United States · United States Congress · 17 March 1994
National Law Enforcement Officers Memorial Coin Act - Directs the Secretary of the Treasury to issue gold and silver coins emblematic of the National Law Enforcement Officers Memorial. Establishes the National Law Enforcement Officers Memorial Maintenance Fund to be administered by the Secretary of the Interior for Memorial-related purposes and to provide educational scholarships to the immediate family members of law enforcement officers killed in the line of duty whose names appear on the Memorial.
United States · United States Congress · 16 March 1994
Deficit Reduction Lock Box Act of 1994 - Establishes the Deficit Reduction Trust Fund consisting of amounts contained in deficit reduction lock box provisions of appropriations Acts. Reduces discretionary spending limits by amounts transferred to the Fund. Amends the Congressional Budget Act of 1974 to require that amounts resulting from reduced spending under general appropriations bills be placed in the Fund. Requires the Congressional Budget Office to score all general appropriations measures as passed by the House and Senate and to publish such scorecard in the Congressional Record.
United States · United States Congress · 11 March 1994
TABLE OF CONTENTS: Title I: Veterans Health Administration Staffing Levels Title II: Pilot Programs Title III: Health Care Resource Agreements Veterans Health Programs Improvement Act of 1994 - Title I: Veterans Health Administration Staffing Levels - Prohibits any reduction, during the five-year period beginning October 1, 1994, in the number of full-time equivalent employees in the Veterans Health Administration (VHA) of the Department of Veterans Affairs other than as specifically required by law or by the availability of funds. States that during such period no law imposing hiring restrictions on executive agencies to achieve workforce reductions shall apply to the VHA. Directs the Secretary of Veterans Affairs to report to the veterans' committees on VHA streamlining activities. Title II: Pilot Programs - Veterans Health-Care Pilot Program Act of 1994 - Authorizes the Secretary to establish and operate a pilot program in up to five States which have established a health care reform plan. Authorizes the Secretary to: (1) provide health-care services to veterans and their dependents on the same or a similar basis as the State reform plan; (2) comply with State law in establishing and operating a veterans' health plan in such State; (3) conduct the pilot program in some or all Department health-care facilities in the State; and (4) establish appropriate catchment areas in the State for enrollment in the pilot programs. Outlines conditions for participation in the pilot programs, including a finding that the workload in one or more Department health care facilities in a State would otherwise decline to a level which would impair the ability to meet assigned missions. Allows a pilot program to be implemented only after the plan has been submitted to the Congress and 30 days have elapsed. Exempts certain high-priority veterans (e.g., those with severe disabilities) from the payment of premiums or copayments in connection with care received under a pilot program. Establishes in the Treasury a revolving fund for conducting the pilot programs. Authorizes appropriations to the fund for FY 1995 through 2000. Provides for: (1) authorized transfers from other accounts to such fund; (2) authorized fund receipts and disbursements; and (3) transfer to the Treasury of excess funds. Requires annual reports. Terminates the pilot programs on September 30, 2000. Title III: Health Care Resource Agreements - Authorizes the director of a Department health care facility serving veterans who reside in a State with a State health reform plan to enter into agreements with health plans and other health care providers to furnish or obtain any health care resource. Requires to provide for reimbursement to the Department based on a methodology that provides appropriate flexibility to establish an appropriate reimbursement rate.
United States · United States Congress · 2 March 1994
Ethics in Billing Act - Amends the Public Health Service Act to make it unlawful for any person to present a bill, claim, or demand for payment to any person other than the patient receiving services. Makes it unlawful for any physician to present a bill for ancillary health services to any recipient of such services unless the services were furnished personally by: (1) the referring physician; (2) a physician who is a member of the same group practice as the referring physician; or (3) individuals employed by such physician or group practice who are supervised by such physician or another physician in the group practice. Makes such prohibitions inapplicable with respect to ancillary health services for which payment may be made under title XVIII (Medicare) of the Social Security Act. Provides exceptions to such prohibitions, including demands for payments made to immediate family members or designated payors of the patient, a health maintenance organization in which a recipient is enrolled, and other exceptions. Provides sanctions against those collecting payment in violation of this Act. Allows the Secretary of Health and Human Services to suspend, revoke, or limit a laboratory certification as part of such sanctions. Defines "ancillary health services" as clinical laboratory services, diagnostic x-rays and other diagnostic imaging services and tests, durable medical equipment, and physical therapy services.
United States · United States Congress · 1 March 1994
TABLE OF CONTENTS: Title I: Handgun Licensing and Registration Title II: Restrictions on Firearm Possession Title III: Restrictions on Gun Sellers Title IV: Prohibited Weapons Title V: Gun Exchange Tax Incentives Gun Violence Prevention Act of 1994 - Title I: Handgun Licensing and Registration - Amends the Federal criminal code to prohibit the sale, delivery, or other transfer of a handgun to an individual not licensed to import, manufacture, or deal in firearms or ammunition, unless: (1) the transferor has verified that the transferee possess a valid State handgun license by examining the license and a valid photograph identification and by contacting the chief law enforcement officer of the State that issued the license; (2) the transferor has provided to the chief officer of the State in which the transfer is to take place a State handgun registration form; and (3) seven days have elapsed since the transferor contacted the chief officer of the State that issued the license or the transferee has presented to the transferor a written statement issued within the previous ten days by the chief officer of the State in which the transferee resides stating that the transferee requires access to a handgun because of a threat to the life of the transferee or any member of the transferee's household. Prohibits: (1) the transfer of handgun ammunition to an individual who is not a licensed dealer unless the transferor has verified that the transferee possesses a valid State handgun license by examining the license and a valid photograph identification; and (2) any such individual from receiving transfer of a handguns or handgun ammunition unless the individual possesses a valid State handgun license. Sets forth requirements regarding: (1) State handgun licenses; (2) State handgun registration forms; and (3) State handgun safety certificates (issued after the applicant has completed a course and passed an examination in handgun safety). Sets penalties for violations. Directs the Attorney General, subject to the availability of appropriations, to make a grant to each State for the initial startup costs associated with establishing a system of licensing and registration. Authorizes appropriations. Title II: Restrictions on Firearm Possession - Prohibits: (1) the transfer of a firearm to, or possession of a firearm by, a person convicted of a violent crime or subject to a protection order; and (2) the transfer of a handgun (or handgun ammunition) to an individual under age 21 or of a firearm other than a handgun (or ammunition) to an individual under age 16, and the possession of such weapon (or ammunition) by such individuals, respectively, with exceptions. Sets penalties for violations. (Sec. 203) Prohibits the storage or leaving of a loaded