Flexible Medical Access and Cost Containment Act of 1992

Flexible Medical Access and Cost Containment Act of 1992 - Title I: Requiring Employers to Provide Health Insurance Coverage for Employees and Dependents - Amends the Internal Revenue Code to impose on employers who fail to cover employees and their dependents under a qualified employer health plan an excise tax of $100 per employee for each day of noncompliance. Applies certain deficiency procedures to such tax. Amends the Social Security Act to add a new title XXI under which employers are required to enroll their employees and dependents under a qualified employer health plan. Makes an employer that fails to make such an enrollment liable for payment of such excise tax. Provides that a small employer may meet such requirements through purchase of coverage under the public plan provided under such new title XXI. Sets forth rules for the enrollment of full- and part-time, seasonal, and temporary employees, including rules applicable in cases of families with more than one worker and where both employers offer enrollment under a qualified employer health plan. Phases in implementation of enrollment and tax payment requirements beginning on January 1, 1993, for employers with more than 250 employees. Requires that as of January 1, 1996, all employers must provide coverage or pay the excise tax. Requires employers to provide their employees and family members with a basic health benefit package that at least mirrors the benefits provided under the public health plan. Allows the qualified employer health plan under which the employer must provide such benefit package to be either a private health plan or a self-insured plan, depending upon the size of the employer. Allows employers to charge employees up to 20 percent of the premium for such basic coverage. Outlines additional requirements for qualified employer health plan premiums and cost-sharing as well as requirements for qualified employer health plans relating to the coordination of low-income assistance for deductibles. Sets forth the standards for the Secretary to certify a health plan as a qualified employer health plan. Requires the Secretary to: (1) establish procedures for the periodic review and recertification of plans as qualified employer health plans; and (2) terminate the certification of any such plan that no longer meets such standards. Preempts certain State and Federal requirements with respect to benefit and coverage rules. Provides that the provisions of this title shall not apply with respect to an employee who is not a resident of one of the States or the District of Columbia. Amends the Internal Revenue Code, the Employee Retirement Income Security Act of 1974, and the Public Health Service Act to repeal certain health insurance continuation requirements. Title II: Provision of Health Insurance Through a Public Health Plan - Amends the Social Security Act to add a new title XXII under which is created a public health plan similar to Medicare (title XVIII of the Social Security Act) under which those U.S. citizens and resident aliens who are not Medicare beneficiaries or enrolled under a qualified employer health plan under title I of this Act, or under a Federal health plan, are eligible to enroll for the basic health insurance benefits outlined below. Provides that, in order to meet the requirements of title I of this Act, a small or medium-size employer may provide for the enrollment of full-time employees and their dependents in the public health plan, but only under certain conditions. Makes individuals with income below the Federal poverty level who enroll in the plan on a non-employment basis eligible for assistance to limit or eliminate their financial obligations for premiums, deductibles, and co-payments under the plan. Sets forth provisions detailing the application process for enrollment under the public health plan. Requires individuals who are eligible to enroll under the public health plan, but who have not applied for enrollment by January 1, 1996, to be automatically enrolled on a retroactive basis, subject to a penalty of twice any premiums otherwise due. Provides that the benefits under the public health plan shall generally be the same as those currently covered under Medicare, except that: (1) plan benefits shall include the preventive services added to the Medicare program under title V of this Act, without co-payments or limits on days of care per spell of illness; (2) plan benefits shall include specified pregnancy-related services, subject to a required periodicity schedule and prior authorization for certain services; and (3) there shall be a single annual deductible of $250 per individual/$500 per family with an overall annual limit on deductibles and co-payments of $2,500 per individual/$3,000 per family indexed to the annual increases in the contribution and benefit base. Requires payments for services under the public health plan to be based on rates established by the Secretary in accordance with specified standards, and approved by the Federal Health Care Cost Containment Commission, under title III of this Act. Directs the Secretary to establish a global fee schedule for payment of obstetrical services with a disincentive for cesarean sections. Sets forth provisions for: (1) determining the amount of premiums to be charged individuals not connected to the workforce and individuals who are employed on a part-time, seasonal, or temporary basis; and (2) collecting premiums through automatic withholdings from income sources or bank accounts. Creates in the Treasury the Public Health Trust Fund to receive the funds generated from the excise taxes imposed under this Act as well as from other revenues dedicated to the support of the plan. Directs the Secretary to provide for the: (1) submission of claims under new titles XXII and XVIII using uniform forms developed by the Federal Health Care Cost Containment Commission established under title III of this Act; and (2) reporting to the Commission of information on required health services provided under such new titles pursuant to standards the Commission develops. Sets forth administrative provisions applicable to the public health plan. Requires that the Secretary establish a toll-free telephone number for information on the public health plan. Authorizes the Secretary to conduct demonstration projects to: (1) improve the delivery and quality of health care services under new title XXII; and (2) increase the efficiency and effectiveness of the methods for paying for such services. Authorizes reciprocal coverage of foreign nationals whose home countries provide health benefits to U.S. citizens who reside there. Provides that the provisions of this title shall not apply to an individual who is not a resident of one of the States or the District of Columbia. Title III: Cost Containment - Sets national limits on the health expenditures of the public health plan and qualified employer health plans for the services required to be covered for each year beginning in 1993. Indexes the limit each year to the rate of growth in the gross national product plus: (1) four percent for 1993 and 1994; (2) three percent for 1995 and 1996; (3) two percent for 1997 and 1998; (4) one percent for 1999 and 2000; and (5) zero percent for each year after 2000. Establishes the Federal Health Care Cost Containment Commission (Commission) to: (1) apportion