Comprehensive National Health Insurance Act

Comprehensive National Health Insurance Act - Title I: National Health Insurance Program - Provides that this Act shall not interfere with the freedom of every physician and every patient to choose where and how they will give or receive health care.

States that the national health insurance program established by this title shall be administered by the Board of the Social Security Administration established by this Act.

Provides the following benefits under the National Health Insurance Program: (1) inpatient hospital services with no day or dollar limitation; (2) physicians' services, in home, office, or elsewhere, with no dollar limitation; (3) medical and other health services (as defined under medicare); (4) home health services-100 visits per year; (5) post-hospital extended care services-100 days per year; (6) mental health services-inpatient, 30 full days in a psychiatric hospital or 60 partial days; outpatient services in a comprehensive community care center equivalent to the costs of 30 visits to a private practitioner or outpatient services of a private practitioner equal to half the costs of 30 visits; (7) outpatient prescription drugs and biologicals for specified chronic conditions; (8) preventive care services, including (a) routine dental services for children under age 13; (b) developmental vision care services, routine eye and vision exams, and lenses or eyeglasses for children under age 13; (c) hearing aids and exams for children under age 13; (d) well-child care to age 6; (e) prenatal care; and (f) family planning services.

Makes all services, except those listed under preventive care subject to a combined annual per person deductible of $150 except that no family would have to meet more than 2 deductibles. States that all services, except drugs, would be subject to a 25-percent coinsurance. Provides that out-patient drugs would be subject to a separate copayment of $1 per prescription drug.

Makes all residents who are not eligible for Medicare eligible for the program through their contributions to the Social Security System, contributions being made by all Americans who have earned or unearned income of any kind, including governmental benefits.

Makes each person who is fully or currently insured, as defined under the present social security law, and his dependents eligible.

Provides immediate coverage under the plan for the individuals who are not fully or currently insured. Provides that coverage be extended to an employee during the first week during which he worked 25 hours or more, coverage not ending until after there were three consecutive weeks in each of which he did not work 25 hours or more. Provides that people beginning self-employment, or starting to receive unearned income, would be eligible beginning with the first day of the first year in which they have such income.

Makes all social security and railroad retirement cash beneficiaries (including widows and widowers under age 65) who are not eligible for coverage under Medicare, eligible for the program.

Directs the Social Security Administration to establish for each eligible individual an account against which such individual may charge the cost of obtaining any items and services furnished him under this title, without regard to any deductible or coinsurance requirement which may be applicable.

Requires that payment for items and services furnished an eligible individual be made by the Social Security Administration to the providers of services on the basis of charges against such individual's account.

States that the Administration shall have full responsibility for the collection of any deductible and coinsurance amounts due from an individual.

Provides for a special waiver of or limitation on deductibles and coinsurance for lower income families.

Enumerates the conditions of and limitations on payment for the following: (1) requirement of requests and certifications, (2) no payments to Federal providers of services, (3) payment for emergency hospital services, (4) payment for inpatient hospital services prior to notification of noneligibility, (5) payment for posthospital extended care services, (6) payment for home health services, (7) limitation on payment for outpatient drugs and biologicals, (8) limitations on payment for surgery and other specialized services, (9) limitation on payment for practitioner services furnished in nonparticipating hospitals, (10) limitation on payment for certain prosthetic devices, (11) payment for certain outpatient services furnished by nonparticipating hospitals, and (12) collection by hospitals of customary charges for certain outpatient services.

Makes provisions for payment to the providers of services and for prospective determination of payment to providers of services.

Directs the Administration to award on an annual basis quality management payments to any provider of services under this title whenever either the percentage amount or the dollar amount of increase in such provider's prospective rate for a fiscal year is less than the average annual increase in such rate for the three previous fiscal years for all providers in the same class, such payment to be equal to 50 percent of the difference between such provider's total costs to the program and what its costs to the program would have been had they increased at the class average rate.

Lists the agreements a provider of services must file with the Administration in order to qualify to participate and to be eligible for payments under this title.

Authorizes the Administration to use public agencies or private organizations to facilitate payment to providers of services.

Authorizes the Administation to use carriers, as defined in this Act, for the administration of noninstitutional benefits.

Requires that payment for services rendered by a physician be made in accordance with a single fee schedule applicable throughout that area.

