Foundation analysis · Healthcare
Foundation draft · Not enacted law
A comprehensive public healthcare system pairing enforceable benefits and no patient charges for covered care with permanent financing, progressive revenues, provider payment, facilities, workforce, science, and patient rights.
National Public Healthcare System and Financing Reform
Replacement model bill · September 19, 2026 · 51,612 words · 36 titles · 314 sections
Foundation model docket. Identifiers and proposed referrals are internal and are not official congressional or legislative assignments.
A guide to this proposal
The bill would replace duplicative primary insurance with a national public payer while retaining public, nonprofit, Tribal, and private providers. Full benefits depend on residence and the qualifying statuses in Title II; every person receives the specified limited protections. Coverage would not depend on tax payment, a new card, or State participation.
Analysis is commentary. Model text is a proposal. Fiscal scenarios, where provided, are illustrative.
Foundation Analysis
The September replacement expands the earlier 14-title packet into 36 titles and 314 sections. It pairs a national coverage promise with delivery duties, payment routes, staffing, patient remedies, and a separate counsel and fiscal report.
In plain language: The bill would replace duplicative primary insurance with a national public payer while retaining public, nonprofit, Tribal, and private providers. Full benefits depend on residence and the qualifying statuses in Title II; every person receives the specified limited protections. Coverage would not depend on tax payment, a new card, or State participation.
Residents eligible for full coverage receive comprehensive benefits, including dental, vision, hearing, behavioral health, and medically necessary long-term supports, without charges for covered services. Other eligibility categories receive defined limited protections, including life-preserving follow-up. Public financing does not itself nationalize facilities or compel clinicians to work. Titles XIX–XXXVI turn the core system into specific delivery and accountability duties.
Specified early benefits begin by day 90 and the full package by day 180. Provisional enrollment and payment, legacy processing, protected treatment courses, operating advances, and alternative capacity support the transition. Construction and accredited professional training follow longer schedules. The legal start date remains exceptionally demanding; an entitlement alone cannot create a staffed clinic, available specialist, or functioning payment system.
The supplied counsel report identifies voluntary State compacts, federal fallback, express limited State remedial consent, bounded agency powers, compensated patent use, and judicial review as safeguards. It also identifies unresolved risks in taxation, price applications, insurance transition, reproductive and gender-related care, conscience protections, privacy, and remedies. Those protections warrant careful review; they do not establish that every provision will survive litigation.
The report identifies $360 billion in annual first-five-year funding floors, in 2026 dollars, and a separate $150 billion initial startup appropriation. Its three ten-year spending scenarios are $54.359 trillion, $66.507 trillion, and $80.814 trillion, including assumed startup outlays. These are consolidated expenditure sensitivities, not new federal spending or deficit estimates. Existing federal transfers and new employer and corporate receipts are unestimated, so the financing gap remains unresolved.
the replacement substantially develops the delivery, continuity, accounting, and enforcement architecture. Its strongest discipline is separating legal coverage from real capacity, appropriations from revenue, and proposed policy from existing law. Before introduction, priorities remain an integrated CBO/JCT and actuarial score; provider-cost, wage, and workforce validation; State-participation scenarios; clinical and payment-system testing; supply-response analysis; and a current constitutional, statutory, and codification review.
Analysis of the supplied September 19, 2026 model bill and separate counsel/fiscal report. Neither document is enacted law, an official congressional or legislative-counsel product, or an official CBO/JCT score. The report is explanatory; the proposed statutory text controls. Spending scenarios are assumptions, not forecasts, revenue estimates, or findings of budget neutrality.
The September replacement
The full replacement is dated September 19, 2026. The legislation contains the proposed legal duties; the companion explains its design, risks, and fiscal assumptions.
36 titles. 314 sections. The complete replacement bill, including its original table of contents and every operative provision.
Title commentary, legal analysis, fiscal scenarios, implementation, stakeholder review, and the complete source register. This report is not part of the proposed statutory text.
Fiscal reading
The report separates proposed funding authority from modeled spending. Its scenarios do not establish revenue sufficiency, household savings, or the change in the federal deficit.
First five program years, in 2026 dollars. These account floors are included within the scenario totals.
Separate from recurring floors. The scenarios assume this amount is spent once; actual transition costs may differ.
Specified early benefits begin by day 90. Facilities and professional training have longer delivery schedules.
Section 702 sets ordinary federal financing at no less than 75% of expenditure, accepted State contributions at no more than 22%, and the individual solidarity allocation at no more than 3%. That allocation is federal tax revenue, so total federal financing is ordinarily at least 78% when the State share is 22%.
The 3% allocation is not a flat tax rate or a revenue forecast. State nonparticipation and insufficient receipts increase federal financing. Neither actual transferred federal funding nor new employer and corporate receipts is estimated in the report.
Scroll across to compare every time period.
| Assumption set | 1 year | 5 years | 10 years | 30 years |
|---|---|---|---|---|
| Scenario A: C1=5.3; g=0.5% | 5.450 | 26.916 | 54.359 | 171.234 |
| Scenario B: C1=6.2; g=1.5% | 6.350 | 32.094 | 66.507 | 232.890 |
| Scenario C: C1=7.2; g=2.5% | 7.350 | 37.996 | 80.814 | 316.249 |
C1 is assumed first-full-program-year expenditure; g is assumed annual real growth. Every window includes the report's $0.15 trillion startup assumption. The figures cover full program years, not the first fiscal year after enactment. They are spending sensitivities, not probabilities, actuarial forecasts, net new federal outlays, or an official CBO/JCT score.
Read the full fiscal method and limitationsFull Text
Read the legislation.
Expanded legislative text
36 titles • 314 sections
Complete replacement bill September 19, 2026
Proposed federal legislation
This document contains the operative legislative text. A separate counsel report addresses legal authorities, fiscal assumptions, implementation, and unresolved enactment decisions.
This is a model bill, not enacted law, an official congressional draft, or an official CBO or Joint Committee on Taxation score. Full benefits are prescribed to begin 180 days after enactment; physical construction and professional training have separate performance schedules.
A BILL
To establish a publicly financed American Health System; provide comprehensive health benefits without patient charges; establish permanent financing and progressive revenues; simplify healthcare administration; regulate medical-product prices; invest in facilities, research, and the healthcare workforce; protect displaced workers; and provide for disaster response, patient rights, and accountability.
Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,
This Act may be cited as the “American Health Act”.
The table of contents of this Act is as follows:
TITLE I. ESTABLISHMENT, DEFINITIONS, AND SCIENTIFIC GOVERNANCE
SEC. 101. ESTABLISHMENT AND NATIONAL ENTITLEMENT.
SEC. 102. PURPOSES AND CONGRESSIONAL POLICY.
SEC. 104. ADMINISTRATION AND LAWFUL APPOINTMENTS.
SEC. 105. NATIONAL HEALTH SCIENCE AND CLINICAL COUNCIL.
SEC. 106. ACTUARIAL INDEPENDENCE AND PATIENT REPRESENTATION.
TITLE II. ELIGIBILITY, RESIDENCY, ENROLLMENT, AND LIMITED COVERAGE
SEC. 201. FULL-COVERAGE ELIGIBILITY.
SEC. 202. TEMPORARY AND NONQUALIFYING CATEGORIES.
SEC. 203. AUTOMATIC ENROLLMENT AND STATUS VERIFICATION.
SEC. 204. LIMITED HEALTH PROTECTION FOR EVERY PERSON.
SEC. 205. GEOGRAPHIC PORTABILITY AND TEMPORARY ABSENCE.
SEC. 206. SAVINGS, DETENTION, AND IMMIGRATION PRIVACY.
TITLE III. COMPREHENSIVE BENEFITS AND PATIENT FINANCIAL PROTECTION
SEC. 301. COMPREHENSIVE BENEFIT ENTITLEMENT.
SEC. 302. DENTAL, VISION, AND HEARING.
SEC. 303. REPRODUCTIVE, MATERNAL, AND FAMILY HEALTH.
SEC. 304. BEHAVIORAL HEALTH AND SUBSTANCE-USE SERVICES.
SEC. 305. LONG-TERM SERVICES AND SUPPORTS.
SEC. 306. EMERGENCY SERVICES AND TRANSPORT.
SEC. 307. NO PATIENT CHARGES OR MEDICAL COLLECTIONS.
SEC. 308. EVIDENCE, EXCLUSIONS, AND INDIVIDUAL EXCEPTIONS.
TITLE IV. TIMELY ACCESS, CLINICAL STANDARDS, AND APPEALS
SEC. 401. ENFORCEABLE ACCESS STANDARDS.
SEC. 402. CLINICAL REVIEW AND LIMITED PRIOR AUTHORIZATION.
SEC. 403. NOTICE, ADMINISTRATIVE APPEAL, AND CONTINUING CARE.
SEC. 404. CIVIL RIGHTS, CONSENT, AND QUALITY.
TITLE V. PROVIDERS, INSTITUTIONAL PAYMENT, AND FAIR COMPENSATION
SEC. 501. PARTICIPATION AND CLINICAL INDEPENDENCE.
SEC. 502. PROFESSIONAL PAYMENT AND TRANSITION RATES.
SEC. 503. HOSPITALS AND ESSENTIAL FACILITY BUDGETS.
SEC. 504. CLINICAL COMPENSATION FLOORS.
SEC. 505. STAFFING, WORKING CONDITIONS, AND PAYMENT TRANSPARENCY.
SEC. 506. PROMPT PAYMENT AND FINANCIAL STABILITY.
TITLE VI. PRESCRIPTION DRUGS, MEDICAL PRODUCTS, AND SUPPLY SECURITY
SEC. 601. EXPRESS NATIONAL PRICE-SETTING AUTHORITY.
SEC. 602. PRICING METHOD AND PROCEDURE.
SEC. 603. SUPPLY, NONAGREEMENT, AND GOVERNMENT PATENT USE.
SEC. 604. INTERMEDIARIES AND PHARMACY ACCESS.
SEC. 605. PUBLIC MANUFACTURING AND INNOVATION SUPPORT.
TITLE VII. AMERICAN HEALTH TRUST FUND AND PERMANENT FINANCING
SEC. 701. TRUST FUND AND PERMANENT APPROPRIATION.
SEC. 702. FINANCING SHARES AND SOURCE ACCOUNTING.
SEC. 703. TRANSFERRED FUNDING AND PROTECTED OBLIGATIONS.
SEC. 704. PAYMENT RESERVE AND ANTI-CUT PROTECTION.
SEC. 705. ACTUARIAL DISCIPLINE AND REINVESTMENT.
TITLE VIII. PROGRESSIVE HEALTH REVENUE AND TAX ADMINISTRATION
SEC. 801. INDIVIDUAL HEALTH SOLIDARITY CONTRIBUTION.
SEC. 802. ULTRA-HIGH-INCOME HEALTH SECURITY SURTAX.
SEC. 803. HEALTH INCOME BASE; TRUSTS; ANTI-AVOIDANCE.
SEC. 804. EMPLOYER HEALTH RESPONSIBILITY CONTRIBUTION.
SEC. 805. CORPORATE HEALTH RESPONSIBILITY CONTRIBUTION.
SEC. 806. COLLECTION, EFFECTIVE DATE, AND TAXPAYER RIGHTS.
TITLE IX. FEDERAL-STATE COMPACTS AND TERRITORIAL AND TRIBAL ARRANGEMENTS
SEC. 901. VOLUNTARY STATE FINANCING COMPACTS.
SEC. 902. NONPARTICIPATION, DEFAULT, AND FISCAL STRESS.
SEC. 903. FEDERAL-ONLY COSTS AND TERRITORIAL AND TRIBAL PROTECTION.
SEC. 904. STATE SUPPLEMENTS AND ADMINISTRATIVE STANDARDS.
TITLE X. INSURANCE TRANSITION AND CONSOLIDATION OF EXISTING PROGRAMS
SEC. 1001. REPLACEMENT OF DUPLICATIVE PRIMARY INSURANCE.
SEC. 1002. CONTRACT RUNOFF AND PROTECTION OF ASSETS.
SEC. 1003. EXISTING FEDERAL BENEFIT PROGRAMS.
SEC. 1004. VETERANS, MILITARY, INDIAN HEALTH, AND OTHER PUBLIC SYSTEMS.
SEC. 1005. EMPLOYER AND COLLECTIVE-BARGAINING TRANSITION.
SEC. 1006. LIABILITY PAYERS AND RECOVERY.
TITLE XI. ADMINISTRATIVE SIMPLIFICATION, CONTRACTING, AND COMPETITION
SEC. 1101. SINGLE PUBLIC PAYMENT STANDARD.
SEC. 1102. MINISTERIAL CONTRACTING AND GOVERNMENT CONTRACT REVIEW.
SEC. 1103. OWNERSHIP, SELF-DEALING, AND SITE-NEUTRAL PAYMENT.
SEC. 1104. PROCUREMENT INTEGRITY.
TITLE XII. FACILITIES, RURAL CAPACITY, AND MODERNIZATION
SEC. 1201. NATIONAL HEALTH FACILITIES AND TECHNOLOGY ACCOUNT.
SEC. 1202. CAPACITY PLAN AND PROJECT SELECTION.
SEC. 1203. GRANTS, DIRECT FACILITIES, AND PUBLIC-USE COVENANTS.
SEC. 1204. RURAL AND UNDERSERVED OPERATING SECURITY.
SEC. 1205. RESILIENCE AND TECHNOLOGY STANDARDS.
TITLE XIII. WORKFORCE EDUCATION AND MEDICAL SCIENCE
SEC. 1301. HEALTH PROFESSIONS EDUCATION ACCOUNT.
SEC. 1302. RESIDENCIES AND TRAINING CAPACITY.
SEC. 1303. SCHOLARSHIPS, LOAN REPAYMENT, AND SERVICE.
SEC. 1304. RETENTION, CREDENTIALING, AND SAFE EXPANSION.
SEC. 1305. MEDICAL SCIENCE AND PUBLIC-INTEREST INNOVATION.
TITLE XIV. DISPLACED-WORKER ADJUSTMENT AND REEMPLOYMENT
SEC. 1401. ELIGIBILITY AND ADMINISTRATION.
SEC. 1402. INCOME AND WAGE PROTECTION.
SEC. 1403. TRAINING AND REEMPLOYMENT PATHWAYS.
SEC. 1404. PERMANENT ADJUSTMENT FUNDING.
TITLE XV. PUBLIC HEALTH, NATURAL DISASTERS, AND ENVIRONMENTAL INJURY
SEC. 1501. PUBLIC HEALTH AND MEDICAL READINESS.
SEC. 1502. ACTIVATION AND DISASTER BENEFITS.
SEC. 1503. ENVIRONMENTAL EXPOSURE CARE.
SEC. 1504. RECOVERY FROM RESPONSIBLE PARTIES.
SEC. 1505. LONGITUDINAL REGISTRIES AND COMMUNITY OVERSIGHT.
TITLE XVI. PRIVACY, DIGITAL INFRASTRUCTURE, AND ARTIFICIAL INTELLIGENCE
SEC. 1601. FEDERATED HEALTH INFORMATION INFRASTRUCTURE.
SEC. 1602. PROHIBITED USES AND PATIENT RIGHTS.
SEC. 1603. GOVERNMENT DATA EXCHANGE AND ENFORCEMENT FIREWALLS.
SEC. 1604. AI AND CLINICAL TECHNOLOGY SAFEGUARDS.
SEC. 1605. CYBERSECURITY AND INCIDENT CONTINUITY.
TITLE XVII. ENFORCEMENT, REMEDIES, AND PUBLIC ACCOUNTABILITY
SEC. 1701. BENEFICIARY ENFORCEMENT AND FEDERAL LIABILITY.
SEC. 1702. PRIVATE VIOLATIONS AND PATIENT REMEDIES.
SEC. 1703. CIVIL PENALTIES AND DUE PROCESS.
SEC. 1704. EXCLUSION, CONTINUITY, AND INVESTIGATIVE LIMITS.
SEC. 1705. OTHER APPEALS AND JUDICIAL REVIEW.
SEC. 1706. WHISTLEBLOWERS AND INDEPENDENT OVERSIGHT.
SEC. 1707. PUBLIC REPORTING AND PERFORMANCE CORRECTION.
TITLE XVIII. IMPLEMENTATION, COORDINATION, AND CONSTRUCTION
SEC. 1801. SIX-MONTH BENEFIT COMMENCEMENT.
SEC. 1802. BRIDGE OPERATIONS AND STARTUP APPROPRIATION.
SEC. 1803. RULEMAKING AND LIMITS ON DELEGATION.
SEC. 1804. COORDINATION AND EXPRESS PREEMPTION.
SEC. 1805. REVIEW, SEVERABILITY, AND EFFECTIVE DATE.
TITLE XIX. PRIMARY CARE, PREVENTION, AND COMMUNITY HEALTH DELIVERY
SEC. 1901. COMPREHENSIVE PRIMARY CARE SERVICE.
SEC. 1902. PRIMARY CARE PAYMENT AND PANEL CAPACITY.
SEC. 1903. PREVENTIVE SERVICES AND INDIVIDUALIZED EXCEPTIONS.
SEC. 1904. CLOSED-LOOP REFERRALS AND TEST RESULTS.
SEC. 1905. HEALTH CENTERS AND SAFETY-NET MISSION PAYMENTS.
SEC. 1906. HOME-BASED PRIMARY CARE AND MOBILE TEAMS.
SEC. 1907. NUTRITION, MOVEMENT, AND CHRONIC-DISEASE PREVENTION.
SEC. 1908. COMMUNITY HEALTH WORKERS AND NAVIGATION.
SEC. 1909. HEALTH LITERACY AND ACCESSIBLE INFORMATION.
SEC. 1910. SCHOOL, COLLEGE, AND YOUNG-ADULT CLINICS.
SEC. 1911. FREQUENT USERS AND COMPLEX SOCIAL NEEDS.
SEC. 1912. PRIMARY CARE PERFORMANCE AND CORRECTIVE DUTIES.
TITLE XX. ORAL HEALTH, VISION, HEARING, AND ASSISTIVE PRODUCTS
SEC. 2001. INTEGRATED ORAL HEALTH DELIVERY.
SEC. 2002. RESTORATIVE CARE AND PROSTHODONTIC NECESSITY.
SEC. 2003. ORTHODONTIA AND CRANIOFACIAL CARE.
SEC. 2004. DENTAL SEDATION AND SPECIAL-NEEDS ACCESS.
SEC. 2005. VISION EXAMINATIONS AND CORRECTIVE PRODUCTS.
SEC. 2006. OCULAR DISEASE AND LOW-VISION REHABILITATION.
SEC. 2007. HEARING SERVICES AND PATIENT CHOICE.
SEC. 2008. IMPLANTABLE AUDITORY DEVICES AND REHABILITATION.
SEC. 2009. ASSISTIVE PRODUCT STANDARDS AND REPAIR RIGHTS.
SEC. 2010. INTEGRATED BENEFITS AND BILLING CLASSIFICATION.
SEC. 2011. SCHOOL, RURAL, AND RESIDENTIAL SCREENING SERVICES.
SEC. 2012. BENEFIT ACCESS AND PROFESSIONAL SUPPLY REVIEW.
TITLE XXI. MATERNAL, REPRODUCTIVE, CHILD, AND FAMILY HEALTH
SEC. 2101. MATERNAL CARE NETWORKS AND CONTINUITY.
SEC. 2102. MATERNAL EMERGENCY READINESS.
SEC. 2103. MIDWIFERY, DOULA SUPPORT, AND BIRTH SETTINGS.
SEC. 2104. REPRODUCTIVE CHOICE AND CONTRACEPTIVE ACCESS.
SEC. 2105. FERTILITY SERVICES AND ASSISTED REPRODUCTION.
SEC. 2106. NEWBORN CARE AND EARLY INTERVENTION.
SEC. 2107. COMPREHENSIVE PEDIATRIC STANDARD.
SEC. 2108. ADOLESCENT CONFIDENTIALITY AND TRANSITION.
SEC. 2109. FOSTER CARE, ADOPTION, AND PLACEMENT CHANGES.
SEC. 2110. FAMILY VIOLENCE AND SEXUAL-ASSAULT SERVICES.
SEC. 2111. MENOPAUSE, UROLOGIC, AND LIFE-COURSE REPRODUCTIVE CARE.
SEC. 2112. MATERNAL AND CHILD HEALTH ACCOUNTABILITY.
TITLE XXII. BEHAVIORAL HEALTH, ADDICTION, AND CRISIS SYSTEMS
SEC. 2201. COMMUNITY BEHAVIORAL HEALTH NETWORKS.
SEC. 2202. CRISIS CONTACT, DISPATCH, AND MOBILE RESPONSE.
SEC. 2203. CRISIS STABILIZATION AND SHORT-TERM FACILITIES.
SEC. 2204. SUICIDE-PREVENTION AND POSTCRISIS FOLLOW-UP.
SEC. 2205. EVIDENCE-BASED ADDICTION TREATMENT.
SEC. 2206. HARM REDUCTION AND OVERDOSE RESPONSE.
SEC. 2207. INPATIENT AND RESIDENTIAL CLINICAL NECESSITY.
SEC. 2208. COMMUNITY SUPPORT FOR SERIOUS MENTAL ILLNESS.
SEC. 2209. EATING DISORDERS AND COMPLEX BEHAVIORAL CONDITIONS.
SEC. 2210. PEER SERVICES AND RECOVERY WORKFORCE.
SEC. 2211. BEHAVIORAL-HEALTH PRIVACY AND COERCION LIMITS.
SEC. 2212. BEHAVIORAL-HEALTH CAPACITY AND OUTCOME REVIEW.
TITLE XXIII. DISABILITY, AGING, AND COMMUNITY LIVING
SEC. 2301. FUNCTIONAL ELIGIBILITY AND INDEPENDENT ASSESSMENT.
SEC. 2302. PERSON-CENTERED SERVICE PLANS.
SEC. 2303. SELF-DIRECTED SUPPORTS AND FISCAL ASSISTANCE.
SEC. 2304. FAMILY CAREGIVERS AND RESPITE.
SEC. 2305. COMMUNITY TRANSITION AND NO INSTITUTIONAL BIAS.
SEC. 2306. HOME MODIFICATIONS AND ACCESSIBLE EQUIPMENT.
SEC. 2307. DIRECT-SUPPORT WORKFORCE AND MISSED VISITS.
SEC. 2308. RESIDENT RIGHTS AND INSTITUTIONAL QUALITY.
SEC. 2309. DEMENTIA AND COGNITIVE SUPPORT.
SEC. 2310. ADULT DAY SERVICES AND COMMUNITY PARTICIPATION.
SEC. 2311. ELDER ABUSE, NEGLECT, AND FINANCIAL EXPLOITATION.
SEC. 2312. LONG-TERM SERVICES CAPACITY AND FISCAL REVIEW.
TITLE XXIV. COMPLEX SPECIALTY CARE, CHRONIC CONDITIONS, AND PALLIATIVE SERVICES
SEC. 2401. REGIONAL SPECIALTY NETWORKS.
SEC. 2402. CANCER DIAGNOSIS AND TREATMENT CONTINUITY.
SEC. 2403. RARE DISEASE AND UNDIAGNOSED CONDITIONS.
SEC. 2404. ORGAN TRANSPLANTATION AND ALLOCATION.
SEC. 2405. LIVING DONOR PROTECTION.
SEC. 2406. KIDNEY DISEASE AND DIALYSIS.
SEC. 2407. CARDIOVASCULAR, METABOLIC, AND RESPIRATORY CARE.
SEC. 2408. NEUROLOGIC CONDITIONS AND REHABILITATION.
SEC. 2409. CHRONIC PAIN AND MULTIDISCIPLINARY CARE.
SEC. 2410. PALLIATIVE CARE AND HOSPICE.
SEC. 2411. SECOND OPINIONS AND COMPLEX DECISION SUPPORT.
SEC. 2412. SPECIALTY QUALITY AND ACCESS ASSURANCE.
TITLE XXV. EMERGENCY MEDICAL SERVICES, TRAUMA, AND TRANSPORTATION
SEC. 2501. NATIONAL EMERGENCY MEDICAL ACCESS STANDARD.
SEC. 2502. EMERGENCY SERVICE GLOBAL READINESS PAYMENTS.
SEC. 2503. TREATMENT WITHOUT TRANSPORT AND ALTERNATIVE DESTINATIONS.
SEC. 2504. AIR AND WATER MEDICAL TRANSPORT.
SEC. 2505. NONEMERGENCY MEDICAL TRANSPORT.
SEC. 2506. INTERFACILITY TRANSFER AND BED COORDINATION.
SEC. 2507. TRAUMA, STROKE, AND TIME-SENSITIVE REGIONAL CARE.
SEC. 2508. PEDIATRIC AND DISABILITY-READY EMERGENCY SERVICES.
SEC. 2509. EMERGENCY COMMUNICATIONS AND INTEROPERABILITY.
SEC. 2510. EMERGENCY WORKFORCE SAFETY AND CLINICAL SUPPORT.
SEC. 2511. EMERGENCY CHARGES AND MUNICIPAL FINANCE COORDINATION.
SEC. 2512. EMERGENCY ACCESS OVERSIGHT.
TITLE XXVI. FACILITY DELIVERY, RURAL OPERATIONS, AND CAPITAL ASSURANCE
SEC. 2601. NATIONAL CAPITAL INVENTORY AND NEEDS ASSESSMENT.
SEC. 2602. PROJECT APPLICATIONS AND PUBLIC NEED REVIEW.
SEC. 2603. RENOVATION AND DEFERRED MAINTENANCE.
SEC. 2604. NEW FACILITIES AND SERVICE CONFIGURATION.
SEC. 2605. RURAL AND FRONTIER OPERATING COVENANTS.
SEC. 2606. MATERNITY, BEHAVIORAL, AND REHABILITATION CAPACITY.
SEC. 2607. CONSTRUCTION PROCUREMENT AND COMPETITION.
SEC. 2608. COST OVERRUNS AND MILESTONE PAYMENTS.
SEC. 2609. BUILDING RESILIENCE AND UTILITY CONTINUITY.
SEC. 2610. EQUIPMENT, SOFTWARE, AND LIFECYCLE PROCUREMENT.
SEC. 2611. PUBLIC-USE COVENANTS AND DISPOSITION.
SEC. 2612. CAPITAL AUDIT AND POSTOPENING PERFORMANCE.
TITLE XXVII. WORKFORCE DELIVERY, PROFESSIONAL SUPPORT, AND EMPLOYMENT TRANSITION
SEC. 2701. NATIONAL WORKFORCE ACCOUNTS AND REGIONAL PLANS.
SEC. 2702. COMPENSATION PASS-THROUGH AND PAYROLL VERIFICATION.
SEC. 2703. SPECIALTY, GEOGRAPHIC, AND DIFFICULT-DUTY SUPPLEMENTS.
SEC. 2704. RESIDENCY AND SUPERVISED TRAINING EXPANSION.
SEC. 2705. SCHOLARSHIP AND SERVICE OBLIGATION ADMINISTRATION.
SEC. 2706. LICENSURE, CREDENTIALING, AND VERIFIED COMPETENCE.
SEC. 2707. SAFE STAFFING AND SCHEDULING IMPLEMENTATION.
SEC. 2708. WORKFORCE WELLBEING AND CONFIDENTIAL SUPPORT.
SEC. 2709. DISPLACED-WORKER CERTIFICATION AND OUTREACH.
SEC. 2710. RETRAINING QUALITY AND REEMPLOYMENT PATHWAYS.
SEC. 2711. WAGE INSURANCE, BENEFIT COORDINATION, AND OVERPAYMENTS.
SEC. 2712. WORKFORCE OUTCOMES AND ANTI-SUBSTITUTION.
TITLE XXVIII. MEDICAL PRODUCTS, BIOMEDICAL RESEARCH, AND SUPPLY IMPLEMENTATION
SEC. 2801. NATIONAL PRODUCT PRICING DOCKET.
SEC. 2802. COST AND VALUE SUBMISSIONS.
SEC. 2803. PRICING DECISIONS AND RECONSIDERATION.
SEC. 2804. SHORTAGE PREVENTION AND SUPPLIER DIVERSIFICATION.
SEC. 2805. STRATEGIC STOCKS AND INVENTORY INTEGRITY.
SEC. 2806. PUBLIC-INTEREST MANUFACTURING AGREEMENTS.
SEC. 2807. PATENT USE AND REGULATORY RELIANCE PROCEDURES.
SEC. 2808. PHARMACY DISPENSING AND LOCAL ACCESS.
SEC. 2809. INDEPENDENT RESEARCH PRIORITY SETTING.
SEC. 2810. CLINICAL TRIAL ACCESS AND PARTICIPANT PROTECTION.
SEC. 2811. PUBLIC RETURN ON FEDERALLY FUNDED INNOVATION.
SEC. 2812. SCIENTIFIC INTEGRITY AND TECHNOLOGY REASSESSMENT.
TITLE XXIX. REVENUE COLLECTION, TREASURY OPERATIONS, AND STATE ACCOUNTING
SEC. 2901. SEPARATE REVENUE LEDGERS AND PUBLIC RECONCILIATION.
SEC. 2902. INDIVIDUAL WITHHOLDING AND ESTIMATED PAYMENTS.
SEC. 2903. EMPLOYER DEPOSITS AND CONTROLLED-GROUP ALLOCATION.
SEC. 2904. COMPENSATION CLASSIFICATION AND SELF-EMPLOYMENT.
SEC. 2905. HIGH-INCOME ATTRIBUTION AND TRUST ADMINISTRATION.
SEC. 2906. CAPITAL INCOME, INSTALLMENT TRANSACTIONS, AND LOSSES.
SEC. 2907. CORPORATE GROUPS AND INCOME RECONCILIATION.
SEC. 2908. TAXPAYER ASSISTANCE, EXAMINATION, AND APPEAL.
SEC. 2909. TERRITORIAL, FOREIGN, AND TREATY COORDINATION.
SEC. 2910. STATE ALLOCATION AND RECONCILIATION RULES.
SEC. 2911. CASH MANAGEMENT, RESERVES, AND BORROWING DISCLOSURE.
SEC. 2912. REVENUE FORECASTS AND FISCAL CORRECTION PROCESS.
TITLE XXX. PAYMENT INTEGRITY, OWNERSHIP, INSURANCE RUNOFF, AND COMPETITION
SEC. 3001. STANDARD CLAIM CONTENT AND DOCUMENTATION LIMITS.
SEC. 3002. GLOBAL BUDGET RECONCILIATION AND EXCEPTIONAL COSTS.
SEC. 3003. PROFESSIONAL PAYMENT AND LOW-VALUE SERVICE REVIEW.
SEC. 3004. OWNERSHIP TRANSPARENCY AND RELATED-PARTY TRANSACTIONS.
SEC. 3005. CLINICAL INDEPENDENCE AND FINANCIAL CONTROL.
SEC. 3006. MERGER AND ESSENTIAL-SERVICE NOTICE.
SEC. 3007. INSURANCE CONTRACT RUNOFF AND CLAIMS PRESERVATION.
SEC. 3008. PREMIUM REFUNDS AND SUPPLEMENTAL CONVERSION.
SEC. 3009. EMPLOYER PLANS, RETIREES, AND COLLECTIVE AGREEMENTS.
SEC. 3010. LIABILITY PAYERS AND RECOVERY SAFEGUARDS.
SEC. 3011. FRAUD AUDITS AND PROPORTIONAL RECOVERY.
SEC. 3012. ADMINISTRATIVE COST ACCOUNTABILITY.
TITLE XXXI. PUBLIC HEALTH, ENVIRONMENTAL INJURY, AND DISASTER RECOVERY
SEC. 3101. PUBLIC-HEALTH RESPONSIBILITIES AND BASE CAPACITY.
SEC. 3102. LABORATORY NETWORKS AND DIAGNOSTIC READINESS.
SEC. 3103. INFECTIOUS-DISEASE CONTINUITY AND VACCINATION.
SEC. 3104. OCCUPATIONAL HEALTH AND EXPOSURE CARE.
SEC. 3105. ENVIRONMENTAL HEALTH ACTIVATION AND EXPOSURE ZONES.
SEC. 3106. ENVIRONMENTAL SCREENING AND LONG-LATENCY CARE.
SEC. 3107. NATURAL-DISASTER MEDICAL OPERATIONS WITH FEMA.
SEC. 3108. DISPLACEMENT, EVACUATION, AND SHELTER HEALTH.
SEC. 3109. DISASTER PRESCRIPTION AND DEVICE REPLACEMENT.
SEC. 3110. POLLUTER RECOVERY AND EVIDENTIARY PRESERVATION.
SEC. 3111. PUBLIC COMMUNICATION AND COMMUNITY PARTICIPATION.
SEC. 3112. AFTER-ACTION REVIEW AND LONG-TERM RECOVERY.
TITLE XXXII. DIGITAL CARE, HEALTH DATA, ARTIFICIAL INTELLIGENCE, AND CYBERSECURITY
SEC. 3201. FEDERATED ARCHITECTURE AND DATA MINIMIZATION.
SEC. 3202. PATIENT IDENTITY AND RECORD MATCHING.
SEC. 3203. PATIENT ACCESS, CORRECTION, AND REPRESENTATIVES.
SEC. 3204. INTEROPERABILITY AND INFORMATION-BLOCKING CONTROLS.
SEC. 3205. TELEHEALTH AND EQUITABLE MODALITY CHOICE.
SEC. 3206. HIGH-IMPACT ALGORITHM REGISTER.
SEC. 3207. HUMAN REVIEW AND ADVERSE DECISIONS.
SEC. 3208. SECONDARY USE, COMMERCIAL TRAINING, AND CONSENT.
SEC. 3209. CYBERSECURITY BASELINE AND SMALL-PROVIDER SUPPORT.
SEC. 3210. INCIDENT NOTIFICATION AND CLINICAL DOWNTIME.
SEC. 3211. CLOUD, CROSS-BORDER PROCESSING, AND VENDOR EXIT.
SEC. 3212. DIGITAL OVERSIGHT AND REASSESSMENT.
TITLE XXXIII. CIVIL RIGHTS, CLINICAL ACCOUNTABILITY, AND REMEDIES
SEC. 3301. ACCESSIBLE NOTICE AND MEANINGFUL OPPORTUNITY TO RESPOND.
SEC. 3302. EXPEDITED CLINICAL REVIEW AND INTERIM RELIEF.
SEC. 3303. REPRESENTATION AND INDEPENDENT PATIENT ASSISTANCE.
SEC. 3304. NONDISCRIMINATION AND REASONABLE ACCOMMODATION.
SEC. 3305. RESOURCE ALLOCATION AND DISABILITY SAFEGUARDS.
SEC. 3306. INFORMED CONSENT AND TREATMENT REFUSAL.
SEC. 3307. CONSCIENCE ACCOMMODATION AND ACTUAL ACCESS.
SEC. 3308. MALPRACTICE, OPEN DISCLOSURE, AND PATIENT SAFETY.
SEC. 3309. STATE PARTICIPATION AND EXPRESS REMEDIAL CONSENT.
SEC. 3310. CIVIL ENFORCEMENT, JURY RIGHTS, AND LIMITATIONS.
SEC. 3311. WHISTLEBLOWER PROCESS AND RECORD PRESERVATION.
SEC. 3312. SYSTEMIC FAILURES AND PUBLIC ACCOUNTABILITY.
TITLE XXXIV. TRIBAL, TERRITORIAL, VETERAN, AND OTHER SPECIAL DELIVERY ARRANGEMENTS
SEC. 3401. TRIBAL SOVEREIGNTY AND GOVERNMENT-TO-GOVERNMENT AGREEMENTS.
SEC. 3402. TRIBAL AND URBAN INDIAN CLINICAL CAPACITY.
SEC. 3403. TERRITORIAL HEALTH DELIVERY AND REFERRAL.
SEC. 3404. REFUGEES, GRANTED ASYLEES, AND STATUS TRANSITIONS.
SEC. 3405. HEALTHCARE IN CUSTODY AND DETENTION.
SEC. 3406. HOMELESSNESS AND MEDICAL RESPITE.
SEC. 3407. VETERANS AND MILITARY HEALTH COORDINATION.
SEC. 3408. EDUCATION AND DISABILITY-RELATED SERVICE COORDINATION.
SEC. 3409. MIGRANT, SEASONAL, AND MOBILE RESIDENTS.
SEC. 3410. OUT-OF-AREA AND FOREIGN REFERRAL CARE.
SEC. 3411. REENTRY AND TRANSITION FROM PUBLIC INSTITUTIONS.
SEC. 3412. SPECIAL-DELIVERY ACCOUNTABILITY AND BENEFIT LIMITS.
TITLE XXXV. NATIONAL MOBILIZATION, OPERATIONS, AND PERFORMANCE.
SEC. 3501. NATIONAL IMPLEMENTATION COMMAND AND RESPONSIBILITY.
SEC. 3502. INITIAL INVENTORY AND PAYMENT PREPARATION.
SEC. 3503. EARLY-BENEFIT PHASE AND COVERAGE COMMUNICATION.
SEC. 3504. NATIONAL READINESS TESTS AND CORRECTIVE ACTION.
SEC. 3505. FULL-BENEFIT CONVERSION AND PARALLEL OPERATIONS.
SEC. 3506. PROTECTED TREATMENT COURSES AND MEDICATION CONTINUITY.
SEC. 3507. PAYMENT OUTAGES, OPERATING ADVANCES, AND LIQUIDITY.
SEC. 3508. BENEFICIARY AND PROVIDER ASSISTANCE OPERATIONS.
SEC. 3509. PROGRAM-INTEGRITY CONTROLS DURING MOBILIZATION.
SEC. 3510. TRANSITION PROCUREMENT AND TEMPORARY PERSONNEL.
SEC. 3511. PERFORMANCE DASHBOARD AND CORRECTION DUTIES.
SEC. 3512. INDEPENDENT EVALUATION AND LONG-TERM ADAPTATION.
TITLE XXXVI. TECHNICAL COORDINATION, SUPPLEMENTAL RULES, AND CONTINUING EFFECT.
SEC. 3601. CONSTRUCTION OF SUPPLEMENTAL TITLES.
SEC. 3602. MEDICARE PREMIUMS, ACCRUED RIGHTS, AND RESIDUAL COVERAGE.
SEC. 3603. MEDICAID, CHILDREN'S COVERAGE, AND LONG-TERM SERVICES.
SEC. 3604. MARKETPLACE TAX CREDITS AND EMPLOYER COVERAGE DUTIES.
SEC. 3605. EMPLOYEE BENEFIT AND INSURANCE LAW COORDINATION.
SEC. 3606. HEALTH SAVINGS AND REIMBURSEMENT ARRANGEMENTS.
SEC. 3607. RECORDS RETENTION, DISCLOSURE, AND LEGAL HOLDS.
SEC. 3608. DRUG DISCOUNTS, EXISTING PRICING PROGRAMS, AND SAFETY LAW.
SEC. 3609. PUBLIC CLINICAL EMPLOYMENT AND COMPENSATION COORDINATION.
SEC. 3610. ACCOUNT CLASSIFICATION AND NONDUPLICATION OF APPROPRIATIONS.
SEC. 3611. COMPUTATION OF TIME AND INITIAL COMPLIANCE.
SEC. 3612. PENDING PROCEEDINGS, CONTINUING OBLIGATIONS, AND FINAL CONSTRUCTION.
(a) ESTABLISHMENT. There is established within the Department of Health and Human Services the American Health System Authority, referred to in this Act as the “Authority”. The Authority shall administer the American Health System and the American Health Program.
(b) INDIVIDUAL RIGHT. Each individual satisfying title II shall be entitled to the benefits applicable to that individual under this Act. The entitlement shall arise by operation of law, not by issuance of a card, entry into a database, employment, payment of a tax, or approval of a discretionary grant.
(c) PUBLIC FINANCING; PLURAL DELIVERY. The System shall finance care through a national public payer and participating public, Tribal, nonprofit, cooperative, and private providers. Except through consensual purchase or other separately authorized lawful acquisition with compensation, this Act does not transfer ownership of private facilities or compel an individual to practice a health profession.
(d) NATIONAL RESPONSIBILITY. The United States shall remain responsible for payment and access notwithstanding state nonparticipation, contractor failure, data-system failure, or insufficiency of dedicated receipts.
Congress establishes this Act to replace fragmented primary health insurance with comprehensive public coverage; protect clinical independence; eliminate charges for covered care; maintain attractive compensation and safe working conditions; reduce unnecessary administrative work and excessive prices; expand rural and underserved capacity; support rigorous science and effective innovation; and ensure continuity during disasters and transitions. Cost containment shall target unnecessary expenditure, excessive intermediation, unsafe care, and economic rents rather than clinically necessary care or arbitrary reductions in patient-facing compensation.
For purposes of this Act:
(1) “Administrator” means the Administrator appointed under section 104; “Secretary” means the Secretary of Health and Human Services; and “Treasury Secretary” means the Secretary of the Treasury.
(2) “Covered person” means an individual entitled to full AHP benefits under section 201. “Limited-benefit person” means an individual entitled to services under section 204 but not full benefits.
(3) “Covered service” means an item, treatment, support, product, accommodation, or transportation benefit payable for the person receiving it under this Act. A service covered for one eligibility class is not thereby covered for every class.
(4) “Medically necessary” means appropriate to prevent, diagnose, treat, alleviate, rehabilitate, habilitate, or palliate a health condition, preserve function, support independent living, or prevent clinically significant deterioration, considering reliable evidence, the individual's circumstances and preferences, and reasonable alternatives. It does not require an expectation of cure or improvement where maintenance or prevention of deterioration is clinically appropriate.
(5) “Qualified provider” means a person or entity holding the professional license, facility approval, or federal credential necessary to furnish the service, not excluded for fraud or a current patient-safety threat. “Participating provider” means a qualified provider with a participation agreement under section 501.
(6) “Patient charge” includes a premium imposed as a condition of AHP enrollment, deductible, copayment, coinsurance, balance bill, facility surcharge, covered-service membership fee, emergency charge, transport charge, and a fee for administering or obtaining a covered benefit. Taxes imposed under title VIII are not patient charges.
(7) “Full-benefit date” means the date that is 180 days after enactment. “Program year” means each successive 12-month period beginning on that date. “Transition period” means enactment through the day preceding that date.
(8) “State” means a State of the United States or the District of Columbia. “Territory” means Puerto Rico, Guam, American Samoa, the United States Virgin Islands, or the Commonwealth of the Northern Mariana Islands. “United States”, for residency and delivery, includes the States and territories.
