National Health Insurance and Health Services Improvement Act

National Health Insurance and Health Services Improvement Act - Title I: Amendments Relating to Health Insurance Provided by Title XVIII of the Social Security Act -

Part A: Coverage of All Aged and Disabled; Extension Without Premium of Supplementary Benefits to All Covered Individuals - Revises title II of the Social Security Act, relating to who is entitled to hospital insurance benefits under medicare (title 18, part A), so as to include all persons aged 65 and older (including those not presently insured) and all others receiving benefits based upon their disability (including those 18 and over with childhood disability). Establishes entitlement to such benefits for widows aged 60 and over and for widowers aged 62 and over.

Renames the present Health Insurance Program for the Aged to the "Health Insurance Program," and the program description is changed to refer to the disabled as well as to the aged. Repeals various provisions of the present supplementary program and transfers to a Federal Health Insurance Fund the assets and liabilities of the Supplementary Medical Insurance Trust Fund now used to finance current Part B benefits. Eliminates reference in the present medicaid law (title 19) to the present Part B, or supplementary program.

Coordinates provisions of the Railroad Retirement Act with the expanded title XVIII (Medicare) program and includes disabled railroad retirement employees among those entitled to health insurance benefits, in a manner similar to those disabled covered under the Social Security Act.

Part B: Coverage of Drugs - Expands the benefit coverage under the new title XVIII (Medicare) program to include protection against the costs of certain maintenance drugs appropriate to the treatment of certain long-term conditions.

Provides for the cost-sharing by beneficiaries for such maintenance drugs available on an outpatient basis. Establishes the conditions for which drugs are to be included, how drug costs are to be paid, and other standards for administering and supervising a drug benefit under the program. Provides that the inclusion of a maintenance drug benefit be effective with respect to drugs dispensed after June 30, 1973.

Part C: Annual Physical Checkups - Adds a new benefit to the revised title XVIII (Medicare) program by covering the costs of physical checkups to include eye examinations, ear examinations, and such other diagnostic tests or examinations which would be likely to reveal defects, diseases or conditions susceptible to effective treatment and control. Provides that check-up services shall include the costs of physicians' services appropriate for the interpretation, evaluation or analysis of these tests. Provides that the deductible provision, now applicable to the Part B program, would not apply in the case of expenses incurred for checkups, except that limits are placed upon the maximum charges which would constitute incurred charges for checkups. Makes these additional benefits avaialble after June 30, 1975.

Part D Dental Services - Revises the new health insurance program so as to provide for routine dental care for children under 8 years of age. Provides that these benefits become available after June 30, 1975.

Part E: Limitations on Certain Charges for Services, Physician's Qualifications - Revises effective January 1, 1972 the current "reasonable charges" section of the present Part B program and substitutes the phrase "appropriate and reasonable charges."

Revises under Title 18 of the Social Security Act the definition of the term "physician" by imposing qualifications for physicians providing services under the health insurance program. Makes such qualifications related to standards for: (1) continuous professional education; (2) national minimum licensure requirements; and (3) performance of various specialty services. Provides that any physician or specialist failing to meet such standards would not be recognized as a "physician" for purposes of the program.

Part F: Agreements with States for Administration - Permits the Secretary of HEW to arrange for State administration of the health insurance programs established pursuant to Title XVIII (Medicare) of the Act. Provides for reimbursement to the States for costs of carrying out such agreements as made by the Secretary of HEW.

Part G: Improvement in Organization of Health Care - Provides that the purpose of this part is to encourage the rational organization of health care services and facilities so as to provide greater continuity and comprehensiveness of care to the individual, to provide greater consumer education and participation, and to emphasize preventive, diagnostic,and early therapeutic services, to control the costs of services paid under the title and to stimulate diversity and innovation in the provision of health insurance protection.

Authorizes the Secretary to develop, by means of contracts and by other methods, the growth of comprehensive health service systems. Requires such systems to agree to provide the basic benefits provided for in the revised health insurance program and to agree to carry out appropriate utilization and cost control responsibilities in connection with the provision of benefits. Requires such systems to be consistent with comprehensive health plans developed by each State. Authorizes the Secretary to use various means of reimbursement (other than a reasonable cost system) to pay for benefits provided by comprehensive health service systems, and permits him to develop special incentive provisions for these systems if their costs were generally less than costs otherwise experienced by the health insurance program. Authorizes a special employer-employee health plan option where employers provide for their employees' health care benefits under a qualified plan in lieu of benefits otherwise provided by the new program. Makes the effective date for the new Part G program July 1, 1972.

Title II: Health Benefits for the General Public - Adds a new title XX to the Social Security Act to provide for the entitlement to benefits of the revised title 18 program for all persons not otherwise so entitled by reasons of other provisions in the law.

Provides that any person, who is a resident and a citizen (or an alien lawfully admitted for permanent residence), not otherwise entitled to the revised title 18 program under the Social Security Act shall be entitled to the same benefits of that program on July 1, 1973. Provides that special provisions would govern the manner and period during which such entitlement would be established.

Creates within the new Federal Health Insurance Trust Fund a special account known as the "Special Account for the Uninsured." Requires that benefits provided for persons entitled under title XX be paid from, and only from, this Special Account. Specifies the manner in which funds are to be appropriated to the Special Account within the Health Insurance Trust Fund.

