Action Now Health Care Reform Act of 1993

TABLE OF CONTENTS:

Title I: Improved Access to Affordable Health Care Coverage

Subtitle A: Increased Affordability and Availability

for Employees

Subtitle B: Improved Small Employer Purchasing Power of

Affordable Health Insurance

Subtitle C: Health Deduction Fairness

Subtitle D: Improved Access to Community Health Services

Subtitle E: Improved Access to Rural Health Services

Title II: Health Care Cost Containment and Quality

Enhancement

Subtitle A: Medical Malpractice Liability Reform

Subtitle B: Administrative Cost Savings

Subtitle C: Medical Savings Accounts (Medisave)

Subtitle D: Medicaid Program Flexibility

Subtitle E: Limitations on Physician Self-Referrals

Subtitle F: Removing Restrictions on Managed Care

Subtitle G: Medicare Payment Changes

Subtitle H: Limitation of Antitrust Recovery for Certain

Hospital Joint Ventures

Subtitle I: Encouraging Enforcement Activities of

Medical Self-Regulatory Entities

Action Now Health Care Reform Act of 1993 - Title I: Improved Access to Affordable Health Care Coverage - (Sec. 102) Preempts inconsistent State laws.

(Sec. 103) Requires small employer health insurance carriers to offer a MedAccess basic plan (providing only benefits for essential preventive and medical services and having an actuarial value not over 60 percent of a MedAccess standard plan) and a MedAccess standard plan (providing benefits typical of the small employer market). Amends the Internal Revenue Code (IRC) to tax the failure of a carrier or plan to comply with related standards. Mandates: (1) acceptance of every small employer and full-time employee; or (2) in States that so provide, allocation of risk.

(Sec. 104) Regulates pre-existing condition requirements, premiums, rating practices disclosure, minimum participation requirements, and renewability.

(Sec. 108) Mandates development of models for reinsurance or allocation of risk mechanisms. Requires State (or Federal) establishment of at least one mechanism in each State. Amends the IRC to impose a tax in any such Federal reinsurance State.

(Sec. 110) Establishes the Office of Private Health Care Coverage and a related advisory committee.

(Sec. 111) Authorizes research and demonstration projects on the impact of these provisions on the availability of affordable small employer coverage. Requires: (1) methods for measuring the relative health risks of eligible individuals; and (2) a model for equitably distributing health risks among small employer carriers. Authorizes appropriations.

(Sec. 121) Preempts State laws: (1) requiring the offering of health plans providing certain services; and (2) prohibiting employer groups from purchasing health insurance.

(Sec. 131) Amends the IRC to increase and make permanent deductions for the health insurance costs of self-employed individuals.

(Sec. 141) Amends the Public Health Service Act (PHSA) to provide for grants to: (1) migrant and community health centers and to entities providing health services for the homeless to promote primary health services for underserved individuals; and (2) increase access to outpatient primary services in certain geographic areas. Authorizes appropriations.

(Sec. 171) Changes the heading of title XII (Trauma Care) of the PHSA to "Emergency Medical Services" and makes similar changes to references within the title.

(Sec. 172) Authorizes grants to States for State offices of emergency medical services.

(Sec. 173) Requires projects under existing provisions to include demonstrations on telecommunications between rural medical facilities and other medical facilities with useful expertise or equipment.

(Sec. 174) Authorizes appropriations to carry out specified provisions of title XII.

(Sec. 181) Mandates grants to States for rural air medical transport systems. Authorizes appropriations.

(Sec. 191) Amends title XVIII (Medicare) of the Social Security Act to extend special payments for the inpatient services of small, rural Medicare-dependent hospitals.

Title II: Health Care Cost Containment and Quality Enhancement - (Sec. 211) Reforms medical malpractice regarding: (1) a statute of limitations; (2) use of alternative dispute resolution systems (ADRs), including for claims against the United States; (3) settlement offers and conferences; (4) noneconomic and punitive damages; (5) periodic payment for future damages; (6) mandatory offsets for collateral source payments; (7) contingent attorney's fees; (8) several and joint liability; (9) findings of negligence; (10) practice guidelines sanctioned as affirmative defenses; (11) the standard of proof regarding certain labor and delivery circumstances; (12) supersedure of certain State laws; and (13) establishment and certification of State ADRs.

