Health Security Act

Health Security Act - Title I: Health Security Benefits - Provides that every resident of the U.S. (and every non-resident citizen when in the U.S.) will be eligible for covered services. Permits reciprocal and "buy-in" agreements for groups or non- resident aliens, and in some cases benefits to U.S. residents when visiting in other countries.

Entitles every eligible person to have payments made by the Health Security Board for covered services provided within the United States by a participating provider.

Provides that all necessary professional services of physicians, wherever furnished, are covered, including preventive care, with one restriction: mental health services to an outpatient are covered only for active preventive, diagnostic, therapeutic, or rehabilitative service with respect to emotional or mental disorders.

Provides that comprehensive dental services (exclusive of most orthodontic services) are covered for children under age 15, with the covered age group increasing by two years each year until all those under age 25 are covered.

States that inpatient and outpatient hospital services, nursing home services, and services of a home health agency are covered, subject to specified limitations. Includes pathology and radiology services as parts of institutional services.

Limits payment for skilled nursing home care to 120 days during a benefit period. Limits the psychiatric hospital benefit to 45 inpatient days.

Provides covereage for prescribed drugs furnished to individuals enrolled in group practice organizations or to inpatients or outpatients within participating hospitals, and drugs necessary for the treatment of specified chronic illnesses or conditions requiring long or expensive therapy.

Requires the Board to establish two lists of approved drugs, taking into account the safety, efficacy and cost of each drug.

Directs the Board to establish lists of therapeutic devices, appliances, and equipment which are eligible to be covered when prescribed by a participating physician or dentist.

Asserts that the professional services of optometrists and podiatrists are covered, subject to regulations, as are diagnostic or therapeutic services furnished by independent pathology laboratories and radiology services. Provides covereage for care of patients in mental health day care service for not more than sixty days during or following a benefit period, for the active treatment of individuals diagnosed as needing treatment for alcoholism or drug abuse, and for family planning and rehabilitation services.

States that health services furnished or paid for under a workmen's compensation law are not covered. Provides that the services of a professional practitioner are not covered if they are furnished in a hospital which is not a participating provider.

Requires that participating providers meet standards established in this title or by the Board. Requires that such providers must agree to provide services without discrimination, to make no unauthorized charge to the patient for any covered service, and to furnish data necessary for utilization review by professional peers, statistical studies by the Board, and verification of information for payments.

Makes professional practitioners licensed when the program begins eligible to practice in the State where they are licensed and requires that all newly licensed applicants for participation meet national standards established by the Board in additional to those required by his State.

Establishes conditions of participation for general hospitals and for mental hospitals. Provides that mental hospitals will be eligible to participate only if the Board finds that the hospital (or a distinct part of the hospital) is engaged in furnishing active diagnostic, therapeutic and rehabilitative services to mentally ill patients.

Establishes conditions of participation for skilled nursing homes. Requires such homes to be primarily engaged in providing skilled nursing care and related to services to inpatients, and to have written policies governing the services provided. Makes provision for the participation of home health services agencies.

Describes as eligible a group practice organization which undertakes to provide an enrolled population with complete health services (other than mental health or dental services) and meets specified qualifying conditions. Lists other health service organizations eligible for qualification as providers under this Act.

Specifies the conditions under which independent pathology laboratories, independent radiological services, and providers of drugs, devices, appliances, equipment, or ambulance services may qualify as providers under Health Security.

Requires that a participating skilled nursing home have in effect an agreement with at least one participating hospital for the transfer of patients and medical and other information as medically appropriate.

Prohibits in malpractice judgments any damages to be awarded to the injured party for the cost of remedial services which he is entitled to receive under this Act.

Excludes the institutions of the Department of Defense and the Veterans Administration, and institutions of the Department of Health, Education, and Welfare serving merchant seamen or Indians or Alaskan natives, from serving as participating providers, as well as any employee of these institutions when he is acting as an employee.

Provides reimbursement for any services furnished by these institutions or agencies to eligible persons who are not a part of their normal clientele.

Permits a physician, dentist, optometrist, podiatrist, or psychologist licensed in one State and meeting the national standards, to furnish Health Security benefits in any other State, the scope of his permissible practice being governed by the law of the State in which he is practicing.

Establishes the Health Security Trust Fund. Provides that four separate accounts shall be established in the Health Security Trust Fund: a health services account, a health resources development account, and administration account, and a general account.

Provides that in each of the first two years of program operation, 2 percent of the general account of Trust Fund shall be set aside for the health resources development account; and the allocation shall increase by 1 percent at two-year intervals to 5 percent within the next six years.

Provides for allocation of the Health Services account among the regions of the country.

Provides that the allocations to each region shall be based on the most recent 12-month period for covered services (with appropriate modification for estimated changes in the cost of living, the expected number of eligible beneficiaries, and estimated changes in the number of participating providers).

Provides that the Board shall divide the allocation to each region into funds available to pay: institutional services; physician services; dental services; furnishing of drugs; furnishing of devices, appliances, equipment; and miscellaneous services.

Provides that payments for covered services provided to eligible persons by participating providers will be made from the health service account in the Trust Fund.

Describes the method to be used in applying, as between practitioners electing the various methods of payment (fee-for-service and capitation), the monies available in each health service area for payment to each category of professional providers.

Authorizes the Board to experiment with other methods of reimbursement so long as the experimental method does not increase the cost of service or lead to overutilization or underutilization of services.

Provides that skilled nursing homes and home health agencies will will be paid in the same manner as a general hospital (on an approved annual budget basis).

