National Health Insurance for Mothers and Children Act

National Health Insurance for Mothers and Children Act - Title I: General Provisions and Administration - Entitles every individual who is a United States citizen or an alien lawfully admitted for permanent residence, and who is a child or who is pregnant, to have payment made for health care services received by such individual in accordance with this Act.

Establishes in the Department of Health, Education, and Welfare a Maternal and Child Health Board. Directs the Board to continuously study the operation of this Act and the most effective methods of providing comprehensive personal health services to mothers and children. Requires the Board to report annually to Congress on its activities.

Establishes a National and Child Health Council to advise the Board on matters of general policy, study the operation of this Act, and recommend changes it deems advisable.

Title II: Nature and Scope of Benefits - Sets forth procedures to be used in determining whether institutions are qualified health services providers under this Act.

Includes within covered professional services: (1) preventive children's health services; and (2) professional services for the diagnosis, treatment, or rehabilitation of a child following injury, disability, or disease.

Includes within covered inpatient hospital services: (1) emergency medical care for children; (2) inpatient services for a child 12 years of age or older in a qualified hospital; and (3) child inpatient services in a qualified nursing home.

Includes the following services within the coverage of this Act: (1) rehabilative services, encompassing physical therapy and speech therapy; (2) social services; and (3) mental health services, encompassing psychiatric and psychological services furnished to a child in a qualified facility.

Includes within the coverage drugs and biologicals prescribed for a child who is not an inpatient in a nursing home or hospital if such drug or biological is prescribed to be taken for longer than four weeks. Includes within coverage devices, appliances, and equipment, the dispensing of such devices for the correction of a child's vision or hearing, and the dispensing of such devices as are necessary for the treatment or rehabilitation of a child of a child following injury, disability, or disease.

Includes within maternity coverage: (1) professional services for the diagnosis and treatment of pregnancy and related medical problems; (2) inpatient hospital services for care during pregnancy and for 12 weeks after the pregnancy's termination; (3) diagnostic services performed by a qualified pathology laboratory during such time period; (4) drugs and biologicals prescribed during such time period for a woman not an inpatient in a nursing home or hospital if such drug or biological is prescribed to be taken for more than four weeks; and (5) devices, appliances and equipment for treatment of a woman for any pregnancy-related condition during such time period.

Directs the Board to arrange for the furnishing of covered medical services to individuals who reside in a medically underserved area or who, because of poverty, discrimination, or cultural barriers, are determined by the Board to suffer higher risk of infant and maternal mortality than other individuals. Includes within coverage of such individuals, transportation to and from the place where medical services are furnished, care of dependents while such individuals are being furnished medical services, and social outreach services to inform such individuals about services available under this Act.

Title III: Administration and Method of Payment of Benefits - Authorizes the Secretary of Health, Education, and Welfare to enter into contracts with carriers to perform some or all of specified administrative functions.

Stipulates that payments for covered services may be made only to: (1) the person furnishing such services; (2) the employer of such person; or (3) the facility in which such services were provided. Directs the Secretary to pay 100 percent of the full payment amount for covered services in specified circumstances and to pay 90 percent of that amount in all other cases.

Allows the Board, upon determining that a person furnishing covered services under this Act has substantially or consistently violated requirements under this title, to prohibit the making of any payments under this Act for a period not to exceed one year.

Requires an individual requesting payment under this Act to: (1) display public notice of participation in the program; and (2) inform each patient of the amount of any copayment the patient must make for covered services, prior to furnishing such services.

Requires the Board to approve for each fee payment area a schedule of the amount of payments to be made under this Act for the furnishing of covered professional services. Directs the Board to designate for each fee payment area a non-profit fee payment board, to submit to the Board a proposed fee payment schedule, and to propose annual revisions. Permits persons adversely affected by the Board's approval or disapproval of a fee payment schedule to seek review in accordance with the provisions of he he Administrative Procedure Act.