(Sec. 241) Amends title II (Old Age, Survivors, and Disability Insurance) (OASDI) of the Social Security Act to authorize appropriations for sanctioning guidelines as affirmative defenses. Mandates: (1) research and demonstrations on the use of data on malpractice actions; and (2) development of a standard reporting form for State ADRs in transmitting information on disputes resolved.

(Sec. 242) Authorizes State professional disciplinary agencies to make agreements with professional societies to allow the societies to: (1) participate in licensing; and (2) review malpractice allegations or other information on the practice patterns of a practitioner.

(Sec. 243) Requires each health professional and provider to participate in a risk management program.

(Sec. 244) Mandates grants: (1) for basic research on malpractice prevention and compensation and outcomes research; (2) to States to improve licensing and discipline; and (3) for public education on appropriate health care use and realistic expectations, public education on the resources and role of licensing and disciplinary boards, and development of faculty training and curricula regarding quality assurance, risk management, and medical injury protection. Authorizes appropriations.

(Sec. 245) Mandates a study on factors preventing or discouraging physicians from volunteering in medically underserved areas.

(Sec. 251) Regulates: (1) data elements, uniform claims forms, and uniform electronic transmission of data elements; (2) provider claims submission; and (3) hospital and non-hospital electronic medical data.

(Sec. 262) Requires hospitals, in order to participate in Medicare, to maintain and electronically transmit clinical data on patients in a set of electronic comprehensive data elements.

(Sec. 263) Provides for electronic transmission of data elements to Federal agencies.

(Sec. 264) Prohibits plans from requiring that a provider provide any data element not in the set or transmit any data element in a manner inconsistent with standards.

(Sec. 265) Establishes an advisory commission. Authorizes appropriations.

(Sec. 271) Provides for a comparative health care value program in each State. Authorizes grants and appropriations.

(Sec. 273) Requires each Federal agency concerned with health insurance or care to develop comparative value information.

(Sec. 274) Mandates model systems for the gathering and analysis of data on health care cost, quality, and outcome. Authorizes appropriations.

(Sec. 281) Provides for standards regarding Medicare and Medicaid identification cards. Establishes a Medicare and Medicaid system to provide information on primary payors. Authorizes appropriations.

(Sec. 282) Nullifies any State law requiring that medical or health insurance records be maintained in written rather than electronic form.

(Sec. 283) Provides for standards regarding: (1) beneficiary and provider identification numbers; and (2) coordination of benefits.

(Sec. 285) Mandates grants to demonstrate the application of comprehensive information systems in continuously monitoring patient care and improving patient care. Authorizes appropriations from the Federal Hospital Insurance Trust Fund.

Authorizes grants for: (1) communication links between plan and provider information systems; (2) regional or community-based clinical information systems; and (3) developing and testing, for physicians and non-hospital entities, the definition of a comprehensive data set and the specification and presentation of individual data elements. Authorizes appropriations.

(Sec. 291) Amends the IRC to exclude from an employee's gross income any amount contributed by the employer to a trust created exclusively to pay an individual's medical expenses (medical savings account). Sets contribution limits. Subjects the employee to taxation as owner of the account.

(Sec. 301) Amends Medicaid provisions to modify contracting requirements for coordinated care services.

(Sec. 311) Amends Medicare provisions to extend physician self-referral limitations to all payors and certain additional services. Revises exceptions.

(Sec. 314) Mandates a study to estimate the changes in aggregate costs that will result from the amendments made by these provisions.

(Sec. 321) Preempts managed care restrictions under State law. Mandates a study of managed care benefits and cost effectiveness.

(Sec. 331) Amends Medicare provisions to revise the method for determining prospective payment updates to hospitals.

(Sec. 332) Lowers the limitation amount and suspends certain annual adjustments regarding clinical diagnostic laboratory tests.

(Sec. 343) Limits antitrust recovery to actual damages if certain requirements are met, including the filing and publication of information regarding hospital joint ventures.

(Sec. 345) Establishes the Interagency Committee on Competition, Antitrust Policy, and Health Care.

(Sec. 351) Prohibits, subject to exception, damages and other recovery under the Clayton Act or similar State laws from a medical self-regulatory entity engaging in standard setting or enforcement activities designed to promote the quality of health care and not conducted for financial gain.