firearm, or an unloaded firearm and ammunition, at any place to which a juvenile is likely to gain access at a time when the juvenile is not under the personal supervision of an adult who is not prohibited by Federal, State, or local law from possessing the firearm. Requires each licensed dealer to post conspicuously at each of the dealer's places of business a warning that it is a Federal crime to store or leave a loaded firearm, or an unloaded firearm and its ammunition, where an unsupervised juvenile can gain access. Sets penalties for violations. (Sec. 204) Prohibits a person from possessing more than 20 firearms or more than 1,000 rounds of ammunition unless the person is a licensed dealer or has been issued an arsenal license. Direct the Secretary of the Treasury to issue such a license if specified conditions are met, including the payment of a $300 fee for a three-year license period. Subjects the holder of such a license to all requirements pertaining to licensed dealers. Sets penalties for violations. (Sec. 205) Repeals provisions authorizing persons prohibited from possessing, shipping, transporting, or receiving firearms or ammunition to apply to the Secretary for restoration of firearm privileges under certain circumstances. Specifies that a conviction shall not be considered a conviction for purposes of Federal firearms provisions if: (1) it has been expunged or set aside or a named person has been pardoned or has had civil rights restored; and (2) the authority that grants such action expressly authorizes the person to ship, transport, receive and possess firearms and expressly determines that the person is not likely to act in a manner that is dangerous to public safety and that the granting of the relief is not contrary to the public interest. Makes this provision inapplicable to a conviction of a serious drug offense or violent felony. Title III: Restrictions on Gun Sellers - Prohibits (with exceptions): (1) transferring or receiving a transfer of more than one handgun during any 30-day period; or (2) transferring a handgun to another person who has received transfer of another handgun during the previous 30-day period. Sets penalties for violations. (Sec. 302) Makes compliance with State and local law a condition of licensure as a dealer. (Sec. 303) Increases: (1) license application fees; and (2) the length of time before which the Secretary must approve or deny an application. (Sec. 305) Authorizes the Secretary, for ensuring compliance with recordkeeping requirements, to inspect a firearms licensee's inventory and records three times during any 12-month period or at any time with respect to records relating to a firearm involved in a criminal investigation (currently, once during any 12-month period). (Sec. 306) Requires an applicant, for approval as a licensed dealer, to certify that the business is covered by an insurance policy providing personal injury protection to any person injured while engaged in lawful activity by a handgun obtained through the negligence of the applicant, to a limit of $100,000 for loss sustained by any such person as a result of bodily injury or death. (Sec, 307) Establishes licensing and recordkeeping requirements for ammunition dealers. (Sec. 308) Prohibits a licensed dealer from employing any person in a position in which the person would have unsupervised access to firearms or ammunition, unless: (1) in the case of access to handguns or handgun ammunition, the person has a valid State handgun license; and (2) in the case of access to firearms other than handguns or ammunition other than handgun ammunition, the person is at least age 18, the licensee has contacted the national system designated by the Attorney General pursuant to the Brady Handgun Violence Prevention Act and the system has notified the licensee that the possession of a firearm by the person would not violate Federal, State, or local law, and the licensee has verified the identity of the person by examining a valid photograph identification. Sets penalties for violations. (Sec. 309) Prohibits a licensed dealer from selling, delivering, or otherwise transferring a firearm from any motorized or towed vehicle or at a location other than that specified on the license. (Sec. 310) Requires each licensee to: (1) respond immediately to a request by the Secretary for information contained in required records relevant to a criminal investigation; and (2) report the theft or loss of a firearm from inventory within 24 hours after discovery to the Secretary, the chief officer, and appropriate local authorities. (Sec. 312) Expands the definition of a "firearm" to include its component parts. (Sec. 313) Prohibits any common or contract carrier from delivering in interstate or foreign commerce a firearm or ammunition without examining the Federal firearms or ammunition license of the recipient and obtaining written acknowledgement of receipt. (Sec. 314) Makes any person who transfers any firearm or ammunition in violation of Federal law liable for all damages proximately caused by such transfer. Permits an action to be brought in a U.S. district court by, or on behalf of, any person who suffers bodily injury or death as a result of the discharge of a firearm or ammunition transferred in violation of Federal law, with exceptions. Sets forth provisions regarding the award of costs and punitive damages. Title IV: Prohibited Weapons - Prohibits the manufacture, transfer, or possession of "prohibited weapons," defined as firearm mufflers or silencers, short-barreled shotguns and rifles, destructive devices, semiautomatic assault weapons, Saturday-night-special handguns, nonsporting ammunition, and large-capacity ammunition feeding devices. Defines "semiautomatic assault weapon," "Saturday-night-special handgun," and "large-capacity ammunition feeding device." Categorizes various brands of weapons. Amends the Internal Revenue Code to include a prohibited weapon within the definition of "firearm." Requires the serial number of any prohibited weapon manufactured after the date of enactment to clearly show the date on which the weapon was manufactured. Sets penalties for violations. Subjects persons using or possessing a semiautomatic assault weapon during a crime of violence or drug trafficking crime to the same enhanced penalty as for such use or possession of a short-barreled shotgun. (Sec. 402) Prohibits (with exceptions) the manufacture or import of a firearm that does not incorporate a device that: (1) prevents a child of less than age seven from discharging the firearm; (2) prevents a firearm that has a removable magazine from discharging when the magazine has been removed; and (3) in the case of a handgun other than a revolver, clearly indicates whether the magazine or chamber contains a round of ammunition. Sets penalties for violations. (Sec. 403) Increases the tax on handguns and handguns ammunition. Establishes in the Treasury a Health Care Trust Fund and appropriates to it amounts equivalent to such taxes. Makes Trust Fund sums available only for grants to assist hospitals, trauma centers, or other health care providers that have incurred substantial uncompensated costs in providing medical care to gunshot victims, subject to specified limitations. Makes such a provider eligible to apply for such a grant for any calendar year if it is in compliance with Federal and State certification and licensing requirements, is a non-profit entity, and has incurred substantial uncompensated costs during the previous calendar year in providing medical care to gunshot victims. Title V: Gun Exchange Tax Incentives - Establishes special tax rules for gun exchange programs contributions. (Sec. 502) Directs the Attorney General to: (1) develop a written model program for business-sponsored gun exchange programs; and (2) make such model available to States, local governments, and businesses.
United States · United States Congress · 1 March 1994
Expresses the sense of the House of Representatives that there should be financial incentives for employers to offer worksite health promotion programs.
United States · United States Congress · 24 February 1994
Amends title XIX (Medicaid) of the Social Security Act to make technical corrections to provisions added by the Omnibus Budget Reconciliation Act of 1990 in order to allow children and pregnant women to receive Medicaid services from osteopathic physicians.