(9) “Tribal government” means an Indian Tribe recognized as eligible for federal Indian programs because of its status as an Indian Tribe. “Tribal health program” includes an authorized Tribal organization and an urban Indian organization furnishing health services.
(10) “Ordinary residence” means the United States is the individual's actual principal home, established through physical presence and intent to remain for other than a transient visit. Homelessness, institutional placement, temporary displacement, or absence for study, work, caregiving, or treatment does not alone defeat residence. A fixed address, minimum prior residence period, property ownership, and citizenship of a particular State shall not be required.
(11) “Net program expenditure” means actual allowable Trust Fund expenditure for all benefits, administration, investment, research, transition, and enforcement under this Act, less cash refunds and recoveries of those same expenditures. It excludes internal transfers, securities purchases, repayment of principal, unspent budget authority, and expenditure separately financed outside this Act. No expenditure or recovery shall be counted twice.
(12) “Clinical operating expenditure” means expenditure for direct healthcare delivery, including reasonable facility operations and provider compensation, but excluding separate capital grants, national administration, general research grants, and worker-adjustment benefits.
(13) “Controlled group” means entities under common direct or indirect control exceeding 50 percent of ownership, voting power, or beneficial economic interest, including arrangements divided principally to avoid this Act.
(14) “Inflation adjustment” means the ratio of the annual average Consumer Price Index for All Urban Consumers for the preceding calendar year to that for 2026, with no downward adjustment below the stated amount. Unless a provision expressly provides otherwise, monetary floors and grant amounts are stated in 2026 dollars and shall be adjusted annually, with annual wages, individual benefits, and individual grant limits rounded to $100, hourly wage floors to $0.10, tax thresholds to $1,000, and aggregate program appropriations to $1,000,000. An individually assessed penalty shall be adjusted to the nearest dollar.
(15) “AHS” or “System” means the American Health System; “AHP” or “Program” means the American Health Program; “Fund” means the American Health Trust Fund; and “Council” means the National Health Science and Clinical Council.
(16) “HHS” means the Department of Health and Human Services; “FDA” the Food and Drug Administration; “FEMA” the Federal Emergency Management Agency; “EPA” the Environmental Protection Agency; “CDC” the Centers for Disease Control and Prevention; “ATSDR” the Agency for Toxic Substances and Disease Registry; “NIH” the National Institutes of Health; “ARPA-H” the Advanced Research Projects Agency for Health; “OMB” the Office of Management and Budget; and “GAO” the Government Accountability Office. References include lawful successor components performing the specified function.
(a) The President shall appoint the Administrator with the advice and consent of the Senate. The Administrator shall possess substantial experience in health operations, medicine, public health, public finance, or health-system management. The Secretary shall supervise the Authority and may exercise its functions until an Administrator is lawfully serving.
(b) The Secretary shall appoint regional directors and subordinate officers in accordance with the Appointments Clause and applicable appointment statutes. Career personnel shall be selected on merit. No advisory body or private association may exercise unreviewable regulatory, spending, or adjudicative authority.
(c) The Authority shall include offices for benefits and enrollment; provider payment; facilities and workforce; medical-product pricing; health information and cybersecurity; civil rights and patient assistance; and program operations. Existing competent federal offices shall be used rather than duplicated where practicable.
(a) The Secretary shall appoint a 25-member Council after public solicitation. At least 18 members shall be actively practicing clinicians or scientists with substantial peer-reviewed, clinical, methodological, or public-health expertise. Membership shall include primary and specialty medicine, nursing, dentistry, vision and hearing, behavioral health, disability and long-term care, epidemiology, biostatistics, health economics, rural and Tribal health, and patient safety. At least five members shall represent patients, caregivers, or community organizations, including persons with disabilities. A member may satisfy more than one expertise requirement but counts once toward membership.
(b) Members shall serve staggered four-year terms, no more than two consecutive terms. Members shall disclose material financial interests and recuse from affected matters. Current senior executives of insurers, pharmacy benefit managers, and medical-product manufacturers may not serve. Persons with other relevant financial interests shall be subject to public disclosure and conflict management, not automatic exclusion from scientific consultation.
(c) The Council shall conduct public evidence reviews and advise on benefits, pricing methodology, quality, research, and workforce needs. Dissenting analyses shall be published. The Secretary shall issue a reasoned decision on a recommendation within 60 days and may reject its scientific findings only on an identified evidentiary or legal basis. Fiscal consequences may inform implementation within this Act but shall not justify undisclosed alteration of evidence.
(d) The Council is advisory. Binding decisions shall be made by lawfully appointed officials under the standards and review procedures of this Act. Open-meeting, federal advisory committee, and records laws shall apply, subject to patient and confidential-commercial protections.
(a) The Secretary shall appoint a qualified career Chief Actuary. The Chief Actuary shall publish assumptions, uncertainty ranges, and annual 1-, 5-, 10-, and 30-year projections and transmit them simultaneously to Congress and the public without political preclearance.
(b) An American Health Ombudsman shall assist patients, monitor access failures, and report independently to Congress. Ombudsman services, interpretation, and disability accommodation shall be free. The Ombudsman may not adjudicate a dispute in which it represented a party.
(c) The HHS Inspector General and the Comptroller General shall have direct access to records and personnel necessary for oversight, subject to safeguards for identifiable patient information.
(a) Full benefits shall be available to an individual ordinarily resident in the United States who is: (1) a United States citizen or national; (2) lawfully admitted for permanent residence, including conditional permanent residence; (3) admitted as a refugee; (4) granted asylum; (5) granted withholding of removal or protection against removal under the Convention Against Torture; (6) lawfully residing under a Compact of Free Association; or (7) granted T or U nonimmigrant status, or a federal trafficking-victim certification carrying refugee-equivalent benefit eligibility.
(b) An individual maintaining a valid immigration classification authorizing residence and employment for at least one year, other than a category excluded by section 202, shall qualify while ordinarily resident. A spouse or dependent child lawfully authorized to reside with such an individual shall qualify without a work-authorization requirement. Duration refers to the authorized period, not a requirement to wait one year before coverage.
(c) No five-year bar, sponsor-income attribution, immigration-status waiting period, work requirement, asset test, or premium shall apply to a person eligible under this section. Refugees and persons granted asylum shall qualify upon admission or grant, respectively, and establishment of ordinary residence.
(d) This section governs AHP notwithstanding contrary eligibility limitations in title IV of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 or prior federal health-benefit legislation. An immigration classification shall not be granted, extended, or changed by this Act.
(a) Physical presence or possession of a taxpayer identification number shall not by itself create eligibility. Visitors for business, tourism, transit, or medical treatment; crew members; foreign diplomatic personnel; and persons admitted solely for short-term study, training, or cultural exchange shall not qualify solely by that classification. A person independently satisfying section 201 shall not be excluded by a prior classification.
(b) A pending asylum application, pending immigration petition, employment-authorization document, deferred action, temporary protected status, or parole, standing alone, shall not confer full AHP coverage. A person in such a category retains limited coverage under section 204 and any separately available, lawfully funded coverage preserved by section 206. This subsection does not treat a lawfully present person as undocumented.
(c) A person entering primarily to obtain planned treatment without establishing ordinary residence shall not acquire full eligibility through a stated intention unsupported by objective evidence. Evidence shall be assessed without discrimination based on nationality, accent, race, disability, or anticipated medical cost. Routine intrusive home investigations are prohibited.
(a) The Authority shall enroll eligible persons through secure matching of existing benefit and vital-record systems and a direct application process accessible in person, by telephone, by mail, and online. A State shall share data only under a lawful agreement; federal enrollment shall not depend on state cooperation.
(b) Verification shall establish identity, ordinary residence, and an eligible status using the least information necessary. DHS shall return a status-confirmation response without receiving diagnoses, treatment records, or provider-location histories. Tax records may be disclosed only to the extent specifically authorized under section 1603.
(c) A signed attestation supported by available information shall establish provisional eligibility for 90 days where records are unavailable or inconsistent. The Authority shall extend provisional eligibility while agency verification remains unresolved. A discrepancy alone shall not establish fraud.
(d) Before termination, the Authority shall provide specific reasons, accessible notice, at least 30 days to correct the record, and appeal rights. Benefits shall continue during a timely appeal unless an independent adjudicator finds clear evidence of identity fraud. No recovery shall be made from a good-faith patient for agency error.
(e) A secure identifier shall not display an immigration category or Social Security number. Lack of a card shall not prevent treatment. Hospitals shall initiate enrollment for eligible newborns without conditioning the child's coverage on a parent's status.
(a) Every person physically present in the United States who is not entitled to full benefits, including an undocumented person, shall be entitled without patient charge to emergency screening and stabilization; ground, air, or water emergency medical transport; medically necessary interfacility transfer; labor, delivery, and immediate postpartum care; communicable-disease testing, vaccination, and treatment; urgent mental-health and substance-use crisis stabilization; and immediate disaster or environmental-exposure care.
(b) Limited protection includes clinically necessary follow-up, medicines, wound care, and treatment required to make discharge safe or avoid reasonably foreseeable death or serious permanent harm. It includes scheduled dialysis and comparable life-sustaining stabilization where withholding maintenance treatment would merely create a repeated emergency. The Secretary shall publish condition-based standards; the emergency department shall not be the mandatory site of access.
(c) Pediatric vaccinations, communicable-disease prevention, and urgent treatment necessary to prevent death or serious permanent injury are included. Nonemergency comprehensive elective, routine restorative, and long-term services remain outside limited coverage unless needed under subsection (b) or required by another law.
(d) The services in this section are expressly authorized federal public benefits notwithstanding contrary alien-benefit restrictions. A provider shall not inquire into immigration status before emergency treatment. Limited coverage creates neither lawful status nor eligibility for full AHP benefits.
(a) Benefits shall be portable throughout the United States. No state waiting period or state network restriction may be imposed. Care furnished across a state boundary shall be charged to the patient's residence for compact accounting, not to the treating State merely because the facility is there.
(b) A covered person temporarily outside the United States shall receive emergency stabilization and necessary medical repatriation for absences not exceeding 90 days, or longer where approved for study, public service, employment, or unavoidable circumstances. Planned foreign care requires approval based on unavailable domestic capability or demonstrated value and equivalent safety.
(c) A citizen residing permanently abroad does not receive full domestic-resident coverage solely by citizenship. Returning residents shall not face a minimum-duration waiting period. Military and diplomatic deployment coverage is preserved under section 1004.
(a) A State or locality may finance additional coverage, including coverage for excluded immigration categories, with its own funds. Existing separate statutory eligibility shall not be terminated merely because a person fails to qualify under this Act. No AHP matching payment shall finance an additional state-only benefit unless expressly authorized.
(b) Incarceration or detention shall not suspend an otherwise eligible person's coverage. Custodial authorities retain their independent duties to provide constitutionally adequate and statutorily required care to every person in custody. No provision authorizes a reduction to the limited package where those duties require more.
(c) AHP eligibility and clinical information shall not be furnished for civil immigration enforcement, used to locate a patient for such enforcement, or treated as evidence of inadmissibility on public-charge grounds. AHP use shall not trigger sponsor reimbursement. No health official may waive this subsection by agreement. Ordinary judicial process for a particular criminal matter remains subject to section 1603.
(a) A covered person is entitled to medically necessary primary, preventive, specialty, hospital, surgical, anesthesia, emergency, urgent, maternity, newborn, pediatric, geriatric, rehabilitative, habilitative, home-based, palliative, and hospice services; diagnostics, imaging, pathology, laboratory and genetic services; prescription and clinically indicated nonprescription medicines; vaccines, biologics, devices, prostheses, orthoses, and durable equipment; organ and tissue transplantation; dialysis, oncology, rare-disease, infectious-disease, and chronic-condition care; dental, vision, hearing, behavioral-health, reproductive, and long-term services specified in this title; and associated transport, interpretation, care coordination, and disability accommodation.
(b) Benefits include telehealth when clinically suitable, in-person alternatives, school and community clinics, nutrition assessment, medically tailored meals or formula when required by a clinical plan, pain management, rehabilitation after occupational injury, and treatment of congenital or developmental conditions. A person shall not be required to become acutely ill before preventive or maintenance care is covered.
(c) The Secretary may add benefits through evidence-based rulemaking. Neither the Secretary nor a contractor may remove an enumerated benefit category, impose an annual or lifetime dollar ceiling, or impose a utilization limit unrelated to an individualized clinical assessment.
(a) Dental benefits include examinations, cleaning, sealants, fluoride, diagnostic imaging, fillings, periodontal and endodontic treatment, medically necessary crowns, bridges, dentures, implants where a clinically suitable alternative would not restore adequate function, oral and maxillofacial surgery, and orthodontia required for function, congenital conditions, significant pain, or prevention of substantial harm. Appearance alone does not establish medical necessity.
(b) Vision benefits include examinations, refraction, glasses, medically indicated contact lenses, low-vision aids, ocular disease treatment, and surgery. Clinically indicated replacement shall not be denied solely because a fixed replacement interval has not elapsed. Purely elective refractive surgery is excluded unless a less costly clinically suitable correction cannot meet the patient's functional needs.
(c) Hearing benefits include screening, audiology, hearing aids, fittings, batteries and charging equipment, repair, replacement, cochlear and other indicated implants, assistive communication devices, and auditory rehabilitation.
(d) Functionally adequate standard products shall be available without charge. An optional aesthetic upgrade may be purchased only with separate informed consent and without delaying or degrading the covered option. Providers may not relabel an essential feature as an upgrade.
(a) Benefits include contraception; abortion; miscarriage and ectopic-pregnancy treatment; prenatal, delivery, and postpartum care; fertility evaluation and evidence-based assisted reproduction for inability to reproduce without assistance, without discrimination based on marital status, sexual orientation, or gender identity; and medically necessary gender-related treatment under age-appropriate, evidence-based standards and valid consent.
(b) No provision of a federal appropriations law enacted before this Act that restricts funding of abortion or another service expressly covered by this section shall apply to the Trust Fund. AHP funds may be used for such services notwithstanding that restriction.
(c) No State may impose criminal, civil, or licensing liability solely because a qualified provider furnishes an evidence-based service expressly covered by this section to a consenting patient in compliance with federal AHP standards. Neutral professional competence, facility safety, and informed-consent requirements remain applicable unless they materially frustrate that federal authorization. This subsection expressly regulates the furnishing and purchase of covered healthcare, not unrelated state conduct.
(d) No individual clinician shall be compelled to perform a procedure contrary to a sincerely held religious or moral objection. A participating institution shall promptly arrange an available willing clinician or safe transfer, without charge or delay threatening health; emergency screening, truthful information, stabilization, and nondiscriminatory routine care remain required. This Act does not displace the Religious Freedom Restoration Act. The Secretary shall maintain alternative access sufficient to avoid making an individual objection a loss of coverage.
Benefits include assessment, psychotherapy, psychiatry, inpatient and residential treatment, intensive outpatient services, crisis teams, peer support, clinically indicated harm-reduction services, medications for substance-use disorders, and sustained recovery support. Coverage standards shall not be more restrictive than comparable medical standards. Relapse shall not terminate eligibility. AHP financing does not independently authorize involuntary treatment, confinement, restraint, or disclosure of specially protected records.
(a) Benefits include personal assistance, skilled and nonskilled support necessary for activities of daily living, home health, respite, adult day services, accessible equipment, necessary home modifications, and institutional care where chosen and clinically appropriate. Eligibility shall be based on functional need, not impoverishment, asset transfer, or a requirement to exhaust family resources.
(b) Assessment shall be person-centered and performed by a qualified assessor independent of a provider's financial interest. Home and community-based services shall be offered in the most integrated appropriate setting. No enrollment cap or waiting list may replace an individual entitlement. Where the preferred service is temporarily unavailable, the Authority shall fund a safe, acceptable interim arrangement and capacity expansion.
(c) Essential room and board inseparable from institutional clinical care is covered; ordinary housing and general living expenses are not, except authorized respite, medical lodging, or disaster assistance. This distinction shall not justify institutionalization when supported community living is feasible.
(d) Family caregivers may receive training, respite, and compensation for authorized care under a written plan, with conflict safeguards and independent reassessment. A relative shall not be compelled to provide unpaid care. No estate recovery, lien on a primary home, or spousal impoverishment requirement shall apply to AHP benefits.
(a) Emergency coverage shall use a prudent-layperson standard based on presenting symptoms, not a retrospective final diagnosis. Prior authorization, network status, lack of a card, and inability to pay shall not delay screening, stabilization, or transport.
(b) Covered transport includes medically necessary ground, air, and water ambulance; emergency dispatch and treatment without transport; interfacility transfer; medically supported disaster evacuation; and nonemergency transport where disability, clinical condition, distance, or inability to obtain a safe reasonable alternative prevents access. Necessary travel and modest lodging for the patient and a required caregiver shall be paid directly.
(c) Air transport shall be paid where clinically justified by time, terrain, or service availability, not merely because it is more profitable. A good-faith emergency choice shall not produce patient liability if a later payer review disputes mode or destination. Payment disputes shall occur solely between the provider and the Authority.
(a) No person furnishing, arranging, financing, or collecting for a covered service may impose a patient charge, demand a deposit, require a payment card, collect a purported voluntary mandatory donation, or condition access on a membership. This prohibition applies to qualified providers whether or not they have executed a participation agreement.
(b) A prohibited bill is void and unenforceable. A collector shall cease collection and correct credit reporting within 15 days of notice. A provider shall refund an unlawful collection with interest within 30 days. No lien, wage garnishment, credit report, collection suit, or arbitration demand may arise from a covered service.
(c) A provider may charge for an actually noncovered elective service only after disclosing the covered alternative, obtaining separate written consent at least 72 hours in advance unless the patient freely requests a shorter elective interval, and providing a binding written price. Consent obtained during an emergency or as a condition of covered care is invalid. A good-faith coverage dispute shall suspend collection pending appeal.
(d) Tax delinquency, failure to file a return, insurer insolvency, exhausted institutional budgets, or a payment error shall not shift liability to a patient. This section does not cancel a valid debt for care furnished before its applicable coverage date; existing consumer defenses remain intact.
(a) Exclusions are limited to interventions lacking medical necessity, purely aesthetic services, luxury accommodations, knowingly fraudulent services, and products or practices prohibited for safety under applicable federal law. Routine patient costs in ethically reviewed clinical trials are covered. Investigational products may be covered under an evidence-development or compassionate-access protocol consistent with FDA authority.
(b) FDA approval does not alone require unrestricted coverage of every use, and absence of randomized evidence shall not alone exclude a rare-condition treatment. Reviews shall consider the best evidence reasonably available, uncertainty, alternatives, unmet need, and the patient's circumstances.
(c) An individualized exception process shall address intolerance, failure of standard treatment, rare diseases, disability, and clinically material distinctions. A formulary shall not exclude every clinically suitable treatment for a condition.
(d) No quality-adjusted life-year threshold or similar method may value a year of life less solely because a person is disabled, elderly, or chronically ill. Comparative effectiveness may be considered without discriminatory valuation of persons.
(a) From the full-benefit date, the Authority shall arrange emergency care immediately, urgent care within 24 hours, an initial primary-care appointment within seven days, urgent behavioral-health assessment within 24 hours, routine behavioral-health initiation within 14 days, and routine specialty, dental, vision, or hearing assessment within 30 days. A treating clinician's shorter medically necessary deadline shall control. Treatment and surgery shall occur within an individualized clinically safe period, not merely an appointment for evaluation.
(b) A person may voluntarily choose a later appointment with a preferred clinician. Such choice shall be documented and shall not be treated as satisfaction of timely access for system reporting unless an earlier clinically appropriate appointment was genuinely offered.
(c) Upon failure or reasonably foreseeable failure, the Authority shall arrange another qualified provider, a regional clinical team, telehealth when appropriate, or transport and lodging. It shall pay reasonable additional costs needed to obtain timely care and activate capacity funding. A local budget ceiling is not a defense.
(d) The Authority shall operate a continuously staffed access line and resolve urgent access requests within four hours. A court may order arrangement of appropriate care, but no order under this Act shall compel an unwilling individual clinician to provide labor.
(a) Prior authorization is prohibited for emergency or urgent care, primary and preventive care, routine dental, vision and hearing care, maternity care, pediatric screening, continuity medicines, and guideline-concordant treatment designated by the Secretary upon Council recommendation.
(b) For other services, the Secretary may authorize prospective review only by published rule identifying a material safety, misuse, or comparative-effectiveness concern and showing that a less burdensome measure is inadequate. Cost alone shall not justify delaying necessary care. A relevantly qualified clinician, without a financial denial incentive, shall make an adverse clinical determination.
(c) Standard requests shall be resolved within 72 hours and urgent requests within 24 hours or sooner where necessary. Failure to act constitutes provisional approval, except where the requested intervention is prohibited by federal safety law. No artificial-intelligence system may issue a final adverse decision.
(d) Step therapy shall not require a previously failed, contraindicated, or clinically inferior treatment for that patient. Stable patients shall not be switched solely to generate a rebate. High-performing providers shall receive reduced review requirements under audited, revocable safe harbors.
(a) An adverse eligibility, benefit, or access decision shall identify the facts, governing standard, evidence, decisionmaker, available alternatives, and appeal route in plain language and accessible format. The patient and authorized representative shall receive the relevant record without charge.
(b) The patient shall have at least 120 days to request reconsideration. An independent clinical reviewer shall decide within 24 hours for an urgent matter, 72 hours for a time-sensitive matter, and 14 days otherwise. A review shall be independent of the original decision and relevantly specialized. A hearing before an impartial officer shall be available within 30 days of request, or sooner for medical urgency.
(c) Previously authorized ongoing treatment shall continue during a timely appeal unless a qualified independent clinician finds a substantial immediate safety risk. New urgent care shall receive provisional coverage while review is pending. Good-faith provisional payments shall not be recovered from the patient.
(d) The Authority bears the burden, by a preponderance of the evidence, of supporting an adverse determination. A patient shall not be required to obtain legal representation or an expensive privately purchased expert opinion.
(a) No covered entity shall discriminate based on race, color, national origin, religion, sex, pregnancy, sexual orientation, gender identity, age, disability, genetic information, language, income, or an expressly protected immigration category. Eligibility distinctions shall be limited to title II. Reasonable modifications, effective communication, and qualified interpretation are covered obligations.
(b) Informed consent, supported decision-making, advance directives, confidentiality, access to records, and refusal of unwanted treatment shall be protected. AHP participation is not consent to research. Pediatric decisions require lawful consent and age-appropriate assent, subject to emergency and other lawful exceptions.
(c) The Secretary shall adopt risk-adjusted measures for preventable mortality, infection, avoidable complications, maternal outcomes, mental-health outcomes, functional independence, patient experience, workforce safety, and access. Measures shall distinguish patient complexity from provider performance and shall not reward avoidance of high-need patients.
(d) Serious preventable harm shall trigger rapid independent review and corrective assistance. Financial sanctions shall be proportionate and shall not remove essential local services without a funded continuity plan.
(a) A qualified provider may enter a standard participation agreement accepting payment as payment in full, patient rights, quality standards, reasonable reporting, privacy safeguards, and audit. No exclusive insurer network, restrictive referral list, or payment for patient steering shall be permitted.
(b) Existing Medicare, Medicaid, CHIP, federal employee, or state-licensed providers in good standing shall receive provisional recognition from the full-benefit date, subject to safety screening and an opportunity to decline ongoing participation. A qualified provider furnishing covered services without a signed agreement shall be entitled to applicable public payment, subject to verification, and bound by the prohibition on patient charges for those services.
(c) Except for existing emergency and other legal duties, a provider is not compelled to accept new patients. Acceptance decisions shall not unlawfully discriminate. No provider may accept a person for a covered service and then demand private payment to bypass this Act.
(d) Nothing authorizes administrative officials to direct an individual diagnosis, compel a procedure, or punish a reasonable evidence-supported clinical deviation merely because it differs from a guideline.
(a) The Secretary shall establish a national professional fee schedule and optional risk-adjusted prospective primary-care and team-care payments. Rates shall reflect clinical labor, training, complexity, practice expense, geographic cost, malpractice costs, teaching, reasonable independent-practice surplus, and shortage conditions. Quality supplements shall be limited to measures that do not encourage patient selection.
(b) During the first program year, a professional service previously priced by Medicare shall be paid at not less than 125 percent of the pre-enactment Medicare nonsequestered amount, increased to 143.75 percent of that Medicare amount for primary care and behavioral health. A higher amount shall be paid where needed to support section 504 compensation and efficient practice cost. These are temporary payment floors, not estimates of adequate long-term rates.
(c) For dental, hearing, vision, and other services lacking an appropriate Medicare amount, the interim rate shall equal the median actual allowed amount in available public and commercial data for the preceding year, excluding extreme outliers, or documented reasonable cost plus a 10 percent practice margin where reliable data are unavailable. Chargemaster or undiscounted list prices shall not determine payment.
(d) Permanent rates shall begin by program year two after notice and comment and independent actuarial analysis. No uniform percentage reduction may be imposed merely to meet a spending target. Rates shall be adjusted promptly when access, solvency, or workforce data show inadequacy. A provider shall receive reasoned notice and may appeal an individualized rate or classification error.
(a) Hospitals and other designated institutions shall receive prospective global operating budgets separate from approved capital funding. Budgets shall include efficient labor and supply costs, emergency readiness, population need, complex care, teaching, necessary reserves, approved pension obligations, and reasonable financing costs. They shall exclude excess related-party payments, avoidable insurance billing expense, speculative acquisition premiums, and distributions inconsistent with required care.
(b) The interim budget shall be based on audited recent operating expenditures, adjusted for coverage expansion, compensation floors, inflation, debt obligations properly allocable to care, and removal of displaced billing costs. Hospitals shall receive monthly advances before expenditures fall due. Capital costs shall not be recovered both through a grant and an operating rate.
(c) Low-volume rural, frontier, Tribal, obstetric, trauma, burn, pediatric, and safety-net capacity shall receive readiness payments based on the cost of maintaining access rather than on a requirement to generate unnecessary volume.
(d) Unanticipated utilization, epidemics, disaster, or access obligations shall trigger supplementary budget review within 15 days. Patients shall not be refused because a prospective budget was underestimated. Persistent inefficiency may trigger management assistance, oversight, competitive service arrangements, or voluntary acquisition, not abandonment of patients.
(a) A participating employer, and any other employer receiving AHP payment for its employees' clinical services, shall pay each full-time employee principally furnishing covered clinical services at least the following annual cash compensation, excluding benefits and adjusted under section 103: $275,000 for a fully trained physician; $225,000 for a dentist; $150,000 for a physician assistant, advanced-practice registered nurse, or pharmacist; $130,000 for a licensed clinical psychologist; $105,000 for a registered nurse; $90,000 for a physician or dental resident or fellow; and $80,000 for a paramedic. An emergency medical technician shall receive at least $32 per hour, and a direct-care aide or community health worker at least $30 per hour.
(b) The annual floors apply to a normal full-time appointment of not more than 40 hours weekly and are prorated for a genuine part-time appointment. Additional pay for overtime, on-call work, training duty, or premium shifts shall be determined under applicable labor law and a written agreement; no employer may require unpaid additional service to evade the floor. For residents and fellows, the annual floor is the base salary for an accredited training appointment, with a duty-hour and fatigue-protection standard adopted by the Secretary upon Council recommendation; it does not authorize unsafe hours.
(c) For clinical occupations not enumerated, the floor shall be at least the 60th percentile of national cash wages for the occupation in 2024, converted to 2026 dollars and thereafter inflation-adjusted, based on a published federal occupational survey. Where suppressed or unavailable, the Secretary shall establish a comparable floor using a disclosed independent survey and skill comparison. The Secretary shall publish the initial supplemental schedule by day 120.
(d) Specialty, geographic, shortage, training, responsibility, and unusually difficult duty supplements shall preserve competitive compensation above these floors. A floor is not a ceiling. Permanent payment schedules shall be designed to sustain efficient clinicians' compensation at or above the pre-enactment 75th percentile for the relevant specialty, inflation-adjusted, without rewarding unnecessary procedures.
(e) Independent practitioners are entitled to rates sufficient to support these standards for reasonable workloads but are not guaranteed income unrelated to services, availability obligations, or an agreed salary arrangement. A practice may elect a public salaried-service contract. Compensation shall not be reduced solely because reimbursement replaces private insurance, and no clinician has a statutory guarantee of historic monopoly profits or payment for unnecessary care.
(a) The Secretary shall adopt acuity-based minimum staffing and fatigue standards by day 180 with enforceable staffing plans, worker participation, protected reporting, and emergency contingencies. A time-limited staffing variance requires proof of an unavoidable shortage, a funded recruitment plan, and compensating patient safeguards; it shall last no more than 90 days per approval and shall be publicly reviewed.
(b) Compensation-support payments shall be separately identified and passed through to covered workers. Employers shall report payroll compliance and may not divert such payments to executive compensation, dividends, buybacks, related-party fees, or debt incurred for owner distributions. Underpayment shall be remediable as a wage violation under title XVII.
(c) The Act preserves collective bargaining, occupational safety, professional licensure, and stronger state labor protections. Noncompete terms restricting a clinician's future provision of AHP services are unenforceable prospectively; narrowly tailored protection of confidential information and repayment of actual, reasonable training costs remains permissible.
Clean electronic claims shall be paid within 14 days and other complete claims within 30 days. Requests for additional information shall be specific and consolidated. Undisputed portions shall be paid on time. Late payments shall bear the Treasury prompt-payment interest rate. Small and essential providers may obtain provisional payments based on prior activity during system failure. An individualized finding of substantial credible fraud risk may justify holding disputed sums, subject to immediate review and protection for unaffected patient care.
(a) There is established within the Authority the Office of Medical Product Pricing, under an officer appointed and supervised by the Secretary. Acting through that Office, the Secretary shall negotiate and, where agreement is not reached, establish a binding maximum AHP acquisition price for every covered drug, biologic, vaccine, diagnostic, device, implant, supply, and durable medical product. No minimum product age, annual numerical selection limit, noninterference clause, or exemption based on orphan designation shall restrict this authority.
(b) The authority is expressly conferred by Congress and extends to sole-source and patented products. A participation agreement need not require a manufacturer to endorse the government's characterization of a price as fair. Payment terms are legal conditions, not compelled expressions of belief.
(c) Existing lower statutory or contractual net prices shall remain available until replaced by an equal or more favorable lawful arrangement, subject to a documented shortage exception. On the full-benefit date, the provisional ceiling for a product not yet reviewed shall be its verified volume-weighted United States net acquisition price during the preceding 12 months, excluding exceptional noncomparable transactions; an existing lower lawful AHP acquisition price controls. For a new product without transaction history, the Secretary shall determine a provisional cost-and-value ceiling before the first ordinary purchase, subject to urgent bridge purchasing under section 603. AHP shall not pay list price where a lower lawful net price is available.
(a) The Secretary shall consider demonstrated therapeutic benefit; alternative treatments; efficient manufacturing, distribution, and necessary research costs; public research contributions; unmet need; reasonable risk-adjusted return; international net prices where reliable; volume; and continuity of supply. Marketing expenditure, share repurchases, unsupported transfer prices, and acquisition premiums do not establish clinical value.
(b) The Secretary shall publish a proposed product or product-class ceiling, a nonconfidential methodology, and the principal evidence. A manufacturer shall have 30 days to submit data and a counterproposal. Negotiation shall conclude within 60 days thereafter, followed within 15 days by a reasoned final determination. Expedited temporary determinations may be made for shortages, emergencies, or excessive launch prices, with post-decision review.
(c) The ceiling shall ordinarily not exceed the lower of the existing AHP-equivalent net acquisition price and a clinically adjusted median net price from at least five comparable high-income national systems, where reliable comparable data exist. The Secretary may adopt a higher ceiling only upon published findings that the ordinary benchmark would materially threaten supply, fail to recognize substantial additional clinical benefit, or omit efficient cost and a reasonable return. If comparative data do not exist, cost, value, and reasonable-return analysis shall control.
(d) Maximum prices shall be reviewed annually and upon important new safety, value, or supply evidence. A manufacturer may seek administrative reconsideration within 30 days and judicial review of final action under title XVII. Confidential cost data shall be protected, but secrecy shall not conceal the payable price or governing method.
(a) A manufacturer is not compelled to manufacture indefinitely or to convey title to its facilities. Withdrawal from AHP supply shall require 180 days' notice, except for a verified safety emergency or impossibility, and fulfillment of valid supply obligations. Anticompetitive coordinated withdrawal remains subject to antitrust law.
(b) If needed supply is unavailable at the ceiling, the Secretary shall arrange alternatives, qualified imports, negotiated licenses, advance purchase commitments, or public or nonprofit manufacturing. Essential treatment shall not be suspended as leverage in a pricing dispute; temporary bridge purchasing may exceed a ceiling upon published necessity findings and later recovery where legally available.
(c) The Secretary may expressly authorize use or manufacture by or for the United States under 28 U.S.C. 1498. Procurement and dispensing to AHP beneficiaries pursuant to such authorization shall constitute government use for this purpose. Patent owners retain their claim for reasonable and entire compensation in the United States Court of Federal Claims. A price determination does not invalidate a patent.
(d) Notwithstanding statutory data or marketing exclusivity under the Federal Food, Drug, and Cosmetic Act or section 351 of the Public Health Service Act, FDA may permit a qualified government-authorized supplier to rely on lawfully held regulatory data where necessary to remedy a certified essential-product access failure. FDA shall maintain safety, efficacy, manufacturing, and pharmacovigilance requirements. This authority does not compel disclosure of privately held manufacturing know-how; any required acquisition of protected property shall occur by consent or separately lawful compensated process.
(a) A pharmacy benefit manager or purchasing intermediary acting for AHP shall be a fiduciary to the Trust Fund, receive only a disclosed fixed fee, and remit all discounts, rebates, and price concessions to the Fund or point of purchase. Spread pricing, rebate retention, pay-to-prefer formulary placement, affiliate steering, and compensation linked to list price are prohibited.
(b) Pharmacies shall receive acquisition cost plus a transparent dispensing and clinical-service fee adequate for efficient operation. Rural and independent pharmacies shall receive readiness supplements where required for access. Retroactive undisclosed fees and below-cost reimbursement are prohibited.
(c) Product sellers shall report net transaction prices, shortages, manufacturing capacity, material public research support, and relevant related-party payments under protected reporting rules. Knowingly false reports and sales exceeding a binding ceiling are subject to title XVII.
The Secretary shall maintain diversified domestic and allied supply for essential products, fund qualified public or nonprofit manufacturing when markets fail, and use competitive milestone prizes and research grants where they offer better value than prolonged monopoly payment. Procurement shall avoid dependence on a single facility. No product shall be preferred merely because it is newer; adoption shall depend on safety, benefit, reliability, and lifecycle value. Medical repair and maintenance information necessary for safe authorized servicing shall be available on reasonable terms, subject to cybersecurity and intellectual-property protections.
(a) There is established in the Treasury the American Health Trust Fund. Amounts credited to the Fund shall be available without fiscal-year limitation for all obligations under this Act.
(b) There are permanently appropriated, from money in the Treasury not otherwise appropriated, such sums as are necessary to discharge those obligations in full and when due, including benefits, provider payments, grants, infrastructure, worker adjustment, administration, tax collection, adjudication, oversight, and essential operations of participating federal agencies attributable to this Act. These appropriations do not depend upon an annual authorization, allocation, or discretionary appropriation.
(c) Dedicated taxes, accepted state contributions, lawful transfers, and actual recoveries shall be credited to the Fund. The Treasury Secretary shall credit the remaining amount necessary each month and more frequently when required for timely payment. A forecast, actuarial estimate, administrative spending target, or exhaustion of a subaccount shall not limit an individual's entitlement.
(a) For each program year, the Chief Actuary shall determine net program expenditure, designated C; valid state contributions actually received and applied to that expenditure under title IX, designated S; and the solidarity allocation under subsection (b), designated Q. The ordinary federal contribution, designated F, shall equal C minus S minus Q. S shall not exceed 22 percent of C; Q shall not exceed 3 percent of C; and F shall not be less than 75 percent of C.
(b) Receipts from sections 801 through 803, including available accumulated receipts, shall finance Q up to 3 percent of C. Receipts beyond that allocation shall remain in a solidarity reserve for subsequent allocations and Fund liquidity. The tax liability of any taxpayer shall not be capped because the 3 percent allocation has been reached. Insufficient solidarity receipts shall increase F rather than reduce benefits or authorize a tax-rate increase by regulation.
(c) The ordinary federal contribution shall consist of lawfully redirected federal health funding, employer and corporate revenues under sections 804 and 805, other federal receipts assigned to the Fund, and the general-revenue balance appropriated under section 701. The solidarity allocation is itself federal tax financing; it is accounted for separately to express the 75-22-3 financing design, not to conceal that aggregate federal financing is at least 78 percent when the state share equals 22 percent.
(d) Federal-only expenditures under title IX and state nonparticipation may increase the federal share above those percentages. State contributions, federal transfers, tax receipts, and expenditure recoveries shall be separately reported. An internal transfer is not new national revenue. An administrative or procurement saving is a reduction in expenditure, not a second cash receipt.
(a) On the full-benefit date, federal amounts that would otherwise finance a benefit displaced under title X shall instead finance that benefit through the Fund. The transfer shall be based on the legally applicable appropriation or tax receipt and an allocation approved by the Chief Actuary. The Secretary shall maintain a public crosswalk showing the original account, displaced benefit, transfer, remaining obligation, and avoidance of duplicate payment.
(b) Medicare payroll taxes and other existing dedicated health taxes shall continue unless expressly changed by this Act. Social Security retirement and disability trust funds shall not be transferred or used. Medicare trust-fund assets may be transferred only after provision for outstanding liabilities, prior-period claims, and obligations not assumed by AHP. Neither the same asset nor its subsequent expenditure shall be counted twice.
(c) Amounts legally necessary for residual Medicaid, CHIP, veterans, military, Indian health, or other preserved obligations shall remain available. A transfer shall not extinguish an accrued claim, earned employee benefit, valid debt, or protected treaty obligation.
(a) The Treasury Secretary shall maintain liquidity equal to at least 90 days of forecast program payments, replenished through section 701. Establishment of a reserve is an internal financing transaction and shall not be scored as delivery of a medical service. The Fund may invest temporary balances in obligations of the United States.
(b) Budget authority, outlays, and accounts established under this Act are exempt from sequestration under the Balanced Budget and Emergency Deficit Control Act of 1985, including sections 251A and 256, and the Statutory Pay-As-You-Go Act of 2010. They shall be treated as exempt programs under section 255 of the former Act, codified at 2 U.S.C. 905. Budgetary effects of this Act shall not be entered on the statutory PAYGO scorecards. These exemptions do not constitute a finding that the Act is deficit neutral.
(c) Apportionment may establish payment schedules but shall not reserve or withhold funds to reduce an entitlement or achieve an unlegislated policy change. The President, Secretary, Treasury Secretary, and Director of the Office of Management and Budget shall not impound, defer, or rescind Fund obligations except pursuant to a later Act of Congress or a lawful individualized program-integrity determination.
(d) During a lapse in annual appropriations, all operations necessary to administer, pay, enforce, and adjudicate benefits under this Act shall continue using section 701(b). Employee compensation for such operations is included in the permanent appropriation.
(e) Nothing in this Act restricts the constitutional legislative authority of a subsequent Congress or represents a guarantee against a sovereign default. A proposal to amend its financing or benefits shall not have legal effect before enactment.
The Chief Actuary shall publish quarterly cash-flow statements and annual 1-, 5-, 10-, and 30-year expenditure and revenue scenarios, separating nominal and constant dollars, actual receipts and assumptions, and federal-budget effects and total national health spending. A projected imbalance shall trigger recommendations within 60 days, not automatic benefit, provider-compensation, or coverage reductions. Verified net savings shall remain in the Fund and support care, compensation, facilities, workforce, science, reserves, and lower future financing requirements. Congress shall retain authority over tax rates and eligibility.
(a) In addition to other federal taxes, each individual subject to federal income taxation shall pay an annual Health Solidarity Contribution on the health income base defined in section 803. For an unmarried individual other than a head of household, the marginal rates are: zero on the first $75,000; 1 percent on the portion exceeding $75,000 through $150,000; 2 percent on the portion exceeding $150,000 through $400,000; 3 percent on the portion exceeding $400,000 through $1,000,000; 4 percent on the portion exceeding $1,000,000 through $10,000,000; and 5 percent on the portion exceeding $10,000,000.
(b) Thresholds in subsection (a) shall be doubled for a joint return or qualifying surviving spouse, multiplied by 1.5 for a head of household, and equal to the unmarried thresholds for married persons filing separately. Filing status shall be determined under the Internal Revenue Code of 1986. Thresholds shall be inflation-adjusted. Each rate applies only to income within its bracket. There is no maximum taxable income or maximum dollar contribution.
(c) This tax shall not be reduced by personal itemized deductions, the qualified business income deduction, preferential capital-gain rates, or credits against another tax, except a credit expressly allowed by this title or required by an applicable tax treaty. A payment under this section is not a premium and does not determine eligibility.
(a) An additional marginal surtax shall apply to the health income base: 2 percent on the portion exceeding $100,000,000 through $250,000,000; 4 percent on the portion exceeding $250,000,000 through $500,000,000; and 6 percent on the portion exceeding $500,000,000. These rates are added to, and do not replace, section 801. There is no upper limit on income subject to the surtax or revenue collected.
(b) The thresholds apply per return, including a joint return, and shall be halved for married persons filing separately. They shall be inflation-adjusted. Grantor income and income assigned to a controlled nominee shall be attributed to the beneficial taxpayer; the same income shall not be taxed twice under this title.
(a) The health income base is adjusted gross income under section 62 of the Internal Revenue Code of 1986, increased by income excluded under section 911 and interest on obligations issued after enactment that would otherwise be excluded under section 103, and reduced by Social Security benefits included under section 86 and deductions required to prevent duplicate inclusion of the same income. Interest on an obligation outstanding on enactment shall not be added solely by reason of this section.
(b) The base includes taxable compensation, net business and pass-through income, interest, dividends, net realized capital gains, royalties, rents, and taxable retirement distributions. Losses shall be recognized to the extent genuinely allowable under the Code, subject to existing basis, at-risk, related-party, and economic-substance limitations. This Act does not tax unrealized appreciation or net wealth and does not authorize the Treasury Secretary to impose mark-to-market taxation by regulation.
(c) A nongrantor trust or estate shall pay 5 percent on its undistributed health income base exceeding $10,000, together with the surtax under section 802 where applicable. Distributable net income included in a beneficiary's base shall be deducted once from the trust's base. Grantor trusts shall be disregarded consistently with the Code. Trusts with substantially identical grantors, beneficiaries, and avoidance purposes shall be aggregated, with notice and ordinary tax appeal rights.