Directs that payments be made on a timely basis for covered institutional services. Requires qualified institutions requesting payment under this Act to: (1) display public notice of their participation in the program; and (2) inform each patient of the amount of any copayment the patient must make for covered services, prior to furnishing covered services.

Directs the Board to make available to the public the name, address, and telephone number of each dispenser of drugs and devices covered under this Act. Requires dispensers to display public notice of their participation in the program and to inform patients of any copayment that must be made for any drugs and devices furnished under this Act. Directs the Board to publish annually a schedule of the wholesale cost of covered drugs and devices commonly dispensed under this Act.

Title IV: Comprehensive Maternal and Child Health Practice - Authorizes the Secretary of Health, Education, and Welfare to make grants to public and nonprofit private entities and enter into contracts with public and private entities for projects: (1) studying the feasibility of developing and operating comprehensive maternal and child health practices or of expanding the operation of existing practices; and (2) establishing or expanding comprehensive maternal and child practices. Authorizes the Secretary to guarantee to non-Federal lenders payment of the principal of and the interest on loans made to private entities for such projects.

Authorizes the Secretary to make private loans and loan guarantees for initial operations costs of comprehensive maternal and child health practices. Prohibits the approval of an application for a loan guarantee unless the Secretary determines that the loan terms, conditions, security, and schedule are sufficient to protect the financial interests of the United States and are otherwise reasonable.

Establishes in the Treasury a loan guarantee fund and a loan fund to be available to the Secretary without fiscal year limitation for the purposes set forth in this Act. Authorizes the appropriation of specified amounts in fiscal years 1978 through 1980 for the purpose of making grants and contracts under this Act.

Authorizes the Secretary to make available medical malpractice reinsurance for claims exceeding $100,000 brought against a comprehensive maternal and child health practice. Authorizes the Secretary to institute litigation to recover from any insurer the amount of any unpaid premium lawfully payable by such insurer to the Secretary. Requires each insurer reinsured under these provisions to file with the Secretary: (1) a copy of each annual statement filed with the insurance authority of the State; (2) information respecting claims asserted by insureds against comprehensive maternal and child health practices, and (3) of adverse medical incidents filed by such insureds.

Authorizes the Secretary to make grants to and enter into contracts with public and nonprofit private entities for projects to promote: (1) the teaching of students in health professional schools respecting alternative methods of delivering medical care; (2) the training of medical students in family medicine and general pediatrics; (3) programs wherein health professional schools provide support services to comprehensive maternal and child health practices serving special populations; and (4) programs for training in the management of comprehensive maternal and child health care practices.

Directs the Secretary to give special consideration to applications for assignment of National Health Corps personnel to practice in comprehensive maternal and child health practices.

Title V: Financing the Maternal and Child Health Program - Amends the Internal Revenue Code of 1954 to impose a maternal and child health care tax on employees, employers, and self-employed individuals.

Creates on the books of the United States Treasury a Maternal and Child Health Trust Fund. Authorizes the appropriation of such sums as are necessary to carry out the purposes of this Act in each fiscal year. Appropriates to the Fund for the fiscal year 1976 and each fiscal year thereafter, amounts equivalent to the revenue from the maternal and child health care taxes. Authorizes the Managing Trustee of the Fund to accept and deposit into the Fund money, gifts, and bequests made unconditionally for the benefit of such Fund or any of its activities.

Creates a body to be known as the Board of the Trustees of the Fund and designates the Secretary of the Treasury as Managing Trustee. Directs such Board to submit an annual report to Congress on the operation and status of the Fund. Charges the Managing Trustee with the duty of investing such portion of the Fund as is not required to meet current withdrawals.

Title VI: Penalties, Effective Dates, and Technical Amendments - Makes it unlawful to make false statements, misrepresent material facts, or fraudulently conceal or fail to disclose material facts in connection with applications and payment requests under this Act. Makes it unlawful to solicit, offer, or receive kickbacks, bribes, or referral charge rebates in connection with services covered under this Act. Subjects violators to a fine of not more than $10,000, imprisonment for not more than one year, or both.

Makes specified technical and conforming amendments in the Social Security Act.