United States · United States Congress · 24 February 1994
Opal Creek Forest Preserve Act of 1994 - Establishes the Opal Creek Forest Preserve in Oregon. Provides for the addition to the Preserve of the Bornite Project Area lands under specified circumstances.
United States · United States Congress · 24 February 1994
Directs the Secretary of Health and Human Services to establish a demonstration project under which: (1) physicians providing services for which payment may be made under Medicare part B (Supplementary Medical Insurance) may, upon request and the patient's consent, periodically receive certain information on a particular patient's utilization of other Medicare providers; and (2) such physicians receive orientation and training on the use of such information to effectively manage patient care.
United States · United States Congress · 23 February 1994
Fire Safe Cigarette Act of 1994 - Directs the Consumer Product Safety Commission to issue by rule a fire safety standard for cigarettes. Prohibits stockpiling of cigarettes between the issuing and effective dates of the standard. Provides for judicial review of the standard. Prohibits manufacture or importing of cigarettes unless in compliance with such standard. States that this Act and the standard issued under it does not preempt any law of a State which prescribes a more stringent fire safety standard for cigarettes.
United States · United States Congress · 23 February 1994
Federal Research Informed Consent Act - Amends the Public Health Service Act to direct the Secretary of Health and Human Services to establish the requirement that, in federally qualified research in which any human subject is to be used, the principal researcher obtain the informed consent of the subject. Allows the Secretary to exempt categories of research from such consent requirement. Requires congressional notification of such exemptions and a 60-day waiting period before the exemption is effective. Directs the Secretary to establish requirements for obtaining informed consent. Provides for civil actions by those from whom no such consent was obtained, allowing damages, equitable relief, and attorney's fees and costs. Preempts any State law concerning the obtaining of such consent.
United States · United States Congress · 23 February 1994
1995 Special Olympics World Games Commemorative Coin Act - Directs the Secretary of the Treasury to issue one-dollar silver coins emblematic of the 1995 Special Olympics World Games. Mandates that the surcharges collected from the sale of such coins be paid to the 1995 Special Olympics World Games Organizing Committee, Inc.
United States · United States Congress · 11 February 1994
Amends the Interstate Commerce Act to direct the Interstate Commerce Commission (ICC) to require a fair and equitable arrangement for protection of the interests of railroad employees who may be affected by an ICC order approving an application for construction or acquisition and operation of a railroad line. Requires such arrangement to be no less fair and beneficial to the interests of such employees than those established under specified provisions for employee protective arrangements in transactions involving rail carriers.
United States · United States Congress · 9 February 1994
United States Passenger Vessel Development Act - Amends Federal shipping law to authorize endorsement of a certificate of documentation for an eligible passenger vessel with an interim coastwise passenger trade endorsement if it is: (1) owned by, or demise chartered for at least 18 months to, a U.S. citizen; (2) at least 250 gross tons, with at least 175 berths; and (3) not a ferry. Conditions issuance of such an endorsement on the vessel owner's or charterer's entering into one or more contracts for the construction in the United States of one or more vessels having a total berthing capacity at least 80 percent of the capacity of the vessel for which the endorsement is issued. Conditions renewal of such endorsements on specified progress in vessel construction. Requires an interim coastwise passenger trade endorsement to prohibit the operation of the vessel in any trade served by another documented passenger vessel of at least 250 gross tons and having at least 175 berths, unless the owner or operator of the vessel so operated is also the owner or operator of the other vessel having the endorsement. Amends the Shipping Act, 1916 to authorize a person to place under a foreign registry or operate under the authority of a foreign country, without the Secretary of Transportation's approval, any vessel with an interim coastwise passenger trade endorsement if such person notifies the Secretary within certain deadlines. Amends Federal shipping law to require the Secretary to issue the appropriate inspection, load line, and tonnage certificates to any documented vessel with an interim coastwise passenger trade endorsement that meets the standards for passenger vessel construction for safety of life at sea (SOLAS) issued under the International Maritime Organization convention to which the United States is a party. Amends the Shipping Act, 1916 to define U.S. citizenship of a corporation for purposes of documentation with an interim coastwise passenger trade endorsement as the vesting of at least 51 percent of the corporation's stock in U.S. citizens free from any trust or fiduciary obligation in favor of any non-citizen. Prohibits the Secretary of Commerce from permitting a person to operate a vessel in any unit of the National Park System except in accordance with a specified priority giving first place to U.S.-documented vessels. Requires the Secretary to revoke permission for operation of a foreign-documented vessel if: (1) a person requests permission to operate a U.S.-documented vessel; and (2) the permission may not be granted because the number of permits that may be issued is limited.
United States · United States Congress · 9 February 1994
United States Passenger Vessel Development Tax Act - Amends the Merchant Marine Act, 1936 to include U.S. documented passenger vessels in all domestic trades in the capital construction fund (CCF) program in order to encourage investment in the replacement of such vessels with U.S. constructed and documented vessels. Makes a passenger vessel with an interim coastwise passenger trade endorsement eligible for the CCF program. Sets forth a formula for the calculation of tax on earnings, including capital gains, derived from investments made with amounts from passenger vessel funds. Sets forth provisions regarding: (1) the tax treatment of qualified withdrawals from such funds for certain passenger vessel lease payments; (2) computation of interest with respect to nonqualified withdrawals from the fund; (3) inclusion of passenger vessel design and engineering costs as a permissible qualified withdrawal from the fund; (4) inclusion of income-producing assets, including accounts receivable, as permissible investments for such funds; and (5) tax treatment on interim certificate vessel deposits in and withdrawals from the fund which are not committed to new vessel construction. (Sec. 4) Amends the Internal Revenue Code to set forth similar provisions. (Sec. 5) Provides a three-year recovery period for the depreciation deduction on eligible passenger vessels. (Sec. 6) Modifies requirements governing the deductibility of expenses related to an individual's attendance at conventions, seminars, or other meetings held on cruise ships as a business expense. Requires only the home port of such a ship (currently all ports) to be in the United States or a U.S. possession. Repeals the $2,000 limitation on the deductibility of such expenses. Reduces the number of reporting requirements for such deduction. Provides that for deduction purposes, certain interim documentation of a vessel shall be treated as registration in the United States. (Sec. 7) Permits an employer to take a tax credit of ten percent of a travel reward (up to $200) paid to an employee for travel on domestic cruise ships. Limits the deductible travel expenses incurred by a taxpayer for foreign cruise ship transportation to 90 percent of the otherwise allowable expenses.
