Healthy Americans Act

TABLE OF CONTENTS:

Title I: State Universal Health Insurance Coverage

Programs - Phase I

Subtitle A: Expansion of SCHIP to Provide Health

Insurance Coverage to Additional Individuals

Subtitle B: State Health Coverage Outreach Programs

Title II: Universal Affordable Comprehensive Health Care -

Phase II

Title III: Patient Protections

Subtitle A: Utilization Management

Subtitle C (sic): Health Plan Standards

Subtitle D: Miscellaneous Provisions

Title IV: Miscellaneous

Healthy Americans Act - Title I: State Universal Health Insurance Coverage Programs - Phase I - Subtitle A: Expansion of SCHIP to Provide Health Insurance Coverage to Additional Individuals - Amends title XXI (Children's Health Insurance) (SCHIP) of the Social Security Act (SSA), renamed State Health Insurance Programs, to add a new part B (State Universal Health Insurance Coverage Program - Phase I) (UHICP) in order to provide funds to enable participating States to initiate and expand State-administered systems of health insurance coverage for individuals and families with incomes at or below 300 percent of the poverty line.

(Sec. 101) Provides that a State is not eligible for a payment under this title unless it has submitted to the Secretary of Health and Human Services a phase I State universal coverage plan (phase I plan) that: (1) sets forth how the State intends to use the funds provided to expand SCHIP, now under a new part A of SSA title XXI, to provide universal health insurance coverage to eligible individuals and families within the State; and (2) has been approved in accordance with prescribed guidelines.

Outlines plan requirements. Conditions a State's eligibility to receive part B funds on its agreeing to administer a phase I plan with a goal of providing health insurance coverage for 100 percent of the eligible individuals and families who reside in the State and who have income that is equal to or less than 300 percent of the poverty line by not later than September 30, 2003. Specifies the required scope of such health insurance coverage. Allows for cost-sharing, with certain limitations.

Prohibits phase I plans from permitting the imposition of any preexisting condition exclusion for covered benefits under the plan. Makes appropriations for part B allotments to States, Indian tribes, and Native Hawaiian organizations.

Subtitle B: State Health Coverage Outreach Programs - Directs the Secretary to award grants to qualified States submitting outreach plans in order for them to establish State-administered outreach programs to maximize the enrollment of eligible individuals and families in the Medicaid, SCHIP, and UHICP (Phase I) programs. Makes necessary appropriations.

Title II: Universal Affordable Comprehensive Health Care-Phase II - Amends SSA title XXI to add a new part C (State Universal Health Insurance Coverage Program - Phase II) in order to provide funds to enable participating States to establish State-administered systems to ensure universal, affordable, and comprehensive health insurance coverage. Sets forth plan, allotment, and grant requirements similar to those for phase I plans. Requires States, to be eligible to receive part C funds, to establish and implement procedures to certify: (1) private and public health care plans as qualified plans; and (2) public health care programs as qualified programs.

(Sec. 202) Requires States submitting phase II plans to have in effect a State law that requires any health plan offered in the State to: (1) offer benefits to plan enrollees that are at least actuarially equivalent to health insurance benefits offered to Federal employees; (2) include mental health and substance abuse benefits at least equal to medical and surgical benefits; and (3) limit premiums and cost-sharing to certain formula maximums.

(Sec. 205) Directs the Secretary to propose to the appropriate congressional committees technical and conforming amendments necessary to: (1) apply such premiums and cost-sharing limitations to Medicare- eligible residents; (2) provide coverage for outpatient prescription drugs for such individuals under Medicare; and (3) provide full mental health and substance abuse treatment parity to such individuals under Medicare.

Title III: Patient Protections - Subtitle A: Utilization Management - Requires a health plan to have in place a utilization review program certified by the State and meeting the requirements of this subtitle.

(Sec. 313) Directs the Secretary to establish standards for the establishment, operation, and certification and periodic recertification of health plan utilization review programs.

Authorizes a State to certify a health plan as meeting such standards if it has met the utilization standards required for accreditation as applied by a nationally recognized, independent, nonprofit accreditation entity. Requires a State that makes such a determination to review periodically the standards used by the private accreditation entity to ensure that they meet or exceed the Secretary's standards.

Outlines health plan requirements with respect to the disclosure of information to prospective covered individuals, covered individuals, and State officials, as well as requirements with regard to emergency care.

Subtitle C (sic): Health Plan Standards - Directs the Secretary to establish standards for the certification and periodic recertification of health plans, including standards which require plans to meet the requirements of this subtitle.

(Sec. 321) Requires a State to provide for the certification of health plans if the certifying authority designated by the State determines that the plan meets the applicable requirements of this title.

(Sec. 322) Specifies requirements for health plans relating to: (1) minimum solvency requirements; (2) information on terms of plan; (3) accessibility of covered health care services and access to specialized treatment; (4) credentialing for health providers; (5) grievance procedures; (6) confidentiality standards; (7) discrimination; and (8) selective marketing.

Subtitle D: Miscellaneous Provisions - Directs a State to prohibit the offering or issuance of any health plan which does not meet the requirements of this title.

(Sec. 331) Authorizes the Secretary of Labor to take corrective action to terminate or disqualify a self-insured plan that does not meet the standards developed under this title.

Title IV: Miscellaneous - Provides that specified administration and enforcement requirements of the Employee Retirement Income Security Act of 1974 shall not apply with respect to health benefits provided under a group health plan qualified to offer such benefits under a phase I or II plan.

(Sec. 402) Expresses the sense of the Congress that any sums necessary for the implementation of this Act should be offset by: (1) reductions in unnecessary tax benefits available only to individuals and large corporations in the maximum tax brackets; (2) increases in taxes from the sale of tobacco products; (3) elimination of duplicative and wasteful military spending; and (4) direct savings in health care expenditures resulting from the implementation of this Act.