(d) The Treasury Secretary shall implement these express rules against sham assignments, artificial losses, related-party deferral lacking substantial business purpose, disguised compensation, and fragmentation of controlled entities. Regulations may specify reporting and attribution within this statutory base but may not create a tax on loan principal from a bona fide loan, invent additional brackets, or treat ownership alone as realized income.
(a) Each employer shall pay an annual contribution on aggregate compensation constituting Medicare wages, without a wage ceiling. The marginal rates are zero on the first $2,000,000 of payroll, 4 percent on payroll exceeding $2,000,000 through $10,000,000, and 8 percent on payroll exceeding $10,000,000. Thresholds shall be inflation-adjusted. Controlled-group employers shall share one set of brackets.
(b) Net earnings from self-employment shall be included in the business contribution base, applying the same thresholds once to the person's controlled trade or business. Income classified as compensation solely to avoid contributions, or as contractor payments where the recipient is in substance an employee, shall be treated according to its economic substance and applicable employment law. Ordinary independent vendors shall not be converted into employees by this section.
(c) Public employers are subject to this section on the same terms. Intergovernmental payments shall be identified separately in fiscal reports and shall not be represented as new economy-wide resources. Contributions shall be deductible as ordinary business costs where otherwise permitted, but not creditable against the employee's section 801 liability. No employer shall condition AHP access on payment of the contribution or deduct the employer contribution from an employee's wages as a purported employee tax.
A corporation subject to federal corporate income tax shall pay an additional marginal contribution on corporate taxable income: zero on the first $10,000,000; 1 percent on the portion exceeding $10,000,000 through $100,000,000; 2 percent on the portion exceeding $100,000,000 through $1,000,000,000; and 3 percent on the portion exceeding $1,000,000,000. Thresholds shall be inflation-adjusted. Consolidated and controlled groups shall share thresholds, and ordinary rules governing United States taxable income, losses, foreign income, and related-party pricing shall apply. A pass-through entity shall not become a corporation solely under this section; its owners remain subject to sections 801 through 803 on attributed income.
(a) The Treasury Secretary shall assess and collect sections 801 through 803 and 805 in the same manner as taxes imposed by chapter 1 of the Internal Revenue Code, with ordinary return, deficiency, refund, interest, penalty, Tax Court, and judicial-review procedures. Section 804 shall be administered as an employer employment-tax contribution, with quarterly deposits and annual reconciliation. Existing withholding systems shall be adapted; employees may adjust withholding without losing benefits.
(b) Taxes under this title first apply on the full-benefit date. For a taxable year containing that date, individual and corporate annual tax computed under this title shall be multiplied by the proportion of days in the taxable year on or after that date. Employer contributions shall apply to compensation paid on or after that date, with annual bracket thresholds prorated for the applicable period. There shall be no liability under this title for earlier taxable years or earlier portions of the transition year.
(c) The Treasury Secretary shall publish withholding tables and compliance guidance not later than 120 days after enactment. No underpayment penalty attributable solely to unavailable government guidance shall apply during the first six months of collection if the taxpayer files accurately and pays by the ordinary return due date.
(d) There are permanently appropriated $5,000,000,000 for each of the first five program years and $3,000,000,000 annually thereafter for administration and enforcement of this title, inflation-adjusted and included in net program expenditure. Information security, taxpayer assistance, and audits of high-income and controlled-entity avoidance shall receive priority. Tax-rate changes require an Act of Congress.
(a) Not later than 45 days after enactment, the Secretary shall offer each State a compact for cooperative administration and financing. Acceptance shall be authorized under state law and state expressly the contribution formula, duties, reporting, dispute procedure, and withdrawal terms. No State shall be compelled to accept or enact a tax.
(b) An accepting State shall contribute 22 percent of its allocable net program expenditure, except as reduced under this title. Individual clinical costs shall be attributed to ordinary residence, not the location of treatment. Shared national operating costs shall be allocated by resident eligible population; regional capital costs by the documented population served. Federal-only costs under section 903 shall not be allocated to a State. The methodology shall be published before acceptance and applied consistently, with actuarial audit.
(c) The State shall remit estimated quarterly amounts, subject to annual reconciliation within 90 days after audited expenditure is determined. A credit shall be allowed only for state-origin money actually transferred or an expenditure expressly assumed on behalf of the Fund and independently verified. Federal grants, accounting entries, expected savings, and the same dollar previously credited elsewhere shall not satisfy the state contribution.
(a) In a nonparticipating State, the Authority shall directly administer and finance benefits. Residents shall receive identical federal eligibility, benefits, financial protections, and access rights. No special federal tax shall be imposed on a State's residents because their government declines a compact. Unrelated federal assistance shall not be withdrawn as leverage.
(b) An accepted compact is enforceable by the United States. Before collection proceedings, the Secretary shall provide a statement of arrears, 60 days to cure, and administrative review. The United States may seek payment in federal district court. Offset shall be limited to administrative payments owed under the same compact and shall not interrupt patient or provider payments. The Authority shall advance necessary funds during a dispute.
(c) A State may withdraw prospectively on 365 days' notice and satisfaction of accrued obligations. Federal administration shall begin without a coverage gap. Withdrawal shall not accelerate obligations for periods after its effective date.
(d) If a State's trailing six-month average unemployment rate exceeds its preceding three-year average by at least 1.5 percentage points, its contribution rate shall be 17 percent for the following 12 months, renewable while that condition persists. The federal contribution shall replace the difference. Disaster-specific costs and additional relief expressly authorized by law shall not be charged against that State. No patient charge may be imposed to make up the difference.
(a) Transition-period expenditure; limited-benefit services under section 204; national disaster and environmental-response expenditure under title XV; federally obligated Indian health services; and costs attributable to territories shall be federally financed without a state contribution. Such amounts remain part of national net program expenditure and therefore may increase the aggregate federal share.
(b) Territorial residents shall receive the same benefit package and financial protections as other eligible residents. Territorial governments may accept administrative agreements without assuming the 22 percent state contribution. Existing territorial Medicaid limitations shall not limit AHP benefits or payment.
(c) The Secretary shall consult and, where authorized, compact directly with Tribal governments. Indian Health Service, Tribal, and urban Indian facilities shall retain their specialized missions and treaty-related obligations. No Tribal government shall be required to waive sovereign immunity, cede ownership, or assume a state contribution. AHP shall supplement and coordinate with, rather than silently replace, separately preserved obligations.
A State may finance additional benefits and eligibility classes with its own funds, including comprehensive care for persons receiving only limited federal benefits. A compact may assign ministerial enrollment, provider assistance, public-health coordination, and quality functions to a State, but final national benefit standards, financing responsibility, and federal appeal rights shall remain with the Authority. State privacy and patient protections more protective than the federal minimum shall remain effective unless they prevent a federally guaranteed service or payment.
(a) Beginning on the full-benefit date, no insurer, employer plan, self-funded plan, association, or other entity shall issue, renew, or perform a contract that insures a covered person as primary or substitute coverage for a covered AHP service. A contract shall not purchase preferential access to the public payment stream or require private payment for a covered service.
(b) This prohibition does not apply to insurance for persons ineligible for full AHP benefits to the extent their services are not federally covered; genuinely noncovered cosmetic or accommodation benefits; lawful foreign-travel benefits; income-replacement disability insurance; life insurance; professional liability insurance; or nonmedical indemnity under workers' compensation and automobile coverage. A supplemental product shall clearly identify its exclusions and shall not be marketed as necessary to obtain AHP benefits.
(c) The Act specifically relates to the business of insurance for purposes of the McCarran-Ferguson Act. It applies to self-funded and insured employee health plans notwithstanding conflicting provisions of the Employee Retirement Income Security Act of 1974. Pension, retirement, life, disability, collective-bargaining, and other nonduplicative earned rights remain protected.
(a) An existing primary insurance contract shall cease prospective duplicative coverage when the person's AHP coverage begins. The issuer shall refund unearned premiums within 30 days and remain liable for services incurred before that date, appeals, rebates, and other accrued obligations. Automatic conversion into a paid supplemental product without affirmative consent is prohibited.
(b) Reserves, plan assets, and trust assets shall first satisfy lawful obligations to beneficiaries, providers, workers, pension arrangements, and other creditors according to applicable priorities. This Act does not confiscate insurer property or authorize distributions that evade outstanding obligations. State insurance receivership and insolvency safeguards remain applicable unless inconsistent with an express federal patient protection.
(c) Insurers and administrators shall provide secure, necessary enrollment, claims, and continuity-of-care information for transition. Government acquisition of proprietary software or other property beyond existing contractual and legal disclosure obligations shall be by license, purchase, or separately authorized lawful compensated process.
(a) On the full-benefit date, AHP shall assume covered healthcare obligations for eligible Medicare beneficiaries under Parts A, B, C, and D; Medicaid and CHIP beneficiaries; recipients of displaced federal marketplace subsidies; and federal employees and annuitants receiving duplicative federal employer coverage. A person shall not be required to enroll in a private plan to receive an assumed benefit.
(b) Medicare premiums, premium deductions, and AHP-duplicative federal employee contributions shall cease prospectively upon assumption. Medicare disability determinations, Social Security cash benefits, and benefits not assumed by AHP shall continue. Prior-period claims and appeals shall remain payable through an identified runout administrator, without extinguishing accrued rights.
(c) Medicaid and CHIP financing and eligibility shall continue for persons or services not assumed by AHP. Nonmedical disability supports, housing assistance, and other benefits shall not be repealed merely because healthcare is consolidated. Where two programs could pay for the same service, AHP shall pay first and agencies shall reconcile without billing the patient.
(d) Prospective premium tax credits under section 36B of the Internal Revenue Code shall cease for months in which full AHP entitlement replaces marketplace insurance. Treasury shall notify issuers and taxpayers; an agency's delayed termination or erroneous payment shall not create recapture liability for a beneficiary who furnished accurate information. Other tax credits are unaffected.
Veterans Health Administration, military, Indian Health Service, Tribal, public-health, and correctional facilities may continue delivering care and specialized services. Existing eligibility and earned rights shall not be narrowed. AHP shall permit independent access to participating community providers for covered residents. Interagency agreements shall identify which appropriation pays each service, preserve mission-specific operating budgets, and prevent duplicate reimbursement. This Act does not convert military operational medicine, veterans disability compensation, or treaty obligations into ordinary insurance benefits.
Employers shall give workers a plain-language statement of discontinued premium deductions, new employer contributions, retained supplemental benefits, and changes in compensation arrangements. Employee premium deductions for displaced coverage shall cease immediately upon AHP entitlement. Plan assets shall remain subject to fiduciary duties, collective-bargaining obligations, and lawful vesting rules; they shall not become employer profits by mere administrative declaration. Employers shall bargain over compensatory adjustments where labor law or an agreement requires bargaining. This Act does not assume that every dollar of employer insurance savings automatically becomes wages.
AHP shall furnish necessary care without awaiting a workers' compensation, automobile, tort, or other liability determination. The United States may recover from a legally responsible payer for the same medical expenditure, subject to applicable liability findings and settlement allocation. Recovery shall not consume compensation specifically awarded for pain, lost wages, or nonmedical loss, impose a charge on the patient, or collect twice for the same service. Workers' compensation income replacement, rehabilitation rights beyond AHP, and lawful tort remedies remain in force.
(a) The Authority shall establish one national eligibility inquiry, provider identifier, core claim format, payment explanation, credentialing application, clinical-exception process, and appeal gateway. Necessary specialty data may supplement but not duplicate those standards. A provider shall not complete a different administrative process for each patient employer, former insurer, or State.
(b) Existing usable electronic records and clearinghouses shall be connected through secure interoperable interfaces rather than replaced as a condition of day-180 payment. Paper, telephone, accessible, and assisted channels shall remain available. Clinical documentation required for safety shall not be abolished merely because insurer-specific billing documentation is eliminated.
(c) The Authority shall publish administrative-cost accounts and pursue a national payer-administration target of not more than 3 percent of expenditure beginning in program year three. This target is not a statutory ceiling on cybersecurity, appeals, fraud prevention, patient assistance, or necessary staffing and shall not be used to deny a benefit. Provider administrative expenses shall be reported separately to prevent denominator manipulation.
(a) The Authority may purchase ministerial processing, support, technology, and integrity services through fixed-fee or cost-controlled contracts. A contractor shall have no insurance-risk interest in denying care, no final authority over benefit law, and no right to retain an overpayment or denial-based bonus. Federal officials remain accountable for decisions.
(b) Within 90 days after enactment, OMB and affected agencies shall inventory displaced health contracts and identify consolidation, renegotiation, lawful termination, or conversion opportunities. Each action shall preserve accrued contractual rights, required termination compensation, and continuity of care. The Government shall not declare a valid contract void solely to manufacture savings.
(c) Savings shall be reported net of termination, migration, litigation, and replacement costs. Legacy processing contracts used for launch may operate for up to 24 months after the full-benefit date, with open-book costing, conflict controls, and a public exit plan. This does not extend private primary insurance, premiums, or denial authority beyond the full-benefit date.
(a) A participating entity shall disclose every beneficial owner holding at least 25 percent and every person exercising material control, together with related-party leases, management agreements, debt, and supply arrangements. Artificial splitting shall not avoid disclosure. Information necessary to assess conflicts and public payment shall be public; personal security information shall be protected.
(b) Public payment shall not include an excessive related-party management fee, rent, acquisition premium, dividend, or debt service incurred primarily to extract public funds. Efficient legitimate financing and facility costs remain payable. Comparable services shall receive comparable payment unless verified acuity, readiness, teaching, geographic, or facility costs justify a difference. A change in ownership alone shall not justify a facility fee.
(c) The Secretary shall refer suspected anticompetitive consolidation, self-preferencing, exclusionary contracting, or collusive withdrawal to the Department of Justice and Federal Trade Commission. Remedies affecting ownership shall follow applicable antitrust process and judicial review, not an unreviewable administrative order to eliminate a named company.
Major purchases shall use competitive procedures, published evaluation standards, lifecycle costing, beneficial-ownership disclosure, conflict screening, and enforceable performance milestones. Emergency sole-source awards require written necessity findings, price reasonableness review, and publication within 30 days except for protected security details. Applicable domestic procurement, labor, environmental, and small-business laws shall remain effective. Vendor lock-in, unnecessary exclusive data rights, and proprietary interfaces that obstruct lawful continuity shall be disfavored and justified in writing when unavoidable.
(a) A dedicated Facilities and Technology Account is established within the Fund. There are permanently appropriated to that account $200,000,000,000 for each of the first five program years and, annually thereafter, the greater of $100,000,000,000, inflation-adjusted, or 2 percent of the preceding year's clinical operating expenditure. Additional sums necessary to satisfy a specific access obligation may be provided under section 701 upon a published needs determination.
(b) These are minimum available investment amounts, not commands to finance unnecessary projects. Unobligated sums remain available. Expenditure shall be counted once within net program expenditure, not added again as a separate financing requirement after inclusion in an operating forecast.
(c) Of each year's planned commitments, 40 percent shall support renovation, resilience, and replacement of obsolete equipment; 35 percent new or substantially expanded facilities; 15 percent clinical technology, interoperability, and cybersecurity; and 10 percent emergency transport, mobile capacity, and community delivery. Across those categories, at least 40 percent shall serve rural, frontier, Tribal, or otherwise medically underserved communities. A geographic designation shall not be counted as a second expenditure. After public notice and 180 days without qualified demand in a functional category, the Secretary may reallocate within the account based on verified need while maintaining the geographic minimum.
(a) Within 120 days after enactment, the Secretary shall publish a national needs map addressing travel time, service shortages, facility condition, disaster exposure, disability access, maternal care, behavioral health, dental, vision, hearing, laboratory, pharmacy, and specialty capacity. The map shall be updated annually with local and Tribal consultation.
(b) Each project shall include a clinical needs assessment, alternatives analysis, staffing plan, training partnerships, lifecycle cost, environmental and safety review, accessibility plan, and a funded operating commitment. Construction shall not be approved merely because a building can be completed; staffing and sustainable service delivery must be demonstrated.
(c) Priority shall be given to communities facing closure of essential facilities, excessive transport times, preventable mortality, shortages of maternity and emergency services, environmental injury, or persistent lack of specialty access. Applications shall be decided within 120 days after completeness. Initial grant awards shall begin by the full-benefit date.
(a) The Secretary may provide grants covering 80 to 100 percent of eligible costs to public, Tribal, nonprofit, and cooperative entities, with no match required where a match would prevent a necessary project. A for-profit recipient may receive a secured loan or a grant only with an enforceable public-use covenant, independent cost review, and protection against diversion to distributions or inflated related-party payments.
(b) A capital recipient shall maintain the financed public healthcare use for 30 years or the asset's useful life, whichever is shorter. Sale, closure, conversion, or diversion shall require approval and proportionate repayment of the unexpired public investment, except where continued use is infeasible and an equivalent access-preserving substitute is funded. The United States shall hold a recorded security interest where appropriate.
(c) The Authority may voluntarily acquire, construct, lease, or directly operate a facility where no qualified local entity can meet an essential need. Acquisition shall not dispense with just compensation, applicable land-use procedures, environmental review, or labor standards. Temporary clinics, mobile surgical units, telehealth-supported local teams, and transport arrangements shall provide interim capacity while permanent facilities are built.
An essential rural or underserved facility shall receive a prospective readiness payment sufficient for efficient minimum staffing and emergency availability, separate from volume-based reimbursement. Approved new facilities shall receive a ten-year renewable operating commitment subject to quality and continuing need, not year-to-year discretionary grant competition. Obstetric, psychiatric, dental, pharmacy, rehabilitation, and transport services shall qualify for equivalent support where indispensable to access. Closure shall require 180 days' notice where practicable, an access-impact assessment, and a funded continuity plan.
Funded facilities shall meet applicable infection-control, accessibility, seismic, fire, water, ventilation, and climate-resilience standards. Hospitals providing emergency or life-sustaining inpatient services shall maintain protected backup power, potable water, communications, and essential supplies adequate for at least 96 hours, unless a stricter risk-based standard applies. New technology shall be clinically validated, maintainable, interoperable, secure, and cost-effective over its lifecycle. Procurement shall include staff training and maintenance rather than equipment acquisition alone. No provision exempts a project from otherwise applicable environmental or prevailing-wage law.
There are permanently appropriated $60,000,000,000 for each of the first five program years and $40,000,000,000 annually thereafter, inflation-adjusted, for accredited education, clinical placements, faculty, apprenticeships, scholarships, stipends, and loan repayment. The Secretary shall fund physicians, dentists, nurses, behavioral-health professionals, pharmacists, emergency personnel, allied health workers, direct-care workers, interpreters, public-health workers, biomedical scientists, and health technology specialists according to independently assessed need. Funding shall supplement, not substitute for, provider compensation under title V.
(a) The Secretary shall fund at least 10,000 additional first-year residency positions in each of the first five entering classes after the full-benefit date, above the positions funded before enactment, and continue funding each admitted trainee through the accredited training term. Each successive entering class shall retain positions created for prior classes, producing at least 50,000 additional annual entry positions by the fifth entering class, subject to accreditation and safe training capacity.
(b) Where sufficient accredited positions cannot immediately be opened, the funding obligation shall remain available, the Secretary shall publish the constraint and a six-month corrective plan, and scholarship and faculty development funds shall address that constraint. No numerical requirement authorizes an unaccredited residency or unsupervised practice.
(c) At least half of new funded entry positions shall address primary care, psychiatry, obstetrics, pediatrics, or demonstrated rural and underserved specialty shortages. Nursing, dentistry, and allied-health training expansion shall include paid supervised clinical placements, instructors, simulation facilities, and retention support.
(a) A scholarship may cover reasonable tuition, required fees, equipment, and living costs. A recipient accepting a service obligation shall perform one year of qualifying service for each subsidized academic year, with a minimum of two and maximum of five service years. Qualifying service includes public, Tribal, rural, underserved, or other designated shortage practice, with compensation meeting title V.
(b) Loan repayment may be provided up to $50,000 per service year and $250,000 in total, inflation-adjusted. Awards shall be transparent and need-based. Existing debt relief shall not be recaptured solely because the national financing system changes.
(c) A recipient who voluntarily breaches a service agreement shall repay only the proportionate unserved assistance and reasonable interest, not a punitive multiple. Disability, caregiving hardship, unsafe placement, and failure by the government to provide a qualifying opportunity shall justify modification or waiver. Notice, hearing, and judicial review shall be available.
The Secretary shall finance retention, flexible scheduling, childcare access, mental-health support, and safe staffing; assist lawful recognition of verified equivalent foreign training; and establish transparent federal participation credentials consistent with patient safety. Immigration status shall not be altered by a training grant. Expedited licensing cooperation shall not authorize unqualified practice or displace legitimate state disciplinary findings. Displaced administrative workers may enter clinical pathways only after completing the same accredited training and competency requirements as other entrants.
(a) There are permanently appropriated $40,000,000,000 annually, inflation-adjusted, for additional peer-reviewed research, advanced development, clinical trials, public-interest manufacturing research, prevention science, and deployment evaluation. The Secretary shall coordinate this account with NIH, ARPA-H, CDC, FDA, and other scientific agencies. Funds under this section are independently available and shall not depend upon discretionary appropriations to those agencies.
(b) Grants shall be selected through qualified peer review, conflict-of-interest disclosure, reproducibility standards, ethical review, and transparent scientific criteria. Political disagreement with a lawful research question or result shall not justify retaliation, falsification, suppression, or withdrawal of an awarded grant outside lawful grant procedures.
(c) Awards shall support basic as well as applied research, including rare disease, aging, disability, cancer, mental health, infectious disease, reproductive health, environmental health, pain, rehabilitation, and health services delivery. Investigators shall not be required to predict an immediate commercial return for scientifically valuable basic research.
(d) Peer-reviewed articles reporting research financed under this section shall be deposited in an appropriate public repository and made publicly accessible without an embargo not later than the date of publication. Award terms shall secure the necessary nonexclusive rights before acceptance; this requirement does not compel disclosure of protected patient information. Data sharing shall protect consent, privacy, security, and legitimate intellectual property. Award terms shall preserve appropriate government licenses and reasonable public-access conditions on resulting products, stated before acceptance. Neither expert recommendations nor research awards shall confer authority to practice medicine, market an unapproved product, or bypass patient consent.
(a) The Secretary of Labor shall administer the Health Transition Worker Program for an employee or substantially dependent contractor who loses employment or at least 30 percent of usual paid hours or earnings substantially because of this Act. Covered industries include health insurance, insurance sales, billing, claims, prior authorization, medical collections, pharmacy benefit management, and administrative vendors. Eligibility shall not depend on educational attainment or membership in a particular union.
(b) An individual or employer may petition for certification. Labor shall decide a complete petition within 30 days and permit independent administrative appeal within 30 days after denial. Where an establishment closes or materially restructures because of the Act, affected workers shall be presumptively eligible unless contrary evidence is established. Executives receiving contractual separation compensation exceeding two years of prior earnings shall not receive income or wage insurance until that period expires.
(c) Eligible displacements must occur between enactment and the end of program year five. A claim shall be filed within one year of displacement, with good-cause extension. Entitlements arising from a timely claim shall continue for their full statutory term even after the application period closes.
(a) An eligible unemployed worker shall receive income support equal to 90 percent of average prior earnings during the preceding 52 paid weeks, capped at $100,000 annually, for up to 12 months; thereafter, 80 percent subject to the same cap for up to 12 additional months. The benefit shall be reduced by unemployment benefits and current earnings attributable to the same period, but not below zero. Caps shall be inflation-adjusted.
(b) An eligible worker reemployed at lower pay may instead receive 70 percent of the difference between prior and current annualized earnings, capped at $25,000 annually, for up to 36 months. The same week shall not generate both income support and wage insurance. Statutory severance, vested pensions, and earned leave remain enforceable and shall not be surrendered as a condition of assistance.
(c) Reasonable job-search and training participation may be required, with exceptions for approved training, disability, caregiving, and lack of available suitable work. A worker shall not be required to accept unsafe work or surrender collective-bargaining rights. AHP coverage is independent of compliance with this section.
Labor and the Authority shall provide individual skills assessments; tuition and required fees at public institutions; up to $35,000 annually at other approved programs where necessary; paid apprenticeships; career counseling; reasonable disability accommodations; childcare assistance up to $1,000 monthly; and relocation assistance up to $10,000. Amounts shall be inflation-adjusted. Providers shall disclose completion, placement, and earnings outcomes. Predatory training contracts and mandatory borrowing as a condition of participation are prohibited.
Qualified displaced workers shall receive priority consideration, consistent with civil-service merit and other legal preferences, for patient navigation, records management, cybersecurity, fraud investigation, provider support, public health, scheduling, and other necessary positions. The Authority shall maintain a national placement service and employer partnerships. Retraining shall not be represented as a guaranteed clinical credential, job, or prior wage.
There are appropriated $25,000,000,000 for each of the first five program years, inflation-adjusted, and such additional sums as are necessary to honor benefits under this title. Funds remain available for accrued claims, administration, training completion, and wage support after year five. Employers remain liable under applicable notice, wage, pension, and severance laws; public benefits do not subsidize an evasion of those obligations.
(a) There are permanently appropriated $30,000,000,000 annually, inflation-adjusted, for public-health laboratories, surveillance, vaccination delivery, community prevention, emergency medical readiness, health departments, and continuity infrastructure, together with such sums as are necessary for an actual response under this title. All response expenditure is federally financed.
(b) HHS, acting through the appropriate public-health and preparedness components, shall lead clinical and medical operations. FEMA shall coordinate disaster logistics and relevant emergency assistance; EPA shall lead within its lawful environmental assessment and response functions; CDC and ATSDR shall support exposure assessment, surveillance, and health monitoring. Agreements shall identify command responsibilities, procurement authority, reimbursement, shared logistics, and privacy protections without transferring medical decisions to nonmedical officials.
(a) The Secretary may activate medical response upon a federal disaster or emergency declaration or a documented finding that a natural event, outbreak, infrastructure failure, mass casualty, or environmental incident threatens substantial health harm. Activation shall not depend exclusively on a presidential declaration. Findings shall identify geography, services, duration, and evidence, be published within seven days when practicable, and be reviewed at least every 90 days.
(b) Response benefits include screening, emergency and follow-up care, evacuation and medical transport, temporary facilities, mobile teams, prescription replacement, oxygen, dialysis, maternity and pediatric care, behavioral-health support, replacement of essential devices, rehabilitation, and medically necessary transport and lodging for displaced persons. Reasonable emergency prescription supplies may extend to 90 days, subject to clinical safety and controlled-substance law.
(c) Event-related benefits shall be provided without charges to affected persons regardless of immigration status. This does not confer full unrelated AHP coverage on a person otherwise ineligible. Necessary long-term monitoring or treatment attributable to the event shall continue after the emergency declaration ends.
(d) The Secretary shall preposition resources and initiate deployment decisions within 24 hours of a verified request for urgent federal medical assistance. Inability to deploy because of safety or resource constraints shall prompt documented alternatives and coordination, not a fictitious guarantee of instantaneous physical capacity.
Persons exposed to a material environmental health threat shall receive necessary exposure assessment, testing, surveillance, treatment, rehabilitation, reproductive and developmental evaluation where clinically appropriate, and mental-health support. Covered threats include contaminated air, water, soil, buildings, and workplaces; toxic substances; radiation; industrial releases; chemical fires; and harmful disaster-related exposures. Clinical eligibility shall depend on credible exposure and medical need, not prior proof that a particular company is legally liable. EPA and health agencies shall share validated hazard information subject to privacy and security law.
(a) The United States may recover reasonable AHP expenditure attributable to an environmental injury from a person liable under otherwise applicable environmental, tort, or workplace law. In addition, an owner or operator of a facility responsible for a release of a hazardous substance occurring after enactment shall be liable for reasonable, medically necessary federal costs proximately caused by that release, subject to the defenses in subsection (b).
(b) Liability under the additional cause of action shall require proof of release, responsibility, causation, and reasonable costs by a preponderance of the evidence. The defendant may establish that the release was caused solely by an act of war or an unrelated third party despite reasonable care and precautions. Divisible harm shall be apportioned; indivisible harm caused by multiple responsible defendants may support joint and several liability, with contribution among defendants.
(c) The Attorney General shall bring an action in federal district court within six years after the United States reasonably discovers the basis for a recoverable expenditure. Defendants retain jury rights where constitutionally applicable. Recovery shall not duplicate another recovery for the same federal cost or diminish a victim's independent claim. Care shall never await payment, settlement, or litigation.
The Secretary shall establish privacy-protective event registries, with informed participation for research beyond necessary care and lawful public-health surveillance. Follow-up shall continue for the clinically justified latency period, including decades where evidence supports that duration. Affected communities, independent scientists, workers, and Tribal governments shall participate in advisory oversight. A registry is not a substitute for remediation, compensation, or treatment and shall not become a list for immigration enforcement or commercial targeting.
The Authority shall establish a minimum-necessary, federated information architecture supporting eligibility, payment, clinical exchange, quality, and lawful public health. This Act does not require a single central repository of every clinical note. Patients and authorized clinicians shall receive timely, no-cost access through accessible electronic and nonelectronic channels. Interoperable export, correction requests, access logs, role-based controls, encryption, and secure recovery shall be standard. Proprietary contracts shall not block lawful patient access or continuity of care.
(a) Identifiable health information obtained under this Act shall not be sold, used for targeted advertising, or supplied for employment or housing discrimination. Use to train an unrelated commercial general-purpose model requires separate, freely given, specific authorization. Such authorization does not waive the preceding prohibitions. Access to care shall not depend on agreeing to a secondary commercial use.
(b) Research access shall require lawful authority, independent ethics review where applicable, data minimization, and consent or a legally valid waiver. Deidentification shall include a documented reidentification-risk assessment. Commercial convenience is not a public-health exception. Patients may decline optional secondary uses without losing benefits.
(c) Existing stronger privacy rights shall remain effective. A patient may obtain an accounting of disclosures, request correction or annotation, and challenge unlawful use through title XVII. Records necessary for treatment or legal accountability shall not be destroyed solely because the patient disputes their contents.
(a) Eligibility verification shall use the least information necessary. Where tax information is useful, the Authority may request taxpayer-authorized confirmation of identity or residence consistent with section 6103 of the Internal Revenue Code; no income test shall be created. This Act does not authorize unrestricted access to tax returns. Aggregate actuarial analysis shall use deidentified statistical products or another independently lawful disclosure.
(b) A health record or eligibility file shall not be disclosed or used for civil immigration enforcement. An agency shall not evade this restriction through a contractor, data broker, or interagency request. Disclosure for a criminal investigation requires otherwise lawful authority and a particularized judicial warrant or order identifying the records and their relevance; bulk or speculative access is prohibited.
(c) No disclosure shall be made solely to investigate or punish conduct expressly protected as lawful healthcare under this Act. Nothing permits concealment of child abuse, an imminent serious threat, or other reporting expressly required by a valid law consistent with this Act, subject to minimum-necessary disclosure and applicable constitutional protections.
An automated system used in diagnosis support, triage, utilization review, payment, or fraud detection shall undergo appropriate validation, bias assessment, cybersecurity review, and continuing performance monitoring. Patients shall be informed when automation materially affects a decision and may obtain meaningful human review. No system may autonomously issue a final adverse medical-necessity or eligibility determination. A model score alone shall not establish fraud. Procurement shall require audit access sufficient for public accountability while protecting genuine security and intellectual-property interests. FDA and other applicable safety requirements remain in force.
The Secretary shall coordinate risk-based standards with appropriate federal cybersecurity and standards agencies, finance upgrades for small and essential providers, and require tested backups, segmentation, multifactor access, and recovery plans. A material incident threatening continuity shall be reported to the Authority within 24 hours after confirmation; other reportable material incidents within 72 hours. Existing patient-notification laws remain applicable, and the Authority shall order earlier notice when needed to avert harm. A cyber incident shall trigger protected alternate payment and care channels rather than suspension of benefits.
(a) A person entitled to a benefit or protection under this Act may bring a civil action against the Secretary in federal district court for declaratory relief, prospective injunctive relief, access arrangements, or payment of a benefit wrongfully withheld. The United States expressly waives sovereign immunity for those remedies. No amount-in-controversy requirement applies. Venue includes the district of the person's residence.
(b) Administrative review under section 403 ordinarily shall be exhausted, but exhaustion shall be excused for immediate health risk, missed statutory decision deadlines, futility, or inability of the process to provide effective relief. An action challenging a final individual determination shall be filed within 180 days, subject to equitable tolling. The court may award reasonable attorney fees to a substantially prevailing beneficiary. Punitive damages against the United States are not authorized.
(c) A court may compel a lawful coverage decision, timely payment, or an effective alternative-care arrangement, but shall not compel an individual clinician to perform labor or an unsafe procedure. Sovereign immunity shall not be inferred away beyond the express waiver; ordinary malpractice claims remain governed by applicable law.
(a) A person injured by unlawful billing, intentional prohibited discrimination, unlawful disclosure, underpayment of a compensation floor under section 504, or retaliation under this Act may sue the responsible private entity in federal district court for cessation, restitution, actual damages, and reasonable attorney fees. For a knowing unlawful covered-service bill, statutory damages of $1,000 per encounter may be awarded instead of lower actual damages; a pattern of knowing violations may support twice actual damages. A corrected good-faith clerical error shall not trigger statutory damages absent refusal to cure within 30 days of notice.
(b) Predispute contractual waiver of these rights, or mandatory arbitration of a claim created by this section, shall be unenforceable notwithstanding the Federal Arbitration Act. A patient may elect arbitration after a dispute arises. No amount shall be recovered twice for the same injury under overlapping statutes.
(a) The Secretary may investigate, require relevant records, order correction and repayment through administrative process, and refer an action to the Attorney General. A final adverse administrative order shall follow notice, access to material evidence, an opportunity to respond, and review by an impartial adjudicator. Ordinary repayment shall be based on the amount unlawfully received, not an assumed punishment.
(b) Punitive civil penalties under this Act shall be sought in federal district court. A negligent unlawful bill left uncured after notice may support up to $10,000 per encounter; a knowing unlawful bill, knowing overcharge above a binding product ceiling, or knowing material false payment submission may support up to $50,000 per transaction and three times the improper amount. Knowing refusal to obey a lawful final records order may support up to $10,000 per day, capped at $1,000,000 per order. Amounts shall be inflation-adjusted, and related acts in one encounter shall not be multiplied merely by billing-line fragmentation.
(c) The court shall consider culpability, actual harm, ability to pay, cooperation, repetition, prompt correction, proportionality, and continued patient access. Civil liability shall be established by a preponderance of the evidence; constitutionally required jury rights are preserved. Criminal liability requires an existing applicable offense and proof beyond a reasonable doubt. Clinical disagreement or ordinary medical error is not, without fraudulent intent or another applicable element, a criminal offense.
(d) False Claims Act, healthcare fraud, anti-kickback, antitrust, tax, privacy, and professional discipline remedies remain available where their elements are satisfied. This Act shall be treated as a federal healthcare program for applicable federal healthcare fraud and abuse laws. Recoveries and penalties for the same conduct shall be coordinated to avoid unlawful duplication.
A provider may be excluded for serious fraud, material repeated violations, or an established patient-safety threat for a proportionate period not exceeding five years under this Act, without limiting a longer exclusion independently required by another law. Emergency suspension requires written findings and a hearing opportunity within seven days. Essential services shall be protected through alternate providers, supervised operation, or a lawful receiver rather than abandonment of patients. Financial audits shall be relevant and proportionate; this Act does not authorize warrantless searches where a warrant is constitutionally required or entry into a patient's home without lawful authority.
Provider-payment, pricing, participation, and grant determinations shall provide administrative reconsideration and a final reasoned decision. A petition for review of final agency action may be filed within 60 days in federal district court under chapter 7 of title 5, United States Code, unless a more specific jurisdiction applies. Tax controversies retain ordinary tax forums; government contract and patent-compensation claims retain their otherwise applicable forums. Courts shall independently determine questions of law. No regulation may insulate a decision from review by labeling it scientific, emergency, or proprietary. Confidential evidence may be protected through suitable judicial orders without eliminating meaningful review.
A person shall not retaliate against a worker, patient, researcher, contractor, or other individual for a reasonable good-faith report, cooperation with an investigation, or refusal to participate in unlawful conduct. A prevailing retaliation claimant may obtain reinstatement, twice lost compensation, actual consequential damages, and attorney fees, without duplicate recovery. Existing whistleblower rights remain available. HHS's Inspector General and GAO shall have access necessary to audit the Act, subject to secure handling and protections for privileged material recognized by law.
The Authority shall publish quarterly access and payment dashboards and annual reports on eligibility errors, wait times, clinical outcomes, patient experience, administrative cost, workforce compensation, staffing, rural capacity, research awards, privacy incidents, pricing, procurement, enforcement, and fiscal results. Measures shall be risk-adjusted where appropriate and shall not reward avoiding complex patients. A material failure shall require a corrective plan within 60 days, accountable officials, funding, milestones, and follow-up disclosure. Personal records, protected trade secrets, and information creating a substantial security risk shall not be published. A public summary shall explain each withholding category.
(a) Within 15 days after enactment, the Secretary shall establish an implementation command office and publish accountable leads. Within 30 days, the Secretary shall publish enrollment and continuity procedures. Within 60 days, provisional provider participation, payment testing, and interagency coordination shall be operating.
(b) Beginning 90 days after enactment, eligible persons shall receive emergency and ambulance care, primary care, continuity medications, pregnancy and pediatric care, and urgent behavioral-health care without patient charges. Persons entitled only to limited benefits shall receive the applicable subset. During this phase, AHP shall pay the covered patient liability or furnish direct payment where no other payer applies; an existing insurer shall remain liable for its contract share. The same service shall not be paid twice.
(c) By day 120, the Secretary shall publish provisional rates, state compact terms, clinical appeal procedures, pricing schedules, initial capital awards, and workforce plans. By day 150, an independent operational review shall assess enrollment, payments, provider readiness, cybersecurity, accessibility, and continuity; material failures shall trigger mandatory bridge arrangements.
(d) On day 180, every benefit under title III, including dental, vision, hearing, long-term services, prescriptions, emergency transport, mental health, and specialty and hospital care, shall become legally payable for eligible persons. No Secretary, contractor, State, or administrative readiness finding may postpone that date.
(a) There are appropriated $150,000,000,000 immediately upon enactment for startup systems, enrollment, advance contracting, provider readiness, initial capacity, and worker-transition preparation, together with additional sums necessary for legally due transition benefits and safe continuity. These funds are federally financed and remain available until expended. An advance later applied to a provider claim or capital award shall be counted once, not both as an advance and final expenditure.
(b) Until permanent payment infrastructure is ready, the Authority shall use secure legacy processors, provisional rates, hospital operating advances, direct pharmacy arrangements, and manual or assisted payment channels. A provider may submit a reasonable attestation for provisional payment where system failure prevents an ordinary claim, subject to later reconciliation without patient liability.
(c) Existing medically necessary treatment plans, scheduled procedures, pregnancy care, transplant arrangements, home supports, and stable prescriptions shall continue for at least 180 days after the full-benefit date and thereafter as medically necessary. A formulary or administrative change shall not interrupt treatment without a safe individualized alternative and appeal.
(d) Full benefit commencement does not certify that all new buildings, training cohorts, or technology replacements have been completed in six months. Those programs shall commence by that date and proceed under their funded milestones while interim arrangements satisfy present access duties.
The Secretary and Treasury Secretary shall issue implementing regulations through applicable administrative procedures. An interim final rule may take immediate effect only upon a particularized finding that delay would materially threaten timely coverage, payment, safety, or system continuity. It shall provide at least 60 days for public comment and be reconsidered in a final rule within 18 months. This authority expires 24 months after enactment for new interim rules. No rule may alter tax rates, postpone full benefits, narrow an express eligibility class, waive constitutional rights, or confer final governmental power on a private contractor.
(a) This Act governs eligibility, covered benefits, patient charges, public payment, the financing and insurance transition expressly provided, and federal rights created herein. A conflicting state insurance rule, plan term, payment restriction, or administrative requirement shall have no effect to the extent it prevents those provisions. Stronger compatible privacy, labor, safety, and patient protections remain effective.
(b) State professional licensure, scope-of-practice, malpractice, facility safety, and ordinary criminal law remain applicable except to the extent an express provision of this Act, including section 303, supplies a contrary federal rule. Federal payment alone shall not immunize negligence or create authority to provide an unsafe service.
(c) Federal agencies shall implement the displacement and coordination rules in titles VII and X through regulations and published account crosswalks. They shall submit a technical conforming-amendments report to Congress within 120 days. The report is not a condition precedent to this Act, and an agency may not itself repeal a statute or alter an express congressional requirement through the report.
(a) GAO shall conduct an implementation review after one year and a comprehensive review after five years, including financing, access, compensation, scientific independence, constitutional litigation, and distributional consequences. The review shall recommend improvements and shall not operate as a sunset of coverage or appropriations.
(b) If a provision or application is held invalid, the remainder shall remain effective to the maximum lawful extent. Invalidity of a tax, state contribution, or private-insurance restriction shall not terminate the remaining benefit entitlement; the permanent federal appropriation shall cover lawful obligations unless Congress provides otherwise. Courts shall preserve individual due process and avoid expanding an invalid application through severance.
(c) Except where a later date is expressly stated, this Act takes effect upon enactment. No provision authorizes coverage termination before a lawful successor payment obligation has commenced.
(a) DELIVERY DUTY. The Administrator shall establish a primary care service area for every inhabited portion of the United States and contract with sufficient qualified practices, community health centers, public clinics, and mobile teams to meet section 401. An area designation shall identify its accountable regional official, available sites, after-hours arrangements, and referral partners. Residence within an area shall not restrict a covered person's choice of provider.
(b) TEAM SERVICES. Payment shall support physician services, nursing, pharmacy consultation, behavioral health integration, interpretation, prevention, and patient navigation appropriate to the population served. A clinical team shall identify a responsible practitioner for each accepted patient and a substitute during absence. A patient may decline assignment without losing benefits.
(c) COMMENCEMENT AND FINANCING. By day 120 after enactment, the Administrator shall publish provisional area arrangements; by the full-benefit date, direct purchasing and temporary delivery arrangements shall operate in every area. Services are payable from the Fund under title VII. Permanent construction and education shall use titles XII and XIII, without counting the same expenditure twice.