United States · United States Congress · 8 February 1994
World War II Peace Accords Commemorative Coin Act - Expresses the sense of the Congress that: (1) the 50th anniversary of the signing of the World War II peace accords on the U.S.S. Missouri should not go unrecognized at the national level; and (2) the United States should recognize such anniversary by minting and issuing a commemorative coin. Sets forth specifications for half dollar clad coins. Mandates that the surcharges received from the sale of such coins be paid by the Secretary of the Treasury to the Admiral Nimitz Foundation for the purpose of preserving the Pacific War heritage of the United States.
United States · United States Congress · 2 February 1994
Federal Energy Research Priorities Act - Establishes the Department of Energy Facilities Closure and Reconfiguration Commission. Directs the Secretary of Energy to publish in the Federal Register and transmit to the congressional energy committees (the committees) the criteria proposed to be used in making recommendations for the closure or reconfiguration of Department of Energy (DOE) facilities resulting in a 25 percent budget reduction for such facilities. Requires the Commission to report to the President and the committees on its analysis and review of the Secretary's recommendations. Directs: (1) the Comptroller General to transmit to the committees amd the Commission a detailed analysis of the Secretary's recommendations; and (2) the President to transmit to the committees his approval or disapproval of them. Sets forth procedural guidelines for the closure and reconfiguration of DOE facilities. Establishes the Department of Energy Facility Closure Account to receive the proceeds resulting from the closures and reconfiguration under this Act. Requires the Secretary to submit a status report to the committees concerning: (1) the Account; and (2) implementation of the closure and reconfiguration actions. Prescribes guidelines for congressional consideration and disapproval of the Commission's report. (Provides for implementation of the recommendations if the Congress does not disapprove.)
United States · United States Congress · 2 February 1994
Expresses the sense of the House of Representatives that: (1) the people of the United States deserve a full accounting of the radiation experiments conducted by the Government; (2) the Secretary of Energy should be commended for quickly responding to the disclosures that such experiments had been conducted on individuals without their consent by promising to locate and release all relevant records and the President should be commended for establishing a Human Radiation Interagency Working group and an independent Advisory Committee on Human Radiation Experiments; (3) all Federal departments and agencies should act expeditiously to locate, retrieve, and inventory all records and documents related to the experiments which should be made available to the subjects and their families; (4) the subjects who are still alive should receive appropriate followup medical care; (5) the President should consider whether compensation should be provided to such individuals or their survivors; and (6) an apology should be made by the Government to the individuals and their families.
United States · United States Congress · 26 January 1994
Safe Shipment and Handling Act of 1994 - Authorizes any port authority to: (1) establish, through a public comment process, reasonable guidelines to ensure that the unloading, transfer, and shipment of spent nuclear fuel at or through a port under its jurisdiction is conducted in a manner that protects the public health and safety and the environment in the port's vicinity; and (2) prohibit any such unloading, transfer, or shipment not in compliance with such guidelines. Specifies certain contents of such guidelines. States that nothing in this Act shall affect the liability or indemnification of the port in the handling of nuclear materials.
United States · United States Congress · 25 January 1994
Expresses the sense of the Congress that a postage stamp should be issued to honor the 100th anniversary of the Jewish War Veterans of the United States and that the Citizens' Stamp Advisory Committee of the U.S. Postal Service should make such recommendation to the Postmaster General.
United States · United States Congress · 22 November 1993
Amends the Fair Labor Standards Act of 1938 to exempt from coverage under such Act inmates of penal or other correctional institutions who participate in correctional work programs.
United States · United States Congress · 22 November 1993
Commercial Mortgage Capital Availability Act of 1993 - Sets forth a regulatory scheme under which qualified insured depository institutions meeting prescribed reserve and capital requirements may execute mortgage loan transfers with a recourse arrangement. Amends the Securities Exchange Act of 1934 to modify the definition of "mortgage related security" to include notes directly secured by a first lien on real estate with commercial structures located upon it (thus bringing such securities within the purview of the Act). Directs the Secretary of Labor to exempt commercial mortgage related securities transactions from: (1) certain restrictions of the Employee Retirement Income Security Act of 1974; and (2) certain taxes imposed under the Internal Revenue Code. Mandates that securities relying on the provisions of this Act comply with all Federal securities laws relating to disclosure to investors, registrations, reporting and anti-fraud provisions. Requires insured depository institutions to maintain the minimum adequate capital prescribed by regulatory banking agencies when executing mortgage backed securities transactions.
United States · United States Congress · 22 November 1993
President Harry S Truman Congressional Gold Medal Act - Authorizes the President, on behalf of the Congress, to present a gold medal to Margaret Truman Daniel in recognition of the accomplishments of President Harry S Truman on the 50th anniversary of his first inauguration. Authorizes appropriations. Authorizes the Secretary of the Treasury to provide for the sale of bronze duplicates of the medal.
United States · United States Congress · 22 November 1993
Amends the Export Administration Act of 1979 to grant the Secretary of Commerce exclusive authority to control exports of all computer hardware, software, and technology for information security (including encryption), except any specifically designed or modified for military use. Exempts specified items from license requirements. Instructs the Secretary to authorize the export or reexport under specified circumstances of software with encryption capabilities for nonmilitary end-uses.
United States · United States Congress · 22 November 1993
Postal Service Fiscal Responsibility Act of 1993 - Rescinds a specified amount of the funds made available for the U.S. Postal Service in the Treasury, Postal Service, and General Government Appropriations Act, 1994 on January 1, 1994, unless, before such date, the Postmaster General notifies the Congress that the Postal Service will not proceed with the adoption and implementation of a new corporate logo.
United States · United States Congress · 22 November 1993
Expresses the sense of the Congress that the national policy of the United States should be to: (1) increase energy efficiency, as specified; (2) increase renewable energy technologies to 20 percent of the overall national energy mix by 2010; and (3) achieve these goals by adopting a specified national strategy.