Provides a method to determine the fee schedule. Allows all physicians to elect whether to participate or not to participate.

States that each fee schedule in effect and the names and addresses of all participating physicians shall be made available to the public throughout the State involved, in such manner and at such times as the Administration may consider appropriate, by the Administration or by the appropriate State agency with the approval of the Administration.

Establishes, within the Social Security Administration, a National Health Insurance Formulary Committee, a majority of whose members shall be physicians and which shall consist of the Commissioner of Food and Drugs and of four individuals (not otherwise in the employ of the Federal Government) who do not have a direct or indirect financial interest in the compensation of the Formularly established under this Act and who are of recognized professional standing and distinction in the fields of medicine, pharmacology, or pharmacy, to be appointed by the Administration without regard to the statutory provisions governing appointments in the competitive service. Provides that the Chairman of the Committee shall be elected annually from the appointed members, by majority vote of the members of the Committee.

Requires the Formulary to compile, publish, and make available a National Health Insurance Formulary, containing an alphabetically arranged listing, by established name, of those drug entities within specified therapeutic categories which the Committee decides are necessary for individuals using such drugs.

States that a fee, charge, or billing allowance shall not be payable under this title with respect to any drug entity that is furnished as an incident to a physician's professional service, and is of a kind commonly furnished in physicians' offices and commonly either rendered without charge or included in the physicians' bills.

Provides a reasonable allowance for outpatient drugs and biologicals.

Makes special provisions for physicians dispensing outpatient drugs and biologicals where the Administration determines that no participating licensed pharmacies exist in a community.

Creates on the books of the Treasury of the United States a trust fund to be known as the National Health Insurance Trust Fund and a body to be known as the Board of Trustees of the Trust Fund, composed of the Secretary of the Treasury, the Secretary of Labor, the Chairman of the Board of the Social Security Administration, and the Secretary of Health, Education, and Welfare.

Directs the Administration to consult with State agencies and other organizations to develop conditions of participation for providers of services.

Provides for the use of State agencies to determine compliance by providers of services with the conditions of participation.

States that the determination of whether an individual is entitled to benefits under this title, and the determination of the amount of such benefits, shall be made by the Administration in accordance with regulations prescribed by it.

Provides that where overpayments on behalf of individuals occur, proper adjustment shall be made under regulations prescribed by the Administration, by decreasing subsequent payments.

Provides for the settlement of claims for benefits on behalf of deceased individuals.

Provides criminal penalties for violation of this Act.

Creates a National Health Insurance Benefits Advisory Council consisting of 19 persons, not otherwise in the employ of the United States, appointed by the Board without regard to statutory provisions governing appointments in the competitive service.

Lists criteria for serving on the Council.

Declares that it shall be the function of the Advisory Council to provide advice and recommendations for the consideration of the Administration on matters of general policy with respect to this title.

Imposes the following taxes for each taxable year for health insurance purposes: two and one half percent of the amount of an individual's self-employment income (and unearned income); on the income of every individual, one percent of the person's wages; and on every employer, an excise tax equal to three percent of the wages paid by him with respect to employment.

Provides special coverage provisions, under the Social Security Act, for purposes of National Health Insurance Taxes.

Title II: Changes in Medicare Program - Establishes, under title XVIII of the Social Security Act (Medicare), a voluntary program to provide long-term care benefits for aged and disabled individuals who elect to enroll under such program, financed from premium payments by enrollees together with contributions from funds appropriated by the Federal Government and contributions by the States.

Lists criteria for eligibility for long-term care service benefits. Provides that the benefits provided to an individual by the program established by this Act shall consist of (1) home health services, (2) homemaker services, (3) nutrition services, (4) long-term institutional care services, (5) day care and foster home services, and (6) community mental health center outpatient services.

Enumerates the requirements for a State long-term care agency.

Provides for the payment of premiums for benefits received under this Act.

Establishes on the books of the Treasury of the United States a trund fund to be known as the Federal Long-Term Care Trust Fund.

Creates a body to known as the Board of Trustees, composed of the Secretary of the Treasury, the Secretary of Labor, the Chariman of the Board of the Social Security Administration, and the Secretary of Health, Education, and Welfare. States that the Secretary of the Treasury shall be the Managing Trustee of the Board of Trustees and that the Executive Director of the Social Security Administration shall serve as the Secretary of the Board of Trustees. Provides that the Board of Trustees shall meet not less frequently than once each calendar year. Enumerates the duties of the Board of Trustees.

