Directs the Secretary of Health and Human Services (the Secretary), in consultation with the NAIC and others, to establish minimum guidelines for the issuance by each State of delivery system quality standards.
(Sec. 1005) Requires each health plan offering coverage in the small group market to participate in a risk adjustment program.
Subtitle B: Establishment and Application of Standards - Deems a requirement or standard on a health plan under this Act to be a requirement or standard imposed on the insurer or sponsor of such plan. Prohibits any requirement of this title from being construed as preempting any State law unless such State law directly conflicts with such requirement.
Subtitle C: Definitions - Sets forth definitions used in this title and title II.
Title II: Grants to States for Small Group Health Purchasing Arrangements - Directs the Secretary to make grants to States that submit applications meeting specified requirements for the establishment and operation of small group health insurance purchasing arrangements. Authorizes appropriations.
Title III: Tax Incentives to Encourage the Purchase of Health Insurance - Amends the Internal Revenue Code to permanently extend and increase to 100 percent the deduction for health insurance costs of self-employed individuals.
(Sec. 3002) Provides a credit for a percentage of qualified health insurance expenses.
Title IV: Incentives to Increase the Access of Rural and Undeserved Areas to Health Care - Provides for a nonrefundable credit of up to $12,000 annually for a primary health services provider who has not received a National Health Service Corps scholarship and who serves in a health professional shortage area.
Increases, by $10,000, the amount which may be expensed in the case of health care property used to provide primary health care services in a health professional shortage area.
(Sec. 4003) Amends the Public Health Service Act to direct the Secretary to make grants to federally qualified health centers (FQHCs) and other entities submitting applications for the purpose of providing access to services for medically undeserved populations or in high impact areas not being served by a FQHC. Sets forth grant eligibility requirements. Authorizes appropriations.
(Sec. 4004) Revises the authorizations of appropriations for the National Health Service Corps Scholarship Program and area health education centers.
(Sec. 4005) Makes the head of the Office of Rural Health Policy an Assistant Secretary.
(Sec. 4006) Directs the Prospective Payment Assessment Commission to study the need for legislation or regulations to ensure that vulnerable populations have access to health plans and health care providers and services.
Title V: Quality and Consumer Protection - Subtitle A: Quality Improvement Foundations - Directs the Secretary to award demonstration grants for the establishment and operation of quality improvement foundations. Authorizes appropriations.
Subtitle B: Administrative Simplification - Provides for the establishment of standards and requirements for the electronic transmission of certain health information, including information under the Medicare and Medicaid programs. Sets: (1) timetables for the adoption of such standards and requirements; and (2) penalties for failure to comply with such standards and requirements. Authorizes appropriations.
Subtitle C: Privacy of Health Information - Sets forth provisions concerning the disclosure of health information generally and for: (1) specific disclosures relating to the patient; (2) oversight, public health, and research purposes; (3) judicial, law enforcement, and administrative purposes; (4) disclosure pursuant to a government subpoena or warrant; and (5) disclosure pursuant to party subpoena.
(Sec. 5236) Sets forth procedures for ensuring the security of protected information, including standards for electronic disclosures.
(Sec. 5256) Sets forth civil and criminal sanctions for privacy violations.
Subtitle D: Health Care Fraud Prevention - Health Care Fraud Prevention Act of 1995 - Directs the Secretary and the Attorney General to establish: (1) an all-payer fraud and abuse control program; and (2) by regulation, standards to carry out the program. Authorizes appropriations as necessary to conduct investigations and audits of such fraud and abuse and to carry out such program. Establishes the Health Care Fraud and Abuse Control Account from which funds shall be available to carry out the fraud and abuse control program.
(Sec. 5312) Amends part A (General Provisions) of Title 11 (General Provisions and Peer Review) of the Social Security Act to provide for the application criminal and civil health fraud and abuse sanctions under such Act to any health plan.
(Sec. 5331) Directs the Secretary to establish a national health care fraud and abuse data collection program to report final adverse actions against health care providers, suppliers, or practitioners.
(Sec. 5351) Amends Federal criminal law to set penalties for health care fraud and related offenses.
(Sec. 5361) Requires each State to establish and maintain a State agency to act as a Health Care Fraud and Abuse Control Unit. Sets forth: (1) requirements for such units; and (2) provisions providing for payments to the States for such units.
Title VI: Malpractice Reform - Directs the Secretary to establish a program of grants to assist States in establishing alternative dispute resolution systems. Authorizes appropriations. Sets forth the requirements for such systems. Directs the Secretary to establish an Alternative Dispute Resolution Advisory Board to advise the Secretary regarding the establishment of such systems. Provides for the establishment of an alternative Federal Dispute Resolution System for States not having a their own certified system. Requires the Secretary to report to the Congress concerning such systems.
Title VII: Health Promotion and Disease Prevention - Permits an income tax deduction for qualified expenditures for disease prevention and health promotion programs.
(Sec. 7002) Directs the Secretary to award grants to States in order to provide assistance to businesses with not to exceed 100 employees for the establishment and operation of worksite wellness programs.
(Sec. 7003) Authorizes appropriations to expand comprehensive school health education programs administered by the Centers for Disease Control and Prevention under the Public Health Service Act.
Title VIII: Tax Incentives for Long-Term Care - Private Long-Term Care Family Protection Act of 1995 - Subtitle A: Tax Treatment of Long-Term Care Insurance - Amends the Internal Revenue Code to permit a deduction for qualified long-term medical care services and insurance covering medical care, if such insurance is provided under a qualified long-term care policy.
(Sec. 8102) Provides, under the Internal Revenue Code, for the treatment of: (1) a qualified long-term care insurance policy as an accident and health insurance contract; (2) amounts received under such a policy as amounts received for personal injuries and sickness; (3) amounts paid for such a policy as amounts payments made for medical insurance; and (4) such a policy as a guaranteed renewable contract. Sets forth provisions for the treatment of long-term care coverage provided as a rider on a life insurance contract.
(Sec. 8105) Treats distributions from a life insurance contract on the life of a terminally ill individual as amounts paid by reason of the insured's death.
Subtitle B: Standards for Long-Term Care Insurance - Provides for the appointment of a National Long-Term Care Insurance Advisory Council.
(Sec. 8202) Imposes a specified tax on the issuer of any qualified long-term care insurance policy which fails to meet certain model regulation and disclosure requirements.
Subtitle C: Incentives to Encourage the Purchase of Private Insurance - Amends title XIX (Medicaid) of the Social Security Act to provide for the disregard of certain assets and resources for the purposes of the Medicaid estate recovery provisions.
(Sec. 8302) Provides for the exclusion from gross income of distributions from an IRA, if such distributions are used to purchase long-term care insurance by an individual over the age of 59 and one- half. Allows for distributions from qualified retirement plans, without the imposition of the ten percent penalty, if such distributions are for medical care or for the purchase of long-term care insurance.
Subtitle D: Effective Date - Sets forth effective date provisions.
Title IX: Budget Neutrality - Provides for the budget neutrality of this Act.
Introduced in Senate
Sponsor introductory remarks on measure. (CR S1760-1762, S1786-1787)
Read twice and referred to the Committee on Finance.
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