(a) PAYMENT. A participating primary care practice may elect a prospective, risk-adjusted monthly payment for agreed coordination and availability functions, together with a service payment for clinical encounters. The Administrator shall identify which costs each component covers. A practice shall not receive two payments for the same documented activity.
(b) SAFEGUARDS. Risk adjustment shall consider clinical complexity, disability accommodation, language needs, and local delivery costs. A prospective payment shall not make a clinician personally liable for unrelated specialty or hospital costs. No practice may refuse a patient because the patient's expected needs exceed a budget, subject to an objectively documented capacity limit applied without discrimination.
(c) CAPACITY REVIEW. Each practice shall quarterly report available appointment capacity and temporary panel closure through a single standardized return. The Authority shall verify a sample against actual scheduling records, protect staff and patient identities, and fund replacement access where a panel is closed. Performance payments shall not penalize a practice for an informed patient refusal of recommended care.
(a) EVIDENCE PROCESS. The Council shall maintain a public prevention schedule addressing screening, vaccination, counseling, prophylaxis, and early intervention. Recommendations shall distinguish population screening from diagnostic investigation of symptoms and identify the evidence, expected benefits, material harms, and uncertainty relevant to each recommendation.
(b) COVERAGE. A covered person shall receive recommended preventive services without a separate risk, income, or deductible requirement. A recommendation against indiscriminate screening shall not bar a clinically justified diagnostic test or an individualized preventive intervention ordered after consideration of the person's circumstances. A reviewer shall explain a denial on the applicable clinical grounds, not merely cite the absence of a population recommendation.
(c) CONSENT AND REVIEW. No wellness target, payment incentive, or eligibility rule shall compel screening or vaccination under this Act. Other lawful public-health authority is neither expanded nor repealed by this subsection. Recommendations shall be reviewed at least every three years and earlier upon a material safety or efficacy finding, with continuity protection for an active course of preventive treatment.
(a) RESPONSIBLE CLINICIAN. A referring provider shall transmit the clinical question, relevant records, urgency, and accommodation needs through the national referral standard. A receiving provider shall acknowledge receipt within two business days and state acceptance, requested clarification, or a specific capacity reason for declining. The referring team retains responsibility for arranging an alternative until another team accepts responsibility.
(b) RESULTS. A laboratory, imaging provider, or consultant shall communicate a result threatening immediate serious harm directly to a responsible licensed practitioner without relying solely on a patient portal. The ordering practice shall maintain a daily process for unresolved actionable results, including a documented backup when the ordering practitioner is absent.
(c) PATIENT COMMUNICATION. Patients shall receive understandable results and an identified contact for questions. An electronic release alone does not satisfy a duty to explain a serious unexpected finding. Additional outreach and interpretation are covered coordination costs. Nothing in this section authorizes withholding a record otherwise required to be made available to the patient.
(a) CONTINUING FUNCTIONS. A federally qualified health center, rural health clinic, public clinic, or comparable Tribal facility may receive a prospective mission payment for outreach, interpretation, transportation coordination, case management, and services for persons receiving lawful residual coverage. Such payment is separate from payment for a clinical service only to the extent it covers a separately documented cost.
(b) BUDGET AGREEMENT. An agreement shall identify the population served, reasonable staffing, sites, operating hours, residual program obligations, and annual reconciliation. Neither a historical low reimbursement rate nor an earlier shortage of grant funds shall conclusively establish the efficient cost of an expanded service.
(c) ACCESS AND ACCOUNTABILITY. Mission payments may not depend on the number of uninsured persons remaining after implementation. The Authority shall assess unmet clinical need, geographic access, and nonduplicative enabling services. Existing community-governance requirements shall be preserved unless directly inconsistent with this Act. A reduction requires notice, an opportunity to submit cost evidence, and an access-continuity determination under title XVII.
(a) ELIGIBILITY. A covered person unable to obtain clinically appropriate office-based care because of a substantial functional limitation, medical fragility, geographic isolation, or an unsafe transport burden shall be entitled to home-based or mobile primary care when a qualified practitioner determines it appropriate. A person need not be wholly confined to the home.
(b) SERVICES. Covered arrangements include examinations, specimen collection, medication reconciliation, clinically indicated remote monitoring, caregiver instruction, and referral coordination. The Authority shall finance vehicle, portable equipment, travel time, infection-control supplies, and staff safety through the applicable operating budget. A visit shall not become a housing inspection or immigration inquiry.
(c) CHOICE. A patient may request an in-person facility alternative, and a clinician may require a suitable facility when the service cannot safely be delivered at home. An inability to use a digital device shall not disqualify the patient. Teams shall document emergency escalation, backup staffing, and how patients reach clinical assistance outside ordinary visit hours.
(a) CLINICAL BENEFIT. Coverage includes nutrition assessment, medical nutrition therapy, smoking-cessation treatment, and evidence-based movement or rehabilitation services prescribed to prevent or manage a diagnosed condition or a substantial documented clinical risk. An intervention shall have an individualized goal, appropriate professional supervision, and a reassessment plan proportionate to risk.
(b) BOUNDARIES. The Fund shall not purchase general luxury fitness memberships, unvalidated supplements, ordinary household food without a qualifying clinical purpose, or products marketed through a clinician's undisclosed financial interest. Clinically necessary formula, enteral nutrition, and medically tailored meals remain covered under section 301.
(c) NONPUNITIVE DELIVERY. A patient's body size, substance use, missed target, or inability to follow advice shall not reduce coverage or increase a tax. Programs shall provide practical accommodation for disability, culture, food access, and work schedules. Contractors shall be paid for delivered, evidence-based services, not solely for weight loss or another result susceptible to unsafe manipulation.
(a) PROGRAM. Regional offices shall contract for community health workers and patient navigators trained in benefit access, appointment coordination, health literacy, and referral to lawful housing, nutrition, and social-service programs. Such workers shall not independently diagnose or prescribe unless separately licensed to do so.
(b) STANDARDS. Training shall include confidentiality, boundaries, disability access, interpretation referral, safeguarding, and recognition of urgent symptoms requiring licensed assessment. Compensation shall comply with section 504. Experience and demonstrated community knowledge may qualify an applicant for supervised entry training without an unnecessary degree requirement.
(c) LIMITS AND REVIEW. Navigators may not receive referral commissions, solicit product sales, obtain blanket authority over a patient's finances, or require political, religious, or commercial participation. Each patient shall be told the worker's role and complaint channel. The Authority shall assess successful connections to care and patient experience, not merely contacts attempted. Grants shall support independent community organizations while retaining federal responsibility for decisions affecting benefits.
(a) MATERIALS. The Authority shall maintain plain-language explanations of benefits, treatment choices, appeal rights, patient charges, and emergency access in commonly used languages and accessible formats. A notice with legal consequences shall identify the action required, deadline, assistance channel, and effect of nonresponse without relying on a link to another document.
(b) SERVICES. Qualified interpretation, sign-language interpretation, augmentative communication, and accessible document conversion are covered services. A provider shall not require a child, accompanying relative, or untrained employee to interpret sensitive or consequential clinical information except temporarily during an immediate emergency when no qualified alternative is available.
(c) TESTING. Before national release, essential forms shall undergo usability testing with people who have limited literacy, disabilities, and limited English proficiency. The Authority shall publish aggregate results and correct material obstacles. A readability score alone shall not substitute for testing comprehension. Patients may request an explanation by telephone or in person without a service fee.
(a) DELIVERY AGREEMENTS. The Authority may fund qualified clinics located in schools, vocational programs, and postsecondary institutions to provide covered services without converting education personnel into compulsory federal administrators. Participation by an educational institution shall rest on a voluntary agreement defining space, clinical responsibility, emergency procedures, and separate accounting.
(b) RIGHTS. Clinical consent shall comply with section 404 and applicable lawful minor-consent rules. Education records and clinical records shall be governed by their respective confidentiality requirements; a clinic agreement shall not authorize unrestricted exchange. Treatment shall not depend on school attendance, academic performance, or parental payment of a fee.
(c) CONTINUITY. Clinics shall arrange access during school closures and transitions between pediatric and adult care. Qualified services remain payable at other facilities. A school shall not reduce its independent special-education or disability obligations by characterizing an educational duty as a health benefit. Section 3408 governs coordination of related services and protection against duplicate payment.
(a) OFFER OF ASSISTANCE. A person with repeated emergency visits, avoidable care interruptions, or multiple conflicting treatment plans shall be offered a voluntary interdisciplinary review. The purpose shall be to identify unmet need, medication problems, inaccessible appointments, and practical barriers, not to establish a category of undeserving patients.
(b) CARE PLAN. With valid consent, the team shall designate a coordinator, reconcile treatment, identify crisis preferences, and connect the person to separately authorized social services. Ordinary rent or subsistence shall not become payable solely because a team recommends it; medical respite and other expressly covered accommodation remain available.
(c) SAFEGUARDS. Declining coordination shall not justify denial of emergency care or reduced benefits. Utilization flags shall be accurate, reviewable, time-limited, and free of derogatory labels. Predictive tools shall comply with title XVI. A contractor shall not receive compensation for preventing necessary hospital admission or for shifting costs onto a patient's family.
(a) MEASURES. By the full-benefit date, the Administrator shall publish an initial dashboard of appointment access, continuity, actionable-result follow-up, patient-reported experience, and avoidable administration. Clinical measures shall be selected through the Council and stratified only where lawful and statistically meaningful.
(b) CORRECTION. Two consecutive quarters of material access failure shall require a regional corrective order specifying additional hours, teams, transport, or contracted capacity, the official responsible, and funded milestones. The order shall not substitute a penalty against a small practice for the government's duty to purchase sufficient care.
(c) REVIEW. Patient and clinician representatives shall participate in an annual service-area review. Public reporting shall omit identifying records and suppress unreliable small cells. A patient may invoke sections 403 and 1701 without waiting for a dashboard or corrective order. Improvement targets shall not become a quota for treatment, a limit on benefits, or a reason to discharge a clinically complex patient.
(a) SERVICE CAPACITY. The Administrator shall establish dental service arrangements sufficient for preventive, restorative, surgical, and emergency benefits under section 302. Dental participation shall be available to qualified independent practices, public clinics, community health centers, teaching clinics, and mobile providers. No primary-care referral shall be required for an initial dental examination or urgent dental complaint.
(b) CONTINUITY. A participating dental practice shall provide a written treatment plan distinguishing clinically necessary procedures, reasonable alternatives, and optional aesthetic services. A plan may be revised for new findings without requiring the patient to begin the enrollment process again. Interrupted treatment shall be transferred with records and laboratory work product necessary for safe completion.
(c) PAYMENT. Rates shall recognize professional time, materials, laboratory costs, sedation safety, and the compensation protections of title V. An annual dollar maximum, missing-tooth exclusion, or waiting period shall not apply. The Authority shall operate provisional dental payment arrangements by the full-benefit date even where the permanent electronic interface is incomplete.
(a) INDIVIDUAL ASSESSMENT. Coverage of a crown, bridge, denture, or implant shall depend on oral function, prognosis, remaining dentition, bone and tissue condition, maintenance needs, and suitable alternatives. The least expensive item is not necessarily a clinically suitable alternative. A reviewer shall identify an actual functional alternative before denying a requested covered restoration on comparative-cost grounds.
(b) NO EXTRACTION INCENTIVE. Payment rules shall not favor extraction of a restorable tooth merely because extraction has a lower immediate cost. A treatment plan shall consider durable function and reasonably foreseeable subsequent treatment. Patients retain the right to decline preservation after informed discussion.
(c) REVIEW AND WARRANTIES. A disputed restorative plan shall receive review by a dentist with relevant competence within ten business days, or sooner under section 403. Repeated failure of a product shall trigger supplier review and replacement protection, not an automatic patient charge. A reasonable product warranty does not permit denial of new medically necessary treatment caused by an unrelated clinical condition.
(a) COVERAGE STANDARD. Orthodontia is covered where necessary to address functional impairment, congenital craniofacial difference, significant pain, impaired chewing or speech, or a substantial risk of physical harm. A numerical index may inform but shall not conclusively determine individual necessity. Neither age alone nor an earlier inability to obtain treatment bars a clinically justified course.
(b) TEAM CARE. Craniofacial treatment shall include coordination among dentistry, oral surgery, speech services, hearing care, nutrition, and appropriate medical specialties. The Authority shall pay separately identifiable coordination and necessary travel where expertise is regional. A payer shall not divide a coordinated plan into excluded medical and dental portions.
(c) CONSENT. Aesthetic objectives shall be distinguished from functional objectives, and the patient shall receive an explanation of duration, maintenance, and alternatives. Optional products may not displace a no-charge clinically adequate option. Retainers and follow-up necessary to preserve the result of covered treatment shall be covered without a new categorical eligibility test.
(a) CLINICAL CRITERIA. Sedation, anesthesia, and an appropriate treatment setting shall be covered when necessary because of procedure complexity, disability, severe clinically documented anxiety, medical fragility, age-related cooperation limits, or another individualized safety need. A requirement to fail unsafe unsedated treatment is prohibited.
(b) SAFETY. Providers shall hold the credentials applicable to the depth of sedation and setting, maintain rescue equipment, perform appropriate preprocedure assessment, and identify personnel responsible for monitoring and emergency transfer. Payment shall recognize necessary safety personnel rather than require their cost to be recovered from the patient.
(c) CAPACITY. Regional offices shall reserve sufficient appointments for patients needing supported dental access and shall contract with hospital or ambulatory services when office care is unsuitable. A person may not be placed indefinitely on a separate disability waiting list. A documented shortage shall trigger the arranging duties under section 401 and a funded capacity plan under title XII.
(a) ACCESS. Covered persons may obtain examinations and refraction directly from a qualified eye-care professional. A practitioner shall provide an accessible copy of a valid prescription and relevant measurements needed to obtain a covered product, without tying release to purchase from the practice.
(b) PRODUCTS. The no-charge product selection shall include durable frames in adult and pediatric sizes, clinically appropriate lens materials and coatings, necessary specialty lenses, and fitting. Cosmetic branding alone is not covered. Contact lenses shall be covered when clinically indicated, including circumstances in which spectacles do not provide adequate function.
(c) REPLACEMENT. A replacement shall be covered for a material prescription change, growth, loss of essential function, irreparable damage, or inability to use the prior product. Repeated loss may justify supportive planning or a more durable product, not abandonment of functional vision. Suppliers shall provide repair and replacement turnaround commitments and a safe temporary option where practicable.
(a) CONTINUUM. Coverage includes diagnosis, medicine, procedures, surgery, low-vision assessment, orientation and mobility training, and adaptive equipment needed because of ocular disease or visual impairment. A loss of expected visual recovery shall not defeat coverage of rehabilitation, safety, or function-preserving care.
(b) URGENT ACCESS. A report of sudden vision loss, severe ocular injury, or another time-sensitive ocular condition shall receive clinically appropriate urgent triage and a direct referral pathway. Administrative uncertainty between optometric, ophthalmic, and emergency services shall not delay treatment.
(c) FUNCTIONAL SUPPORT. Low-vision devices shall be selected on demonstrated functional need, compatibility with the person's activities, and training requirements. Payment may include a home or workplace functional assessment but shall not relieve an employer of an independent reasonable-accommodation duty. The Authority shall resolve overlapping responsibility between public programs without requiring the patient to purchase the device first.
(a) SERVICES. The Authority shall ensure access to audiologic assessment, medical evaluation when indicated, hearing devices, fittings, counseling, and communication support. A person shall not be required to purchase a retail device before receiving an assessment where symptoms, age, or clinical circumstances warrant professional evaluation.
(b) PRODUCT SELECTION. A fitting shall consider hearing profile, dexterity, vision, cognition, environment, communication preferences, and compatibility with necessary assistive technology. A no-charge product shall provide the clinically necessary features. A provider may not reserve essential connectivity, programmability, or safety features for an upgrade category.
(c) FOLLOW-UP. Initial provision shall include a reasonable trial, adjustment visits, patient instruction, batteries or charging equipment, and a repair pathway. A failed trial shall result in reassessment and a suitable alternative. Patient choice includes declining amplification and obtaining appropriate communication support. Coverage shall not be conditioned on preferring spoken communication over sign language.
(a) EVALUATION. An implantable auditory device shall be covered after a multidisciplinary evaluation establishes clinical suitability and informed consent. Evaluation shall include expected benefit, limitations, operative risks, maintenance, rehabilitation, and communication alternatives. The Authority shall not require an arbitrary duration of failed nonimplant treatment where the clinical record establishes that such treatment is unsuitable.
(b) LIFECYCLE BENEFIT. Coverage includes surgery, implanted and external components, programming, rehabilitation, repairs, medically necessary upgrades, and replacement of unsupported essential components. A manufacturer's discontinuation of an accessory shall trigger continuity procurement rather than cessation of benefit.
(c) CHILDREN AND SUPPORT. Pediatric services shall include age-appropriate family education and communication support without requiring a particular educational placement. Outcomes shall be assessed against individualized goals. A person's disability identity, use of sign language, or decision to decline implantation shall not be treated as noncompliance or as grounds to reduce other benefits.
(a) PROCUREMENT CONDITIONS. A contract for a covered assistive product shall require usable operating instructions, accessible controls, availability of necessary replacement parts, and disclosure of expected support life. Where safety permits, the supplier shall provide authorized independent repair services with information and tools on nondiscriminatory terms.
(b) LIMITS. This section does not require disclosure of unrelated source code, compromise of cybersecurity controls, or unsafe modification of a regulated device. The Secretary shall resolve a claimed safety restriction through a documented technical review rather than accept an unsupported blanket refusal to repair.
(c) CONTINUITY. A person dependent on a product for communication, mobility, medication delivery, or another essential function shall receive an appropriate loaner or alternative during repair when clinically necessary. Ordinary wear, a recall, or a vendor's insolvency shall not create patient liability. The Authority may recover warranty or contract costs from the responsible supplier after securing the patient's replacement.
(a) SINGLE DETERMINATION. Where an episode involves medical, dental, vision, hearing, or rehabilitative services, the Authority shall make one coordinated coverage determination. No component may be denied solely because another specialty ordinarily performs it or because a legacy insurer used a different benefit category.
(b) PAYMENT ALLOCATION. Providers shall identify services actually performed and responsible professionals. The Authority shall allocate payment internally without requiring separate patient applications. A common evaluation shall not be repeatedly billed as unrelated encounters, but medically distinct professional assessments remain payable.
(c) DISPUTES. A professional-scope question shall be referred to the appropriate licensing authority; it shall not become a denial of the patient's entitlement to an otherwise covered service furnished by a qualified professional. Pending a provider allocation dispute, undisputed payment shall issue and care shall continue. The patient's appeal deadline runs from a complete accessible notice, not an internal billing rejection.
(a) OUTREACH. The Authority shall purchase voluntary mobile oral, vision, and hearing screening in areas with documented access gaps, including schools, long-term-care settings, and rural communities. A screening contract shall include a funded referral and treatment pathway, not merely identification of an untreated condition.
(b) CONSENT AND SAFETY. Providers shall obtain lawful consent, protect privacy during examinations, use appropriate infection-control procedures, and explain the limitations of screening. A screening result shall not be used by a school, employer, or institution to exclude a person contrary to applicable civil-rights law.
(c) ACCOUNTABILITY. Contractors shall report completed referrals and barriers in aggregate. Payment shall not depend on selling a device, finding a predetermined number of abnormalities, or recruiting patients into a financially related practice. Where a mobile program identifies urgent need, it shall arrange treatment under section 401 and not leave the person with an unassisted list of telephone numbers.
(a) PLAN. By the full-benefit date, each regional office shall publish an oral, vision, and hearing access plan identifying qualified capacity, specialist gaps, equipment needs, and geographic travel burdens. Plans shall include the staffing and supervised training necessary for expanded clinics, consistent with lawful professional scope.
(b) CORRECTIVE PURCHASES. Where ordinary contracting cannot meet section 401, the Authority shall purchase additional sessions, mobile services, referral-center capacity, or necessary transport. An insufficient dental or hearing budget shall not justify imposing an annual benefit maximum.
(c) MONITORING. Annual review shall address treatment completion, restoration durability, device fit, repair delay, patient experience, and avoidable extraction or loss of function. Measures shall not penalize providers merely for serving people with complex disease or disability. Spending for this title is included within the clinical, facility, and workforce accounts established by this Act; no new duplicative administrative office is required.
(a) NETWORK DUTY. The Authority shall establish regional maternity networks linking prenatal practices, qualified midwifery services, delivery facilities, maternal-fetal medicine, blood supply, anesthesia, neonatal care, and emergency transport. A network plan shall identify an accepting facility for foreseeable escalation and responsibility for coordinating a transfer.
(b) COVERAGE. A covered person shall receive clinically appropriate prenatal, delivery, and postpartum services without an arbitrary postpartum termination date. Services include lactation support, treatment of pregnancy-related complications, recovery support, and mental-health assessment. Limited-benefit persons retain the scope established by section 204.
(c) CONTINUITY. Transfer between clinicians, insurers in runoff, or residences shall not require repetition of nonessential testing or loss of an established treatment plan. Essential records shall accompany the patient promptly. The Authority shall finance interpreters, disability accommodations, and transport as part of maternity delivery, rather than treat them as optional amenities. Full-benefit commencement shall not depend on completion of a new maternity facility.
(a) FACILITY DUTIES. Each participating delivery facility shall maintain written and rehearsed procedures for hemorrhage, hypertensive emergencies, sepsis, cardiopulmonary deterioration, and emergency transfer. Procedures shall specify escalation authority, necessary supplies, blood access, and the roles of clinical personnel. The Council shall update evidence-based standards without replacing professional judgment in an individual emergency.
(b) FUNDING. A rural or low-volume facility shall receive reasonable readiness payments for essential staff availability and safe stabilization capability. The Authority shall not require a facility to offer services beyond its demonstrated competence merely to satisfy a geographic target; it shall finance an appropriate regional alternative.
(c) REVIEW. A serious maternal safety event shall trigger protected clinical review and, where required, regulatory reporting. Quality learning shall not conceal a patient's records or prevent lawful investigation of negligence. Data collection shall distinguish clinical risk, delayed access, transfer problems, and equipment failure rather than assign responsibility solely from an adverse outcome.
(a) QUALIFIED SERVICES. Licensed midwifery and appropriately trained doula services shall be payable within their lawful scopes. Doula support may include preparation, nonclinical labor support, communication assistance, and postpartum support. A doula shall not be required to perform licensed clinical tasks to qualify for payment.
(b) SETTING CHOICE. The Authority shall cover clinically appropriate hospital, accredited birth-center, or legally authorized home-birth services under individualized risk assessment and safe escalation arrangements. A patient shall receive balanced information about available settings and the reasons for a recommended setting. Emergency transfer shall not create a financial penalty for a prior informed choice.
(c) CONTRACT STANDARDS. Payment shall recognize on-call time, travel, preparation, and follow-up without requiring unlimited unpaid availability. Grantees expanding community birth services shall document referral relationships and emergency equipment. Nothing in this section licenses a practitioner or requires a hospital to grant privileges without verification of relevant competence and due process.
(a) ACCESS. Coverage under section 303 includes counseling, the full range of clinically appropriate contraceptive methods, necessary follow-up, method removal, and treatment of adverse effects. A patient shall not be required to try an unsuitable method before receiving an indicated alternative or to obtain spousal approval.
(b) VOLUNTARINESS. No benefit, public assistance, release decision, immigration service, or compensation shall be conditioned on use of contraception, sterilization, abortion, or continuation of pregnancy. Consent shall be informed, free of coercion, and appropriate to the procedure. A valid decision to discontinue a method shall receive timely assistance.
(c) ADMINISTRATION. The Authority shall maintain confidential access and a sufficient willing-provider network consistent with section 303(d). A formulary or device contract shall not eliminate an entire clinically necessary class because another method is less expensive. The patient shall be offered an actual available alternative, with an individualized exception and appeal when clinically indicated.
(a) NECESSITY. Coverage includes evaluation, treatment of underlying conditions, and evidence-based assisted reproduction where reproduction cannot reasonably occur without assistance. Eligibility shall not depend on marriage, sexual orientation, or a requirement to undertake intercourse that is medically contraindicated or inapplicable to the patient's circumstances.
(b) CLINICAL PLAN. A treatment plan shall identify prognosis, material risks, reasonable alternatives, and criteria for reassessment. An arbitrary lifetime dollar ceiling or categorical cycle limit is prohibited; an independent clinical review may determine that a further intervention lacks reasonable prospect of benefit under section 308. A person may appeal that determination before interruption of a time-sensitive course.
(c) ETHICAL LIMITS. Coverage does not authorize purchase of a person, coercive gamete procurement, unlawful surrogacy, or nonmedical selection of characteristics. Reasonable lawful donor screening, storage necessary for a covered course, and preservation before gonadotoxic treatment are covered. Ownership, disposition, and consent for stored reproductive material shall be documented before treatment, with access to independent counseling.
(a) NEWBORN SERVICES. Qualified providers shall offer clinically recommended newborn examination, screening, vaccination, feeding support, and timely follow-up, with valid consent and explanations of uncertain findings. A suspected serious condition shall trigger a prompt confirmatory pathway rather than a screening result without follow-up.
(b) IDENTIFICATION. A newborn's entitlement shall not depend on issuance of a Social Security number, completion of a parent's immigration application, or payment of a hospital balance. Provisional enrollment shall use the minimum identifying information necessary and shall be reconciled without interruption.
(c) DEVELOPMENTAL SUPPORT. Medically necessary early intervention shall include evaluation and treatment of developmental, sensory, physical, and communication needs. AHP shall coordinate with education and early-intervention programs without shifting their independent duties to the Fund. Families shall receive a named coordinator where multiple programs are involved and shall not be required to litigate payer responsibility before clinically necessary treatment begins.
(a) STANDARD. For a covered person under age 21, medical necessity includes services necessary to correct or ameliorate a physical or mental condition, support development, preserve function, and prevent avoidable deterioration. A service need not produce a cure or restore a function previously possessed by the child.
(b) SCOPE. Screening, diagnostic follow-up, preventive care, dental, vision, hearing, behavioral health, therapies, equipment, and personal supports shall be coordinated through an individualized plan where complexity warrants. Absence of an adult coverage analogue shall not establish that a pediatric service is excluded.
(c) REVIEW. A pediatric denial shall be reviewed by a professional competent in the relevant pediatric condition. Reviewers shall consider age, developmental stage, family circumstances relevant to delivery, and the consequences of delay. Clinical justification shall not be replaced by a general annual therapy limit. The Authority shall furnish assistance to a parent, guardian, or other lawful representative while respecting the child's independent confidentiality rights where applicable.
(a) CONFIDENTIAL CARE. The Authority shall configure communications to protect confidential services that an adolescent may lawfully consent to receive. A general family portal, mailed explanation, or shared contact information shall not automatically disclose such a service. A minor's legal representative shall retain access where law requires it.
(b) TRANSITION PLAN. Beginning when clinically appropriate and ordinarily by age 16 for a child with complex continuing needs, the treating team shall offer a transition plan identifying adult practitioners, prescriptions, equipment, supports, and the patient's developing role in decisions. An age transition shall not itself terminate necessary therapy or equipment.
(c) SAFEGUARD. This section creates no general authority to remove a child from a lawful guardian or administer treatment without legally sufficient consent. A provider confronting abuse or imminent danger shall follow applicable protective law and disclose only information required or lawfully necessary. Disputes over payer responsibility shall not delay an urgent protected service.
(a) CONTINUITY. A covered child entering, leaving, or changing a foster, adoptive, kinship, or residential placement shall retain the same AHP eligibility and necessary services. A change of placement shall not restart an authorization period or require a new diagnosis solely for payment.
(b) COORDINATION. With lawful authorization, the Authority shall supply an up-to-date medication list, essential treatment information, and named care contact to the person responsible for the child's care. Sensitive records shall be segmented where law requires separate consent or additional protection.
(c) PRESCRIBING SAFETY. Where a child receives multiple psychotropic medicines, the Authority shall provide access to independent clinical review appropriate to the child's needs. Review shall not presume that every prescription is improper or authorize abrupt discontinuation. Protective-service or juvenile-court status alone shall not establish medical necessity for medication, restraint, or institutional placement. Clinical and placement decisions shall remain separately accountable.
(a) BENEFITS. Covered services include acute treatment, forensic examination where authorized, injury documentation, clinically indicated prophylaxis, counseling, reproductive care, and safety-related care coordination after sexual assault or family violence. Limited-benefit persons shall receive the applicable emergency and follow-up services under section 204.
(b) NO REPORTING CONDITION. Payment for clinical care shall not depend on filing a police complaint, participating in a prosecution, or identifying an alleged offender, except that a provider shall comply with a separately applicable mandatory-reporting law. The patient shall receive an explanation of any required report and available confidential support.
(c) PRIVACY AND ACCESS. A provider shall offer safe communication methods, confidential interpretation, and an alternative representative where a usual caregiver may be responsible for harm. A covered examination shall not be billed to the patient while two public programs dispute responsibility. Fund recovery shall not reduce victim compensation for a distinct uncompensated loss.
(a) BENEFITS. Coverage includes evaluation and evidence-based treatment of menopause-related symptoms, pelvic-floor disorders, endometriosis, urologic conditions, sexual dysfunction, and other reproductive or endocrine conditions across the life course. An intervention shall be assessed by clinical need rather than an assumption that symptoms are an unavoidable consequence of age.
(b) COUNSELING. Patients shall receive an explanation of reasonable alternatives, expected effects, material risks, and uncertainty. No payment incentive shall favor a procedure over suitable nonsurgical treatment merely because the procedure generates a larger payment.
(c) QUALITY. The Council shall review evidence and access barriers for conditions historically fragmented among specialties. Regional offices shall provide coordinated referral where a patient otherwise receives conflicting or incomplete assessments. Coverage of a medicine or device does not authorize an unapproved marketing claim, and a commercial anti-aging label shall not itself establish medical necessity.
(a) REVIEW. The Authority shall annually report maternal and infant access, preventable service interruption, neonatal transfer delays, pediatric specialty waits, and continuity during placement changes. Measures shall protect small populations from identification and shall distinguish access failure from clinical risk that could not reasonably be prevented.
(b) CORRECTIVE ACTION. A regional pattern of material avoidable delay shall require a funded plan identifying transport, staffing, facility, or referral deficiencies. A plan may not impose a duty on a State that has not accepted the relevant compact; the Authority shall provide a federal alternative.
(c) FUNDING AND RIGHTS. Clinical services under this title are mandatory obligations of the Fund. Training, facility, and research initiatives shall be accounted for within titles XII and XIII and shall not diminish individual benefits. None of the planning deadlines in this title postpones section 1801 or alters the explicit protections and legal relationships established by sections 303 and 404.
(a) ESTABLISHMENT. The Authority shall purchase a continuum of outpatient, intensive outpatient, residential, hospital, mobile crisis, and recovery services for each regional population. The network shall include psychiatry, psychology, counseling, social work, nursing, peer support, and substance-use expertise appropriate to need, with clearly identified clinical leadership.
(b) NO NETWORK BARRIER. A patient may obtain an initial behavioral-health assessment directly without a primary-care referral. Coverage shall not depend on arrest, homelessness, treatment failure in a more restrictive setting, or a diagnosis formulated solely to satisfy a payment category.
(c) FINANCING AND ACCOUNTABILITY. Payments shall cover efficient service costs, crisis readiness, and compensation under title V. Readiness payments shall identify the availability purchased and shall not be conditioned on keeping beds occupied. By day 120 after enactment, each region shall publish interim access arrangements and accepting crisis contacts; necessary services become payable according to section 1801.
(a) COORDINATION. The Secretary shall coordinate clinical response with existing crisis-contact and emergency-dispatch systems through agreements respecting their respective authorities. A clinical call shall be triaged to an appropriately qualified responder, with emergency medical services dispatched when physical danger or medical instability requires them.
(b) RESPONSE. Mobile crisis teams shall include competent behavioral-health personnel and have access to remote or in-person licensed assessment. Law enforcement shall not be the default substitute for an available clinically suitable response. Nothing in this section prevents necessary law-enforcement assistance where an objectively identified immediate safety threat exists.
(c) RIGHTS. Contacting a crisis service shall not itself authorize detention, warrantless entry, or disclosure for unrelated investigation. Responders shall use the least restrictive lawful intervention consistent with immediate safety and shall document the basis for any emergency escalation. Crisis evaluation, stabilization, and medically necessary transport are covered without patient charge.
(a) ACCESS. The Authority shall fund clinically appropriate crisis stabilization facilities that can accept voluntary referrals from patients, mobile teams, and emergency departments. Each facility shall publish acceptance criteria, available capabilities, medical exclusion criteria, and a transfer arrangement for needs beyond its competence.
(b) CARE. Services shall include evaluation, observation, medication when indicated and consented to or otherwise lawfully authorized, de-escalation, safety planning, and discharge coordination. A fixed observation period shall not override an individualized need for earlier discharge or more intensive treatment.
(c) NO CUSTODIAL SUBSTITUTION. A crisis facility shall not function as an unlicensed detention center or hold a patient because community support is unavailable. Any involuntary status requires authority and process independent of this Act's payment provisions. The Authority shall fund an appropriate alternative and promptly investigate repeated use of restraint, unsafe discharge, or refusal of medically suitable patients for financial reasons.
(a) SERVICES. A patient presenting with suicide risk shall receive individualized assessment, collaborative safety planning where feasible, treatment of underlying conditions, and an identified follow-up contact. A risk score shall not independently determine discharge, detention, or eligibility.
(b) TRANSITION. Before discharge from a crisis or inpatient episode, the responsible team shall offer a follow-up appointment within seven days, and earlier when clinically indicated, together with a means to obtain urgent assistance. With valid consent, a contact shall occur within 48 hours to identify prescription, transport, or appointment barriers.
(c) RIGHTS AND LIMITS. A patient's past crisis shall not produce a permanent high-risk label without periodic review. Information sharing with a family member shall follow consent and applicable emergency exceptions. The Authority shall evaluate treatment continuity and safety rather than reward institutions for denying admission or suppressing reporting of self-harm events.
(a) BENEFITS. Covered treatment includes assessment, withdrawal management, indicated medicines, counseling, behavioral interventions, recovery support, and treatment of coexisting physical or mental conditions. A facility shall not require abstinence or completion of counseling before providing a clinically indicated medication where such a requirement is inconsistent with sound practice.
(b) CONTINUITY. Relapse, recurrence, or missed appointments shall prompt reassessment and reengagement, not categorical discharge from coverage. A transfer, detention, hospitalization, or disaster shall not interrupt an established medication regimen without an individualized clinical reason and a safe alternative.
(c) PROGRAM INTEGRITY. Marketing claims, laboratory testing, residential placement, and referral compensation shall be subject to ordinary evidence and anti-kickback requirements. The Authority shall not pay for unnecessary repeated testing or prolonged residential care based solely on the availability of a funded bed. A disputed level of care shall receive independent clinical review under title IV.
(a) COVERED INTERVENTIONS. The Fund shall pay for clinically and legally authorized overdose-reversal medicines, overdose education, infection prevention, wound care, testing, vaccination, and referral to treatment. The Secretary shall identify additional evidence-based interventions through public review and shall specify any separate legal authorization required.
(b) ACCESS. A patient shall not be required to demonstrate readiness for abstinence before receiving emergency or preventive care. Lawfully supplied overdose-reversal products shall be available through qualified pharmacies, community providers, and emergency services without an AHP patient charge.
(c) LIMITATION. Coverage authority does not authorize manufacture, possession, or distribution of a controlled substance in violation of otherwise applicable federal law. A public-health service shall not be used as a routine source of identifying information for unrelated enforcement. Aggregate evaluation shall measure health outcomes and service connection without creating a registry of people who use substances for nonclinical purposes.
(a) INDIVIDUAL STANDARD. Coverage of inpatient or residential behavioral-health treatment shall turn on severity, safety, functioning, available alternatives, and the person's clinical circumstances. A payer shall not require deterioration to an immediate danger threshold where a medically necessary less acute admission would prevent serious harm.
(b) REVIEW. Continued-stay review shall be performed by a professional with relevant competence and shall identify the actual available alternative supporting a proposed transfer. A list of facilities that have no capacity does not establish an available alternative. Emergency and expedited appeal protections apply.
(c) SAFETY. Facilities shall comply with staffing, consent, seclusion, restraint, medication, and safeguarding requirements. AHP payment does not validate involuntary confinement. Residential housing costs are covered only when inseparable from a medically necessary clinical episode or otherwise expressly authorized; ordinary supportive housing remains the responsibility of separately authorized programs.
(a) SERVICES. A covered person with serious functional impairment may receive coordinated community treatment, psychiatric rehabilitation, peer support, medication assistance, and clinically necessary home visits. A written plan shall identify the person's goals, chosen supports, crisis preferences, and responsible team.
(b) VOLUNTARY PARTICIPATION. Refusal of a recommended service shall not automatically terminate the other components of a plan. A team shall explain alternatives and support informed decision-making. Court-ordered treatment, guardianship, and substitute decision-making require independent lawful authority and do not arise from enrollment in AHP.
(c) DELIVERY. The Authority shall fund reasonable travel, smaller caseloads, and team consultation where necessary for complex community care. Payment shall not reward keeping patients on a caseload after the service is no longer needed. Annual independent review shall assess patient experience, community integration, continuity, and unmet need while protecting confidential clinical records.
(a) COVERAGE. Clinically necessary treatment for eating disorders, obsessive-compulsive conditions, severe trauma-related disorders, and comparable complex conditions shall include appropriate medical monitoring, psychological treatment, nutrition services, and indicated levels of care. Body weight, laboratory values, or outward appearance alone shall not conclusively determine severity.
(b) COORDINATED CARE. Providers shall identify a responsible clinical lead where physical and behavioral risks interact. A payer shall not reject each component on the ground that the other specialty is responsible. Medical instability shall trigger suitable emergency or hospital care.
(c) CONTINUITY. Transition to a lower level of care shall include a viable receiving service and monitoring plan. A categorical number of sessions shall not replace individualized necessity. The Council shall publish evidence reviews addressing uncertainty and patient safety, and shall ensure that lack of a large trial population is not automatically treated as proof of ineffectiveness for a rare presentation.
(a) QUALIFICATIONS. The Authority shall recognize peer-support credentials based on relevant training, supervision, ethical standards, and demonstrated competence. Lived experience may be a qualification but shall not compel disclosure of private treatment details to every employer or patient.
(b) SCOPE. Peer workers may provide recovery support, navigation, shared problem-solving, and community connection within their training. They shall not be used to replace licensed assessment or treatment when that level of competence is required. Supervision shall support boundaries and safety without converting peer relationships into coercive monitoring.
(c) EMPLOYMENT. Workers shall receive wages and benefits applicable to their duties under title V and access to advancement training under title XIII. Programs shall maintain complaint and safeguarding procedures. A patient may decline a peer relationship or request another worker without loss of clinical services. Hiring standards shall assess relevant current competence rather than impose a categorical bar based on a past treated condition.
(a) RECORDS. The Authority shall preserve additional protections applicable to substance-use and psychotherapy records. A general payment authorization shall not be treated as consent to unrestricted disclosure of detailed therapy content. Claims shall contain only information reasonably necessary to establish service, qualification, and payment.
(b) SEPARATE AUTHORITY. No payment rule, risk algorithm, or provider contract may itself authorize involuntary examination, confinement, restraint, or forced medication. Where another law authorizes an intervention, the provider shall document the applicable basis and required review.
(c) NONDISCRIMINATION. Diagnosis, prior treatment, or contact with a crisis service shall not justify denial of unrelated benefits, dismissal from an ordinary medical practice, or adverse employment use of AHP data. A patient may obtain correction of an inaccurate record and an accounting of material disclosures. The remedies of title XVII apply to violations within the scope of that title.
(a) CAPACITY MAP. Regional offices shall maintain current information on outpatient access, crisis teams, staffed beds, youth services, addiction treatment, and culturally and linguistically appropriate care. Published capacity shall mean usable staffed capacity, not merely licensed beds.
(b) CORRECTIVE ACTION. A sustained shortage shall trigger funded contracting, workforce deployment, training, or facility expansion under existing accounts. Telehealth may supplement but not replace necessary in-person care. A waiting-list entry alone does not satisfy the arranging duty in section 401.
(c) MEASURES. Review shall include continuity after discharge, patient-defined functioning, treatment access, avoidable restraint, medication interruption, and complaints. Measures shall not require every patient to achieve an identical recovery trajectory. No regional budget or performance contract may override an individual medically necessary benefit. The Authority shall publish reasons for material changes in capacity and a continuity plan before closing an essential service.
(a) STANDARD. A covered person's entitlement to long-term services shall be based on assistance reasonably necessary for daily activities, cognition, communication, health maintenance, or safe community living. An assessor shall consider fluctuating conditions, episodic disability, fatigue, and the cumulative burden of multiple impairments. A diagnostic label or numerical score shall not substitute for an individualized determination.
(b) INDEPENDENCE. The assessor shall not have a compensation arrangement dependent on reducing authorized hours or directing the person to a financially related facility. The person may submit treating-professional evidence and have a chosen support person present. Assessment shall be accessible and occur in a suitable setting, including the home where appropriate.
(c) TIMING. Initial assessment shall begin within ten business days of request and produce a decision within 30 days, or within 48 hours when delay presents a substantial safety risk. Necessary interim services shall be authorized pending assessment. A stable permanent condition shall not require repetitive proof of the same immutable facts.
(a) CONTENTS. A service plan shall state the person's goals, chosen setting, assistance tasks, frequency, staffing qualifications, backup arrangements, and process for obtaining an urgent change. The person shall receive an accessible copy and may identify an authorized representative or supporter without surrendering legal decision-making authority.
(b) AUTHORIZED AMOUNT. Hours shall reflect assessed need, including supervision and overnight support where clinically or functionally necessary. An assumption that a spouse, parent, or other relative will provide unpaid assistance is prohibited. Shared living arrangements shall not automatically reduce an individual's authorized services.
(c) REVIEW. Plans shall be reviewed at least annually and upon a material change in need. A reduction requires individualized evidence, adequate advance notice, and continuing services during a timely appeal as provided in section 403. Administrative delay or a missed assessment appointment caused by an accommodation failure shall not terminate an otherwise supported plan.
(a) OPTION. A competent adult or lawful representative may elect self-directed services, select qualified workers, and manage an approved individual budget with support from an independent fiscal intermediary. Election shall be voluntary, and an agency-delivered alternative shall remain available.
(b) PROTECTIONS. The intermediary shall handle payroll, withholding, insurance, verified payment, and accessible expenditure statements. The participant shall not be required to become an expert in employment-tax administration. Workers shall retain applicable wage, leave, safety, and organizing rights, and family status shall not eliminate those protections where an employment relationship exists.