Title III: Financing of Health Insurance - Identifies and explains the taxing mechanism devised to provide the financial resources with which the national health insurance program will operate.

Revises those sections of the Internal Revenue Code of 1954 (relating to definitions for the purposes of Federal Insurance Contributions) by adding new subsections setting forth definitions of wage and self-employment income bases for purposes of health insurance. Provides that the wage and income bases on which taxes are imposed in connection with the financing of health insurance benefits provided under this Act shall be set at $15,000 rather than $7,800 per annum with respect to the tax paid by employees of the self-employed. Provides that no ceilings are placed on the wages with respect to taxes paid by the employer. Indicates that the effective date of the tax change and wage base shall begin with taxable years ending after December 1970.

Revises the Internal Revenue Cose so as to include only within the framework of the revised taxing mechanism, certain additional categories of employees and employers formerly excluded from the taxing provisions used to finance benefits under Title XVIII, Social Security Act. Includes additional categories of employees for taxing purposes such as: individuals engaged in family employment; Federal, State, and local government employees; ministers; railroad employees; individuals in employ of tax-exempt organizations; and individuals in employ of registered subversive organizations. Includes employers of these individuals within the taxing mechanism for health insurance with the exception of employers falling into the categories of State and local governments and churches and religious orders.

Provides that employment which includes the performance of service by an employee for an employer, who has in effect a contract with the Government relating to a comprehensive health service system, is excluded for purposes of health insurance taxation. Revises the Internal Revenue Code by establishing new tax rate schedules for health insurance purposes applicable equally to employers, employees, and self-employed individuals based upon a graduated scale during the calendar years of 1972-1976.

Provides that, in addition to funds appropriated to the Federal Health Insurance Fund through taxing mechanism described above, there shall be appropriated from general revenues an amount equal to 50 percent of the amount deposited in the Health Insurance Fund collected by means of the payroll tax mechanism and any additional amounts that would have been appropriated if no agreements had been authorized for employer-employee health plan options.

Title IV: Federal Aid to Establish Local Comprehensive Health Service Systems: (1) Findings and Declaration of Purpose - Provides that in keeping with its findings that present programs of health services fail to provide for continuous, efficient, and comprehensive health care, Congress declares that a system of national health insurance must be established in a way that will increase purchasing power, equality care, and affect a change in the health care system. Declares that the purpose of this title is the provision of financial and technical assistance through the awarding of grants and loans to health service institutions and organizagions in order to stimulate the planning, development, and implementation of comprehensive health service systems.

(2) Basic Authority - Authorizes the Secretary of HEW to make such loans, grants, etc., as are provided for under this title.

(3) Financial and Technical Assistance for Planning Comprehensive Health Service Systems - Establishes the criteria for systems wishing to receive financial and technical assistance from the Government for the purposes of developing comprehensive health service systems. Provides that such systems must, among other things, enter into an agreement with the Secretary to provide or arrange to provide services authorized by medicare. Provides that in addition to certain requirements concerning enrollment of beneficiaries in such systems, comprehensive health service systems must develop preventive health care programs, train and employ allied health personnel, and be organized in a manner consistent with the State's overall comprehensive health care plan.

(4) Financial and Technical Assistance for Planning Comprehensive Health Service Systems - Authorizes the Secretary of HEW to make grants to public or non-profit hospitals, medical schools, any insurance carriers or non-profit prepayment plans to pay 80 percent of the cost of planning and development of a comprehensive health service system. Provides that applications for assistance under this title must be approved by a State health planning agency.

(5) Financial and Technical Assistance for Operation of Approved Comprehensive Health Service Systems - Authorizes the Secretary to contract with approved comprehensive health service systems to pay so much of the administrative, operating, and maintenance costs of such system as exceed its income for the first five years after approval. Requires the contract to require the system to make efforts to enroll members, control costs and utilization of services, and otherwise maximize income and minimize costs. Permits the Secretary to terminate a contract after giving 6 months notice. Authorizes the Secretary to make grants to systems for programs of capital development in an amount not to exceed 80 percent of non-Federal contributions otherwise required for construction and modernization of hospitals. Requires the awarding of such a grant to depend upon approval of the proposed project by the reasonable State health planning agency.

(6) Appropriations - Authorizes appropriations to carry out contracts pursuant to Title IV.

(7) Definitions - Defines the term "comprehensive health service systems" so as to identify a system providing health care to an identified population group in a primary service area on the basis of contractual arrangements which embody group practice, are established by a medical school, a hospital medical staff or medical center or similar arrangements among the participating providers of services. Describes comprehensive health service systems as those which provide at least all services specified in Title XVIII (Medicare) under the Social Security Act as amended by this Act.

Title V: Federally Chartered Health Insurance Corporations - Adds new sections to the Social Security Act authorizing the Secretary of HEW to establish various national health insurance corporations which will operate under the guidance of the Secretary.

Authorizes the Secretary of HEW to establish and contract with one or more federally chartered health insurance corporations for provision of health benefits under Title XVIII (Medicare) of the Social Security Act. Provides that such Health Insurance Corporations shall act as agents of the U.S. Government under the guidance of the Secretary of HEW.