United States · United States Congress · 20 November 1993
TABLE OF CONTENTS: Title I: Health Care Security Subtitle A: Universal Coverage and Individual Responsibility Subtitle B: Benefits Subtitle C: State Responsibilities Subtitle D: Health Alliances Subtitle E: Health Plans Subtitle F: Federal Responsibilities Subtitle G: Employer Responsibilities Subtitle J (sic): General Definitions; Miscellaneous Provisions Title II: New Benefits Subtitle A: Medicare Outpatient Prescription Drug Benefit Subtitle B: Long-Term Care Title III: Public Health Initiatives Subtitle A: Workforce Priorities Under Federal Payments Subtitle B: Academic Health Centers Subtitle C: Health Research Initiatives Subtitle D: Core Functions of Public Health Programs; National Initiatives Regarding Preventive Health Subtitle E: Health Services for Medically Underserved Populations Subtitle F: Mental Health; Substance Abuse Subtitle G: Comprehensive School Health Education; School-Related Health Services Subtitle H: Public Health Service Initiative Subtitle I: Coordination With COBRA Continuation Coverage Title IV: Medicare and Medicaid Subtitle A: Medicare and the Alliance System Subtitle B: Savings in Medicare Program Subtitle C: Medicaid Subtitle D: Increase in SSI Personal Needs Allowance Title V: Quality and Consumer Protection Subtitle A: Quality Management and Improvement Subtitle B: Information Systems, Privacy, and Administrative Simplification Subtitle C: Remedies and Enforcement Subtitle D: Medical Malpractice Subtitle E: Fraud and Abuse Subtitle F: McCarran-Ferguson Reform Title VI: Premium Caps; Premium-Based Financing; and Plan Payments Subtitle A: Premium Caps Subtitle B: Premium-Related Financing Subtitle C: Payments to Regional Alliance Health Plans Title VII: Revenue Provisions Subtitle A: Financing Provisions Subtitle B: Tax Treatment of Employer-Provided Health Care Subtitle C: Employment Status Provisions Subtitle D: Tax Treatment of Funding of Retiree Health Benefits Subtitle E: Coordination with COBRA Continuing Care Provisions Subtitle F: Tax Treatment of Organizations Providing Health Care Services and Related Organizations Subtitle G: Tax Treatment of Long-term Care Insurance and Services Subtitle H: Tax Incentives for Health Services Providers Subtitle I: Miscellaneous Provisions Title VIII: Health and Health-Related Programs of the Federal Government Subtitle A: Military Health Care Reform Subtitle B: Department of Veterans Affairs Subtitle C: Federal Employees Health Benefits Program Subtitle D: Indian Health Service Subtitle E: Amendments to the Employee Retirement Income Security Act of 1974 Subtitle F: Special Fund for WIC Program Title IX: Aggregate Government Payments to Regional Alliances Subtitle A: Aggregate State Payments Subtitle B: Aggregate Federal Alliance Payments Subtitle C: Borrowing Authority to Cover Cash-Flow Shortfalls Title X: Coordination of Medical Portion of Workers Compensation and Automobile Insurance Subtitle A: Workers Compensation Insurance Subtitle B: Automobile Insurance Subtitle C: Commission on Integration of Health Benefits Subtitle D: Federal Employees' Compensation Act Subtitle E: Davis-Bacon Act and Service Contract Act Subtitle F: Effective Dates Title XI: Transitional Insurance Reform Health Security Act - Title I: Health Care Security - Subtitle A: Universal Courage and Individual Responsibility - Entitles each eligible individual to: (1) the benefit provided under subtitle B through the applicable health plan in which the individual is enrolled; and (2) a health security card to be issued by the alliance or other entity that offers the applicable health plan in which the individual is enrolled. Defines an eligible individual as an individual who resides in the United States and is: (1) a citizen or national of the United States; (2) an alien permanently residing in the U.S. under color of law; or (3) a long-term nonimmigrant. Entitles a Medicare-eligible individual to benefits under Medicare instead of the above provisions of this Act. (Sec. 1002) Requires each eligible individual to enroll in an applicable health plan and pay any required premium. Prohibits disenrollment of an eligible individual until the individual is either enrolled in another plan or in Medicare. (Sec. 1003) States that nothing in this Act shall be construed as prohibiting: (1) an individual from purchasing any health services; (2) an individual from purchasing supplemental insurance; (3) an individual who is not an eligible individual from purchasing health insurance; or (4) employers from providing additional coverage. (Sec. 1004) States that a regional alliance health plan is the applicable plan for a family, unless a family member is eligible for a corporate alliance health plan. Allows military personnel, veterans, and Indians to enroll either with an alliance or with a military, veteran, or Indian plan respectively. (Sec. 1005) Prohibits an undocumented alien from enrolling in a health plan under this Act. (Sec. 1011) Defines a family as an eligible individual's eligible spouse and children. Defines couple as meaning an individual and the individual's spouse. Defines a child as being under age 18, or under age 24 in the case of a full-time student. Subtitle B: Benefits - Includes the following terms and services in the comprehensive benefit package: (1) hospital services; (2) services of health professionals; (3) emergency and ambulatory medical and surgical services; (4) clinical preventive services; (5) mental illness and substance abuse services; (6) family planning services and services for pregnant women; (7) hospice care; (8) home health care; (9) extended care services; (10) ambulance services; (11) outpatient laboratory, radiology, and diagnostic services; (12) outpatient prescription drugs and biologicals; (13) outpatient rehabilitation services; (14) durable medical equipment and prosthetic and orthotic devices; (15) vision care; (16) dental care; (17) health education classes; and (18) investigational treatments. Describes such items and services. (Sec. 1131) Requires each health plan to offer to its enrollees only one of the following cost sharing schedules: (1) lower cost sharing; (2) higher cost sharing; or (3) combination cost sharing. Provides that the annual maximum out-of-pocket expenses for an individual in any of the plans shall be $1500 and for a family the annual maximum shall be $3000. (Sec. 1135) Sets forth a table of copayments and coinsurance. (Sec. 1141) Excludes the following items and services: (1) an item or service that is not medically necessary or appropriate; (2) an item or service that the National Health Board may determine is not medically necessary or appropriate; (3) custodial care, except hospice care; (4) surgery performed solely for cosmetic purposes, unless required to correct a congenital anomaly or performed to correct a part of the body injured by either disease or accident; (5) hearing aids; (6) eyeglasses and contact lenses for individuals at least 18 years of age; (7) in vitro fertilization; (8) sex change surgery and related services; (9) private duty nursing; (10) personal comfort items, except in the case of hospice care; and (11) any dental procedures involving orthodontic care, inlays, gold or platinum fillings, bridges, crowns, pin/post retention, dental implants, surgical periodontal procedures, or the preparation of the mouth for the fitting or continued use of dentures, except as specified. (Sec. 1151) Gives the National Health Board the authority to promulgate such regulations or establish such guidelines as necessary to assure uniformity in the application of the comprehensive benefit package across all health plans. Permits the Board to expand the benefit package. (Sec. 1162) Permits a health professional or facility to refuse to provide a benefit if the professional or facility objects on the basis of a religious belief or moral conviction. Subtitle C: State Responsibilities - Requires a State, in order to be approved as a participating State, to submit a document describing the State's health care system. (Sec. 1201) Requires a participating State to: (1) establish one or more regional alliances; (2) establish and publish the criteria used in the certification of its health plan; (3) meet minimum financial solvency requirements for health plans established by the National Health Board; (4) designate an agency or official to coordinate State responsibilities under this Act; (5) conform State laws to meet the requirements of title X of this