(c) ACCOUNTABILITY. Spending shall remain tied to the approved service plan. The Authority shall use proportionate verification and independent review, not continuous surveillance inside the person's home. A correctable recordkeeping error shall ordinarily trigger assistance and a cure opportunity rather than abrupt service withdrawal. Fraud sanctions require the elements and procedures prescribed in title XVII.
(a) SUPPORT. A covered person's plan may include training, respite, counseling, and payment for a qualified relative providing authorized assistance. No relative shall be compelled to accept the role. Selection of a family caregiver shall not eliminate access to backup professional care.
(b) ASSESSMENT. Respite shall be based on the person's needs and the sustainability of the care arrangement, including sleep interruption, physical demands, and foreseeable caregiver absence. The Authority shall offer accessible short-term in-home or facility alternatives appropriate to the patient. Respite is not conditioned on a caregiver first experiencing a medical crisis.
(c) SAFEGUARDS. Payment shall identify tasks and time, avoid duplicate reimbursement, and provide independent means for the patient to report coercion or neglect. A caregiver shall not control all communication with the assessor where private patient communication is feasible. The Authority shall refer suspected abuse through lawful protective procedures without presuming that family care is inherently unsafe.
(a) OFFER. A person in an institution who seeks and can appropriately receive community services shall be offered a transition assessment, service plan, necessary equipment, and funded supports. The Authority shall not require exhaustion of institutional eligibility before approving community care.
(b) IMPLEMENTATION. Transition planning shall identify an actual suitable destination, available workers, medicines, accessibility modifications, and contingency arrangements. A discharge to homelessness or an unsupported setting does not satisfy the community-living duty. Covered medical respite or temporary accommodation may be used only within the express benefit authority of this Act.
(c) CHOICE. Nothing in this section compels community placement when a person chooses appropriate institutional care or when the proposed setting cannot safely meet assessed needs. The Authority shall maintain both necessary institutional capacity and integrated alternatives. A budget preference for one setting shall not displace individualized clinical assessment and the enforceable rights under section 305.
(a) BENEFITS. Necessary home modifications may include safe access, bathroom adaptation, environmental controls, and changes required to use covered equipment or receive authorized assistance. Approval shall consider the person's likely use, reasonable alternatives, safety, and the relationship to functional need, not increased property value alone.
(b) PROPERTY ARRANGEMENTS. Before a substantial modification of rented property, the Authority shall obtain necessary owner permission and a written allocation of maintenance responsibilities. It shall explore portable alternatives where consent is unavailable. The patient shall not be required to surrender ownership or grant a lien on a primary home to receive a covered modification.
(c) PROCUREMENT. Contractors shall meet licensing and safety requirements and provide a written scope, fixed or transparently adjustable price, completion schedule, and warranty. Work shall be inspected for function and safety. The Authority shall fund an interim safe arrangement when delay would otherwise require unnecessary institutionalization. Ordinary cosmetic remodeling is not covered.
(a) CAPACITY. The Authority shall finance adequate direct-support staffing, travel time, supervision, training, and backup availability. Payment schedules shall be sufficient to satisfy section 504 and shall distinguish wages actually paid from agency overhead and profit.
(b) MISSED SERVICE. An agency shall notify the patient and regional coordination office promptly when it cannot fill an authorized essential shift. The Authority shall arrange replacement, an appropriate temporary alternative, or emergency support according to risk. Recording a missed visit without arranging a response is not compliance.
(c) WORKER AND PATIENT PROTECTION. A worker shall not be required to remain indefinitely beyond a scheduled shift because the next worker is unavailable. The agency remains responsible for safe handover and escalation. Patients shall not be charged for replacement staffing or compelled to accept an unqualified worker. Persistent staffing failure shall trigger a funded corrective plan and, where necessary, transfer to another provider without reducing authorized care.
(a) RIGHTS. A participating long-term-care facility shall respect privacy, personal choice, communication, visitation, access to records, and freedom from retaliation. Admission shall not require waiver of a statutory remedy, transfer of personal assets, or designation of the facility as the resident's financial agent.
(b) CLINICAL DUTIES. Each resident shall have an individualized care plan, appropriate medication review, access to necessary outside specialists, and effective infection prevention. A facility shall not use chemical or physical restraint for staff convenience, punishment, or replacement of adequate staffing.
(c) DISCHARGE. An involuntary discharge requires a lawful reason, advance notice, a suitable receiving arrangement, and appeal rights. Nonpayment caused by an Authority processing error is not a reason to discharge the resident. Emergency relocation for safety shall preserve access to essential records, medicines, equipment, and the resident's chosen contacts.
(a) SERVICES. Coverage includes appropriate evaluation, treatment, communication support, caregiver education, home safety assessment, respite, and management of coexisting conditions. A diagnosis of dementia shall not by itself justify exclusion from rehabilitation, pain treatment, preventive care, or a clinically indicated procedure.
(b) DECISIONS. Clinicians shall support the person's participation to the maximum practicable extent and assess capacity for the particular decision rather than presume global incapacity. Advance directives and lawfully authorized representatives shall be respected, subject to applicable safeguards against abuse.
(c) DELIVERY. The Authority shall finance teams competent in cognitive impairment and alternatives to avoidable emergency transfer. Programs shall distinguish distress caused by untreated pain, infection, communication barriers, or environment from a need for sedating medication. Technology used for location or safety monitoring requires lawful consent and proportionate limits; it shall not become an unrestricted surveillance system.
(a) BENEFIT. Medically or functionally necessary adult day services may include nursing, therapy, assistance with daily activities, structured cognitive support, transportation, and supervision. A plan shall identify the health or functional need served and the participant's preferences.
(b) INTEGRATION. Services shall support participation in ordinary community life where appropriate, not require segregation by diagnosis for administrative convenience. A provider shall offer accessible communication, meaningful activities, and reasonable opportunities for personal choice.
(c) PAYMENT AND LIMITS. The Authority shall pay reasonable delivery costs and necessary transport without a patient fee. General recreation or social membership unrelated to an assessed health need is not independently covered by this section. The absence of a day program shall not justify reducing separately necessary home supports. Provider quality review shall include attendance barriers, participant experience, safety, and the availability of alternatives when a program closes temporarily.
(a) SAFEGUARDING. Participating providers shall maintain a confidential means to report suspected abuse, neglect, coercion, or misuse of a patient's resources. Personnel shall be trained to recognize indicators, preserve relevant evidence, and make reports required by law.
(b) RESPONSE. The Authority shall coordinate with lawful protective agencies and shall arrange medically necessary alternative care where the current arrangement presents a substantial risk. A protective referral does not itself establish incapacity or authorize entry into a home, asset seizure, or involuntary placement.
(c) INDEPENDENCE. A provider or fiscal intermediary shall not accept a gift, beneficiary designation, or financial power from a patient in circumstances creating an exploitative conflict. The Secretary shall establish narrow exceptions for ordinary nominal expressions of appreciation through rulemaking. Patients shall have independent assistance in raising concerns, and good-faith reporting shall be protected against retaliation under section 1706.
(a) REPORT. The Chief Actuary shall separately report service use, workforce costs, institutional and community expenditures, caregiver payments, and unmet need. Transfers between settings shall be evaluated for patient outcomes and total cost, not assumed to generate a fixed saving.
(b) CAPACITY DUTY. Each region shall annually identify unfilled authorized hours, preventable institutional delay, inaccessible housing-related barriers, and needed training. The Authority shall fund corrective capacity through the appropriate clinical, facilities, and workforce accounts.
(c) ENTITLEMENT. Fiscal forecasting shall not create an enrollment cap, asset test, estate recovery, or waiting list inconsistent with section 305. A newly identified funding need increases the lawful payment obligation under title VII rather than authorizes an unlegislated benefit reduction. All clinical services under this title commence under section 1801; later planning and workforce deadlines govern improvement of delivery, not the existence of coverage.
(a) ORGANIZATION. The Administrator shall designate regional networks for complex care requiring concentrated expertise, specialized equipment, or coordinated disciplines. Designation shall be based on verified competence, outcomes adjusted for risk, access, staffing, and capacity, not ownership type or political sponsorship.
(b) PATIENT ACCESS. Referral to a center shall be required only where necessary for safety or a specialized service unavailable locally. Routine follow-up shall remain available near the patient's residence where clinically appropriate. Necessary travel, lodging, interpretation, and caregiver assistance are covered under section 306.
(c) ACCOUNTABILITY. A network agreement shall specify accepting clinicians, referral response times, emergency transfer, records exchange, and shared responsibility after discharge. Designation shall not confer an exclusive franchise or immunity from competition law. The Authority shall maintain an alternative when a designated center is full, unavailable, or unsuitable for the patient's documented needs.
(a) PATHWAY. A suspected malignancy shall receive timely diagnostic workup according to clinical urgency, including pathology, imaging, and specialist review. A referral shall identify who is responsible for confirming that the evaluation is completed.
(b) PLAN. A treatment plan shall integrate surgery, systemic therapy, radiation, supportive care, fertility preservation when indicated, rehabilitation, and surveillance. The patient shall receive understandable alternatives and access to a second opinion without loss of a scheduled treatment opportunity where delay would be harmful.
(c) CONTINUITY. Formulary changes, institutional budgeting, or transfer between regions shall not interrupt an active medically necessary course without individualized review and a safe alternative. The Authority shall fund management of treatment toxicity and survivorship needs rather than restrict payment to administration of the principal cancer therapy. Care decisions shall not be based on a patient's financial resources or unrelated social status.
(a) ACCESS. A covered person with a suspected rare or undiagnosed condition may receive appropriate specialist consultation, genetic counseling, diagnostic evaluation, and coordinated review where ordinary evaluation has not resolved a serious clinical problem. Lack of a final diagnosis shall not bar symptom management or necessary supportive care.
(b) EVIDENCE. The Council shall use methods appropriate to small populations, natural-history evidence, and credible patient-reported outcomes. Small trial size alone shall not establish that a treatment is ineffective, but novelty or patient demand alone shall not establish effectiveness.
(c) REVIEW. Individual exceptional-coverage requests shall receive a reasoned determination from competent reviewers with conflicts disclosed. When treatment is approved with evidence development, data requirements shall be proportionate, ethically reviewed, and funded. A patient shall not bear a research-administration charge or lose routine clinical care because the patient declines optional research participation.
(a) BENEFITS. Coverage includes evaluation, listing-related assessment, transplantation, procurement costs lawfully allocable to clinical care, post-transplant medicines, monitoring, and treatment of complications. A patient shall not be required to demonstrate personal ability to finance lifelong medicines covered by this Act.
(b) ALLOCATION. AHP shall respect the nationally applicable lawful organ-allocation framework and shall not purchase priority, alter allocation for political reasons, or authorize organ sales. Selection criteria shall be transparent and based on relevant clinical considerations, with disability and civil-rights safeguards.
(c) REVIEW. A center shall provide specific reasons for a listing decision and access to an independent clinical review or another qualified center. AHP review cannot guarantee an organ or override an allocation rule outside the Authority's lawful power. Necessary donor evaluation and follow-up shall be financed through the transplant episode without shifting charges to a living donor.
(a) COVERED COSTS. A medically suitable living donor participating in a lawful transplant for an AHP-covered recipient shall receive no-charge evaluation, donation-related care, necessary travel, and treatment of donation-related complications. A donor not otherwise entitled to full AHP coverage receives these episode-specific protections without acquiring unrelated full eligibility.
(b) INDEPENDENT ADVOCACY. The donor shall have an independent advocate, confidential evaluation, and an opportunity to withdraw before donation without an obligation to reimburse clinical costs. Information about reasons for withdrawal shall be disclosed only as permitted by law and consent.
(c) ECONOMIC SUPPORT. Reasonable documented lost earnings and dependent-care costs directly necessary for evaluation, donation, and immediate recovery may be reimbursed up to the donor's actual loss and a daily limit equivalent to the national median weekly wage divided by five. Such reimbursement compensates expense and loss; it is not payment for an organ. Duplicate reimbursement is prohibited.
(a) CONTINUUM. Coverage includes prevention, specialist evaluation, dialysis, access procedures, transplant evaluation, nutrition, medicines, and home-treatment support. Patients shall receive balanced information about clinically suitable modalities without financial steering toward a provider's preferred site.
(b) HOME SERVICES. A home modality shall include necessary equipment, supplies, training, maintenance, and clinically required utility adjustments. A patient's inability to provide unpaid caregiver labor shall not automatically bar an otherwise suitable modality. Facility treatment remains available where preferred or clinically necessary.
(c) SAFETY. Dialysis providers shall maintain infection-control systems, emergency transfer arrangements, supply reserves, and continuity plans for utility disruption. A missed session caused by transport failure shall trigger immediate assistance. Limited-benefit persons retain scheduled life-preserving dialysis to the extent provided in section 204; the scope shall not be narrowed to repeated emergency rescue alone.
(a) SERVICES. Integrated care shall include appropriate risk assessment, medicines, monitoring, rehabilitation, smoking-cessation treatment, and specialist referral for cardiovascular, metabolic, and respiratory conditions. Necessary equipment and consumable supplies shall be furnished together with training and maintenance.
(b) CLINICAL INDIVIDUALIZATION. A single laboratory target, body-size measure, or prior treatment failure shall not substitute for assessment of overall clinical risk and reasonable alternatives. Coverage of an indicated medicine shall not be conditioned on a patient purchasing a commercial lifestyle program.
(c) CONTINUITY. The Authority shall support shared plans for patients with interacting conditions and prevent contradictory authorizations. Care coordinators shall identify duplication, adverse interactions, and access barriers without independently overriding a qualified prescriber's clinical judgment. Contract incentives shall not encourage withholding necessary devices or medicines to reduce short-term expenditure while increasing foreseeable serious harm.
(a) BENEFITS. Coverage includes evaluation, medicines, procedures, assistive products, rehabilitation, habilitation, and support for neurologic disease or injury. A progressive condition shall not defeat coverage aimed at preserving function, communication, independence, or comfort.
(b) COORDINATION. Following a stroke, spinal injury, brain injury, or comparable event, the responsible team shall arrange an individualized rehabilitation plan before discharge. The plan shall identify the appropriate setting, therapies, equipment, transport, and follow-up clinician, and shall be revised as the person's condition changes.
(c) ACCESS. The Authority shall not substitute an inflexible visit limit for clinical need or require a person to demonstrate rapid improvement to continue maintenance therapy. A disputed intensity or setting shall receive review by a professional with relevant rehabilitation competence. Educational, employment, and social-service obligations remain separately enforceable and shall be coordinated without duplicate payment.
(a) SERVICES. A covered person with persistent pain shall have access to individualized assessment and evidence-based pharmacologic, rehabilitative, psychological, procedural, and supportive options. A diagnosis shall not be rejected solely because imaging or another test does not fully explain the person's symptoms.
(b) SAFETY. Prescribing shall remain subject to applicable controlled-substance law and professional standards. This Act creates neither a right to a particular controlled medicine nor a mandatory prohibition of an otherwise clinically justified prescription. Abrupt treatment changes shall be avoided where they would create a foreseeable safety risk, with an individualized plan and appropriate follow-up.
(c) NONDISCRIMINATION. A history of addiction shall prompt suitable risk management and treatment access, not abandonment. Payment shall support time-intensive evaluation and coordination rather than make a procedure the only adequately compensated option. Product manufacturers and procedure vendors shall disclose material financial involvement in funded pain-management programs.
(a) PALLIATIVE BENEFIT. Symptom relief, communication support, serious-illness counseling, and interdisciplinary palliative care shall be covered concurrently with disease-directed treatment when medically necessary. A patient need not elect to forgo curative treatment to receive palliative services.
(b) HOSPICE. Hospice shall provide individualized clinical and supportive care, necessary medicines and equipment, respite, and family bereavement support within evidence-based service standards. Recertification shall assess current clinical need without imposing an arbitrary lifetime duration limit.
(c) AUTONOMY. Patients retain informed-consent, treatment-refusal, and advance-directive rights. No payment incentive may pressure a person to decline treatment, enter hospice, or shorten life. AHP coverage does not independently authorize assisted suicide or euthanasia. Where another law permits a service, its coverage shall be determined under this Act's express benefit and clinical rules, not by an implication from this section.
(a) ENTITLEMENT. A covered person facing major surgery, a life-altering diagnosis, an irreversible treatment, or a materially disputed complex care plan may obtain an independent second opinion. The Authority shall arrange remote review or travel when local expertise is unavailable.
(b) INFORMATION. The reviewing clinician shall receive relevant records promptly and explain agreement, disagreement, and uncertainty. A second opinion shall not automatically cancel the first plan or require the patient to repeat every diagnostic test. Additional testing shall be justified by clinical need.
(c) INDEPENDENCE. A reviewer shall disclose financial relationships with the proposed provider, product supplier, and referring entity. Payment shall compensate review time without rewarding denial. An urgent treatment need shall take priority over administrative completion of an optional second opinion. The patient may decline further review after informed discussion without losing coverage for an otherwise authorized service.
(a) MEASURES. Specialty programs shall report clinically appropriate outcomes, complications, referral acceptance, treatment interruption, and patient-reported function using risk adjustment and privacy safeguards. Low-volume programs shall not be assigned misleading rankings from statistically unreliable comparisons.
(b) CORRECTIVE ACTION. A material safety concern shall trigger clinical review, remediation, supervised practice, or transfer of specific services as warranted. The Authority shall maintain access during a corrective action and shall not close an essential regional service without an actual alternative or a documented immediate safety necessity.
(c) FINANCING. Clinical obligations under this title are paid under title VII, specialist training under title XIII, and necessary facilities under title XII. Designated-center status shall not create a separate unlimited grant. Existing allocations shall be reconciled annually, while an individual medically necessary benefit remains payable notwithstanding exhaustion of a center's planned operating budget.
(a) RESPONSIBILITY. The Authority shall purchase emergency medical readiness and response sufficient to serve every region, in coordination with State, Tribal, territorial, local, and private emergency-service entities that voluntarily contract or otherwise act under their own authority. Federal fallback services shall be arranged where local contracting is insufficient.
(b) STANDARD. Clinical response targets shall account for acuity, terrain, travel distance, weather, and available communications. The Secretary shall publish methodology and regional improvement obligations. A target shall not authorize unsafe driving, flight, or deployment of an unqualified crew.
(c) FUNDING. Readiness, dispatch integration, assessment, stabilization, and medically necessary transport shall be financed as covered operations. A patient shall not be charged a subscription, membership, dispatch fee, mileage supplement, or municipal collection assessment as a condition or consequence of a covered response. General taxes imposed independently of an individual response are not prohibited patient charges.
(a) BUDGETS. An emergency medical service may receive a prospective budget for qualified staffing, vehicles, equipment, medical direction, training, and standby capacity, together with payment for costs not already included. The Authority shall distinguish readiness from transport volume.
(b) RURAL AND LOW-VOLUME SERVICES. A low volume of calls shall not by itself justify withdrawal of essential coverage. The budget shall consider minimum safe staffing, response area, mutual aid, and transport distances. Volunteer participation may supplement but shall not conceal an unfunded requirement for dependable professional availability.
(c) ACCOUNTABILITY. Contracts shall specify unit availability, maintenance, crew qualifications, backup arrangements, and audited expenditures. The Authority may recover unearned readiness payments after due process. It shall first arrange continued response capacity and shall not respond to contractor default by shifting costs to patients or discontinuing emergency service in the affected area.
(a) PAYMENT. Qualified assessment and treatment shall be payable when transport is not medically necessary or when a clinically appropriate alternative destination is used. Payment shall not require delivery to a hospital emergency department solely to generate an eligible claim.
(b) CLINICAL SAFEGUARDS. An alternative-destination protocol shall define patient selection, required competence, informed consent, receiving-site availability, and escalation criteria. A crew shall confirm that the destination can actually receive the patient. A patient may request further evaluation where serious symptoms remain unresolved.
(c) LIMITS. Financial incentives shall not encourage premature release or diversion of unstable patients. A good-faith patient refusal of transport shall be documented with an explanation of material risks and available assistance. Payment disputes over destination or medical necessity shall not create patient liability under section 307.
(a) CLINICAL AND OPERATIONAL NECESSITY. Air or water transport shall be covered where time, terrain, distance, weather-access constraints, or the patient's condition makes it a clinically appropriate means of reaching suitable care. Dispatch criteria shall be developed jointly by clinical and transport-safety personnel.
(b) SAFETY. Operators shall comply with applicable aviation, maritime, equipment, and personnel rules. A payer or referring facility shall not pressure an operator to accept an unsafe mission. A declined unsafe mission shall prompt coordination of another safe option and appropriate stabilization.
(c) PRICING. Public payments shall reflect efficient readiness and operating costs, necessary crew qualifications, and transparent capital expense. A geographic monopoly does not authorize an unreviewable charge. Contracting shall preserve practical backup capacity rather than select a sole supplier solely on a low bid. Patients shall not receive a residual bill when a provider contests the public rate.
(a) BENEFIT. A covered person unable to reach a covered service through a safe reasonable alternative because of disability, clinical need, distance, or an identified access barrier shall receive suitable transport. Eligibility shall be assessed from practical circumstances, not possession of a vehicle that the person cannot use safely.
(b) SERVICE STANDARD. A transport order shall specify required assistance, mobility equipment, escort needs, timing, and the return arrangement. Brokers shall verify actual vehicle and driver capacity. A missed dialysis, oncology, rehabilitation, or other time-sensitive appointment shall trigger immediate recovery arrangements.
(c) RIGHTS. A driver shall not demand a tip or additional payment, leave a person at an inaccessible entrance, or disclose clinical information unnecessarily. Complaints shall be accessible by telephone and other nondigital means. The Authority shall assess on-time completion, safety, and actual access, not simply the number of rides booked.
(a) COORDINATION. Each region shall operate a clinical transfer coordination function with current information about staffed beds, specialist availability, isolation capability, and transport options. Participating facilities shall provide timely updates without disclosing patient-identifying information in public dashboards.
(b) RESPONSIBILITIES. A sending facility shall stabilize within its capability, transmit essential records, and arrange qualified transport. A receiving facility shall promptly state acceptance or a specific clinical or capacity reason for refusal. Financial class and AHP payment disputes are not permissible refusal grounds.
(c) ESCALATION. Where no ordinary accepting facility is available, the regional medical lead shall arrange additional contracting, cross-region transfer, or temporary capacity. A digital bed listing alone does not satisfy this duty. Transfer decisions shall respect patient consent and applicable emergency law, and shall not compel an individual clinician to perform beyond competence.
(a) NETWORKS. The Authority shall finance coordinated networks for trauma, stroke, acute cardiac emergencies, burns, and other conditions requiring rapid specialty intervention. Designation shall identify capabilities, activation criteria, transfer relationships, and readiness payments.
(b) BALANCE. Regional planning shall support specialized capacity without unnecessarily bypassing a suitable closer facility or destabilizing essential local emergency care. Clinical protocols shall be evidence-based and reviewed for geography, transport time, and actual staffing.
(c) QUALITY. Networks shall examine delays from initial contact through definitive treatment and identify correctable communications, transport, staffing, and equipment failures. Reviews shall preserve required patient access to records and lawful accountability. Funding for readiness shall not require a facility to generate unnecessary procedures or admissions to remain financially viable.
(a) PREPAREDNESS. Emergency teams and receiving facilities shall maintain appropriate pediatric equipment, medication-dosing support, communication aids, and training for patients with disabilities. Equipment selection shall reflect the population and mission rather than adult-only assumptions.
(b) ACCOMMODATION. A necessary caregiver, interpreter, service animal, or communication device shall accompany the patient where safe and practicable. Where transport constraints prevent accompaniment, the team shall arrange communication and reunion without an additional patient charge.
(c) CLINICAL DECISIONS. A disability, communication difference, or need for assistance shall not be mistaken for refusal, intoxication, or lack of decision-making capacity without assessment. Restraint shall be used only under lawful clinical and safety standards, not for convenience. The Authority shall fund training and equipment upgrades from the applicable readiness and capital accounts.
(a) AGREEMENTS. The Secretary shall support interoperable communication among dispatch, mobile responders, hospitals, crisis teams, and public-health authorities through lawful agreements and open technical standards. A federal grant shall not require a jurisdiction to relinquish unrelated emergency-management powers.
(b) CONTINUITY. Systems shall include fallback radio or other appropriate channels, backup power, accessible contact methods, and procedures for network outage. Essential patient information shall be limited to what is necessary for response and handover.
(c) TESTING. Regions shall conduct at least annual multiagency exercises that include communications failure and inaccessible digital systems. After-action reports shall identify corrective purchases and accountable officials. Sensitive security details may be withheld from public release with an explanatory summary. A proprietary vendor agreement shall not prevent lawful interoperability or export of operational data needed to continue service.
(a) CONDITIONS. Emergency employers shall provide appropriate protective equipment, safe lifting resources, fatigue management, violence-prevention procedures, and confidential mental-health support. Required readiness and training time shall be paid as provided by applicable wage law and this Act.
(b) MEDICAL DIRECTION. Each service shall have accountable medical direction, clear protocols, access to consultation, and a process for reviewing unusual clinical events. A protocol shall not require a worker to perform outside legal scope or current competence.
(c) NONRETALIATION. A worker may report a good-faith safety concern or decline an objectively unsafe transport assignment through a documented escalation process without retaliation. This protection does not excuse abandonment of a patient without reasonable handover. The Authority shall fund reasonable safety costs and investigate contracts that achieve low prices by excluding necessary staff protections.
(a) NO DOUBLE COLLECTION. A public or private entity receiving AHP payment for a covered emergency response shall not collect an additional service-based amount from the patient, a household member, or a property owner solely because the response occurred at the property. A local tax of general application remains subject to ordinary law.
(b) TRANSITION. The Authority shall work with participating municipalities to replace lawful service-fee revenue attributable to covered AHP responses with transparent public payments. Replacement shall reflect verified services and readiness, not an inflated historical charge schedule or an assumed collection amount that was never received.
(c) REMEDIES. A patient may invoke section 307 without first resolving a dispute over municipal accounting. The Authority shall provide accessible model notices for local billing offices and debt collectors. Collections made in error shall be refunded and related credit information corrected within the statutory deadlines.
(a) PUBLIC REPORT. Regions shall quarterly report response availability, clinically significant delays, failed transport, unstaffed units, diversion, and continuity during outages. Reporting shall distinguish estimated dispatch times from verified patient-contact and destination times.
(b) CORRECTIVE ACTION. A material persistent gap shall require a funded response plan within 30 days, with temporary capacity arranged sooner where needed to protect life. The Authority may contract across regional boundaries and use federal resources lawfully available to it.
(c) LIMITS AND FINANCING. No statistical target authorizes unsafe care or extinguishes an individual remedy. Services and readiness under this title are obligations within title VII; vehicles, facilities, and communications investments are accounted for under title XII or the public-readiness account as appropriate. The same equipment cost shall not be charged to multiple federal programs.
(a) INVENTORY. The Administrator shall maintain an inventory of participating facilities, staffed capacity, major equipment, physical condition, accessibility, critical utility dependence, and emergency resilience. Initial information shall use existing lawful records and provider attestations, with risk-based verification rather than a duplicative survey of every site.
(b) NEED. Capital proposals shall identify the clinical access problem, population served, existing alternatives, workforce availability, operating cost, and expected useful life. A technologically advanced product shall not qualify solely because it is new or commercially promoted.
(c) SCHEDULE. An initial inventory and priority process shall be published by day 120 after enactment and updated annually. Immediate life-safety work and necessary interim access may proceed before the inventory is complete. Title XII funding floors remain mandatory; this section governs selection and accountability rather than creates an additional appropriation of the same amount.
(a) APPLICATION. A capital application shall contain a defined scope, clinical justification, alternatives analysis, site control, cost estimate, staffing and training plan, operating budget, procurement method, risk register, and proposed completion milestones. Small essential projects shall receive proportionate simplified requirements and technical assistance.
(b) PUBLIC PROCESS. For a major new facility or service relocation, the Authority shall publish a summary and provide at least 30 days for community comment, including accessible participation by affected patients and workers. Emergency temporary projects may proceed with prompt subsequent disclosure of the necessity.
(c) DECISION. Approval or denial shall state the material findings and funding conditions. Political endorsement, naming rights, or an applicant's ability to purchase consulting services shall not substitute for demonstrated need. An unsuccessful applicant may request administrative reconsideration but may not delay another essential project solely by filing an unsupported objection.
(a) ELIGIBLE WORK. The facilities account shall support necessary structural repair, infection-control improvements, accessibility, emergency power, water safety, fire protection, clinical-space modernization, and replacement of unsafe or unsupported essential equipment. Cosmetic renovation unrelated to clinical function is not a priority expense.
(b) PLAN. A renovation award shall identify how care continues during construction, including noise, dust, infection risk, temporary relocation, and emergency egress. A facility shall consult affected clinical staff before finalizing sequencing that changes patient flow or access.
(c) MAINTENANCE. The recipient shall maintain an asset-management schedule and reserve a reasonable portion of its approved operating budget for routine maintenance. An award shall not excuse an owner from an existing legal duty to maintain safe premises. Where prior neglect contributed to risk, the Authority may require management correction or recoverable financing, while protecting immediate patient access.
(a) AUTHORITY. The Administrator may finance, acquire by voluntary agreement, construct, or lease a facility necessary to meet documented access obligations. Public, Tribal, nonprofit, cooperative, and qualified private operators may participate under transparent public-use conditions.
(b) CONFIGURATION. The project shall compare a new full-service hospital with expansion, distributed clinics, emergency stabilization, teleconsultation, and regional transport. Selection shall be based on safe service capability and total lifecycle cost, not a presumption that every community needs every specialty on site.
(c) COMMISSIONING. No facility shall open a service until the operator demonstrates required staffing, licenses, equipment, emergency procedures, and clinical governance. Delayed commissioning shall trigger interim access purchases, not a waiver of safety. Capital completion and the start of a particular local service shall not postpone nationwide benefit entitlement under section 1801.
(a) COMMITMENT. An essential rural or underserved facility receiving a ten-year operating commitment under section 1204 shall have an agreement specifying covered readiness, expected services, efficient costs, wage obligations, maintenance, and annual adjustment. The commitment shall be renewable after access review and shall not depend on annual discretionary appropriation.
(b) REVIEW. A low patient volume shall not by itself establish inefficiency where the capacity is necessary for emergency readiness or geographic access. The Authority may revise service configuration after clinical and community review, but shall finance a safe actual alternative before ending an essential function.
(c) REMEDIES. Material operator breach may result in supervised management, contract transfer, or lawful receivership through a court. The government shall not acquire private property without applicable compensation and process. Patient access and earned employee compensation shall be protected during enforcement, subject to the lawful priority of claims in any insolvency proceeding.
(a) TARGETED CAPACITY. Within the title XII allocation process, the Authority shall identify gaps in maternity, behavioral-health crisis, rehabilitation, dental special-needs, and other clinically essential services not adequately supplied by general hospital beds. A proposal shall demonstrate appropriate workforce and referral support.
(b) NO UNSTAFFED-BED COUNTING. Licensed beds without personnel, equipment, and operating authority shall not be counted as available capacity. Capital awards may include preopening recruitment and training only where those costs are identified and not separately reimbursed under another account.
(c) OPERATION. A funded service shall maintain safe admission criteria, emergency transfer, and continuity when staffing falls below requirements. The Authority shall monitor actual service availability after opening and may condition later payments on correction of a material failure. Patient benefits shall remain payable elsewhere during any correction.
(a) PROCUREMENT. Capital recipients shall use transparent competitive procedures appropriate to project size, disclose material beneficial ownership and related-party interests, and document the basis for contractor selection. Emergency procurement requires a written necessity finding and review within 30 days.
(b) COST CONTROL. Contracts shall define deliverables, change-order authority, schedule, inspection, warranty, insurance, and remedies for nonperformance. Cost-plus arrangements require a specific justification and independent cost review. A contractor may not recover an undisclosed referral fee, unlawful kickback, or duplicative management charge from the Fund.
(c) WORKFORCE AND SAFETY. Applicable prevailing-wage, worker-safety, nondiscrimination, and accessibility requirements shall be observed. Procurement shall not evade those requirements by dividing one project into nominally separate awards. Small and local qualified firms shall receive a fair opportunity to compete without being exempted from clinical or structural safety standards.
(a) PAYMENT. Capital funds shall be released against verified milestones, with a reasonable mobilization advance and retainage where appropriate. The recipient shall maintain separate project accounting and certify completed work through a competent independent reviewer.
(b) OVERRUN. A projected increase exceeding 10 percent of the approved project budget, or a material change in clinical scope, shall require a revised estimate, alternatives review, explanation of cause, and approval before additional discretionary project commitments are made. Necessary immediate life-safety work may proceed with prompt notice.
(c) NO AUTOMATIC BAILOUT. A contractor's loss or an owner's unrelated debt does not create an entitlement to additional capital funding. The Authority may restructure, rebid, reduce nonessential scope, or replace an operator, while separately satisfying patient-access duties. Recoveries from defective work shall be credited once to the Fund and shall not delay needed clinical protection.
(a) STANDARD. Funded facilities shall assess locally relevant flood, fire, seismic, heat, wind, water, power, and communications risks. Critical clinical functions shall have documented backup and evacuation arrangements proportionate to patient acuity and the foreseeable duration of disruption.
(b) DESIGN. Major renovation and new construction shall incorporate efficient ventilation, infection control, safe water, accessible evacuation, maintainable equipment, and appropriate emergency power. A resilience measure shall be evaluated for reliability and lifecycle cost rather than selected solely for a marketing certification.
(c) TESTING. Operators shall test backup systems at appropriate intervals, correct material failures, and train staff in degraded operations. The Authority shall prioritize upgrades where utility failure would interrupt dialysis, ventilation, refrigeration, surgery, or emergency response. Federal investment does not eliminate the operator's duty to comply with applicable building and safety law.
(a) LIFECYCLE REVIEW. A major clinical-technology purchase shall identify evidence of benefit, interoperability, cybersecurity, staff training, maintenance, consumables, replacement parts, data access, and expected support life. The evaluation shall compare suitable alternatives and total cost of ownership.
(b) CONTRACT TERMS. Vendors shall disclose material restrictions on repair, migration, or use of third-party consumables and shall provide continuity arrangements for insolvency or withdrawal. Essential clinical data shall remain exportable in usable form. A license shall not permit a vendor to disable life-sustaining equipment to enforce a billing dispute.
(c) OBSOLESCENCE. The Authority shall maintain a replacement plan for unsafe or unsupported systems. Replacement shall not require every facility to adopt the same proprietary product. A pilot may establish evidence before national deployment, but an experimental technology shall not displace an effective necessary service without a safe alternative and appropriate review.
(a) COVENANT. A substantial capital award shall include an enforceable period of public clinical use appropriate to the asset's useful life, ordinarily not less than 20 years for a new building. The covenant shall identify service obligations, transfer restrictions, reporting, and proportional recovery for unauthorized disposal or change of use.
(b) APPROVED TRANSFER. The Authority may approve a sale, lease, or operator transfer that preserves necessary access and the public investment. Recovery shall reflect the unamortized federal interest and shall not impose a penalty unrelated to loss or breach. A purchaser shall receive clear notice of the covenant.
(c) CLOSURE. Before an essential facility closes, the operator shall provide at least 180 days' notice unless an immediate safety condition makes continued operation unlawful. The Authority shall arrange a transition and consider lawful acquisition or alternative capacity. This section does not authorize confiscation or defeat rights established by federal bankruptcy law.
(a) AUDIT. The Inspector General shall conduct risk-based audits of major projects, related-party transactions, milestone certifications, and actual use. Recipients shall retain project records for ten years after final payment or resolution of a pending audit, whichever is later.
(b) PERFORMANCE. At one and three years after opening a major service, the Authority shall assess actual access, staffing, utilization, quality, maintenance, and operating cost against the approved plan. Material underperformance shall require a corrective agreement, not automatic withdrawal of patient services.
(c) PUBLIC REPORTING. Project summaries shall disclose scope, award, material changes, completion, operator, and aggregate performance. Security-sensitive design and protected commercial information may be withheld with reasons. Capital spending shall be recorded when the relevant expenditure occurs; commitments, advances, asset values, and annual operating payments shall not be counted as interchangeable measures of program cost.
(a) PLAN. The Secretary shall maintain a five-year rolling workforce plan identifying clinical disciplines, geographic gaps, training capacity, retirement and attrition risks, and required support occupations. The plan shall use transparent assumptions and distinguish licensed headcount from available full-time clinical capacity.
(b) IMPLEMENTATION. Each region shall identify recruitment, retention, supervised training, and transport or teleconsultation arrangements needed to meet access duties. Funding shall be drawn from the clinical operating, education, and facilities accounts according to the actual purpose of the expenditure.
(c) NO DELAY OF BENEFITS. A workforce projection shall not authorize postponement of the full-benefit date or reduction of a statutory compensation floor. The Authority shall use qualified interim capacity and lawful cross-region arrangements while training expands. No person is compelled to enter a health profession or perform involuntary service under this Act.
(a) ACCOUNTING. A provider receiving payment intended to support section 504 shall maintain payroll records sufficient to show covered occupation, full-time equivalent, cash compensation, hours where relevant, and separately identified benefits. Public reporting shall use aggregate data and shall not disclose an individual worker's salary without lawful authority.
(b) PASS-THROUGH. Amounts expressly awarded to cure a compensation shortfall shall be applied to worker compensation and associated lawful payroll costs. They may not be diverted to owner distributions, acquisitions, debt unrelated to the award, or executive bonuses.
(c) ENFORCEMENT. The Department of Labor, in coordination with the Authority, shall investigate supported complaints and use the remedies provided by this Act. A worker shall receive notice of applicable floors and a confidential complaint channel. A disputed employer classification shall be resolved from actual duties, not a title adopted to evade the floor. The government shall coordinate recovery to prevent duplicate compensation for the same loss.
(a) STANDARD. In setting professional rates and compensation-supported budgets, the Authority shall consider training length, responsibility, intensity, recruitment difficulty, local living costs, and necessary on-call service. Supplements shall be published with their justification and reviewed at least every two years.
(b) NO CAP. A statutory floor or supplement is not a ceiling on lawful compensation. Employers may pay more through collective bargaining, market recruitment, or legitimate productivity arrangements that do not incentivize unnecessary care. A payment model shall not guarantee independent-business profits unrelated to delivered services or contracted availability.
(c) INTEGRITY. A provider shall not obtain a shortage supplement by creating an artificial vacancy, understating available capacity, or shifting nominal work locations without actual service. Removal of a designation shall operate prospectively with reasonable notice and shall preserve earned compensation and existing lawful contracts, subject to their terms.
(a) AWARDS. Education-account awards shall expand accredited residency, fellowship, nursing, allied-health, and other clinical training capacity where supported by workforce need. Funding shall cover supervision, protected teaching time, appropriate clinical placements, and trainee compensation.
(b) SAFETY. A new position shall not be counted as training capacity until qualified supervisors and suitable patient experience are available. Expansion shall not dilute accreditation, independent assessment, duty-hour protections, or patient consent applicable to trainee participation.
(c) DISTRIBUTION. The Secretary shall prioritize primary care, high-need specialties, rural and underserved placements, and disciplines with documented shortages while maintaining sufficient specialty and research training. Selection criteria and awards shall be public. A training institution shall report completion, attrition, placement, supervision quality, and the use of funds, without guaranteeing that every graduate will remain at a particular site.
(a) AGREEMENT. Before accepting a substantial scholarship or loan repayment under section 1303, a recipient shall receive an agreement stating the benefit, qualifying service, duration, permissible sites, transfer options, hardship relief, and repayment consequence. Terms may not be materially increased after acceptance without consent.
(b) PERFORMANCE. Service shall be credited for lawful part-time work on a proportional basis and for approved leave under uniform rules. A recipient shall not be required to remain in an unsafe or abusive placement. The Secretary shall offer an alternative qualifying site where the original site closes or cannot provide suitable work.
(c) BREACH. Unexcused failure to perform may require repayment of the unearned proportional subsidy with ordinary interest after notice and appeal. Punitive multipliers and compelled labor are prohibited under this Act. Disability, serious illness, caregiving hardship, death, and circumstances beyond reasonable control shall support waiver, suspension, or proportional adjustment.
(a) SIMPLIFICATION. The Authority shall maintain one verified credential record usable for participation, including licenses, training, sanctions, and relevant privileges. A provider shall not repeatedly submit identical verified information to each public-payment contractor.
(b) LIMITS. Federal payment credentialing does not itself confer a State professional license or expand lawful scope. The Secretary may support voluntary interstate recognition and compacts, expedited verification, and federal practice authority expressly provided by another law. Internationally trained professionals may receive funded assessment and bridging education without waiver of essential competence requirements.
(c) DUE PROCESS. A record shall identify its source, allow correction, and distinguish an allegation from a final sanction. A temporary restriction requires an identified safety or integrity basis and prompt review. A provider denied participation shall receive reasons and the remedies under title XVII, with patient continuity arranged where necessary.
(a) PLANS. Participating facilities shall maintain unit-specific staffing plans based on patient acuity, skill mix, turnover, geography, and service capability. Plans shall identify escalation when staffing falls below safe levels and shall involve patient-facing personnel.
(b) FUNDING. Global budgets and service rates shall recognize the cost of safe staffing, paid handover, necessary breaks, and backup coverage. The Authority shall not impose a staffing requirement while denying reasonable payment for the staffing it requires.
(c) PROTECTIONS. Emergency overtime shall not become a routine substitute for adequate staffing. A worker may report unsafe assignments without retaliation and shall have a defined escalation route that protects patients from abandonment. Applicable collective-bargaining and stronger lawful labor protections remain effective. Staffing reports shall reflect personnel actually available for care, not scheduled workers absent from the unit.
(a) SERVICES. Employers participating in AHP shall provide confidential access to occupational mental-health assistance, postincident support, and referral to treatment. Necessary clinical treatment is covered under ordinary AHP eligibility and benefits; employer assistance shall not replace it.
(b) PRIVACY. Seeking treatment shall not automatically trigger discipline, loss of privileges, or reporting to a licensing authority. Disclosure and fitness review shall be limited to applicable legal duties and objectively relevant current impairment or safety concerns. The Authority shall not establish a registry of clinicians who obtain mental-health care.
(c) WORK DESIGN. Funded retention plans shall address avoidable documentation, unsafe schedules, violence, harassment, and barriers to leave, not rely solely on individual resilience training. The Secretary shall publish aggregate retention and working-condition findings while protecting identities. Workers shall retain remedies for discrimination, retaliation, and unsafe conditions under otherwise applicable law.