Provides that a health organization will be paid for covered services, on the basis of a fixed capitation rate multiplied by the number of eligible enrollees.

Contains a series of provisions for developing a continuous process of health service planning and for assisting in the recruitment, education, and training of health personnel.

Authorizes grants: (1) to any public or nonprofit agency or organization, and (2) to any existing group practice organization or other health service organization to assist in expanding the scope of health maintenance organization services and to enable such organizations to service a larger clientale.

Authorizes special improvement grants: (1) to any public or other non- profit health agency or institution to establish improved coordination and linkages with other providers of services, and (2) to organizations providing comprehensive ambulatory care, to improve their utilization review, budget, statistical, or records and information retrieval systems, to acquire equipment needed for those purposes, or to acquire equipment for diagnostic or therapeutic purposes.

Requires the Board to transmit to the Congress within three years a comprehensive report, together with recommendations for improved methods of personal care services in communities lacking such programs, and recommendations for the continuing financial support of such services.

Authorizes appropriations to the Trust Fund for grants of $200,000,000 for the first fiscal year of program operation and $400,000,000 for the succeeding fiscal year.

Establishes a five-member, full-time Health Security Board serving under the Secretary of Health, Education, and Welfare.

Provides that the members shall be appointed by the President with the advice and consent of the Senate, for five-year overlapping terms.

Creates the position of an Executive Director, appointed by the Board with the approval of the Secretary. Provides that the Executive Director will serve as secretary to the Board and shall perform such duties in the administration of the program as the Board may assign.

Provides that the program will be administered through the regional offices of the Department of Health, Education, and Welfare. Requires the establishment of local health service offices.

Establishes a National Health Security Advisory Council, with the Chairman of the Board serving as the Council's Chairman and 20 additional members not in the employ of the Federal Government.

Authorizes the Advisory Council to appoint professional or technical committees to assist in its functions.

Provides that the Advisory Council will advise the Board on matters of general policy in the administration of the program, the formulation of regulations, and the performance of the Board's program.

Charges the Board with responsibility for informing the public and providers about the administration and operation of the Health Security program.

Requires the Board to make a continuing study and evaluation of the program, including adequacy, quality and costs of services. Authorizes the Board directly or by contract to make detailed statistical and other studies on a national, regional, or local basis of any aspect of the title; to develop and test records and information retrieval systems, equipment useful in the furnishing of preventive or diagnostic services, and model systems for use by providers of services; to develop improved administrative practices; and to make such other studies as it may consider necessary to improve the operation of the program.

Directs the Board to issue guidelines for health manpower education and training designed to relate the clinical education conducted by providers of services more closely to the relative need for the different classes of such personnel.

Grants authority to the Board, in accordance with regulations, to make determinations of who are participating providers of services, determinations of eligibility, of whether services are covered, and the amount to be paid to providers.

Allows a provider of services who is dissatisfied with a final Board determination to obtain a hearing before a Board panel, and judicial review of a final decision.

Authorizes the Board, with the advice and assistance of the Commission on the Quality of Health Care, to issue and review regulations assuring the quality of care furnished under this Act. Requires continuing professional education by physicians, dentists, optometrists, podiatrists, and psychologists.

Provides for the appointment of a Deputy Secretary of HEW and an Under Secretary for Health and Science.

States that no provision of this Act shall alter any contractual obligation of an employer to provide health services to his employees and their dependents.

Title II: Health Security Taxes - Converts the existing Medicare hospital insurance payroll taxes into Health Security taxes, and raises the rates to 1 percent on employees and 3.5 percent on employers. Broadens the definitions of covered employment to include foreign agricultural workers, employees of the U.S. and its instrumentalities (other than members of the armed forces and the President, Vice-President, and Members of Congress), employees of charitable and similar organizations, railroad employees, and (for the employee tax only) employees of States and their political subdivisions.

Excludes from the gross income of employees, for income tax purposes, payment by their employers of part or all of the Health Security taxes on the employees. Spells out the precise effective dates of the new payroll tax provisions.

Converts the existing Medicare self-employment tax into a Health Security self-employment tax, raising the rate to 2.5 percent.

Imposes a 2.5 percent Health Security tax on unearned income, unless such income is less than $400 per year.

Title III: Commissionon the Quality of Health Care - Establishes in the Department of HEW a Commission on the Quality of Health Care, with the primary responsibility of: (1) initiating and continuing development of methods of assessing the quality of health care furnished under the Health Security Act, and (2) submitting to the Secretary and the Health Security Board its findings and recommendations. Stipulates that in carrying out its duties the Commissioner shall emphasize, and give first consideration to, care furnished for those illnesses and conditions which have relatively high incidence in the population and which are relatively amenable to medical or other care.

Title IV: Repeal or Amendment of Other Acts - Repeals Title XVIII (Medicare) of the Social Security Act and the Federal employee health benefit statutes.

Requires that after the effective date of benefits, no State shall be required to furnish any service covered under Health Security as a part of its State plan for participation under Medicaid.

Title V: Studies Related to Health Security - Authorizes the Secretary of Health, Education, and Welfare in consultation with the Secretary of State and the Secretary of Treasury to study the coverage of health services for U.S. residents in other countries.

Directs the Secretary of HEW to study the feasibility and desirability of coordinating the Federal health benefit programs for merchant seamen and Indians and Alaskan natives and also veterans and members of the Armed Forces, with the Health Security Benefit Program.

Authorizes appropriations of sums necessary to carry out such studies.