Act with respect to workers' compensation and automobile insurance; and (6) carry out all the responsibilities of a participating State specified in this Act. (Sec. 1221) Permits a State, with the Board's approval, to operate a single-payer system if specified requirements are met. Subtitle D: Health Alliances - Provides for regional alliances and corporate alliances. (Sec. 1302) Requires a regional alliance to be governed by a Board of Directors consisting of: (1) employers, including self-employed individuals; and (2) members who represent individuals purchasing coverage. Requires each regional alliance to establish a provider advisory board consisting of health care providers and professionals. (Sec. 1311) Includes in a corporate alliance an eligible sponsor who is either a large employer (more than 5,000 full-time employees) or a multiemployer plan (a plan with more than 5000 active participants). Excludes: (1) an employer whose primary business is employee leasing; (2) the Federal Government (other than the U.S. Postal Service); and (3) a State or local government. Excludes from corporate alliance eligibility the following classes of individuals: (1) AFDC recipients; (2) SSI recipients; (3) military personnel and families, veterans, and Indians who elect to enroll in specified plans specifically designed for them; and (4) seasonal or temporary employees. (Sec. 1321) Directs each regional alliance to enter into a contract with any State-certified health plan to contract with the alliance for the enrollment under the plan of eligible individuals. (Sec. 1322) Requires each regional alliance to offer a choice of health plans, including at least one fee-for-service plan. (Sec. 1326) Requires each regional alliance to establish and maintain an office of an ombudsman to assist consumers in dealing with problems that arise with health plans and the alliance. (Sec. 1329) Permits a regional alliance to adjust payments to plans or use other financial incentives to encourage health plans to expand into areas that have inadequate health services. (Sec. 1341) Set forth provisions concerning the collection of funds by regional alliances from individuals, employers, and others. (Sec. 1351) Requires each regional alliance to compute a blended plan per capita payment amount for each regional alliance health plan for enrollment in the alliance. (Sec. 1353) Requires each regional alliance to make payments to the Federal Government for academic health centers and graduate medical education. (Sec. 1361) Requires each regional alliance to comply with specified standards relating to the management of finances, maintenance of records, accounting practices, auditing procedures, financial reporting, and employer payments. (Sec. 1371) Provides for a reduction in cost sharing for low-income families. (Sec. 1373) Provides for premium discounts and reduction in liabilities for low-income families. (Sec. 1381) Permits each corporate alliance to: (1) offer coverage under either an appropriate self-insured health plan; or (2) negotiate with a State-certified plan to enter into a contract with the plan. (Sec. 1382) Requires each corporate alliance to provide a choice of health plans, including at least one fee-for-service plan and two health plans that are not fee-for-service plans. (Sec. 1385) Requires each corporate alliance to make an additional contribution towards the enrollment in health plans of the alliance by certain low-wage families. (Sec. 1386) Sets forth provisions relating to corporate alliances concerning: (1) consumer information and marketing; (2) plan and information requirements; (3) management of funds; (4) cost control; (5) payments by corporate alliance employers to corporate alliances; (6) ERISA; (7) disclosure and reserve requirements; (8) trusteeship of insolvent corporate alliance health plans; (9) imposition and collection of periodic assessments on self-insured corporate alliance plans; and (10) payments to the Federal Government by multiemployer corporate alliances for academic health centers and gradual medical education. Subtitle E: Health Plans - Requires a health plan to: (1) be either a self-insured plan (meaning a group health plan as defined by a the Employee Retirement Income Security Act of 1974) or a State-certified plan (meaning a plan certified by a State or the National Health Board); and (2) meet the applicable regulatory requirements. (Sec. 1402) Requires each health plan offered by either a regional or corporate alliance to accept for enrollment every alliance eligible individual, unless the plan has reached its enrollment limit. Prohibits the limit from being imposed on the basis of any personal characteristics of enrollees such as health status, need for health care, age, occupation, or affiliation with any person or entity. Prohibits a plan from: (1) restricting or terminating coverage for any reason, including nonpayment of premiums; (2) cancelling coverage for any eligible individual until that individual is enrolled in another plan; (3) excluding an eligible individual because of an existing medical condition; (4) imposing a waiting period before coverage begins; or (5) imposing a rider that excludes the coverage of particular eligible individuals. Prohibits discrimination by a health plan on the basis of race, national origin, sex, language, socio-economic status, age, disability, health status, or anticipated need for health services. (Sec. 1405) Requires each plan to have a grievance procedure. (Sec. 1421) Permits an entity to offer a supplemental insurance policy if the policy and the entity meet specified requirements. (Sec. 1431) Requires each health plan, with respect to each electing essential community provider located within the plan's service area, to either: (1) enter into a written provider participation agreement; or (2) enter into a written agreement under which the plan will make payment to the provider as specified. Provides a special rule for providers of school health services. Makes the provisions of the proceeding sentence applicable only to health plans offered by a health alliance during the five year period beginning with the first year in which any health plan is offered by the alliance. Directs the Secretary of Health and Human Services to study essential community providers and to make recommendations concerning such providers to the Congress. Provides that such recommendations shall apply unless a joint resolution of disapproval is enacted by the Congress. (Sec. 1441) Requires each health plan to meet specified requirements of title X of this Act with respect to workers' compensation and automobile medical liability services. Subtitle F: Federal Responsibilities - Establishes the National Health Board in the Executive Branch. Directs the President to appoint the Board's seven members. (Sec. 1503) Directs the Board to: (1) interpret the comprehensive benefit package; (2) adjust the delivery of preventive services; (3) take steps to assure that the comprehensive benefit package is available on a uniform national basis; (4) recommend to the President and the Congress appropriate revisions to the package; (5) oversee cost containment requirements; (6) develop and implement eligibility standards; (7) establish a performance based system of quality management; (8) develop and implement standards for a national health information system; (9) establish State requirements and monitor State compliance; (10) establish premium class factors; (11) develop a methodology for the risk-adjustment of premium payments; (12) establish financial requirements for guaranty funds; (13) establish standards for health plan grievance procedures; and (14) report annually to the President and the Congress. (Sec. 1506) Authorizes appropriations for the Board. (Sec. 1511) Requires the Board to approve a State health care system if the system meets the applicable requirements of this Act. Prohibits approval of a State health care system prior to 1996. (Sec. 1512) Provides for sanctions for States failing to meet conditions for compliance. (Sec. 1515) Provides for planning grants to States for implementation assistance. (Sec. 1521) Provides for the Federal assumption of responsibilities in the absence of a State system. Provides for increased premiums of 15 percent during Federal operation of a State system to provide reimbursement for the Federal cost of operating the system. (Sec. 1541) Directs the Board to develop a risk adjustment and reinsurance methodology. Sets forth guidelines for developing