(a) CERTIFICATION. The Secretary of Labor shall establish an accessible process to determine displacement substantially attributable to insurance replacement, claims simplification, collections restrictions, or contract consolidation under this Act. A worker may apply individually or through a certified group petition; employer cooperation shall not be a prerequisite.
(b) EVIDENCE. Payroll reduction, a closure notice, contract termination, or reliable evidence of lost self-employment income may establish the causal connection. The Secretary shall decide a complete application within 30 days and provide provisional assistance where available evidence shows likely eligibility and delay would cause hardship.
(c) RIGHTS. Denial shall state the reason and allow reconsideration and independent appeal. A worker shall not be required to publicly endorse the Act, waive employment claims, or disclose political beliefs. Benefits begin under title XIV and shall not depend on a former employer purchasing transition services.
(a) APPROVED TRAINING. Training may prepare an eligible displaced worker for patient navigation, cybersecurity, public administration, clinical support, skilled trades, technology, or another viable occupation chosen with the worker. A health-sector job is not mandatory.
(b) PROVIDER ACCOUNTABILITY. A training provider shall disclose completion, credential recognition, costs, and verified placement information. Approval shall not rest on unsupported earnings promises. Payments shall be tied to delivered instruction and reasonable milestones; a failed provider shall not leave the worker liable for tuition paid under the program.
(c) SUPPORTS. Childcare, disability accommodation, career counseling, and reasonable transport or relocation assistance shall be available within title XIV. Prior learning shall be credited where competence can be demonstrated. The Authority and its contractors shall give qualified displaced workers meaningful consideration for genuine vacancies without creating unnecessary administrative positions solely to preserve a former function.
(a) ADMINISTRATION. Wage insurance and income support shall follow the replacement rates, limits, and durations in section 1402. The Secretary of Labor shall provide a single statement showing gross eligibility, other income considered, offsets, and net payment. A worker may select the applicable alternative without receiving both for the same period contrary to that section.
(b) RECONCILIATION. Variable earnings and self-employment income may be provisionally estimated and reconciled quarterly. An agency error or reasonable good-faith estimate shall not be treated as fraud. Recovery of a nonfraudulent overpayment shall allow hardship waiver and an affordable installment plan after notice and appeal.
(c) CONTINUITY. Acceptance of temporary or part-time work shall not automatically terminate training support. The Secretary shall explain how earnings affect benefits before a worker must make an election where practicable. Health coverage remains independent of employment and tax payment under title II.
(a) REPORTING. Annual reports shall distinguish training enrollment, completion, actual employment, occupation, earnings recovery, geographic placement, retention, and unresolved complaints. Participation counts alone shall not be represented as successful reemployment.
(b) ANTI-SUBSTITUTION. A recipient may not dismiss an existing worker solely to replace that worker with a subsidized trainee performing the same work under materially inferior conditions. Apprenticeships and clinical placements shall provide genuine supervised learning and compensation required by law.
(c) FUNDING. Education activities are charged to title XIII; displaced-worker benefits to title XIV; earned clinical wages to the applicable operating payment. Administrative support necessary for these obligations is permanently financed under title VII. Coordination shall prevent duplicate payment without using interagency disputes to delay a worker's established entitlement.
(a) DOCKET. The medical-product pricing office shall maintain a public docket for categories and products subject to a binding AHP ceiling. The docket shall identify the statutory authority, proposed methodology, evidence requested, comment period, responsible official, and expected decision date.
(b) PARTICIPATION. Manufacturers, clinicians, patients, researchers, purchasers, and other materially affected persons may submit relevant evidence. Confidential commercial information may be protected on a specific showing, but the public decision shall explain the basis sufficiently to permit meaningful scrutiny.
(c) CONTINUITY. Provisional purchasing arrangements shall operate while a ceiling is determined. A missed agency deadline does not permit interruption of essential treatment or authorize the manufacturer to charge patients. Title VI remains the source of price-setting authority; this title specifies procedures and supply protections and does not limit that authority to a fixed number of products.
(a) INFORMATION. A manufacturer shall provide reasonably necessary information on net prices, production and distribution costs, public research support, acquisition of intellectual property, relevant development expenditure, clinical benefit, expected demand, and supply reliability. Costs shall be allocated by a disclosed consistent method and shall not include an unrelated acquisition premium as an automatically recoverable research expense.
(b) VERIFICATION. The Authority may audit material submissions and require explanations of related-party charges. A request shall be proportionate to the pricing decision and allow protection of trade secrets and privileged material recognized by law.
(c) USE. Neither a claimed research cost nor a foreign reference price shall conclusively determine the ceiling. The office shall assess therapeutic alternatives, meaningful innovation, reasonable return, reliable supply, and actual clinical value under section 602. Knowingly false material submissions are subject to title XVII; a good-faith methodological dispute is not itself fraud.
(a) DECISION. A final ceiling shall state the evidence relied upon, treatment of material comments, effective date, supply assumptions, and grounds for reconsideration. Comparable products shall be treated consistently unless an identified clinical or economic difference warrants another approach.
(b) RECONSIDERATION. A manufacturer or affected qualified provider may seek reconsideration based on material new evidence, error, or a demonstrated threat to reliable supply. Filing does not automatically stay the ceiling, but the Secretary may authorize a temporary documented bridge price where needed to maintain essential access.
(c) REVIEW. An independent agency official not responsible for the original negotiation shall review a contested determination before final agency action. Judicial review remains available under section 1705. A court may protect confidential evidence without depriving parties of meaningful opportunity to contest the material basis of the decision. No regulatory label makes a pricing decision unreviewable.
(a) RISK ASSESSMENT. The Secretary shall identify products for which a single site, ingredient, geographic exposure, or production bottleneck creates a material risk to essential care. Assessment shall include manufacturing reliability and actual replacement lead times.
(b) CONTRACTING. Procurement may use multiple qualified suppliers, minimum-volume commitments, reserve capacity, or performance-based reliability payments where justified by total cost and continuity. A lowest-price-only award shall not be required where it would create an unreasonable single-source risk.
(c) NOTIFICATION. A contracted supplier shall promptly report a foreseeable material interruption, quality failure, or withdrawal affecting AHP supply and cooperate in a continuity plan. Protected commercial details may be shared securely with responsible agencies. Notice shall not excuse breach, and enforcement shall be sequenced to avoid worsening an immediate shortage where a lawful alternative remedy protects patients and the Fund.
(a) STOCKS. The Secretary shall maintain or contract for rotating reserves of selected essential medicines, protective equipment, diagnostics, and consumables based on risk and shelf life. An inventory target shall identify assumptions, replenishment triggers, storage requirements, and distribution capability.
(b) MANAGEMENT. Contracts shall require verified quantity, expiration tracking, appropriate temperature control, recall traceability, and periodic physical reconciliation. Stock rotation into ordinary care may reduce waste where safety and accounting requirements are met.
(c) DEPLOYMENT. Release shall be based on documented clinical or emergency need under a published allocation method. No official may direct distribution for partisan, personal, or commercial favoritism. Public reporting shall disclose aggregate quantities and expenditures without revealing security-sensitive locations. Reserve acquisition and subsequent use shall not be counted twice as separate purchases of the same product.
(a) AWARDS. The Secretary may support qualified public, nonprofit, or private manufacturing where a documented shortage, concentrated market, or national readiness need is not adequately addressed by ordinary purchasing. An award shall specify product, capacity, quality requirements, price conditions, milestones, and public access rights.
(b) RISK CONTROL. Feasibility review shall assess technical competence, regulatory pathway, workforce, inputs, and the likelihood of sustainable supply. Public ownership is not required where a contractual arrangement provides a reliable lawful alternative at reasonable cost.
(c) ACCOUNTABILITY. Recipients shall disclose related-party transactions, return unearned funds, and permit audit. A product shall satisfy applicable FDA requirements before clinical use. Public funding does not certify safety or efficacy. Where a project fails, the government may recover or transfer usable assets under agreed terms and shall report the loss rather than count unproduced capacity as an achieved outcome.
(a) NECESSITY FINDING. Before authorizing government patent use under section 603, the Secretary shall document the product need, efforts to secure reasonable access, available alternatives, scope of authorized use, and supply plan. Urgent circumstances may justify expedited action with prompt subsequent findings.
(b) COMPENSATION. Applicable compensation rights under 28 U.S.C. 1498 and the forum established by that section are preserved. Authorization shall identify the government purpose and participating contractors; it does not convey unrelated intellectual property or authorize commercial use outside its lawful scope.
(c) REGULATORY SAFETY. Any regulatory reliance authorized by section 603 shall remain limited to the express statutory conditions, protect confidential information, and preserve required safety, quality, and effectiveness review. Patent authorization alone shall not be represented as access to manufacturing know-how, trade secrets, or regulatory approval. The Secretary shall separately obtain any additional lawful inputs needed for production.
(a) PAYMENT. AHP pharmacy payment shall separately identify the product acquisition component and a reasonable professional dispensing and clinical-service component. A rural or essential low-volume pharmacy may receive a justified access payment tied to actual services and availability.
(b) PROHIBITED PRACTICES. A contractor shall not retain undisclosed spread, rebates, or remuneration; steer patients to an affiliated pharmacy for financial reasons unrelated to suitability; or recoup payment through an unexplained retroactive fee. Necessary audit and recovery remain permitted under transparent procedures.
(c) CONTINUITY. Patients shall have a practical local or delivered option, timely access to temperature-sensitive or urgent medicines, and pharmacist counseling when appropriate. Mandatory mail order shall not be imposed where it creates an unsafe delay or an accessibility barrier. Payment disputes shall not interrupt an established medicine without the continuity protections of this Act.
(a) PROCESS. NIH and other competent research agencies shall administer the additional science funding under section 1305 through transparent scientific review. Priorities shall consider disease burden, unmet need, neglected conditions, prevention, feasibility, and the value of basic research whose eventual application is uncertain.
(b) INDEPENDENCE. A political office or commercial sponsor shall not direct alteration of scientific findings. Program priorities may reflect lawful policy choices, but departures from a peer-review recommendation shall identify the authorized decision-maker and a reason consistent with the statute.
(c) CONFLICTS. Reviewers shall disclose relevant financial and professional conflicts and recuse where necessary. A disagreement with a lawful policy position is not itself a scientific conflict. Awards shall identify deliverables appropriate to the research, responsible institutions, data stewardship, and reporting, without guaranteeing a favorable result or commercialization.
(a) COVERAGE. Routine patient costs in qualified clinical trials are payable under section 308. Research-only costs shall be paid by the sponsor or a research award unless expressly assumed under an approved evidence-development agreement. Allocation shall be disclosed and shall not shift an unanticipated research bill to the participant.
(b) PROTECTION. Trials shall comply with applicable human-subject, informed-consent, safety-monitoring, and registration requirements. Consent shall distinguish clinical care from research, explain alternatives, and describe relevant data uses. Enrollment shall not be a condition for unrelated medically necessary care.
(c) ACCESS. Research awards may support reasonable travel, interpretation, disability accommodation, and decentralized participation where scientifically suitable. Recruitment shall not exploit dependent relationships or conceal material burdens. Adverse findings and failed hypotheses shall be reported according to applicable standards rather than suppressed to preserve commercial value or an agency's reputation.
(a) AGREEMENTS. New substantial research and development awards shall specify publication, reasonable data access, public-interest licensing, affordability, and supply obligations appropriate to the contribution and research stage. Conditions shall be disclosed before acceptance and shall respect applicable preexisting rights.
(b) ACCESS. The government may require nonexclusive licenses or other access terms authorized by the award and applicable law where necessary to realize the funded public purpose. A licensing condition shall not be concealed until after a recipient has incurred reliance costs.
(c) BALANCE. The Secretary shall consider follow-on development, manufacturing investment, and practical dissemination when structuring terms. This section does not retrospectively confiscate existing patents or guarantee private investment returns. Compliance shall be reviewed through the award's dispute procedures, with public reporting of material waivers and the reasons they were granted.
(a) INTEGRITY. Federally funded programs shall maintain procedures for research misconduct allegations, correction of the record, independent review, and protection of good-faith scientific disagreement. A negative study result or criticism of agency policy is not misconduct.
(b) REASSESSMENT. The Council shall periodically review technologies with substantial cost, uncertain benefit, or new safety evidence. A recommendation to reduce use shall distinguish low-value population use from a supported individual exception and shall include a safe transition for current patients.
(c) ACCOUNTING. Research, public manufacturing, procurement, and clinical payments shall be recorded in their proper accounts. A claimed future saving or potential invention shall not be booked as realized cash. Reports shall identify unsuccessful projects, uncertainty, and supply problems as well as achievements. Neither reassessment nor research review may alter statutory tax rates or postpone the full-benefit date.
(a) LEDGERS. The Treasury Secretary shall maintain separate ledger categories for individual solidarity receipts, ultra-high-income surtax receipts, employer contributions, corporate contributions, redirected federal appropriations, state contributions, recoveries, investment earnings, and residual general-revenue transfers. A classification shall identify legal authority and the period to which the receipt relates.
(b) RECONCILIATION. Monthly receipts, refunds, transfers, obligations, disbursements, and reserve balances shall be reconciled between Treasury and the Authority. A discrepancy shall be investigated within 30 days and corrected with an auditable entry. Corrections shall not be concealed by netting unrelated accounts.
(c) PUBLIC DISCLOSURE. Quarterly reports shall show actual receipts separately from estimated future yields and distinguish intragovernmental transfers from newly collected revenue. No report may represent a reduction in anticipated spending as a cash deposit. Aggregate taxpayer data shall satisfy section 6103 of the Internal Revenue Code and other applicable confidentiality protections.
(a) ADMINISTRATION. The Treasury Secretary shall integrate the taxes under sections 801 and 802 into ordinary income-tax withholding and estimated-payment administration under section 806. Tables shall explain that the marginal contribution applies to the health income base rather than gross wages alone or a percentage of medical expenditure.
(b) RECONCILIATION. Withholding is a credit against final liability, not a separate tax. An individual with several employers, investment income, or self-employment income shall reconcile the annual base and applicable filing status on one return. A refund shall be available through ordinary procedures where withholding exceeds liability.
(c) TRANSITION. First-year forms shall separately display the proration required by section 806(b). Treasury shall provide accessible examples and a penalty-relief process for a reasonable error caused by unavailable or materially incorrect official implementation guidance. Relief from a penalty does not forgive an accurately determined underlying tax absent express statutory authority.
(a) GROUP RULE. For purposes of section 804, persons treated as a single employer under sections 52(a), 52(b), 414(m), or 414(o) of the Internal Revenue Code shall share one set of contribution thresholds. Section 414(o) regulations may prevent avoidance within that statutory framework but may not expand the wage base beyond section 804.
(b) DESIGNATED FILER. A group shall designate a reporting member and allocate deposits among members by wages or another consistently applied reasonable method. Members shall remain jointly liable for the group's contribution to the extent provided by implementing rules confined to the shared obligation. No allocation may cause the group to receive duplicate exempt payroll amounts.
(c) CORRECTIONS. Quarterly deposits shall be reconciled annually. A business acquiring another employer shall carry forward relevant same-year payroll information to prevent a second threshold for unchanged operations. A bona fide unrelated new business shall receive its own threshold. Notice, assessment, refund, and collection rights under section 806 remain applicable.
(a) SUBSTANCE. Compensation shall be included in section 804 according to the employment and self-employment rules incorporated by that section. A payment shall not escape the contribution merely because it is routed through a controlled service entity or labeled a distribution where applicable tax law treats it as compensation.
(b) COORDINATION. The same amount shall not be counted twice in the employer contribution base as both wages and net earnings from self-employment. A bona fide business expense shall receive the treatment required by the Code. Treasury may require a reconciliation identifying the amount and the entity responsible for payment.
(c) LIMITS. This section does not tax the principal of a genuine loan, convert all investment returns into wages, or treat every independent contractor as an employee. A classification determination shall state the facts and law relied upon and permit the ordinary tax review process. Healthcare eligibility remains unaffected by the classification dispute.
(a) ATTRIBUTION. Grantor-trust income, partnership and S corporation income, and other income attributable under the Code shall enter the beneficial taxpayer's health income base once. A distribution of an amount previously included shall not generate duplicate inclusion solely because the money is distributed later.
(b) TRUSTS. The section 803(c) deduction for distributable net income shall correspond to an amount included by the beneficiary. Related trusts shall be aggregated only upon findings satisfying the common-grantor, beneficiary, and avoidance-purpose standards in that section. An ordinary estate administration or independent trust shall not be aggregated solely because beneficiaries are relatives.
(c) PROOF AND RIGHTS. Treasury may require records reasonably necessary to reconcile attribution and prevent artificial fragmentation. A material adjustment shall be subject to notice, deficiency procedures where applicable, and judicial review. This section creates no mark-to-market tax and no general tax on a person's net assets.
(a) BASE. Realized gains, installment payments, retirement distributions, and business losses shall enter the health income base according to section 803 and the applicable recognition rules of the Code. Preferential capital-gain rates applicable to another federal tax do not reduce the additional marginal rates in sections 801 and 802.
(b) ANTI-ABUSE. Treasury may apply existing substance, basis, related-party, and loss-limitation rules to a transaction lacking the legal basis for its reported treatment. A regulation shall not deem all collateralized borrowing to be income or impose a new realization event without statutory authority.
(c) DISCLOSURE. A high-income taxpayer shall provide a reconciliation sufficient to show material additions, exclusions, and prior inclusions relevant to the health base. Reporting shall use existing return information where practicable. Genuine losses receive the treatment specified in section 803; the Authority may not reject them to meet a desired annual revenue target.
(a) THRESHOLDS. Corporations filing a consolidated return shall apply section 805 once to consolidated taxable income, with adjustments necessary to prevent duplication of an included amount. Controlled corporations not filing a consolidated return shall share thresholds under the controlled-group principles incorporated in section 805 and this section.
(b) RECONCILIATION. The return shall identify the ordinary corporate taxable-income starting amount and each adjustment expressly required for the health contribution. A pass-through entity does not become subject to the corporate contribution merely because its owners have high incomes; their individual and applicable business contributions remain separately enforceable.
(c) LIMITS. Transfer-pricing, foreign-income, loss, and anti-abuse rules shall apply according to their lawful scope. Treasury may not impose an extra assessment described as a health contribution solely because it considers a corporation's lawful profit excessive. Additional rates or a different tax base require an Act of Congress.
(a) ASSISTANCE. The Internal Revenue Service shall provide dedicated implementation assistance, accessible forms, and clear notices for the taxes established by title VIII. The Taxpayer Advocate's existing functions shall extend to administration of those taxes.
(b) EXAMINATION. Audit selection shall be risk-based and shall not depend on political expression, religion, exercise of appeal rights, or a patient's use of healthcare. Medical records shall not be requested merely to determine income-tax liability. Relevant business payment records may be examined through ordinary lawful tax procedures.
(c) REVIEW. Notices shall identify the tax, year, calculation, factual basis, response deadline, and available forum. No health-benefit termination, provider treatment restriction, or disclosure to a treating clinician shall be used to collect a tax. Applicable limitations periods, refund rights, collection protections, and court jurisdiction are preserved by section 806.
(a) SCOPE. Title VIII applies to persons and income within the federal tax jurisdiction incorporated by that title. Coverage eligibility does not itself extend federal income taxation to income otherwise outside that jurisdiction.
(b) TERRITORIES. Treasury shall coordinate administration with territorial tax systems through agreements consistent with their governing statutes. A mirror-code or reciprocal arrangement shall identify the collecting government and deposit path and shall prevent duplicate collection of the same health tax. Such an agreement may not impose a new territorial tax without lawful territorial authority or change a statutory federal rate.
(c) TREATIES AND CREDITS. An applicable tax treaty shall be administered according to law. No general foreign-tax credit against the health contributions is created by this section beyond a credit expressly required by an applicable treaty or another provision of this Act. Treasury shall publish the treatment of recurring international questions without disclosing taxpayer information.
(a) ALLOCATION. Under an accepted section 901 compact, individual service expenditure shall be assigned to ordinary residence on the service date. A later claim payment does not move the cost to a different State. Shared administrative and capital costs shall use the published population and service-area methods specified in the compact.
(b) NO DUPLICATION. A State shall receive credit only for a verified state-origin transfer or approved expenditure satisfying section 901(c). A payment financed by a federal grant, an accounting reduction in future spending, or a payment already credited to another obligation shall not count again.
(c) DISPUTES. The State shall receive a quarterly statement, access to nonidentifying supporting calculations, and 60 days to identify a disputed allocation. Undisputed amounts remain payable. Federal payment to patients and providers shall continue during the dispute. The Authority shall issue a reasoned reconciliation and provide the review and collection process in title IX.
(a) LIQUIDITY. The Treasury Secretary shall fund lawful obligations and maintain the reserve required by section 704. The reserve shall be reported as liquidity and not as medical care delivered or an additional independently financed benefit.
(b) GENERAL REVENUE. A transfer under the permanent appropriation shall identify the portion not covered by dedicated receipts or state payments. If Treasury finances that balance through borrowing under otherwise applicable authority, public reports shall identify the resulting financing need without claiming the Act is fully funded by its new taxes.
(c) LIMITS. This Act does not independently repeal a statutory public-debt limit or authorize the Secretary to mint a new financial instrument. The President shall timely transmit any legislative financing request needed to meet obligations under existing law. An anticipated financing dispute does not authorize executive cancellation of a benefit or withholding for an unrelated policy purpose.
(a) FORECASTS. Treasury and the Chief Actuary shall publish annual reconciled projections showing the tax base, behavioral assumptions, administrative costs, state participation, clinical expenditure, reserve needs, and general-revenue balance over 1, 5, 10, and 30 years. Static arithmetic and behavioral estimates shall be clearly distinguished.
(b) CORRECTION. A projected material gap shall trigger a report to Congress within 60 days describing lawful spending efficiencies, administrative changes, and legislative revenue alternatives. The report shall show distributional effects and effects on access, compensation, and private compliance costs.
(c) NO AUTOMATIC POLICY CHANGE. Neither a forecast nor an actuarial certification may change tax rates, narrow eligibility, impose patient charges, or reduce a compensation floor. Dedicated receipts and savings shall be reported honestly even when below expectations. The permanent appropriation remains the source of legal payment authority, subject to later enacted law and the constitutional legislative powers of Congress.
(a) STANDARD. The Authority shall specify the minimum claim information necessary to establish eligible person, qualified provider, service, date, amount, and material clinical basis. Data already held and verified shall not be demanded again without a specific need.
(b) DOCUMENTATION. A clinical record shall support care and lawful review, not require repetition solely to satisfy multiple payer formats. The Authority shall distinguish an incomplete claim from an adverse coverage decision and provide a precise correction request. An automated edit shall not silently convert a correctable coding issue into denial of a patient's benefit.
(c) REVIEW. New documentation requirements shall undergo a burden assessment and clinical review. Small practices shall receive technical assistance. Fraud prevention remains required, but an increase in documentation shall be justified by its actual integrity or clinical value rather than an assumption that more forms inherently establish better care.
(a) BUDGETS. An institutional budget shall identify ordinary operating costs, readiness, compensation, teaching, and other approved functions. Capital costs funded separately shall not also be recovered through depreciation or lease charges except as expressly reconciled.
(b) EXCEPTIONAL NEED. A material unforeseeable increase in clinically necessary service demand, disaster obligation, or required staffing shall receive expedited budget review. The institution shall submit evidence of the change and available alternatives. The Authority shall issue provisional support where delay would threaten essential services.
(c) ACCOUNTABILITY. A favorable variance may support quality, maintenance, and access according to the budget agreement. It shall not be automatically distributed to owners while wage or safety obligations remain unmet. An unfavorable variance caused by related-party overcharging or avoidable financial extraction does not create an automatic subsidy entitlement. Patients remain protected from billing in either circumstance.
(a) RATES. Professional rates shall recognize time, complexity, overhead, competence, and compensation objectives under title V. Review shall include historically undercompensated cognitive, preventive, coordination, and rehabilitation work rather than relying exclusively on procedure volume.
(b) LOW-VALUE REVIEW. The Council may identify services that generally lack benefit or create avoidable harm in defined circumstances. The Authority may adopt prospective review or payment restrictions within section 308, with clear criteria and individualized exceptions.
(c) SAFEGUARDS. A utilization outlier is a reason for inquiry, not proof of fraud. The provider shall have an opportunity to explain case mix and clinical context. An integrity program shall not reward contractors for recovering a predetermined sum or denying a predetermined proportion of claims. Final adverse decisions shall state evidence and permit review under title XVII.
(a) DISCLOSURE. An institutional provider or major administrative contractor shall disclose persons holding directly or indirectly at least 5 percent beneficial ownership, controlling interests, management control, and material related-party contracts. The Authority shall protect personal information not necessary for public accountability while publishing business identity and control relationships.
(b) COST RULE. A related-party rent, management fee, supply charge, or interest expense shall be payable only to the extent reasonable, necessary, and supported by arm's-length evidence or a justified cost basis. A transfer between affiliated entities shall not manufacture an additional public-payment entitlement.
(c) ENFORCEMENT. Material concealment is subject to title XVII. A good-faith change in ownership shall be reported within 30 days. The Authority shall coordinate with existing reporting systems to avoid duplicate returns and shall not treat ordinary ownership as misconduct absent a prohibited act or material conflict.
(a) PROHIBITION. An owner, manager, lender, or administrative contractor shall not require a clinician to order unnecessary services, withhold necessary care, falsify documentation, or make a referral contrary to clinical need for financial gain. A contract term requiring such conduct is unenforceable.
(b) STRUCTURAL REVIEW. A participation agreement shall identify who controls clinical policy, staffing, and financial distributions. The Authority may require an independent clinical governance function where necessary to prevent demonstrated interference, with notice and proportionate corrective terms.
(c) LIMITS. This section does not prohibit legitimate budgets, quality standards, lawful practice ownership, or review of unsupported clinical claims. It creates no blanket exemption from antitrust law for professional groups. Clinicians and workers reporting interference shall receive the protections of section 1706, and patients retain access and billing remedies independently of the ownership dispute.
(a) NOTICE. A participating hospital system or other institutional provider proposing a transaction that materially changes control of essential regional services shall notify the Authority at least 90 days before closing, subject to expedited treatment of a court-supervised emergency. Notice shall describe anticipated effects on access, staffing, prices, debt, and public-use covenants.
(b) COORDINATION. The Authority shall refer competition concerns to the Department of Justice, Federal Trade Commission, or other competent enforcer. This Act does not exempt a transaction from generally applicable competition law or make Authority participation approval a defense to an antitrust claim.
(c) CONTINUITY. The Authority may condition continued AHP participation on reasonable, related access and financial-transparency safeguards after due process. It may not order divestiture solely through an informal notice process where judicial or separate statutory authority is required. An essential-service closure shall satisfy section 2611 and applicable safety law.
(a) RUNOFF. Each issuer of displaced primary coverage shall submit a runoff plan identifying covered periods, unpaid claims, appeals, reserves, refunds, provider contracts, and responsible contacts. Liability for a service furnished before displacement remains with the legally responsible payer unless expressly assumed through a compensated lawful arrangement.
(b) CONTINUITY. A policyholder shall receive clear notice distinguishing the end of duplicative future coverage from the continued enforceability of an accrued claim. AHP may make a protective advance where a dispute threatens necessary care and recover from the responsible payer without patient liability.
(c) RECORDS. Issuers shall preserve claim and contract records for the applicable legal period and provide lawful transfer of information necessary for continuity. Clinical information shall not be sold as a runoff asset. Regulators shall protect policyholder and creditor rights according to applicable insurance and insolvency law.
(a) REFUNDS. Unearned premiums for periods in which duplicative primary coverage is prohibited shall be refunded or credited to the person legally entitled to the payment within 60 days of the final reconciliation. An issuer shall provide an itemized calculation and complaint process.
(b) CONVERSION. A policy shall not automatically become an expensive supplemental product without affirmative informed agreement and a clear explanation of the services already covered by AHP. Supplemental coverage may not sell faster access to a public waiting list or require a covered provider to withhold the no-charge option.
(c) ENFORCEMENT. State insurance regulators may enforce compatible consumer protections; the Authority shall enforce the federal prohibition and coordinate referrals. An issuer may market lawful nonduplicative products, but may not misrepresent that a person needs private coverage to retain AHP eligibility. Accrued benefits and valid residual coverage for non-AHP persons remain protected.
(a) TRANSITION. Employers and plan fiduciaries shall identify displaced benefits, residual beneficiaries, accrued claims, employee contributions, and contractual retiree obligations. The replacement of primary insurance shall not erase an earned cash, pension, disability, or supplemental benefit unrelated to duplication.
(b) BARGAINING. Where compensation or benefits are governed by a collective agreement, allocation of lawful savings and replacement supplemental benefits shall be addressed through the applicable bargaining process. The Act does not create a general automatic employer windfall payment or a universal mandatory cash distribution not otherwise specified.
(c) NOTICE AND ACCOUNTING. Employees and retirees shall receive a statement of changes, residual coverage, refund rights, and AHP access. Assets held in trust shall be used or returned according to governing fiduciary and tax rules, not automatically transferred to an employer's unrestricted account. Disputes shall not impair the individual's statutory AHP entitlement.
(a) PAYMENT FIRST. AHP shall pay a covered clinically necessary service without requiring resolution of a workers' compensation, automobile, tort, or other liability dispute. The Fund may pursue recovery to the extent authorized by section 1006 and applicable law.
(b) LIMITS. Recovery shall be confined to the portion legally attributable to medical costs paid by the Fund. It shall not seize compensation for distinct pain, lost earnings, or other losses merely because the claimant received healthcare. Reasonable procurement costs and applicable allocation rules shall be respected.
(c) PROCEDURE. A beneficiary shall receive a clear notice of any asserted recovery and an opportunity to contest amount, allocation, or hardship. Settlement reporting shall use necessary information only. The same medical cost shall not be recovered from several payers beyond the lawful amount, and a pending recovery action shall not suspend future care.
(a) AUDIT DESIGN. Audits shall use validated methods, relevant records, and a stated period and scope. Extrapolation from a sample shall disclose methodology and uncertainty and permit challenge. A contractor's compensation shall not depend solely on gross demanded recoveries.
(b) DISTINCTIONS. The Authority shall distinguish fraud, reckless disregard, overpayment, reasonable coding disagreement, and agency error. A correctable documentation defect shall ordinarily receive a cure opportunity unless delay would materially prejudice safety, evidence, or recovery.
(c) RECOVERY. Established overpayments may be recouped under a reasonable schedule that preserves essential services, subject to lawful exceptions for serious fraud. Punitive penalties require the procedure in section 1703. An audit shall not demand that a patient repay a covered service because the provider used an incorrect code or the government misprocessed a claim.
(a) MEASUREMENT. The Authority shall publish a consistent classification separating direct care, necessary clinical support, public administration, private contracting, marketing, collection, and financial overhead. Reclassifying a cost shall not establish an actual saving.
(b) REDUCTION. Duplicative payer-specific functions shall be removed through phased process redesign, interoperable standards, and workforce transition. Necessary scheduling, patient assistance, safety review, privacy, and fiscal control shall not be eliminated merely because they are administrative.
(c) REVIEW. Annual reporting shall compare actual administrative expenditure and burden with a disclosed baseline, identify transition costs, and explain changes in service volume. Verified net savings remain in the Fund under section 705. No automatic administrative percentage cap shall justify failure to pay claims, protect data, provide appeals, or perform an express statutory duty.
(a) COORDINATION. The Secretary shall maintain a public-health capability plan covering surveillance, laboratories, prevention, emergency logistics, risk communication, and clinical continuity. Existing competent federal agencies shall perform their established functions; the Authority shall not duplicate an agency solely to place its work under another name.
(b) PARTNERSHIPS. State, local, Tribal, and territorial participation shall proceed through lawful agreements specifying services, data safeguards, payment, and accountability. Refusal of an agreement shall not prevent the federal government from furnishing services within its own lawful authority.
(c) FUNDING. The public-readiness account under section 1501 shall support these functions, supplemented by the permanent appropriation for obligations expressly created by this Act. The plan shall identify ordinary operating capacity separately from emergency surge. Population-level public-health expenditure shall not be billed as a fictitious individual clinical encounter.
(a) NETWORK. The Secretary shall maintain access to qualified public-health and reference laboratories capable of confirming priority pathogens, toxic exposures, and unusual clinical findings. Agreements shall specify specimen handling, quality assurance, reporting, backup capacity, and referral when a laboratory lacks capability.
(b) SURGE. Reserve arrangements shall identify staff, reagents, equipment, and validated methods that can be activated during an outbreak or environmental incident. Unvalidated research assays shall not be represented as established clinical diagnostics.
(c) DATA AND QUALITY. Results shall be linked to necessary clinical action and lawful surveillance with minimum identifying information. A laboratory failure or significant false-result pattern shall trigger prompt notification, corrective testing, and patient assistance. The Authority shall finance clinically necessary retesting without a patient charge and may separately recover costs from a responsible contractor under lawful terms.
(a) SERVICES. The Fund shall pay for covered testing, vaccination, prophylaxis, treatment, and clinically necessary follow-up under titles II and III. Public-health outreach shall identify practical barriers and provide accessible service delivery, including mobile arrangements where appropriate.
(b) SUPPLY. The Secretary shall coordinate procurement, cold-chain capacity, reserve supply, and qualified distribution. Allocation during shortage shall use published clinical and public-health criteria with documented exceptions, not personal or political preference.
(c) RIGHTS. This section creates payment and delivery authority, not a general power to compel treatment, quarantine, search, or movement restriction. Any such action requires separate lawful authority and applicable due process. Refusal of a recommended intervention shall not eliminate unrelated AHP benefits. Public communication shall accurately distinguish established evidence, uncertainty, and changes in advice.
(a) BENEFITS. Covered persons shall receive clinically necessary evaluation and treatment of work-related illness or injury, including delayed effects. Initial treatment shall not await resolution of employer responsibility or a workers' compensation claim.
(b) COORDINATION. The Secretary shall cooperate with competent occupational-safety and public-health agencies to identify exposure patterns and refer hazards through lawful channels. A clinician's duty to treat shall remain distinct from an agency's authority to inspect or enforce workplace standards.
(c) PRIVACY. An employer shall receive only information lawfully necessary for occupational obligations, accommodation, or fitness decisions, not unrestricted treatment records. A worker may seek care without retaliation. The Fund's recovery from a responsible payer shall follow section 1006 and shall not reduce benefits or seize compensation for a distinct nonmedical injury.
(a) DETERMINATION. Under section 1503, the Secretary may designate a health-response area upon credible evidence of a material exposure threat. The determination shall identify the substance or hazard, plausible exposure routes, affected geography or population, uncertainty, and services appropriate to clinical need.
(b) SCIENTIFIC ROLE. EPA, ATSDR, CDC, and other competent bodies shall provide validated environmental and health evidence within their authority. A final liability determination against a responsible party is not a prerequisite to healthcare activation.
(c) REVIEW. Designation shall be reviewed at least every 90 days during acute response and at scientifically justified intervals thereafter. Ending an acute designation shall not terminate necessary monitoring or treatment for an exposed person. A boundary shall not conclusively exclude a person presenting credible evidence of exposure outside the initially mapped area.
(a) CLINICAL PROGRAM. A response program shall provide evidence-based screening, exposure assessment, counseling, treatment, and longitudinal follow-up appropriate to the hazard. The program shall distinguish validated clinical tests from exploratory research and shall explain uncertain results.
(b) LATENCY. Follow-up may continue for the clinically justified latency period, including after relocation and after an emergency declaration expires. The Authority shall maintain a portable record and an accessible contact for future symptoms potentially related to the exposure.
(c) LIMITS. A residence within a designated area alone does not establish every subsequent illness was caused by the event, but a patient shall not have to prove legal causation to receive otherwise covered necessary care. Optional research requires the protections of titles XIII and XVI. A monitoring program shall not substitute for lawful environmental remediation by the responsible authorities.
(a) AGREEMENT. HHS and FEMA shall maintain an operational agreement assigning clinical command, logistics, resource requests, evacuation coordination, communications, and reimbursement. FEMA shall perform functions within its emergency-management authority; medical standards and individual clinical decisions shall remain with qualified health personnel.
(b) DEPLOYMENT. The agreement shall support temporary facilities, mobile teams, patient movement, medicine replacement, and essential device continuity. Resources may be deployed under the Authority's independent lawful powers where section 1502 is satisfied, without falsely representing that a Stafford Act declaration has occurred.
(c) ACCOUNTING. Each mission shall identify the paying account and costs eligible for reimbursement by another program. The same service or asset shall not be reimbursed twice. A dispute between agencies shall be resolved after immediate clinical needs are met and shall not produce a patient bill or delay an urgent deployment decision.
(a) CONTINUITY. A displaced person shall retain portable coverage and access to necessary prescriptions, oxygen, dialysis, maternity care, mental-health support, and replacement of essential equipment. Lack of a card, fixed address, or original prescription container shall trigger verification assistance rather than automatic denial.
(b) MEDICAL SHELTERING. HHS shall coordinate with shelter operators for accessible clinical space, infection control, medication storage, communication support, and appropriate transfer. A general shelter shall not be treated as a hospital capable of meeting needs beyond its staff and equipment.
(c) CHOICE AND SAFETY. Evacuation planning shall account for disability, necessary caregivers, service animals, and safe reunification. A person shall receive an explanation of available options and material risks. This section does not independently authorize forced evacuation or confinement; other lawful emergency authority and constitutional safeguards remain applicable.
(a) REPLACEMENT. A pharmacy or qualified provider may furnish a reasonable emergency replacement supply under section 1502 when ordinary access is disrupted. Verification may use available records, contact with a prior prescriber, or a reasonable clinical assessment. Controlled substances remain subject to applicable law.
(b) DEVICES. Essential mobility, respiratory, communication, and monitoring equipment lost or rendered unusable by the event shall be replaced or loaned promptly when medically necessary. A standard replacement interval shall not bar an event-related replacement.
(c) ACCOUNTABILITY. Emergency dispensing and equipment records shall be reconciled when systems are restored. A good-faith recipient shall not become liable because a government system could not verify a prior record. The Authority may investigate a materially false claim under title XVII without imposing routine intrusive searches of a patient's shelter or belongings.
(a) REFERRAL. The Secretary shall refer potential recovery under section 1504 to the Attorney General with available evidence of release, responsibility, exposure, causation, and reasonable federal expenditure. A clinical program shall not condition treatment on a patient's agreement to assist litigation.
(b) RECORDS. Relevant environmental and financial records shall be preserved under lawful authority. Patient-identifying information shall be disclosed only as legally necessary and subject to suitable protective measures. Aggregate cost evidence shall be used where it can fairly establish a claim.
(c) RECOVERY. Settlements shall identify the federal costs compensated, avoid duplicate recovery, and preserve victims' independent claims as required by section 1504. A compromise of federal recovery shall not automatically waive a community's right to remediation or an individual's private claim. Recovered amounts shall return to the Fund and shall not be booked before actual receipt.
(a) COMMUNICATION. Health warnings and recovery information shall state the known hazard, recommended actions, available care, uncertainty, and sources of assistance in accessible language. An official shall promptly correct a material factual error in an agency communication.
(b) PARTICIPATION. Affected communities, workers, local clinicians, independent scientists, and Tribal governments shall have a means to identify access gaps and question assumptions. Advisory participation shall not confer unreviewable regulatory power or require agreement with agency policy.
(c) LIMITS. This Act does not authorize suppression of lawful speech, punishment for criticism, or compelled endorsement of a scientific claim. Fraudulent billing and unlawful commercial conduct remain subject to existing and express enforcement authority. Public education shall be evaluated for comprehension and practical access, not for agreement with an administration's political position.
(a) REVIEW. Within 120 days after the end of acute federal medical deployment, HHS shall publish an after-action report identifying response timing, unmet need, staffing, supply, communications, privacy, and cost issues. A longer clinical follow-up program may continue independently.
(b) CORRECTION. Material findings shall produce a funded corrective plan with responsible officials and deadlines. The Inspector General may audit cost and contracting issues, and clinical reviewers shall examine safety and access without using hindsight alone as proof of individual fault.
(c) CONTINUITY. Long-term exposure, disability, rehabilitation, and mental-health needs shall be transferred to stable care arrangements rather than terminated with temporary mission funding. Applicable individual benefits remain mandatory. Reports shall distinguish unresolved uncertainty from verified harm and shall not claim a recovery has been completed merely because emergency equipment has been withdrawn.
(a) DESIGN. The Authority shall use a federated architecture in which eligibility, payment, and clinical exchange obtain the information necessary for the authorized function without requiring a single national repository of every clinical note. A design decision to centralize a sensitive dataset requires a documented necessity and privacy assessment.
(b) ACCESS. Roles shall be separated for treatment, payment, research, oversight, and technical support. Access shall be time-limited where practicable, logged, and reviewed. An employee's general system role shall not permit browsing records unrelated to assigned duties.
(c) PROCUREMENT. Contracts shall require usable export, interoperability, audit access, and an orderly exit path. The government shall not become dependent on a vendor's proprietary identifier as the only means of accessing a person's legally protected information. Architecture choices shall preserve nondigital service alternatives throughout the transition.
(a) IDENTIFICATION. The AHP identifier shall be used for administration and shall not display immigration status, income, diagnosis, or a Social Security number. A person unable to present the identifier shall receive assistance under section 203.
(b) MATCHING. Record linkage shall use validated methods and human correction where a mismatch can affect care, payment, or privacy. A shared name, address, or family relationship alone shall not establish that two records belong to the same person.
(c) REMEDY. Patients and providers shall have an accessible route to report a mistaken merge, missing record, or identity misuse. Urgent clinical corrections shall be prioritized. A disputed record shall be flagged appropriately without deleting legally necessary history or blocking necessary care. Biometric identification shall not be mandatory where a secure reasonable alternative exists.
(a) ACCESS. A patient shall receive no-charge access to records held by the Authority and participating providers through usable electronic and reasonable nonelectronic channels, subject to lawful exceptions. A proprietary portal shall not be the only permitted method.
(b) CORRECTION. A person may request correction of factual error or an annotation explaining a disputed clinical entry. The responsible entity shall decide within 30 days, or sooner when needed to prevent material clinical harm, and state reasons for a refusal. A clinician's good-faith opinion need not be erased solely because the patient disagrees.