the overall health care spending amount established by this Act for required health services among the States; (2) monitor State compliance with the apportioned amount; (3) approve payment rates in certain States that are without a State Health Commission or are unable to control health care expenditures; (4) establish an appeals process for payment rates established by State Health Commissions; (5) develop uniform claims forms for use under the public health plan, qualified employer health plans, and Medicare; (6) develop uniform standards for reporting information on the types and amounts of required health services provided and the cost of facilities providing such services; (7) analyze information reported pursuant to such standards; and (8) report periodically to the Congress and the public on the effect of this title on the delivery of such services. Authorizes appropriations. Requires each State to establish a State Health Commission (SHC) to: (1) allocate the State apportionment of the health care spending amount among required health services furnished by different classes of providers; and (2) establish, and revise at the direction of the Commission, payment rates for such services which meet specified standards for approval by the Commission. Sets forth conditions for Commission approval of SHC established payment rates. Provides that payment rates approved under this title shall apply under both the Medicare program and the public health plan. Title IV: Group Health Insurance Reforms - Amends the Social Security Act and the Internal Revenue Code, respectively, to: (1) add a new title XXIII under which the Secretary is required to develop standards which employment-related group health insurance plans must be certified as meeting or else face loss of status as qualified employer health plans under new title XXI of the Social Security Act; and (2) impose an excise tax (set at 50 percent of gross accident and health insurance premiums received during the taxable year) on the issuer of such a group plan which fails to meet such standards, with specified exceptions. Directs the Secretary to provide for the establishment of a toll-free telephone information and complaint system which provides for: (1) a system for the receipt and disposition of consumer complaints or inquiries regarding the compliance of health plans with the requirements of this title; and (2) information to small employers about carriers that offer small employer health plans in the area covered by the regulatory authority. Provides that under such standards, no group plans may discriminate on the basis of an individual's health status, claims experience, receipt of health care, medical history, or lack of evidence of insurability. Provides for the same treatment of pre-existing condition exclusions under such group plans as provided under qualified employer health plans under title XXI. Requires the Secretary periodically to publish the names of issuers of insured employment-related small employer health plans that have been found to meet the applicable requirements of this title. Requires any health insurance carrier offering small employer health plans to register with the Secretary. Requires such carriers to offer the same plan to all small employers within their community on a continuous, year-round basis. Allows a carrier to terminate or refuse to issue or renew, a plan only for nonpayment of premiums and fraud or misrepresentation. Prohibits a carrier from offering to, or issuing with respect to, a small employer a small employer health plan with a term of less than 12 months. Requires a plan to provide for benefits for all required health services. Prohibits a plan, however, from imposing cost-sharing with respect to basic benefits in excess of the deductibles and co-payments permitted under new title XXII. Requires premiums to be community-rated for a given geographic area. Allows such premiums to be adjusted for age, gender, and type of family enrollment. Sets forth miscellaneous disclosure and recordkeeping requirements for small employer health plans. Prohibits a small employer carrier from varying the remuneration paid a broker for the sale or renewal of any small employer health plan based on the claims experience associated with the group to which the plan was sold. Allows a health maintenance organization (HMO) to: (1) deny enrollment to employees (and family members) of a small employer if the employees are located outside the HMO's service area, but only if such denial is applied uniformly without regard to health status or insurability; and (2) apply to the Secretary to cease enrolling new small employer groups in its small employer health plan under certain conditions. Exempts HMO health plans from the above mentioned requirements respecting the basic benefit package and maximum cost-sharing restrictions for small employer health plans. Title V: Changes in Medicare Program - Amends the Medicare program to: (1) add annual screenings for colorectal cancer for individuals over age 50 and for breast cancer for women over 64, vaccinations for influenza and tetanus-diphtheria, and well-child care services as program benefits; and (2) make technical and conforming changes in provisions with respect to Medicare enrollment and participation agreements that reflect the additions of new titles XXI and XXII and to ensure the coordination of law-income assistance for Medicare beneficiaries. Directs the Secretary to establish and provide for ongoing demonstration projects providing for the coverage of other specified preventive services under Medicare to determine whether to include coverage of such services for all individuals enrolled under Medicare part B (Supplementary Medical Insurance). Requires reports to specified congressional committees describing findings made under such demonstration projects and the Secretary's plans for future such demonstration projects. Authorizes appropriations. Directs the Director of the Office of Technology Assessment (OTA) to conduct a study to develop a process for the regular review of Medicare coverage of preventive services. Requires an OTA report to specified congressional committees on such study. Title VI: Financing Provisions - Amends the Internal Revenue Code to remove limitations on the contribution base for the hospital insurance tax after 1992. Allows self-employed individuals to deduct the full amount paid for health insurance costs (currently, such deduction is limited to 25 percent of such costs). Repeals the termination date of such deduction, extending it indefinitely. Applies special rules for such individuals and personal corporations before employer health plan requirements take effect. Allows small employers (those employing fewer than 100 employees) a deduction of 20 percent of the insurance premiums paid for the qualified health coverage of their employees. Requires a State, beginning January 1996, to make monthly maintenance of effort payments to the Public Health Trust Fund in order to keep its residents eligible for title XXII benefits. Title VII: Medicaid Provisions - Amends title XIX (Medicaid) of the Social Security Act to: (1) limit Federal financial participation for services covered under the public health plan; and (2) provide for the continuation of Medicaid benefits not covered under the public health plan and for the nonduplication of benefits with the public health plan.