such methodology. (Sec. 1543) Directs the Board to establish an advisory committee to provide technical advice and recommendations regarding the risk adjustment and reinsurance methodology. (Sec. 1551) Directs the Board to establish minimum capital requirements for regional alliance health plans under which at least $500,000 of capital must be maintained for each plan in the area. Permits the Board to require additional capital. (Sec. 1552) Requires the Board to establish standards for guaranty funds established by the States. (Sec. 1571) Sets forth the responsibilities of the Secretary of Health and Human Services. Directs the Secretary to administer and implement all provisions of this Act, except those duties delegated to the Board, any other executive agency, or to any State. (Sec. 1572) Directs the Secretary to appoint an Advisory Council on Breakthrough Drugs that will examine the reasonableness of launch prices of new breakthrough drugs. (Sec. 1581) Provides for the certification of essential community providers. Sets forth the following categories of providers automatically certified (under provisions of the Public Health Service Act): (1) migrant health centers; (2) community health centers; (3) homeless program providers; (4) public housing providers; (5) family planning clinics; and (6) AIDS providers under the Ryan White Act. Includes as automatically certified (under other Acts) following: (1) Indian health programs under the Indian Health Act; and (2) maternal and child health providers and a federally qualified health center or rural health clinic under the Social Security Act. Includes as automatically certified (under provisions of this Act) the following: (1) providers of school health services; and (2) a qualified community practice network. Provides for the setting of standards for additional health providers. (Sec. 1591) Sets forth the responsibilities of the Secretary of Labor. Includes among those responsibilities the following: (1) enforcement requirements applicable to employers; (2) elections to become corporate alliances; (3) temporary assumption of insolvent self-insured corporate alliance health plans; (4) establishment and administration of the Corporate Alliance Health Plan Insolvency Fund; and (5) administering title I of ERISA as it relates to group health plans maintained by corporate alliances. Subtitle G: Employer Responsibilities - Requires employers to provide for the payments required under title VI of this Act. Sets forth other employer responsibilities including: (1) information reporting requirements; (2) requirements relating to new employees; (3) recordkeeping requirements; and (4) antidiscrimination requirements. (Sec. 1606) Prohibits self-funding of cost sharing benefits by regional alliance employers. (Sec. 1607) Requires an employer to make equal employer premium payments to all qualifying employees, if a voluntary premium payment is made. Places a limit on such voluntary employer premium payments. (Sec. 1608) Sets forth an employer's obligation to a qualifying retired beneficiary where the employer, as of October 1, 1993, was providing a threshold payment. (Sec. 1609) Authorizes the Secretary of Labor to impose a civil penalty of up to $10,000 for each violation of this subtitle with respect to each individual. Subtitle J (sic): General Definitions; Miscellaneous Provisions - Sets forth the definitions and rules used in this Act. Subtitle B: Miscellaneous Provisions (sic) - (Sec. 1911) Grants the National Health Board, the Secretary of Health and Human Services, and the Secretary of Labor authority to issue regulations as necessary to permit the timely implementation of this Act. Title II: New Benefits - Subtitle A: Medicare Outpatient Prescription Drug Benefit - (Secs. 2001 through 2005) Amends title XVIII of the Social Security Act to provide for: (1) Medicare coverage of covered outpatient prescription drugs and biologicals as well as home infusion drug therapy services; (2) payment rules and related requirements, such as those pertaining to deductibles, for covered outpatient prescription drugs; (3) manufacturer rebates to the Secretary under Medicare part B for covered outpatient prescription drugs; and (4) determination of the Medicare part B premium attributable to covered outpatient prescription drugs. Subtitle B: Long-Term Care - Establishes requirements for State plans for home and community-based services to individuals with disabilities. Includes among those requirements the following: (1) a prohibition of limiting eligibility of individuals with disabilities based on income, age, geography, severity of disability, residential setting, or other grounds specified by the Secretary; (2) a requirement to serve low-income individuals; (3) a requirement to specify how Federal and State funds will be managed; (4) quality assurance requirements; and (5) reporting requirements. Requires a State to consult with individuals and groups of individuals with disabilities when developing the plan in order to have the plan approved. (Sec. 2103) Defines "individuals with disabilities" to mean any individual within one or more of the following four categories: (1) individuals requiring help with the activities of daily living; (2) individuals with severe cognitive or mental impairment; (3) individuals with severe or profound mental retardation; and (4) severely disabled children. (Sec. 2104) Requires a State plan to specify the services available. Requires each individualized plan to be developed in close consultation with the individual and the individual's family. Prohibits a State plan from covering: (1) room and board; (2) services furnished in a hospital, nursing facility, intermediate care facility for the mentally retarded, or other specified institutional setting; or (3) items or services to the extent coverage is provided for an individual under a health plan or Medicare. (Sec. 2105) Sets forth provisions relating to: (1) cost sharing; (2) quality assurance and safeguards; (3) advisory groups; (4) payments to States; and (5) the total Federal budget for State plans and allotments to States. (Sec. 2301) directs the Secretary, with the advice and assistance of the National Long-Term Care Insurance Advisory Council to promulgate regulations as necessary to implement provisions concerning private long-term care insurance. Directs the Secretary to make appointments to such Council. Authorizes appropriations for such Council. (Sec. 2321) Directs the Secretary, after considering the Council's recommendations to promulgate regulations designed to: (1) standardize formats and terminology used in long-term care policies; (2) require insurers to provide information to customers on the range of public and private long-term care coverage available; and (3) establish other requirements promoting consumer understanding of benefits. (Sec. 2322) Directs the Secretary to promulgate regulations establishing requirements with respect to the terms of and benefits under long-term care policies, which shall include the following requirements that the policy may not: (1) limit coverage based on a preexisting condition, subject to an exception for a six month period; (2) condition eligibility for benefits based on the need or receipt of any other service; (3) condition eligibility for any benefit on any particular diagnosis; (4) condition eligibility for benefits by providers on compliance with requirements not required by State or Federal law; and (5) condition coverage of any service by a provider on the provision of such service at a higher level of care than required by the insured individual. Prohibits discrimination by diagnosis in the treatment of: (1) Alzheimer's disease; (2) any organic or inorganic mental illness; (3) mental retardation or any other cognitive or mental impairment; or (4) HIV infection or AIDS. Sets forth other requirements for such policies, including requirements related to: (1) premiums; (2) sales practices; (3) continuation, renewal, replacement, conversion, and cancellation of policies; and (4) payment of benefits. (Sec. 2342) Provides for grants to States to enforce the Federal standards concerning long-term care policies. Sets forth requirements for receiving such grants. Authorizes appropriations. Prohibits the sale of a long-term care policy in a State without a regulatory program. (Sec. 2361) Authorizes the Secretary to make grants for the development and implementation of long-term care information, counseling, and other programs to: (1) States; (2) regional