(c) REPRESENTATION. Access by a representative shall reflect actual lawful authority and applicable consent limits. A former spouse, abusive caregiver, or expired proxy shall not retain automatic access. The Authority shall provide safe alternatives for persons needing confidential communication and shall maintain an auditable record of representative permissions.
(a) STANDARDS. The Secretary shall adopt open, implementable exchange standards through transparent procedures and identify versions and transition periods. A standard shall address security, accessibility, semantic accuracy, and practical use, not merely technical transmission.
(b) CONTRACTS. A vendor or provider shall not impose an unreasonable fee, contractual restriction, or technical obstacle that prevents lawful patient access, treatment exchange, audit, or transition to another system. Reasonable safety and security restrictions require a documented basis and a practical alternative where feasible.
(c) ENFORCEMENT. Existing information-blocking duties remain applicable. The Authority shall coordinate investigations to avoid duplicative contradictory orders, while retaining its own contract and statutory remedies. A claimed trade secret does not permit withholding a patient's clinical information from that patient. Required exchange shall not authorize disclosure beyond lawful purpose and consent.
(a) COVERAGE. Clinically suitable telehealth, including audio-only service when appropriate, is covered. A person shall not be required to own broadband equipment, use a smartphone, or accept remote care where an in-person examination is medically necessary.
(b) STANDARDS. The clinician shall verify identity, explain modality limitations, maintain privacy, and arrange escalation or an in-person assessment when needed. Payment shall recognize clinical work and necessary technology without automatically treating every electronic message as a separately billable encounter.
(c) LICENSURE. Telehealth shall comply with lawful professional authority in the relevant jurisdiction, except where an express federal practice rule applies. The Authority may support voluntary recognition and shared credential verification but shall not purport to repeal State licensing law through a payment manual. Patients retain ordinary negligence and consent protections.
(a) REGISTER. The Authority shall maintain a register of automated systems materially used in eligibility, coverage review, payment integrity, clinical triage, or allocation. The register shall identify purpose, responsible entity, decision role, data categories, validation status, and complaint route without disclosing security-sensitive details.
(b) CLASSIFICATION. A system that may materially affect life, health, access, or a person's legal entitlement shall receive a documented high-impact review before operational use. Merely renaming a model as decision support does not avoid the review where personnel ordinarily follow its output without meaningful examination.
(c) PROCUREMENT. Contracts shall provide access to evidence necessary to evaluate performance, error, bias, and material limitations. Trade-secret protection may justify controlled access, not complete insulation from oversight. The Authority shall not deploy a system it cannot adequately evaluate for its intended use.
(a) PROHIBITION. No automated system may independently issue a final adverse eligibility or medical-necessity determination. A qualified accountable human reviewer shall examine the relevant record, applicable criteria, model limitations, and the person's evidence.
(b) EXPLANATION. A notice shall identify the actual factual and legal grounds of decision. A generic statement that an algorithm detected risk is insufficient. A patient or provider may challenge incorrect input data, the relevance of a model, and the final determination through ordinary appeal rights.
(c) CLINICAL USE. A clinician may use validated decision support within professional judgment, but the system shall not override informed consent, scope of practice, or a duty to respond to observed deterioration. The operator shall monitor adverse events and maintain a safe manual alternative when a system fails or produces unreliable outputs.
(a) ABSOLUTE LIMITS. Identifiable health information obtained under this Act shall not be sold, used for targeted advertising, or supplied for unlawful employment or housing discrimination. Purported consent does not create an exception to these prohibitions.
(b) OPTIONAL TRAINING. Use for an unrelated commercial general-purpose model is permitted only under the separate, freely given, specific authorization described in section 1602. Authorization shall identify data, purpose, recipient, retention, material risks, and the practical limits of later withdrawal. Refusal shall not affect care or payment.
(c) RESEARCH. Lawful research with consent or a valid waiver remains subject to ethics review where applicable, minimization, and security. A processing fee limited to reasonable lawful research administration shall not be used as a disguised sale of records. Contractors may not enlarge a data-use permission through an unreadable general terms-of-service update.
(a) BASELINE. Participating entities shall implement risk-appropriate access control, multifactor authentication for privileged access, encryption, tested backups, vulnerability management, staff training, and incident response. The Secretary shall issue implementation standards through rulemaking and identify equivalent safeguards for unusual clinical systems.
(b) SUPPORT. Rural, safety-net, Tribal, and small providers shall receive technical assistance and eligible modernization funding. A cybersecurity requirement shall include a realistic implementation pathway and clinical continuity protection; lack of immediate resources shall trigger assistance and risk mitigation, not automatic abandonment of patients.
(c) VERIFICATION. Compliance shall be evaluated through evidence and proportionate testing rather than a vendor's unsupported certification. A provider shall inventory critical systems and unsupported devices. Exceptions require a written risk assessment, compensating controls, an accountable official, and an expiration or review date.
(a) NOTICE. An entity shall notify the Authority within 24 hours after reasonably confirming a cybersecurity incident materially affecting patient safety, essential operations, or a substantial body of protected data. Initial notice may be incomplete and shall be updated as facts become available. Other legally required notifications remain applicable.
(b) CONTINUITY. The entity shall activate downtime procedures for medication administration, patient identification, results, transfers, and payment. The Authority shall assist with alternative processing and urgent clinical support. A system outage shall not justify a patient charge or denial of emergency care.
(c) PROTECTION. Notifications shall distinguish verified facts from suspicion and shall not disclose unnecessary patient details. The Authority shall coordinate with competent cybersecurity and law-enforcement bodies under title XVI's disclosure limits. This Act does not authorize an unlawful ransom payment or immunity for concealing a known breach.
(a) RISK REVIEW. A contract placing protected data with a cloud or external processor shall identify storage and access locations, subcontractors, applicable legal exposure, encryption control, deletion, and continuity. Cross-border access shall require a documented lawful purpose and safeguards adequate to the risk.
(b) LIMITS. A nationality label alone shall not substitute for a security assessment, and a commercial assurance shall not substitute for enforceable protections. No contract may authorize access prohibited by section 1603 or evade restrictions through a subcontractor.
(c) EXIT. Vendors shall support export, credential transfer, continuity, and verified deletion of residual copies according to lawful retention requirements upon termination. A payment dispute shall not permit destruction of clinical records or suspension of essential access. The Authority shall test exit arrangements before a critical system becomes dependent on the contractor.
(a) REVIEW. The Authority shall annually evaluate technology expenditure, interoperability, errors, privacy incidents, access barriers, and the actual administrative burden imposed on clinicians and patients. A system's adoption rate alone shall not establish clinical benefit.
(b) REMEDIATION. Material harm or unreliability shall require correction, restricted use, or withdrawal with a safe alternative. The Secretary shall identify the responsible official and a funded remediation schedule. Patients and workers may report concerns without retaliation.
(c) FINANCING. Digital operating costs are included in appropriate clinical or administrative payments; major modernization is financed through the facilities account. Research testing shall use the research account where appropriate. The same software expense shall not be billed to multiple accounts, and no technology standard may postpone the statutory entitlement because a preferred platform is not ready.
(a) NOTICE. An adverse eligibility, coverage, payment, participation, or enforcement notice shall identify the proposed action, material facts, applicable provision, evidence relied upon, effective date, available response, and deadline. A code without an understandable explanation is insufficient.
(b) RECORD. The affected person shall receive access to the nonprivileged record necessary to contest the action, subject to appropriate protection of another person's information. A protected commercial submission may be summarized or disclosed under safeguards where necessary for meaningful review.
(c) ASSISTANCE. The Authority shall provide interpretation, disability accommodation, and reasonable help submitting a response. A deadline shall be extended where agency error or failure to provide required accommodation materially impaired the opportunity to act. More protective or faster clinical deadlines in title IV govern over an ordinary procedural timetable.
(a) URGENCY. A treating professional's supported statement that delay threatens life, health, serious function, or safe treatment continuity shall trigger expedited review unless a qualified reviewer promptly identifies a specific reason it does not. An unsupported administrative designation of routine priority shall not control.
(b) INTERIM SERVICES. The Authority shall authorize necessary temporary services while an urgent dispute is resolved where withholding presents a substantial risk and the request is not plainly outside statutory coverage. Provisional payment shall not create a patient debt if a later decision differs.
(c) REVIEWER. The reviewer shall have relevant clinical competence and no financial incentive to deny. A reviewer may seek clarification but shall not repeatedly restart the decision clock with immaterial requests. Failure to decide within the governing deadline permits recourse under section 1701 and requires the Authority to arrange safe continuity rather than simply close the appeal.
(a) ASSISTANCE. The Ombudsman shall maintain regional and remote assistance for eligibility, access, billing, and appeal problems. Services shall be free and accessible without requiring a digital account. A patient may use a chosen lawful representative, including counsel, without retaliation.
(b) INDEPENDENCE. An advocate who assisted a party shall not serve as the adjudicator of that party's dispute. Funding agreements shall protect the advocate's ability to identify systemic failures and communicate lawfully with oversight bodies.
(c) RECORDS. Representation authority shall be limited to its stated purpose and duration. A provider shall not obtain a blanket assignment of a patient's rights as a condition of treatment. The Ombudsman may refer an unresolved systemic matter to the Inspector General or a competent enforcement office without disclosing more identifying information than necessary and legally permitted.
(a) STANDARD. Within this Act's defined eligibility classes, services and administration shall not discriminate on the basis of race, color, national origin, religion, sex, sexual orientation, gender identity, age, disability, or another protected status under applicable federal law. Differential clinical treatment based on relevant individualized evidence is not prohibited discrimination.
(b) ACCOMMODATION. The Authority and participating entities shall provide reasonable modifications, effective communication, and accessible facilities and equipment necessary for equal access. A person shall not be charged for an accommodation required by this Act.
(c) ENFORCEMENT. A denial based on a claimed fundamental alteration or other lawful defense shall identify the facts and actual alternatives. The availability of a separate statutory defense does not authorize shifting the burden entirely to the patient. Existing stronger federal and compatible State civil-rights remedies remain available, and duplicate recovery for the same injury is prohibited.
(a) ORDINARY CARE. A general budget, disability-adjusted life-value measure, anticipated social productivity, or a person's wealth shall not independently determine whether an individually necessary benefit is provided. Cost-effectiveness evidence may inform public purchasing and comparative choices only within the Act's benefit and nondiscrimination requirements.
(b) GENUINE SCARCITY. During an actual scarcity of a nonexpandable immediate resource, allocation shall use transparent, clinically relevant criteria developed with appropriate expertise and civil-rights review. Criteria shall assess likely benefit of the particular intervention, not stereotypes about a person's overall worth or quality of life.
(c) REVIEW. The protocol shall specify who decides, how disagreement is reviewed promptly, and what alternative care is provided. Scarcity shall be reassessed and documented. A financial limit or administrative backlog shall not be relabeled a physical scarcity to avoid an entitlement or the Authority's duty to purchase additional available capacity.
(a) INFORMATION. Before a nonemergency material intervention, the patient shall receive an understandable explanation of purpose, expected benefit, material risks, alternatives, and relevant uncertainty, with appropriate communication assistance. Consent shall concern the actual procedure, not merely admission to a facility.
(b) VOLUNTARINESS. A capable person may refuse or discontinue treatment subject to otherwise applicable lawful limits. The provider shall explain consequences and offer reasonable alternatives without abandonment. Refusal shall not cancel unrelated benefits or permit punitive billing.
(c) REPRESENTATIVES. Where the person lacks capacity for a particular decision, applicable advance directives, lawful representatives, and emergency rules govern. This Act does not create general guardianship or detention power. A conflict shall be addressed through an ethics consultation or appropriate legal process without using the absence of immediate resolution to withhold necessary emergency stabilization.
(a) INDIVIDUAL PROTECTION. Section 303(d) governs individual clinician objections and preservation of the Religious Freedom Restoration Act. A clinician shall communicate a foreseeable service limitation in a manner that permits safe planning without humiliating or abandoning a patient.
(b) SYSTEM DUTY. The Authority shall maintain sufficient willing qualified capacity and a practical arrangement for timely care. Institutional participation terms shall identify how necessary access is maintained, subject to applicable constitutional and statutory protections. A directory of unavailable providers is not an adequate alternative.
(c) LIMITS. This section does not extinguish a lawful conscience claim or permit a payer to erase an expressly covered benefit through an administrative policy. A disputed obligation shall receive individualized legal review. Necessary emergency screening, stabilization, truthful information, and nondiscriminatory routine care remain governed by section 303 and otherwise applicable law.
(a) PRESERVATION. Participation in AHP does not immunize a private clinician or facility from negligence, create federal employment, or automatically substitute the United States as defendant. Existing applicable professional-liability and federal tort rules remain effective unless expressly modified by another provision.
(b) DISCLOSURE. A participating provider shall maintain a process for promptly informing a patient of a material known care-related injury, explaining verified facts and uncertainty, arranging necessary treatment, and preserving relevant records. A safety review shall not be used to conceal records otherwise available to the patient.
(c) RESOLUTION. Providers may offer voluntary early resolution and compensation procedures that do not require prospective waiver of a patient's legal rights. Payment of corrective care is not a substitute for compensation otherwise owed. The Authority shall support learning from adverse events while preserving required reporting, evidence, and accountability.
(a) COMPACT CONDITION. A State accepting a new financing or administrative compact under this Act shall expressly consent to suit in federal district court for prospective compliance, benefits or wages wrongfully withheld under the accepted compact, and reasonable attorney fees authorized by this Act. The consent shall identify the covered agencies and obligations and shall not extend to punitive damages or unrelated claims.
(b) VOLUNTARY CHOICE. The State shall receive clear notice before acceptance. Declining this condition shall result in federal administration, not withdrawal of unrelated preexisting federal assistance or loss of resident coverage. The United States retains its independent ability to enforce an accepted compact.
(c) LIMITS. No waiver shall be inferred merely from ordinary federal regulation or from participation in a program not created by this Act. Existing lawful suits against officers for prospective relief and independent civil-rights remedies remain governed by their applicable law. Federal fallback responsibility under section 101(d) continues.
(a) ROUTES. Beneficiary actions, private-entity claims, punitive civil penalties, and administrative review shall follow title XVII. A label describing a sanction as remedial shall not defeat a constitutionally required jury trial or a statutory judicial forum.
(b) LIMITATIONS. Unless a more specific period applies, an action under section 1702 or for retaliation under section 1706 shall be filed within three years after the claimant knew or reasonably should have known the material facts. Equitable tolling and rules protecting minors or persons unable to act remain available as provided by federal law.
(c) COORDINATION. Courts shall prevent duplicate recovery while permitting distinct relief for distinct injuries. Administrative exhaustion shall not be required for a private billing or retaliation claim unless expressly prescribed. Predispute arbitration and waiver restrictions in section 1702 remain effective. This section does not shorten a longer limitations period applicable to an independent claim under another statute.
(a) REPORTING. The Authority shall maintain secure channels for reports of false claims, unlawful billing, scientific suppression, unsafe staffing, data misuse, and interference with patient care. Anonymous reports may be assessed, but unsupported allegations alone shall not justify a final sanction.
(b) PROTECTION. A worker making a reasonable good-faith report or participating in an investigation shall receive the protection of section 1706. Protection does not authorize unlawful public disclosure of patient records or theft of unrelated confidential information; lawful confidential reporting and evidence preservation remain protected.
(c) RESPONSE. The receiving office shall acknowledge a report where contact is possible, assess urgent safety issues promptly, and refer matters within another agency's competence. The subject of an investigation shall receive process appropriate to any proposed adverse action. Records subject to a lawful preservation notice shall not be destroyed under an ordinary deletion schedule.
(a) FINDING. Repeated unlawful denials, missed access deadlines, underpayment of compensation floors, discriminatory practices, or privacy breaches may support a systemic corrective proceeding. The Authority shall state the pattern, evidence, affected functions, and proposed corrective duties.
(b) REMEDY. Orders may require revised procedures, training, independent monitoring, repayment, additional capacity, or contract replacement within express statutory authority. Punitive penalties and exclusion require the processes in title XVII. An order shall protect continuity and shall not punish patients for an institution's failure.
(c) TRANSPARENCY. The Authority shall publish nonidentifying summaries, progress, and unresolved findings. Judicial relief shall remain subject to applicable jurisdiction, standing, class-action requirements, and equitable principles. This Act does not dispense with those requirements by describing a problem as national or systemic.
(a) CONSULTATION. The Secretary shall engage in meaningful government-to-government consultation before adopting a policy materially affecting Tribal health delivery, data, or treaty-related obligations. Consultation shall occur early enough to influence the decision and shall include a written response to material concerns.
(b) AGREEMENTS. Tribal participation shall be through lawful agreements respecting self-determination, applicable trust obligations, and existing Tribal health authorities. AHP payment shall not be substituted for funding of a distinct federal obligation without express statutory authority and appropriate accounting.
(c) SOVEREIGNTY. This Act does not generally waive Tribal sovereign immunity. A particular agreement may contain a clearly stated, limited dispute-resolution consent accepted by the Tribal government. A beneficiary unable to obtain a necessary remedy through a delivery agreement retains the federal access and payment remedies against the Secretary provided in section 1701.
(a) ACCESS. The Authority shall finance covered services furnished by qualified Tribal and urban Indian health programs and shall recognize reasonable costs of remote delivery, cultural and linguistic services, transport, and coordination. A provider shall not be required to abandon an otherwise lawful Tribal operating structure to receive AHP payment.
(b) CAPITAL. Facility and technology awards shall address documented need and the public-use conditions appropriate to Tribal land and governance. Agreements shall identify ownership, maintenance, data stewardship, and continuity without imposing an invalid property interest.
(c) RIGHTS. A person entitled to services through Indian health authorities may use AHP-covered providers without surrendering those distinct rights. Payment coordination shall avoid duplicate reimbursement while preserving access. Traditional or cultural services may be funded where otherwise authorized and clinically or programmatically appropriate, but an AHP payment shall not authorize an unsafe intervention or override informed consent.
(a) FEDERAL FINANCING. Territorial arrangements shall comply with section 903 and shall not impose the standard state contribution where that section provides federal-only financing. A territorial annual grant ceiling shall not limit an individual AHP entitlement.
(b) CAPACITY. Plans shall address specialist shortages, interisland and mainland referral, essential supply shipping, storm resilience, laboratory access, and workforce recruitment. Necessary patient and caregiver transport and lodging are covered when appropriate care is not available locally.
(c) ACCOUNTABILITY. Agreements shall identify qualified operators, public procurement, financial controls, and culturally and linguistically suitable services. Federal oversight shall not be used to disregard legitimate local clinical knowledge. An interruption in territorial administration shall trigger federal continuity arrangements rather than suspension of benefits. Tax coordination remains governed by title XXIX and applicable territorial tax law.
(a) ACCESS. Persons granted asylum and admitted refugees who satisfy section 201 shall receive full coverage without an additional waiting period. Enrollment assistance shall use status verification without sending diagnoses, service histories, or provider-location data to immigration authorities.
(b) TRANSITIONS. A person obtaining an eligible status shall receive full benefits from the date eligibility is established under this Act, subject to the benefit-commencement schedule. An earlier emergency or limited-benefit record shall not prevent enrollment or require disclosure of unrelated immigration history.
(c) LIMITS. A pending application or work authorization alone remains governed by section 202. The Authority shall explain available limited and preserved residual coverage without incorrectly describing every excluded lawful category as undocumented. No provider shall investigate a patient's status beyond what is reasonably necessary for lawful enrollment assistance and payment classification.
(a) COVERAGE. A person otherwise eligible under title II does not lose AHP eligibility solely because of lawful custody. Necessary clinical services may be financed through AHP under agreements that identify the clinical costs assumed and the custodial authority's retained obligations.
(b) LIMITS. Security, punishment, routine confinement, and ordinary detention room and board are not AHP clinical benefits. Limited-benefit persons retain section 204 and any independent constitutional or statutory right to necessary care. This Act does not narrow a custodian's duty because an item falls outside AHP eligibility.
(c) INDEPENDENCE. Clinical decisions shall be made by qualified personnel and shall not be altered for punishment, interrogation, or administrative convenience. Medical information shall be shared with custody staff only as lawfully necessary for safety and care. Oversight shall include confidential patient complaints and protection from retaliation.
(a) RESIDENCE. Lack of a fixed address shall not defeat ordinary residence. The Authority shall accept reliable alternative contact and residence evidence and provide outreach enrollment through qualified community partners.
(b) MEDICAL RESPITE. A covered person who no longer requires inpatient care but cannot safely recover in an unsheltered or unsuitable setting may receive time-limited medical respite, including necessary clinical supervision, wound care, medication support, and accommodation inseparable from that recovery. Eligibility shall be reassessed according to need, not an arbitrary discharge date alone.
(c) BOUNDARIES. Medical respite does not create a general entitlement to permanent housing under this Act. The Authority shall coordinate with separately authorized housing programs and shall not discharge a patient into a medically unsafe situation merely to shift costs. Ordinary housing obligations and benefits of other programs remain independently enforceable.
(a) PRESERVATION. AHP shall supplement access without diminishing benefits, specialized services, or earned rights under veterans' or military health law. A covered person may use AHP providers while retaining eligibility for those distinct systems.
(b) AGREEMENTS. The Secretaries concerned shall identify referral, records, payment, readiness, rehabilitation, and specialty functions that can be coordinated. Military operational and classified information shall remain subject to applicable security law; payment coordination does not authorize unrestricted access to it.
(c) FINANCING. A payment for an assumed clinical service shall be counted once. Funds necessary for retained veterans' and military obligations shall not be swept into the Fund merely because the same person is AHP eligible. An agency dispute shall not interrupt an active treatment course. This section does not convert private AHP clinicians into military personnel or federal employees.
(a) RESPONSIBILITIES. AHP shall pay medically necessary services within its scope; educational agencies retain independent obligations under applicable special-education and disability law. A service may serve both purposes, but the responsible agencies shall identify an appropriate payment allocation without duplicate reimbursement.
(b) PAYMENT FIRST. Where a clinically necessary service is undisputed but agency responsibility is contested, AHP shall provisionally pay its covered component and resolve allocation afterward. A child shall not be required to lose instruction or clinically necessary therapy while agencies exchange invoices.
(c) PRIVACY AND CONSENT. Exchange of education and clinical records shall comply with applicable law and valid consent. A school may not condition education on waiver of health privacy. AHP coverage shall not be used to reduce a child's legally required educational plan, and an educational label shall not automatically determine clinical medical necessity.
(a) PORTABILITY. A covered person temporarily moving for seasonal work, caregiving, education, or disaster recovery shall retain national coverage. A region may not impose a separate residency waiting period or require transfer of enrollment before furnishing necessary care.
(b) COORDINATION. With lawful authorization, providers shall exchange essential treatment information and arrange continuity of medicines, equipment, and appointments. The Authority shall offer contact methods suitable for a person without stable internet, mail, or telephone access.
(c) ACCOUNTING. Residence disputes among regions or States shall be resolved under title IX and shall not create patient liability. Full eligibility remains governed by title II; occupational mobility alone neither establishes nor defeats an immigration category. Public communication shall explain this distinction and the availability of limited protection without discouraging emergency care.
(a) DOMESTIC REFERRAL. The Authority shall arrange care outside a person's home region when necessary for timely suitable treatment, including travel and lodging under section 306. A regional budget shall not prevent a clinically justified referral.
(b) FOREIGN ARRANGEMENTS. Foreign services are covered only to the extent authorized by section 205 or a specific written referral finding that necessary suitable care cannot reasonably be obtained domestically within the clinical timeframe. The agreement shall address qualification, quality, informed consent, records, continuity, and enforceable payment terms.
(c) LIMITS. This section does not establish unrestricted medical-tourism coverage or require a patient to accept foreign care instead of an available appropriate domestic option. The Authority shall explain any material difference in legal remedies or regulatory oversight and shall arrange domestic follow-up. Emergency care abroad remains subject to section 205.
(a) PLAN. For a covered person leaving incarceration, a public hospital, or another custodial institution, the responsible clinical team shall offer a continuity plan identifying medicines, equipment, appointments, assistance needs, and accessible enrollment information.
(b) BRIDGE. Necessary medication and equipment shall be supplied or arranged for a clinically reasonable transition period, ordinarily at least 30 days where safe and legally permissible. Controlled-substance requirements remain applicable. A lack of immediate address or documentation shall trigger provisional assistance rather than interruption.
(c) COORDINATION. Institutions shall make lawful referrals without conditioning release on participation in optional treatment. AHP funding does not alter custody or release authority. The Authority shall track aggregate care interruption and failed referral after discharge and shall address systemic gaps through funded regional correction rather than patient penalties.
(a) REVIEW. Agreements under this title shall identify an accountable official, service obligations, funding source, reporting, records protection, dispute procedures, and continuity in case of termination. Duties shall be proportionate to the provider and population served.
(b) SCOPE. Unless a provision expressly creates an episode-specific protection, this title does not expand or narrow the full and limited eligibility classes in title II. Separate treaty, constitutional, veterans', military, education, and custodial obligations remain preserved as specified.
(c) FINANCING. The Chief Actuary shall separately report federal-only costs and payments under special-delivery arrangements to prevent their mistaken inclusion in a State's 22 percent base. Clinical, capital, education, and administrative expenditures shall be charged to the corresponding existing accounts, and a cooperative agreement shall not create a second claim for the same cost.
(a) COORDINATION. The Secretary shall direct a national implementation office within the Authority and designate an accountable career official for each enrollment, benefits, payment, workforce, facilities, technology, procurement, legal, and communications workstream. Designation does not confer authority requiring appointment under section 104 or transfer another agency's statutory power.
(b) INTERAGENCY DUTIES. Treasury shall lead revenue collection and cash management; Labor shall lead displaced-worker assistance; the Office of Personnel Management shall coordinate affected federal employee benefits; and HHS shall coordinate clinical continuity with States, Tribes, veterans' and military agencies, and participating providers. Each agency shall identify dependencies, resources, decisions, and a responsible official.
(c) PUBLIC CONTROL RECORD. The office shall maintain a public milestone register, excluding protected personal, procurement-sensitive, and security information. Missed milestones shall produce a corrective action and an identified owner within 10 business days. Neither an internal disagreement nor an unsigned interagency memorandum suspends an individual entitlement or authorizes expenditure outside this Act.
(a) FIRST 30 DAYS. Within 30 days after enactment, the Authority shall inventory transferable enrollment records, payment contracts, existing service authorizations, provider participation files, outstanding claims, hospital cash needs, and essential supply agreements. The inventory shall distinguish assumed obligations from obligations remaining with another payer.
(b) VALIDATION. Records shall be matched using minimum necessary identifiers and tested for duplication, missing fields, and inappropriate inclusion. A disagreement in an administrative field shall trigger verification and provisional service arrangements, not cancellation of active treatment.
(c) PREPARATION. Within 60 days after enactment, the Authority shall publish payment routing instructions, provisional participation terms, a dispute contact, and procedures for a provider unable to use the principal electronic channel. Approved emergency advances shall be reconciled to verified costs or subsequent payments. Collection of this inventory shall not authorize access to an entire clinical record when enrollment or payment fields suffice.
(a) DAY-90 PHASE. The early benefits required by section 1801 shall commence on its prescribed date. The Authority shall identify the services assumed in this phase, the responsible payer, and the procedure for preventing duplicate collection from a person or another program.
(b) NOTICE. Covered persons, providers, employers, insurers, pharmacies, transport operators, and public agencies shall receive accessible notice explaining which charges cease, how claims are routed, and how a person obtains help without an enrollment card. Notice shall not suggest that full benefits have begun before the statutory date or that an early-phase omission eliminates a separate existing benefit.
(c) COORDINATION. Existing payers remain responsible for benefits not yet assumed, subject to title X. Disputes about whether a service belongs to the early phase shall be resolved promptly through a designated payment team; medically urgent care shall proceed under provisional payment. Erroneous duplication shall be recovered from the responsible payee rather than an innocent patient.
(a) TESTING. Before the readiness report due under section 1801, the Authority shall conduct end-to-end tests of enrollment, pharmacy dispensing, emergency transport, hospital payment, dental and hearing claims, urgent appeals, payroll contributions, and manual fallback channels. Tests shall include rural, territorial, Tribal, disability-accessible, and non-English-language pathways.
(b) FINDINGS. The report shall identify successful tests, unresolved defects, affected populations, clinical consequences, corrective owners, and a funded fallback. Security-sensitive technical details may be withheld, but a general claim of readiness may not conceal a material access or payment failure.
(c) NO POSTPONEMENT. A failed test does not authorize postponement of the full-benefit date. The Secretary shall use lawful operating advances, temporary staff, legacy processors, direct payment, mobile services, and contracted alternative capacity to discharge the obligation. Corrective action shall preserve audit trails and privacy rather than suspend either protection wholesale.
(a) CONVERSION. On the full-benefit date, every benefit within title III shall be payable for an eligible person under the terms of this Act. Enrollment systems shall record the legal commencement date even where a replacement identifier or migrated record is issued later.
(b) PARALLEL PERIOD. For necessary continuity, the Authority may retain legacy processors and run parallel payment verification under section 1802. A parallel system is an administrative service to AHP and may not continue a prohibited primary insurance product, charge a patient, or exercise profit-linked coverage discretion.
(c) RECONCILIATION. Claims shall carry a service date, payment identifier, and responsible account sufficient to detect duplication. A provider that reasonably follows published transition instructions shall receive an opportunity to reconcile a nonfraudulent error before exclusion or punitive proceedings. Parallel operations shall end when safely replaceable, with retained records and a tested rollback procedure for critical defects.
(a) IDENTIFICATION. The Authority shall offer a confidential continuity process for an individual receiving cancer treatment, transplantation services, dialysis, pregnancy care, behavioral treatment, rare-disease therapy, home support, rehabilitation, or another ongoing course in which interruption would create material clinical risk.
(b) CONTINUATION. Existing prescriptions, scheduled procedures, equipment arrangements, and clinically justified authorizations shall remain effective for the transition period specified in section 1802, subject to patient choice, lawful prescribing limits, and a documented immediate safety concern. Replacement review shall occur before, not after, expiration of necessary service.
(c) HANDOFF. When a provider closes, declines further participation, or cannot safely continue, the Authority shall arrange a receiving provider, records transfer, medicines, transport, and any necessary bridge payment. No provision requires an individual clinician to work involuntarily. Administrative reassignment shall not be represented as the patient's consent to a materially different treatment.
(a) CONTINGENCY. The Authority shall maintain independent methods for urgent pharmacy, hospital, professional, home-care, and transport payments during an outage, cyber incident, disaster, or failed contractor operation. A provider shall have a documented telephone or offline route for essential claims.
(b) ADVANCES. Where delayed payment threatens an essential service, the Authority may advance an amount based on verified payroll, supply obligations, recent service volumes, and prior payment history. The agreement shall specify eligible uses, reporting, reconciliation within 90 days after restoration, and recovery of excess without disrupting indispensable care.
(c) CONTROLS. Treasury and the Authority shall reconcile advance and claims identifiers daily during a material outage where technically feasible. Public reports shall distinguish appropriated authority, cash disbursement, expense recognition, and recoverable advances. An outage does not eliminate patient protections, legal accountability, or the requirement that expenditure serve an authorized purpose.
(a) ACCESS CHANNELS. The Authority shall operate free telephone, mail, accessible electronic, and in-person assistance through its own offices and qualified partners. Emergency access assistance shall be available at all times; ordinary assistance shall include extended hours and prompt callbacks.
(b) SERVICE STANDARD. Staff shall be trained to distinguish eligibility, clinical urgency, payment, privacy, and fraud issues and to route them to a named responsible team. A caller shall not be required repeatedly to recount sensitive clinical details to obtain an administrative referral.
(c) ESCALATION. A complaint alleging imminent interruption of necessary care shall be referred for same-day clinical triage and, where appropriate, an expedited appeal. Call-volume and abandonment reports shall be used to fund staffing and alternative channels. A digital assistant may provide information but shall not replace requested human assistance for an adverse decision, disability accommodation, or urgent clinical concern.
(a) RISK SCREENING. The Authority shall screen for duplicate payments, nonexistent providers, false enrollment, identity theft, diversion of advances, and prohibited patient collections using validated methods and documented review thresholds.
(b) ACCESS SAFEGUARDS. A statistical flag alone shall not establish fraud or terminate medically necessary treatment. A licensed reviewer shall address clinical issues, and a qualified investigator shall assess evidence before punitive referral. A patient whose identity was misused shall receive correction assistance without losing lawful coverage.
(c) MEASUREMENT. Integrity reports shall distinguish confirmed recovery, pending allegation, prevented erroneous payment, administrative expense, and an estimate of future avoided cost. The same recovery shall not be counted by multiple offices. Performance awards shall not depend on raw denial volume, and program-integrity staff shall be evaluated for accuracy, proportionality, and protection of access as well as verified recoveries.
(a) PROCUREMENT. Emergency or accelerated acquisition may be used only under applicable procurement authority and a written finding identifying urgency, scope, price reasonableness, alternatives, and the anticipated transition to ordinary competition. This section does not create a general exemption from procurement or conflict-of-interest law.
(b) PERSONNEL. Agencies may detail consenting personnel, use lawful temporary appointments, and hire qualified displaced workers under title XIV. Inherently governmental decisions shall remain with properly appointed officials. Contractor access shall be role-limited and terminated when no longer necessary.
(c) EXIT REQUIREMENTS. Each critical transition contract shall require usable data export, documentation, cooperation with a successor, continuity during a lawful termination, and a disclosed price for transition assistance. A contractor may not withhold patient records, necessary system credentials, or government-owned work product to force renewal. Payments and contract changes remain subject to inspection and independent audit.
(a) MEASURES. Beginning on the full-benefit date, the Authority shall publish quarterly measures of enrollment correction, actual access times, unresolved urgent referrals, claims timeliness, unlawful billing, medicine interruption, staffing vacancies, appeals outcomes, facilities milestones, cybersecurity restoration, and verified administrative cost.
(b) INTERPRETATION. Measures shall identify denominators, missing data, uncertainty, risk adjustment, and material methodology changes. Public comparisons shall not expose small identifiable groups or discourage service to medically complex people. Clinical outcomes shall not be replaced by favorable process counts.
(c) CORRECTION. A material sustained failure shall require a public corrective plan within 30 days, identifying an accountable official, service alternatives, staffing and funding needs, milestones, and patient assistance. The Secretary may revise methods through lawful rulemaking but may not redefine a failed entitlement as satisfied merely to improve a dashboard. Corrective measures remain reviewable under titles IV and XVII.
(a) EVALUATION. GAO shall perform the reviews required by section 1805 and additional reviews after the tenth and each subsequent fifth full program year. Reviews shall examine access, quality, costs, revenue, compensation, innovation, geographic capacity, administrative burden, rights enforcement, and distributional effects.
(b) METHODS. Evaluations shall distinguish observed changes from causal estimates and compare alternative explanations, including demographic change, technology, disease burden, prices, and economic conditions. The Chief Actuary shall provide reproducible assumptions and sensitivity analysis without representing a planning scenario as an official congressional score.
(c) RESPONSE. Within 120 days after a final review, the Secretary shall publish a response identifying accepted recommendations, reasons for disagreement, lawful corrective actions, and legislative changes requiring Congress. Evaluation shall not suspend coverage, authorize new tax rates, lower statutory compensation floors, or create an automatic sunset. Persons affected by a proposed operational change shall receive notice and applicable participation rights.
(a) INTEGRATED OPERATION. Titles XIX through XXXVI supplement, and do not replace, the entitlements, financing, eligibility, remedies, and deadlines in titles I through XVIII. A specific supplemental requirement governs its particular subject where it can be applied consistently with those entitlements. An agency shall not infer authority to postpone the full-benefit date from a later reporting, construction, training, or procurement deadline.
(b) BENEFIT SCOPE. References to patients or persons in a clinical-delivery title mean persons entitled to the relevant benefit under title II, except for an expressly established donor, disaster, exposure, or other episode-specific protection. A delivery standard alone does not convert limited eligibility into unrestricted full coverage.
(c) TAX RULES. A specifically incorporated tax aggregation, attribution, or filing rule controls the corresponding tax question over a general program definition. No administrative construction may increase a statutory rate, create a new tax base, or count the same receipt as both a State contribution and federal revenue.
(a) ASSUMED BENEFITS. Beginning with the first calendar month wholly within an individual's full AHP coverage, no premium under part A, B, or D of title XVIII of the Social Security Act shall be collected from that individual for benefits fully assumed by AHP. Amounts collected for such a month shall be refunded or credited within 90 days.
(b) CONTINUITY. Prior Medicare enrollment and coverage records shall support AHP enrollment without a new underwriting or late-enrollment penalty. Accrued claims and appeal rights arising before assumption remain enforceable against the responsible program. Statutory trust-fund transfers shall be accounted for under section 703 rather than treated as new tax receipts.
(c) RESIDUAL OBLIGATIONS. Medicare rights of a person or for a service not assumed by AHP remain subject to otherwise applicable law. This section does not create unrestricted overseas AHP coverage or erase premiums validly incurred before assumption. The Secretary shall provide a written allocation for any retained premium-supported benefit.
(a) COORDINATION. Transfers from Medicaid and the Children's Health Insurance Program shall cover only the obligations actually assumed under section 1003. A State shall retain applicable duties for residual beneficiaries or services and may not count a federal transfer as its own compact contribution.
(b) INDEPENDENT AHP ENTITLEMENT. Medicaid financial eligibility, institutional residence rules, estate recovery, enrollment caps, and the exclusions concerning inmates of public institutions or institutions for mental diseases in section 1905(a) of the Social Security Act shall not limit benefits financed independently under this Act. AHP long-term services remain governed by section 305 and title XXIII.
(c) PROTECTION OF CHILDREN. Existing enforceable early and periodic screening, diagnostic, and treatment rights are preserved until corresponding AHP obligations are effective and available without reduced substantive protection. Disputes among programs shall be resolved after provisional payment for necessary care. Duplicate reimbursement remains prohibited, and an individual shall receive notice identifying the program responsible for an ongoing appeal.
(a) ESSENTIAL COVERAGE. Full AHP coverage is government-sponsored minimum essential coverage for purposes of section 5000A(f)(1)(A) of the Internal Revenue Code of 1986. Limited coverage under section 204 is not minimum essential coverage solely by reason of this Act.
(b) PREMIUM CREDITS. For section 36B of such Code, full AHP eligibility shall preclude a premium tax credit for the same individual beginning with the first calendar month wholly within full coverage. A partial transition month shall be reconciled without duplicate public reimbursement of the same premium. Lawful credits for prior months and for persons not fully eligible remain governed by applicable law.
(c) EMPLOYER COORDINATION. For a month wholly within an employee's full AHP coverage, that employee shall not trigger a payment under section 4980H(b). For computing a payment under section 4980H(a), the number of full-time employees shall exclude such employees, and the otherwise applicable numerical reduction shall be multiplied by the ratio of remaining full-time employees to all full-time employees. This rule does not change applicable-large-employer status or section 804 contributions. Treasury shall eliminate duplicative reporting while preserving information necessary for residual obligations, accurate taxes, and enforcement.
(a) FEDERAL INSURANCE RULE. This Act expressly relates to the business of insurance for purposes of section 2(b) of the McCarran-Ferguson Act, 15 U.S.C. 1012(b). No State insurance law shall reverse-preempt its primary-coverage prohibition, runoff protections, patient-billing rules, or authorized federal administration.
(b) EMPLOYEE PLANS. Section 514 of the Employee Retirement Income Security Act of 1974 shall not be construed to displace this Act or State action expressly authorized by it. A self-funded plan is subject to the same prohibition on duplicative primary coverage as an insured plan.
(c) SAVINGS. Accrued claims, fiduciary duties, participant protections, and continuation-coverage rights remain enforceable for periods and benefits not assumed by AHP. No person shall pay a continuation premium for prohibited duplicate coverage. Permitted supplemental coverage does not by itself extinguish an independent employment agreement, collective-bargaining obligation, pension right, or claim arising before conversion. Contract disputes shall not delay AHP services.
(a) EXISTING ASSETS. This Act does not confiscate amounts lawfully held in a health savings account or alter the owner's title to those amounts. Distributions for qualified medical expenses remain subject to section 223 of the Internal Revenue Code of 1986, including restrictions on double reimbursement.
(b) FUTURE CONTRIBUTIONS. Full AHP coverage shall be treated as health coverage other than a high-deductible health plan for purposes of section 223(c)(1). A person may not claim contribution eligibility for a month on a contrary characterization of AHP. Treasury shall apply existing partial-year and testing-period rules consistently with the conversion date and statutory penalty-relief provisions.
(c) REIMBURSEMENT PLANS. Health flexible-spending and reimbursement arrangements shall pay valid accrued claims and may reimburse lawful nonduplicative qualified expenses. No arrangement may reimburse a prohibited patient charge, create a priority lane for a covered service, or obtain both public payment and tax-favored reimbursement for the same expense. Prospective plan amendments shall preserve earned contractual rights and comply with tax and labor law.
(a) SCHEDULE. The Authority shall establish a records schedule distinguishing clinical records, claims, eligibility evidence, audit material, and research data. Identifiable information shall be retained only as long as necessary for care, statutory accountability, or another applicable legal duty. A federal record may not be destroyed contrary to federal records law.
(b) MINIMUM ACCOUNTABILITY. Payment and grant records necessary to substantiate expenditure shall ordinarily be retained for 10 years after final payment; an applicable longer clinical, minor-patient, fraud, tax, or litigation requirement controls. A preservation hold shall identify the relevant material and shall not justify unrelated indefinite retention.
(c) DISCLOSURE. Tax information remains subject to section 6103 of the Internal Revenue Code and section 1603. A records subpoena or discovery request shall receive applicable judicial review and confidentiality protection. Neither data ownership nor a pending payment dispute permits withholding records needed for a patient's care or authorized access. Secure deletion shall be documented when lawful retention ends.
(a) NET ACCOUNTING. The Secretary shall coordinate AHP prices with applicable Medicaid rebates, section 340B discounts under the Public Health Service Act, and Medicare negotiated-price arrangements so that the same unit is not assigned incompatible duplicate rebates or reimbursements. A lower lawful net acquisition cost shall be reflected in the actual public payment.
(b) RETAINED OBLIGATIONS. AHP assumption does not terminate a discount or safety-net obligation for a separate purchaser or service that remains outside the assumed program. A covered entity shall receive clear unit-level instructions and a correction process before a nonfraudulent transition mismatch is penalized.
(c) SCOPE. A ceiling established under title VI applies to the transactions specified there; it is not a general authorization to regulate every foreign or non-AHP sale. FDA approval, quality, manufacturing, and safety requirements remain applicable except for a specifically enacted reliance provision. Price authority does not establish that an unapproved product is safe or effective.