Declares that a community long-term care center shall: (1) provide the items and services listed in this Act to each individual (i) who is eligible for benefits under this part, (ii) who resides in the area served by such center, and (iii) who is certified as requiring such services; (2) evaluate and certify the long-term care needs of an individual for whom such care may be required in order to maintain such individual in an independent living arrangement which is reasonable given such individual's state of health and other circumstances (but not including such individual's economic circumstances); (3) maintain a continuous relationship with (and periodically evaluate not less that annually) each individual who is receiving any of the items and services listed in this Act; (4) provide full opportunity for such individual and his family to participate in the determinations and functions under this Act; (5) provide an organized system for making its existence and location known to all individuals in its service area who are eligible for benefits under this part, and for making known to such individuals the method or methods by which they may most efficiently obtain and use the services which it makes available; and (6) performs such other functions as the Administration may by regulation prescribe in order to have such center most effective carry out the purposes of this Act.

Provides a formula for payments to States for the reimbursement of community long-term care centers.

Directs the Administration, after consultation with organizations representing the chief executives of the various States, and other interested parties, to develop and make available to community long-term care centers one or more methods of obtaining payment for the benefits covered under this Act on a prospective basis. States that once a community long-term care center elects a particular prospective method, it may not alter its election without the prior approval of the Administration. Provides that whenever the Administration finds that the number of community long-term care centers electing a particular prospective payment method promulgated in accordance with this Act is not sufficient to provide an adequate basis for either the operation or evaluation of that method, the Administration shall withdraw that method and allow the community long-term care centers which have elected such method to select another method within 30 days of notice of such withdrawal.

Permits a Governor of a State to certify to the Administration a method of prospective payment other than those promulgated under this Act.

States that the determination of whether an individual is entitled to benefits under this Act shall be made by the Administration in accordance with regulations it prescribes.

Provides coverage for prescription drugs.

Declares that no further deductible or coinsurance requirement shall be imposed under this Act with respect to items or services furnished to or for any individual in any calendar year after the total of the deductibles and coinsurance paid by or on behalf of such individual and the other members of his family in that year equals $1,000.

Eliminates the posthospital requirement for home health services under Medicare and the durational limits on inpatient hospital services.

Title III: Independent Social Security Administration - Establishes, as an independent agency of the executive branch of the Government, a Social Security Administration to be headed by a Board, consisting of three members appointed by the President, by and with the advice and consent of the Senate.

Declares that it shall be the duty of the Administration to administer specified programs of the Social Security Act, and to discharge the duties and responsibilities imposed on the Secretary of Health, Education, and Welfare in connection with the administration of the program established by the Federal Coal Mine Health and Safety Act of 1969.

Abolishes the position of Commissioner of Social Security.

Title IV: Amendment to Public Health Service Act - Establishes in the Department of Health, Education, and Welfare the Health Resources Development Board which shall be composed of three members to be appointed by the President, by and with the advice and consent of the Senate.

Provides for an Executive Director and for the recruitment of qualified persons experienced in the administration or operation of private health insurance and health prepayment plans, or experienced in other fields pertinent to the national health insurance program.

Requires the Board to make an annual report to the Committee on Interstate and Foreign Commerce of the United States House of Representatives and to the Committee on Labor and Public Welfare of the United States Senate.

Enumerates the functions of the Board including: studies and evaluations, systems development, tests and demonstrations, research, and planning.

Establishes a National Health Insurance Resources Advisory Council, consisting of the Chairman of the Board, the Chairman of the Social Security Board, and twenty members, not otherwise in the employ of the United States, appointed by the Secretary on recommendation of the Board, without regard to the statutory provisions governing appointments in the competitive service.

Provides criteria for membership on the Council.

Enumerates the functions of the Council.

Authorizes to be appropriated to carry out this title: $400,000,000 for the fiscal year ending June 30, 1975, and $600,000,000 for the fiscal year ending June 30, 1976.

Title V: Miscellaneous Provisions - Provides for the Administration's certfication of supplemental private health insurance policies.

Sets standards with respect to supplemental health insurance policies.

Leaves existing employer-employee health benefit plans unaffected.

Provides regulations for planning by health care providers and the conditions for payment.