(a) COVERED EMPLOYEES. A federal agency employing a civilian clinician to perform services subject to section 504 shall fund compensation sufficient to satisfy that section. To the extent a civilian statutory basic-pay ceiling would prevent payment of the required floor, the agency may pay the necessary difference as an AHP clinical supplement, notwithstanding that ceiling. The supplement shall be treated as basic pay only where another law expressly so provides.
(b) LIMITS. This authority does not alter uniformed-service military pay, create an uncapped executive-pay exception, waive professional qualification requirements, or permit an agency to pay for unperformed work. Supplements shall be included in public aggregate compensation reporting and audited for consistency.
(c) OTHER PUBLIC PROVIDERS. State and local participating employers remain subject to agreed participation and compact duties, including section 3309 where applicable. Federal enforcement and patient payment obligations remain available as provided by this Act; a court's jurisdiction over a State shall not be presumed beyond an express waiver or valid constitutional authority.
(a) CLASSIFICATION. Clinical delivery, capital, education, research, worker adjustment, public health, administration, and tax-collection costs under supplemental titles shall be charged to the corresponding accounts established in titles VII through XV. A cross-reference to an existing floor is not a second appropriation of the same amount.
(b) SUFFICIENCY. Account floors establish minimum available funding, not ceilings on lawful benefit obligations. Necessary additional payments shall be made under section 701. Unspent authority, an internal allocation, an advance awaiting reconciliation, and an estimated future saving shall not be reported as interchangeable forms of expenditure or revenue.
(c) REPORTING. Annual financial statements shall reconcile each account to consolidated expenditure, actual receipts, State contributions, federal transfers, reserves, recoveries, and unpaid obligations. An expenditure serving multiple purposes shall be allocated on a documented basis and counted once. Inflation adjustments shall follow section 103 and shall not be applied twice to a single statutory amount.
(d) ANNUAL PERIODS. Unless a provision specifies a calendar year, fiscal year, or other commencement, an annual program-account floor shall apply to each program year as defined in section 103. Necessary precommencement activity shall be financed under sections 701 and 1802. This rule does not defer an immediate appropriation, a transition duty, or a benefit expressly commencing before the full-benefit date.
(a) TIME. Unless expressly stated otherwise, a day means a calendar day. A business day excludes Saturdays, Sundays, and federal legal holidays. An ordinary filing deadline falling on such a day extends to the next business day, but a clinical urgency deadline, continuous service obligation, or full-benefit commencement shall not be extended on that basis.
(b) INITIAL DUTIES. A supplemental delivery duty without a separate commencement date shall apply on the full-benefit date. A first annual report without a specified due date shall be due 90 days after completion of the first full program year; quarterly reports shall be due within 45 days after the quarter. Earlier expressly prescribed reports control.
(c) ADMINISTRATION. The Secretary shall publish a consolidated deadline register within 60 days after enactment and update it after a relevant amendment. The register is explanatory and cannot change the Act. Failure to publish a form or regulation shall not defeat a sufficiently supported claim or suspend an independently operative entitlement.
(a) PENDING MATTERS. Except as expressly provided, this Act does not extinguish a claim, judgment, investigation, tax liability, contract remedy, or administrative proceeding concerning conduct before its applicable effective date. The responsible agency may transfer administration of an assumed obligation without depriving an affected person of notice or an existing review right.
(b) CONTINUING SERVICES. If a financing provision, insurer restriction, State compact term, or other separable provision is held invalid, lawful coverage and payment duties shall continue under remaining authority, including section 701, to the extent permitted by the judgment and Constitution. No official may use severability to recreate an invalid tax or disregard a final judicial order.
(c) FINAL RULE. The review and severability provisions in section 1805 apply to every title. No evaluation date is a sunset. Nothing in this Act binds a future Congress against amendment or repeal, expands borrowing authority beyond law, or permits an agency to substitute an aspiration for an enforceable duty expressly imposed herein.
Companion report
Read the counsel
and fiscal report.
Legal analysis, title-by-title commentary, fiscal assumptions, implementation, stakeholder review, and 27 source references. Explanatory material dated September 19, 2026; the bill controls if the documents differ.
Legislative counsel, fiscal, and implementation companion
Prepared September 19, 2026. This report accompanies the complete 36-title replacement bill. It is explanatory material, not part of the proposed statutory text. The bill controls in case of a difference. Dollar figures described as statutory amounts are proposed legislative choices. Scenario inputs are assumptions, not verified estimates of the legislation's actual cost or revenue.
The expanded bill contains 314 sections, including the short title and statutory table of contents. It retains and refines the original 18-title framework and adds 18 implementation and delivery titles comprising 216 additional sections. The operative text, excluding the table of contents, contains approximately 49,000 words. The attached PDF contains 203 pages, with 193 pages devoted to titles I through XXXVI after the introductory material and contents. The separate report is not counted toward that total.
The drafting method is to pair entitlements with delivery obligations, delivery obligations with payment and staffing, and administrative discretion with process and review. Coverage is not dependent on the existence of a completed national database, a participating State, an annual appropriation, or a person's payment of an individual tax. Conversely, the statute does not compel an individual professional to work, guarantee that a particular scientific discovery will occur, or treat a building grant as proof that a functioning hospital exists.
This expansion leaves the policy's central choices intact: comprehensive benefits by day 180; an early benefit phase by day 90; no charges for covered services; compensation floors; broad medical-product pricing powers; replacement of duplicative primary insurance; limited rather than full coverage for excluded eligibility categories; and permanent federal payment authority. The new provisions specify implementation, not merely additional purposes or findings.
Three material refinements deserve particular attention. Section 1602 now separates absolute prohibitions on selling health data, targeted advertising, and discriminatory disclosure from the distinct consent rule for optional commercial model training. Section 1305 now requires public access to funded peer-reviewed articles without an embargo at publication. Section 3309 requires an express, limited remedial consent in a State's voluntarily accepted compact rather than assuming that regulation alone waives sovereign immunity. The research-publication provision is consistent in direction with NIH's current no-embargo public-access approach, although the bill supplies its own statutory terms. [S24]
The full-benefit date is 180 days after enactment. Dental, vision, hearing, mental health, prescription drugs, hospital care, and medically necessary long-term services begin together. Construction, training, and technology programs must commence and satisfy their own milestones; the law does not declare their physical completion at six months. Access failures require alternative providers, appropriate telehealth, transport, bridge payment, or regional capacity deployment, with an express judicial route for lawful relief.
Existing EMTALA requires specified emergency screening, stabilization, and appropriate transfer obligations. It is not itself a general elimination of emergency bills. The Act's no-charge rule is therefore a distinct financing and patient-liability protection, covering both participating and nonparticipating qualified providers for covered transactions. Previously incurred lawful medical debt is not automatically canceled. [S04]
Full coverage depends on ordinary United States residence and a qualifying status under title II. Citizens, nationals, lawful permanent residents, granted asylees, admitted refugees, and specified other durable lawful categories qualify without an income test. Certain longer-term lawful workers and dependents qualify under the statute's express rule. A pending asylum claim, employment authorization, temporary protected status, or parole alone does not necessarily establish full AHP eligibility, and the text does not equate all excluded persons with undocumented persons.
Limited coverage includes emergency stabilization and transport, specified maternity and public-health services, and necessary life-preserving follow-up. The express dialysis provision prevents a payment rule that would cover only predictable emergency deterioration while excluding the maintenance treatment that prevents it. Event-related disaster and exposure protections and the specified living-donor episode can extend beyond ordinary full eligibility. These are deliberate exceptions, not a general grant of unrestricted benefits. States may finance additional lawful benefits separately.
Let C equal consolidated net program expenditure; S accepted State contributions; Q the applied individual solidarity-revenue allocation; and F ordinary federal financing. Section 702 provides C = S + Q + F, with S no greater than 22 percent of C, Q no greater than 3 percent of C, and F no less than 75 percent of C. The standard compact share is 22 percent of allocable costs, with federal-only obligations and specified relief treated separately. Q is itself federal tax revenue, so total federal financing is C minus S, ordinarily at least 78 percent where the State contribution is 22 percent.
The three-percent figure is an expenditure allocation, not an assurance that a uniform three-percent tax pays for the program. The actual individual schedule is progressive and uncapped. Receipts beyond the current allocation remain in reserve; insufficient receipts increase federal financing. State refusal also increases federal financing. The Act uses voluntary compacts and federal administration rather than an invented state-specific punitive federal tax. It cannot simultaneously guarantee optional State participation and guaranteed receipt of a national 22-percent State share.
The ordinary individual schedule has marginal rates of zero, one, two, three, four, and five percent; the five-percent bracket remains open-ended. Additional marginal surtaxes of two, four, and six percent apply above the specified $100 million, $250 million, and $500 million thresholds. Joint-return thresholds for the ordinary tax are doubled; the ultra-high-income thresholds apply per return, with a separate married-filing-separately rule. The top additional marginal rate is eleven percent on the highest bracket, not on the entire return's income.
The employer contribution applies to aggregate covered payroll above an indexed $2 million exclusion, at four percent through $10 million and eight percent above that amount. Related employers share thresholds. A corporate contribution applies to the specified taxable-income brackets. Titles VIII and XXIX define collection, attribution, deposit, reconciliation, notice, refund, appeal, and anti-avoidance procedures. Treasury cannot invent higher rates or a wealth tax by regulation. No tax payment is an eligibility condition.
Section 701 permanently appropriates the amounts necessary for benefits and associated administration, enforcement, workforce, infrastructure, and oversight. Section 704 expressly addresses sequestration, statutory PAYGO, impoundment, and essential operations during annual appropriations lapses. The existence of a permanent appropriation does not establish economic affordability or budget neutrality. Express treatment of automatic reductions matters because federal budget law contains specific exemption rules; mandatory classification alone is not a substitute for the proposed language. [S05]
A subsequent Congress can amend or repeal the law. A reserve of Treasury obligations does not create new national resources or an independent guarantee against sovereign default. The Act does not itself increase the debt limit. These limitations are preserved in the statutory text rather than hidden in an explanatory disclaimer.
Sections 101-106. Creates the public financing system, individual entitlement, federal fallback, accountable appointments, scientific council, actuary, and patient assistance. Public financing does not automatically transfer private facility ownership or conscript professionals.
Sections 201-206. Defines ordinary residence and qualifying status, automatic and provisional enrollment, limited benefits, portability, and information protections. Eligibility follows law rather than the speed of a database or possession of a new card.
Sections 301-308. Establishes the comprehensive clinical package, dental and assistive benefits, long-term supports, emergency transport, and patient-charge prohibition. It preserves clinical review while preventing financial liability for a covered transaction.
Sections 401-404. Sets access deadlines, prior-authorization limits, independent review, continuing care pending appeal, and civil-rights protections. A local budget or failed appointment system does not discharge the national access duty.
Sections 501-506. Combines professional payment standards, institutional operating budgets, compensation floors, safe staffing, and prompt payment. Readiness support permits necessary low-volume capacity without creating incentives for unnecessary admissions.
Sections 601-605. Grants medical-product negotiation and ceiling authority, a defined process, supply alternatives, compensated government patent use, pharmacy-intermediary rules, and public-interest manufacturing. Patient continuity remains distinct from negotiating leverage.
Sections 701-705. Establishes permanent appropriations, the financing identity, actual transfers, a liquidity reserve, anti-cut protections, and actuarial reporting. Spending authority is not represented as proof that revenue is sufficient.
Sections 801-806. Sets individual, ultra-high-income, employer, and corporate contributions; defines the income base; regulates attribution; and provides collection and taxpayer rights. Rates and thresholds are legislative choices, not powers delegated without limits.
Sections 901-904. Provides voluntary financing compacts, federal administration when a State declines, specified fiscal relief, federal-only arrangements, and lawful supplemental State benefits. Coverage is not conditioned on State acceptance.
Sections 1001-1006. Replaces duplicative primary insurance while protecting runoff, unearned premiums, accrued claims, retained specialized programs, employer obligations, and liability-payer coordination. Distinct residual coverage is not abolished by implication.
Sections 1101-1104. Requires administrative simplification, lawful contract changes, ownership transparency, and procurement controls. Necessary clinical records, safety, scheduling, and audit functions remain even where payer-specific billing work ends.
Sections 1201-1205. Creates mandatory capital support for renovation, new capacity, rural access, modern equipment, and reliable operations. Awards require need, staffing, and operating plans rather than a construction announcement alone.
Sections 1301-1305. Funds education, supervised residency expansion, loan and service support, credential pathways, and independent research. Scientific review and public access coexist with ethics, consent, safety, and professional qualification requirements.
Sections 1401-1404. Creates defined displacement eligibility, income support, alternative wage insurance, training, childcare, relocation, and placement assistance. Earned benefits remain enforceable; unnecessary jobs are not artificially guaranteed.
Sections 1501-1505. Funds public-health readiness, disaster clinical response, environmental monitoring, and separate responsible-party recovery. HHS, FEMA, EPA, CDC, and ATSDR have stated coordination roles rather than interchangeable authority.
Sections 1601-1605. Sets data architecture, prohibited uses, consent and disclosure boundaries, interoperable access, AI protections, and cybersecurity. Optional commercial use cannot be a condition of receiving care.
Sections 1701-1707. Establishes benefit remedies, private claims, administrative correction, court-imposed punitive penalties, whistleblower protections, independent audit, and public accountability. Different misconduct and clinical-error categories retain different legal elements.
Sections 1801-1805. Fixes launch milestones, startup authority, legacy operations, treatment continuity, interim-rule limits, preemption, review, and severability. Construction and training schedules do not postpone the statutory full-benefit date.
Sections 1901-1912. Details community teams, primary payment, prevention, referral completion, mobile care, nutrition, health literacy, school links, and complex-care coordination. Performance must reflect completed access, not merely referral generation.
Sections 2001-2012. Specifies dental restoration, oral surgery, clinically necessary orthodontics, low-vision services, hearing devices, implants, repairs, rural delivery, and capacity planning. Replacement and maintenance prevent devices from becoming unusable covered benefits.
Sections 2101-2112. Adds maternal networks, obstetric readiness, midwifery, fertility, newborn and pediatric continuity, adolescent services, foster-care transitions, violence response, menopause care, and outcome review. Independent privacy and consent rules remain applicable.
Sections 2201-2212. Builds behavioral networks, mobile crisis and stabilization, post-crisis follow-up, addiction treatment, harm reduction, intensive and community services, peer support, confidentiality, and capacity measures. A crisis encounter is not treated as complete follow-up care.
Sections 2301-2312. Makes community-living benefits operational through assessments, personal plans, self-direction, caregiver support, transition from institutions, home modifications, direct-support continuity, resident rights, dementia services, and safeguarding.
Sections 2401-2412. Coordinates specialty networks, cancer, rare diseases, transplant and donor episodes, kidney disease, chronic conditions, pain, palliative services, second opinions, and clinically meaningful outcomes. Necessary maintenance is not denied simply because cure is unavailable.
Sections 2501-2512. Finances emergency readiness, ground and air transport, safe treatment without transport, nonemergency access, transfer coordination, trauma, pediatric capability, communications, and the emergency workforce. Transport bills cannot be shifted back to covered patients.
Sections 2601-2612. Adds facility inventories, award criteria, construction milestones, rural operating commitments, procurement, resilience, lifecycle technology costs, public-use covenants, closure notice, and audit. Capital and operating payments must not duplicate each other.
Sections 2701-2712. Implements workforce planning, compensation pass-through, specialty adjustments, training quality, service-commitment protections, credentialing, safe work, displacement decisions, and reemployment measurement. Grants do not replace professional licensing.
Sections 2801-2812. Details price dockets, evidence submissions, review, supply continuity, reserves, manufacturing, patent compensation, pharmacies, clinical research, trial access, licensing conditions, and scientific integrity. Regulatory shortcuts cannot substitute for safety evidence.
Sections 2901-2912. Provides tax-receipt ledgers, withholding, employer aggregation, self-employment and trust coordination, corporate collection, taxpayer rights, foreign and territorial coordination, State allocations, cash controls, and transparent forecasts.
Sections 3001-3012. Specifies claims validation, global-budget reconciliation, ownership and related-party disclosure, clinical independence, transaction notice, insurance runoff, premium refunds, collective-bargaining coordination, liability recovery, audit, and administrative measurement.
Sections 3101-3112. Adds laboratory, infectious-disease, occupational and environmental services; exposure-zone care; long-term monitoring; evacuation; supply; responsible-party recovery; public communication; and after-action review. Care does not wait for liability adjudication.
Sections 3201-3212. Implements federated records, identity correction, patient access, interoperability, telehealth, high-impact AI registration, human review, commercial-use limits, cyber assistance, incident response, cloud exit, and independent oversight.
Sections 3301-3312. Adds accessible notices, independent patient advocacy, nondiscrimination, consent, conscience coordination, clinical accountability, express State remedial consent, private-action timing, whistleblower process, and systemic relief subject to ordinary jurisdictional rules.
Sections 3401-3412. Coordinates Tribal and urban Indian care, territories, granted-status and limited coverage, custody, medical respite, veterans and military services, education-linked care, mobile residents, foreign referral, reentry, and federal-only accounting.
Sections 3501-3512. Turns the six-month launch into workstreams, inventories, early-benefit conversion, readiness tests, parallel operations, continuity, outage payment, assistance, integrity controls, procurement exits, dashboards, and independent long-term evaluation.
Sections 3601-3612. Coordinates Medicare premiums, Medicaid residual rights, marketplace credits, employer penalties, ERISA and insurance law, tax-favored health accounts, records, existing product discounts, public clinician pay, appropriation accounting, deadlines, and pending proceedings.
The statute invokes federal taxing, spending, interstate-commerce, procurement, and necessary-and-proper authorities for a national payment system and related regulation. Regulation of transactions, spending conditions, and benefit obligations should be analyzed separately rather than defended through a single unlimited theory of federal power. A national public payer does not itself require government acquisition of every hospital or professional practice.
NFIB v. Sebelius held the threatened loss of existing Medicaid funding impermissibly coercive in the circumstances before the Court. The Act instead conditions new cooperative arrangements on a disclosed contribution and administration agreement, preserves federal delivery when a State declines, and does not threaten unrelated existing aid. That design addresses a specific coercion concern; it is not a guarantee that every compact condition or application will survive challenge. [S01]
Section 3309 supplies express remedial consent for participating States, limited to specified accepted obligations and nonpunitive relief. Congress's power to authorize a private damages action against a State is not assumed merely because the subject is healthcare. The federal benefit obligation and federal fallback remain important where State immunity or a compact dispute prevents a particular remedy.
The individual taxes use a defined income base principally comprising realized income and established attribution of pass-through income. Moore v. United States upheld the particular attribution tax at issue on the corporation's realized income; it did not decide the constitutionality of every tax on unrealized appreciation or wealth. The Act therefore does not delegate mark-to-market or wealth-tax creation to Treasury. The $100 million surtax is not a tax on holding assets worth that amount. [S02]
The income base's add-back for interest on post-enactment obligations and its treatment of foreign income, trusts, and public employers require distributional and treaty analysis. Group aggregation prevents artificial threshold splitting but can also affect businesses that previously structured separate operations for non-tax reasons. Regulations must remain within the stated base, provide notice, and preserve ordinary tax review. Existing Internal Revenue Code definitions are incorporated rather than replaced with an undefined general instruction to tax ability to pay. [S25]
Scientists and clinicians provide evidence review, professional standards, grant evaluation, and clinical advice. Binding governmental authority remains with lawfully appointed and supervised officials. The bill does not give a private professional association final unreviewable power to tax, appropriate, exclude a provider, or deny an entitlement.
Loper Bright Enterprises v. Raimondo requires courts to exercise independent judgment on statutory meaning rather than defer under the former Chevron framework. Accordingly, the bill specifies benefit classes, financing rules, rates, penalties, and key deadlines in enacted text. Agency discretion remains necessary for clinical evidence, procurement, and operating details, but it is bounded by standards, published reasons, and review. [S03]
Public acquisition prices are not a declaration that intellectual property has no value. Section 603 invokes compensated government patent use and preserves the statutory Court of Federal Claims remedy. Existing 28 U.S.C. 1498 supplies a patent compensation mechanism; it does not itself deliver manufacturing know-how, trained staff, or regulatory approval. The bill separately addresses manufacturing, supply agreements, imports, safety review, and limited regulatory reliance. [S06]
An aggressive price ceiling can affect supply, investment incentives, launch decisions, and the return to innovation. The record for a ceiling must therefore address reasonable returns, clinical value, alternative supply, and access consequences. The statute allows documented temporary bridge purchasing rather than using interruption of essential treatment as negotiating pressure. Those safeguards do not prove that every price will be efficient or every manufacturer will remain in the market.
Insurance restrictions operate prospectively with runoff, claims protection, and permitted supplemental markets. Contract termination costs, vested obligations, and protected property cannot simply be labeled savings. Hospital global budgets also require an adequate administrative record, review, and adjustments for mandatory compensation and unforeseen clinical demand. Whether a particular rate, condition, acquisition, or termination creates a constitutional or contractual remedy will remain fact-dependent.
The Act makes an individual benefit enforceable and separates financing disputes from clinical urgency. It prohibits discriminatory denials and relies on individualized evidence rather than a disability label or generalized quality-of-life assumption. Olmstead v. L.C. interprets disability integration requirements in its legal context; it is not itself the bill's proposed unlimited financial entitlement to every home service. The Act expressly creates its more specific community-care obligations and payment rules. [S07]
The reproductive and gender-related care provisions make substantial substantive policy choices and expressly address conflicting restrictions. They present significant preemption, federal-power, statutory-conscience, and religious-exercise litigation questions. Preserving individual conscientious-objection protections while assuring timely alternative care requires operational capacity and precise application. No statement in this report treats the entire field as legally settled or predicts a final judicial result.
Tax information remains separately protected under Internal Revenue Code section 6103. [S26]
Privacy protections preserve stronger applicable confidentiality requirements, distinguish optional research from care, and prohibit automated final adverse clinical determinations. Substance-use records retain applicable additional protections. HHS's Part 2 framework is a relevant coordination source, not a substitute for the Act's independent protections. [S08]
Restitution, benefit payment, administrative correction, professional discipline, punitive civil penalties, and criminal prosecution are distinct mechanisms with different elements and forums. SEC v. Jarkesy addresses jury-trial rights in the enforcement setting before the Court. The bill routes its punitive civil penalties to federal district court and preserves applicable jury rights, rather than relying on an agency label to eliminate them. [S09]
The Act specifies preponderance standards for civil matters and preserves the elements and beyond-reasonable-doubt burden for criminal offenses. Ordinary clinical disagreement is not newly criminalized. Aggregate billing-line multiplication is restricted, good-faith error can be corrected, and public enforcement may consider the need to preserve essential clinical access without excusing proven fraud.
CMS reports $5.3 trillion in United States national health expenditure for 2024, representing 18.0 percent of GDP. That historical all-payer figure is useful only as a scale reference. It is not the projected cost of this Act, not the amount of new federal spending, and not a measure of federal financing currently available for transfer. The bill's scope, prices, compensation, utilization, investment, and eligibility differ from that historical aggregate. [S10]
CBO's single-payer methodology identifies provider payment, administrative expense, use of services, benefits, and capacity as important cost drivers. Its illustrative systems are not a score of this Act. A formal score would need tax microdata, provider cost and wage distributions, service-use assumptions, State participation, residual-program obligations, implementation expenditure, and behavior by employers, clinicians, manufacturers, and patients. [S11]
This report supplies arithmetic scenarios rather than fabricated revenue estimates. The scenarios are not assigned probabilities and are not claims that the legislation saves money. They do not estimate interest costs, macroeconomic feedback, household disposable-income changes, or the difference from a current-law baseline. Those omissions prevent a net-deficit conclusion.
| Account | Annual first-five-year floor | Authority |
|---|---|---|
| Facilities and technology | $200 billion | Section 1201 |
| Education and training | $60 billion | Section 1301 |
| Additional research | $40 billion | Section 1305 |
| Displaced-worker adjustment | $25 billion | Section 1404 |
| Public health and readiness | $30 billion | Section 1501 |
| Tax administration | $5 billion | Section 806 |
| Total | $360 billion | No duplicate counting |
The first-five-year account floors total $360 billion per program year in 2026 dollars. The five-year arithmetic total is $1.8 trillion of minimum funding authority before indexation in nominal budgets. Section 701 also supplies necessary additional amounts for statutory obligations. Floors are not a direction to waste money on unqualified projects and are not necessarily the cash outlays in the year authority is made available. The $150 billion startup appropriation is separate, with additional necessary transition funding expressly allowed.
After the fifth program year, the capital floor is the greater of indexed $100 billion or two percent of the specified prior clinical operating base; the education floor is indexed $40 billion; research remains indexed $40 billion; public health remains indexed $30 billion; tax administration has its specified continuing floor; and earned worker benefits remain payable. Those changes must be incorporated in a formal annual score rather than extrapolating all first-five-year floors indefinitely.
The illustrative first-full-program-year consolidated expenditure assumptions are $5.3 trillion, $6.2 trillion, and $7.2 trillion, all expressed as constant 2026 dollars, with subsequent real annual growth of 0.5 percent, 1.5 percent, and 2.5 percent respectively. The resemblance of the first assumption to the historical CMS dollar figure is solely a scale choice, not an inflation conversion or forecast. Each assumed total already contains operating care, administration, the statutory grant accounts, and other program obligations; those accounts are not added again.
For a window of n full program years, the table computes 0.15 + C1 multiplied by the sum of (1 + g) to the power t, for t from zero through n minus one. Amounts are trillions of constant 2026 dollars. The 0.15 represents one assumed startup outlay equal to the initial startup appropriation; actual startup outlays could occur differently and could exceed that amount. The one-year column includes that startup assumption for comparability rather than representing the first fiscal year after enactment.
| Assumption set | 1 year | 5 years | 10 years | 30 years |
|---|---|---|---|---|
| Scenario A: C1=5.3; g=0.5% | 5.450 | 26.916 | 54.359 | 171.234 |
| Scenario B: C1=6.2; g=1.5% | 6.350 | 32.094 | 66.507 | 232.890 |
| Scenario C: C1=7.2; g=2.5% | 7.350 | 37.996 | 80.814 | 316.249 |
These are aggregate spending sensitivities, not three actuarial models. They do not resolve how utilization, wages, price reductions, capital grants, and shortages interact. A high compensation standard, comprehensive long-term supports, additional utilization after removal of charges, and rapid capacity investment can offset or exceed reductions in billing costs and product prices. Conversely, improved prevention or purchasing may change later spending, but this report does not book uncertain future savings as available cash.
| Effective State share | State S | Solidarity Q | Ordinary federal F | All federal |
|---|---|---|---|---|
| 22% | 1.364 | 0.186 | 4.650 | 4.836 |
| 11% | 0.682 | 0.186 | 5.332 | 5.518 |
| 0% | 0.000 | 0.186 | 6.014 | 6.200 |
Amounts in trillions of constant 2026 dollars; assumed C = 6.2 and Q = 3 percent of C. This illustration excludes separate startup spending.
For the central $6.2 trillion annual expenditure assumption, a full 22-percent State contribution equals $1.364 trillion; a fully funded three-percent solidarity allocation equals $0.186 trillion; and ordinary federal financing equals $4.650 trillion. Aggregate federal financing, including the solidarity allocation, is $4.836 trillion. These are formula outputs, not forecasts of tax collections or State acceptance. Federal-only categories and relief would lower the effective State share further.
Let E be the verified existing federal funding actually transferred, T the new employer and corporate receipts, Q the applied individual receipts, and S the actual State receipts. The remaining general-revenue requirement is C minus S minus Q minus E minus T, with credits and recoveries accounted for once. Neither E nor T is estimated here. This leaves the fiscal gap visible rather than describing the appropriation itself as a source of tax revenue.
An official distributional analysis should show households by income, filing status, age, disability, geography, immigration eligibility, and prior coverage; employers by payroll and discontinued benefit cost; clinicians by specialty and employment form; and States by tax capacity and accepted obligations. A statutory employer tax is not necessarily borne only by business owners over time. Likewise, elimination of a premium does not establish a family's net gain without comparing taxes, prior employer compensation, and benefits. No household- or employer-specific savings claim is made in this report.
| Period | Responsible bodies | Required execution |
|---|---|---|
| Days 0-90 | HHS, Treasury, Labor, OPM, retained federal programs | Assign officials; inventory records and contracts; provisional enrollment; launch worker support; publish payment and tax guidance; activate the prescribed day-90 benefits. |
| Months 3-6 | Authority and clinical partners | Test complete patient and payment pathways; contract fallback capacity; supply continuation medicines; establish appeals and assistance; commence every full benefit on day 180. |
| Months 6-12 | Regional operations, Treasury, inspectors | Stabilize claims; reconcile advances; correct enrollment; certify State allocations; audit data access; award staffed capital projects; report actual access failures and responses. |
| Year 2 | HHS, education bodies, States and Tribes | Expand supervised training and community capacity; complete priority renovation; reduce legacy systems only after safe migration; evaluate workforce compensation pass-through and worker placement. |
| Years 3-5 | Facilities and workforce offices; GAO | Complete phased construction against approved milestones; verify staffing and public-use covenants; review drug supply, outcomes, tax collections, and employer and State responses. |
| Beyond year 5 | Congress, GAO, actuary, accountable agencies | Perform recurrent independent reviews; model 10- and 30-year finance; renew necessary rural operating commitments; propose statutory changes without an automatic benefit sunset. |
The highest immediate risks are inaccurate enrollment matching, disrupted prescriptions, unavailable dentists or specialists, late hospital payroll funding, untested claims conversion, and confusion about which payer remains responsible. The bill's response is provisional coverage and payment, clinical continuity, responsible escalation teams, legacy processing where necessary, independent appeals, and funded alternative capacity. These mechanisms reduce exposure; they do not make a six-month national conversion routine.
Longer-term risks include cost growth above revenue, State nonparticipation, workforce training bottlenecks, hospital projects lacking staff, manufacturer exit, vendor lock-in, and excessive reporting burdens. Controls include published forecasts, operating commitments before capital awards, supervised training expansion, supply diversification, interoperable exports, and a requirement to measure both administrative cost and actual clinical access. HRSA's workforce projections underscore the need to distinguish financing demand from the supply of qualified personnel; the Act's numerical training goals are proposed targets, not verified evidence that all slots can immediately be filled. [S12]
The same fiscal report must separate budget authority, outlays, tax receipts, transfers, loans or advances, reserves, and recoveries. A public dashboard must distinguish an appointment offered from treatment actually delivered, a grant awarded from an operating facility, and an algorithmic fraud flag from a proven recovery. These are accounting and performance safeguards, not grounds to suspend an entitlement.
Patients gain an enforceable public benefit and protection from covered-service bills but must still distinguish covered clinical care from genuinely noncovered services. Their principal implementation risk is a gap between legal entitlement and local capacity. Independent assistance, expedited review, disability accommodation, and alternative care arrangements address that gap without promising access to every preferred clinician at every requested time.
Clinicians and direct-care workers receive proposed compensation floors, funded staffing and education, and reduced payer fragmentation. Providers also face participation conditions, common reporting, public payment review, and limits on patient charging. Independent practices are not promised guaranteed profits, and the public system must fund efficient operating costs rather than assume every payment reduction is administrative waste.
Hospitals and community providers receive prospective operating payments and capital support, with special readiness funding for necessary low-volume capacity. They must document related-party transactions, maintain staffing, comply with public-use commitments, and disclose closure plans. Owners and lenders may face changes in valuation and contractual economics; claims and lawful security interests require individual legal treatment rather than categorical cancellation.
Primary insurers, benefit administrators, collection vendors, and related businesses face contraction of duplicative functions. Permitted supplemental products and ministerial service contracts remain, but no entity has a guarantee of replacement public business. Employees have time-limited income and training protections, claims procedures, and placement support. Earned pension, leave, and severance rights are preserved independently.
Manufacturers and distributors face broader public price negotiation, ceilings, cost disclosure, supply obligations, and possible alternative procurement. The public-interest research and manufacturing accounts coexist with intellectual-property compensation and safety law. Assessment should examine both purchasing savings and possible effects on launches, shortages, and research investment rather than assume only one direction of effect.
States choose whether to accept defined financing and administration duties. Participation creates fiscal commitments, data and service requirements, and specified remedial consent. Nonparticipation transfers administration and replacement financing to the federal government; residents remain covered. Tribal sovereignty, retained veterans' services, military readiness functions, and residual territorial tax arrangements require distinct agreements and cannot be treated as ordinary State administration.
Maryland's all-payer hospital model provides a domestic example of hospital payment reform with population and quality constraints. It does not establish that identical results would occur under a national system with different benefits, wages, taxes, and institutions. The Act uses global operating budgets, separate capital, and readiness support, while creating its own adjustment and patient-access duties. National transferability therefore requires separate modeling and implementation evidence. [S13]
Existing federal disaster and medical-response arrangements identify different roles for clinical response, logistics, and environmental assessment. The Act builds on that division rather than assigning clinical decisions to FEMA or all environmental healthcare decisions to EPA. It creates its own benefits and funding while preserving each agency's independent legal authority. [S14] [S15]
The polluter-recovery provision is a separately enacted proposed cause of action with responsibility, causation, allocation, defenses, and judicial process. It should not be described as proof that existing CERCLA automatically recovers every person's healthcare costs in every exposure event. Existing CERCLA liability is a relevant coordination framework, but the bill's additional remedy must stand on its own text. Treatment proceeds before allocation litigation. [S16]
The data architecture is federated rather than a requirement to copy all clinical content into a single repository. Interoperability and information-blocking rules supply useful implementation context; NIST's AI Risk Management Framework supplies a voluntary risk-governance reference. Neither substitutes for the Act's legally binding consent, access, security, and human-review requirements. [S17] [S18]
Yes. Full covered services begin on day 180. Emergency transport and specified other services begin in the early phase prescribed for day 90. The bill requires interim arrangements while facilities, workforce, and technology programs mature; it does not claim that every new building and clinician can be produced in six months.
Full eligible residents receive the comprehensive package without an income or employment test. Excluded nonresident or immigration categories receive the specified limited protections, with explicit event-related exceptions. A particular treatment still must satisfy the applicable clinical coverage standard. States may fund lawful additions, and separate retained federal rights are preserved.
Title XXXVI supplies explicit rules for marketplace credits, employer assessments, health savings accounts, ERISA, insurance-law interaction, and Medicaid residual obligations. Those proposed rules should be compared to the respective current statutes at introduction, rather than assuming that a broad consolidation clause updates every legal consequence automatically. [S19] [S20] [S21] [S22] [S23] [S27]
Not necessarily. Public, nonprofit, cooperative, and private ownership may continue. The public system finances covered care and imposes conditions on payment and patient charging. Individual clinicians are not compelled to work. Capital acquisition must use consent or a separately lawful process with applicable compensation.
No. The three-percent solidarity allocation is distinct from the progressive tax schedule and from the ordinary federal and State shares. Existing public funding, employer and corporate taxes, individual taxes, accepted State contributions, recoveries, and residual general revenue are separate components. The report does not establish that the specified new taxes fully finance the promised expenditure.
The Act's permanent appropriation funds covered obligations and necessary administration without annual discretionary approval, and its express anti-cut provisions address specified automatic reductions. A future Congress can nevertheless change the law. The statute also does not remove national debt, borrowing, or sovereign-payment constraints.
Workers meeting the displacement and filing requirements may obtain income support, alternative wage insurance, training, childcare and relocation assistance, and priority consideration for qualified openings. The Act does not promise that every former job or salary survives. It protects people through defined benefits rather than requiring retention of functions that the statute eliminates.
No. Expert review informs standards and research, while lawfully appointed officials remain accountable for statutory decisions and expenditure. Evidence, conflicts, reasons for departures, audits, hearings, and judicial review remain part of the system. No expert body receives unreviewable legislative power.
The following authorities were reviewed for the stated limited purposes. Statutory provisions and decisions are primary legal authorities; agency materials describe their own programs or data. Web materials may be updated after preparation. Source identifiers are used throughout the report to separate existing law and evidence from proposed legislative choices. No source is represented as endorsing or scoring this bill.
[S01] National Federation of Independent Business v. Sebelius, 567 U.S. 519 (2012). Spending conditions and Medicaid coercion.
https://www.law.cornell.edu/supremecourt/text/11-393
[S02] Moore v. United States, 602 U.S. 572 (2024). Limited holding on taxation of attributed realized income.
https://www.supremecourt.gov/opinions/23pdf/22-800_jg6o.pdf
[S03] Loper Bright Enterprises v. Raimondo, 603 U.S. 369 (2024). Independent judicial determination of statutory meaning.
https://www.law.cornell.edu/supremecourt/text/22-451
[S04] 42 U.S.C. 1395dd. Emergency medical screening, stabilization, and transfer requirements.
https://www.law.cornell.edu/uscode/text/42/1395dd
[S05] 2 U.S.C. 905. Statutory sequestration exemptions.
https://www.law.cornell.edu/uscode/text/2/905
[S06] 28 U.S.C. 1498. Government patent use and compensation remedy.
https://www.law.cornell.edu/uscode/text/28/1498
[S07] Olmstead v. L.C., 527 U.S. 581 (1999). Disability integration holding and qualifications.
https://www.law.cornell.edu/supct/html/98-536.ZS.html
[S08] HHS, Fact Sheet: 42 CFR Part 2 Final Rule. Substance-use treatment record protections.
[S09] SEC v. Jarkesy, 603 U.S. 109 (2024). Jury rights in the civil-penalty enforcement setting.
https://www.law.cornell.edu/supremecourt/text/22-859
[S10] CMS, National Health Expenditure Data: NHE Fact Sheet. Historical 2024 national expenditure, not a score of the Act.
[S11] CBO, How CBO Analyzes the Costs of Proposals for Single-Payer Health Care Systems That Are Based on Medicare's Fee-for-Service Program, Working Paper 2020-08.
https://www.cbo.gov/publication/56811
[S12] HRSA, Projecting Health Workforce Supply and Demand. Occupation and geographic planning context.
https://bhw.hrsa.gov/data-research/projecting-health-workforce-supply-demand
[S13] CMS Innovation Center, Maryland All-Payer Model. Domestic hospital-payment demonstration.
https://www.cms.gov/priorities/innovation/innovation-models/maryland-all-payer-model
[S14] ASPR, National Disaster Medical System. Federal medical-response organization.
https://aspr.hhs.gov/NDMS/Pages/default.aspx
[S15] EPA, Emergency Response. Environmental-response role and programs.
https://www.epa.gov/emergency-response
[S16] 42 U.S.C. 9607. CERCLA responsible-party liability and statutory conditions.
https://www.law.cornell.edu/uscode/text/42/9607
[S17] HealthIT.gov, Information Blocking. Federal interoperability context.
https://healthit.gov/information-blocking/
[S18] NIST, AI Risk Management Framework. Voluntary risk-management reference.
https://www.nist.gov/itl/ai-risk-management-framework
[S19] 26 U.S.C. 36B. Marketplace premium credit and minimum-essential-coverage coordination.
https://www.law.cornell.edu/uscode/text/26/36B
[S20] 26 U.S.C. 223. Health savings accounts, eligible individuals, and qualified distributions.
https://www.law.cornell.edu/uscode/text/26/223
[S21] 26 U.S.C. 4980H. Employer shared-responsibility assessments.
https://www.law.cornell.edu/uscode/text/26/4980H
[S22] 15 U.S.C. 1012. Federal laws specifically relating to the business of insurance.
https://www.law.cornell.edu/uscode/text/15/1012
[S23] 29 U.S.C. 1144 and 29 U.S.C. 1161. ERISA preemption and continuation-coverage context.
https://www.law.cornell.edu/uscode/text/29/1144
[S24] NIH, Public Access. Current policy materials on access to funded research publications.
https://grants.nih.gov/policy-and-compliance/policy-topics/public-access
[S25] 26 U.S.C. 62, 52, and 414. Adjusted gross income and tax aggregation provisions.
https://www.law.cornell.edu/uscode/text/26/62
[S26] 26 U.S.C. 6103. Tax-return confidentiality and authorized disclosures.
https://www.law.cornell.edu/uscode/text/26/6103
[S27] 42 U.S.C. 1396d. Medicaid services, EPSDT, and institutional-payment exclusions.
https://www.law.cornell.edu/uscode/text/42/1396d
Consistency: The expanded text preserves AHS as the system, AHP as the coverage program, and the Fund as the financing account. The 36 titles and 314 numbered sections have unique identifiers. Supplemental titles expressly operate with the core entitlement and financing provisions; the table of contents and internal section targets are checked against the assembled text. External statutory references are distinguished from internal section numbers.
Authority: The draft specifies federal payment and tax powers, voluntary cooperative arrangements, agency roles, judicial forums, and limited special-program coordination. It does not assume that States, private associations, or contractors can exercise federal power without lawful authorization. Precise introduction-stage integration with all affected federal and State laws remains necessary.
Constitutional risk: Material issues remain concerning State conditions and remedies, price applications, insurance restrictions, income-base choices, reproductive and gender-related preemption, conscience rights, privacy, and individual applications of remedies. Protective drafting is not a prediction that courts will uphold every provision. The source review is not a comprehensive legal citator certificate.
Enforceability: Duties identify administrators, timing, payment routes, notice, appeals, evidentiary rules, correction, and relief. There are express remedies for wrongful benefit withholding, unlawful patient billing, specified privacy violations, compensation underpayment, and retaliation. Courts are not authorized to conscript individual clinicians or disregard statutory limits on jurisdiction.
Fiscal assumptions: Tax rates and grant floors are specified; actual revenue, net federal cost, borrowing, distribution, and behavioral responses are not scored. The 1-, 5-, 10-, and 30-year calculations are transparent stress arithmetic. Transfers, savings, reserves, appropriations, and receipts are not double-counted as interchangeable resources.
Implementation risk: Six-month legal commencement remains highly demanding. Legacy processing, provisional payment, clinical continuity, readiness tests, operating advances, alternative providers, and dedicated workforce support are explicit, but their adequacy depends on execution and real capacity. Longer-term construction and professional training cannot be accomplished by legal declaration alone.
Open questions before introduction: Obtain an integrated CBO/JCT and actuarial score; validate wages and rates against provider costs; obtain State participation and fiscal-capacity scenarios; test clinical and payment systems; evaluate supply responses; perform a comprehensive constitutional and statutory review; and complete bill-format and codification review against the law in force at introduction. These tasks refine a complete model bill rather than serving as blank provisions in its text.