alliances (at the option of States within which such alliances are located; and (3) national organizations representing insurance consumers, long-term care providers, and insurers. Authorizes appropriations for such grants. (Sec. 2601) Authorizes the Secretary to conduct a demonstration program to test the effectiveness of various approaches to financing and providing integrated acute and long-term care services for the chronically ill and disabled. Sets forth the services and benefits to be provided, including: (1) all benefits of the comprehensive benefit package provided under title I of this Act; (2) transitional benefits, including assessment and home care; (3) long-term care benefits, including adult day care, home-delivered meals, and nursing facility services in specialized care units; and (4) habilitation services. Permits any of the following to be eligible for such services under criteria to be established by the Secretary: (1) individuals with disabilities under a State program; (2) individuals entitled to benefits under the Medicare program; and (3) individuals entitled to Medicaid and who are also either entitled to Medicare or Supplemental Security Income benefits. Requires reports to the Congress on the demonstration program. Title III: Public Health Initiatives - Subtitle A: Workforce Priorities Under Federal Payments - Establishes within the Department of Health and Human Services the National Council on Graduate Medical Education. Directs the National Council to designate for each academic year the number of individuals nationwide who are authorized to be enrolled in each specified approval physician training program for each medical specialty. Sets forth provisions specifying: (1) Federal formula payments to approved physician training programs; (2) application for payments; and (3) amount of payments. (Sec. 3061) Directs the Secretary to carry out a program with respect to graduate nurse training programs that is equivalent to the program for approved physician training programs. Establishes a National Council on Graduate Nurse Education. (Sec. 3071) Authorizes appropriations for the following programs: (1) primary care physician and physician assistant training; (2) training of underrepresented minorities and disadvantaged persons; and (3) nurse training. (Sec. 3072) Authorizes appropriations for the following programs: (1) a program of skill upgrading and occupational retraining for health care workers; (2) a demonstration program to assist workers in health care institutions in obtaining advanced career positions; (3) a program to develop and operate health-worker job banks in local employment services agencies, subject to certain conditions; (4) a program to provide joint labor-management decision-making in the health care sector on workplace matters related to the restructuring of the health care delivery system of this Act; and (5) a program to facilitate the comprehensive workforce adjustment initiative. (Sec. 3073) Directs the Secretary of Health and Human Services and the Secretary of Labor to jointly establish the National Institute for Health Care Workforce Development. States that the Director of the Institute shall make recommendations to the Secretaries regarding: (1) the supply of health care workers; (2) the impact of this Act; and (3) the development and implementation of high-performance, high-quality health care delivery systems. Directs the Secretaries to establish an advisory board to assist in the development of such recommendations. Subtitle B: Academic Health Centers - Directs the Secretary to make payments to a qualified academic health center or qualified teaching hospital in order to assist such eligible institutions with costs that are not routinely incurred by other entities in providing health services, but are incurred by such institutions by virtue of the academic nature of such institutions. States that such costs include: (1) costs resulting from reduced staff productivity due to teaching responsibilities; (2) the uncompensated costs of clinical research; and (3) exceptional costs associated with an institutions specialized expertise. Provides that the funding for such payments will come from transfers from the Federal Hospital Insurance Trust Fund, payments made by regional alliances to the Federal government for academic health centers and graduate medical education, and payments from corporate alliances. (Sec. 3131) Provides for the access of regional and corporate alliance patients to academic health centers. Subtitle C: Health Research Initiatives - Amends the Public Health Service Act to ensure that the National Institutes of Health conducts and supports biomedical and behavioral research on promoting health and preventing diseases, disorders, and other health conditions. Provides for health services research. Authorizes appropriations for such research. Subtitle D: Core Functions of Public Health Programs; National Initiatives Regarding Preventive Health - Authorizes appropriations for the core functions of public health programs and national initiatives regarding health promotion and disease prevention. (Sec. 3312) Authorizes the Secretary to make grants to States to carry out one or more of the following core functions: (1) data collection; (2) activities to protect the environment and to assure the safety of housing, workplaces, and food and water; (3) investigation and control of adverse health conditions; (4) public information and education programs to reduce risks to health such as use of tobacco, alcohol, and drugs, sexual activities that increase the risk of HIV transmission and other sexually transmitted diseases, poor diet, physical inactivity, and low childhood immunization levels; (5) accountability and quality assurance activities; (6) provision of public health laboratory services to complement private clinical laboratory services that screen for diseases and conditions; (7) training and education to assure provision of care by all health professionals; and (8) leadership policy development and administrative activities. (Sec. 3331) Authorizes the Secretary to make grants to agencies of State or local government, private nonprofit organizations, and coalitions that link two or more of these groups for the purpose of carrying out projects to develop and implement innovative community-based strategies to provide for health promotion and disease prevention activities for which there is a significant need. Subtitle E: Health Services for Medically Underserved Populations - Directs the Secretary to make grants to migrant health centers and community health centers, which shall be in addition to other funds available to such centers. Authorizes appropriations. (Sec. 3412) Authorizes appropriations for: (1) grants and contracts for the development of qualified community health plans and practice networks; and (2) loans and guaranteeing the principal and interest to Federal and non-Federal lenders on behalf of public and private entities for the capital costs of developing qualified community health plans and practice networks. (Sec. 3461) Authorizes the Secretary to make grants and enter into contracts with qualified community health groups to provide enabling services such as transportation, community and patient outreach, patient education, and translation services in order to increase the capacity of individuals to utilize the items and services under title I of this Act. Authorizes appropriations. (Sec. 3471) Authorizes appropriations for: (1) the National Health Service Corps; and (2) such amounts as are necessary to ensure that at least 20 percent of participants in the Scholarship Program or the Loan Repayment Program of the Corps are nurses. (Sec. 3481) Entitles a hospital with a low-income utilization rate in a base year of at least 25 percent to a payment as specified. Requires 75 percent of the total available to be allocated to hospitals for low-income assistance. Requires 25 percent of the total available to be allocated to hospitals for assistance in furnishing inpatient hospital services that are not covered services under title I of this Act. Subtitle F: Mental Health; Substance Abuse - Authorizes appropriations to carry out this part. Provides for grants to: (1) increase access to mental health and substance abuse services; (2) improve State and local capacity to coordinate and monitor such services; (3) provide incentives to integrate public and private service systems; and (4) supplement any activity under part B (Alcohol and Drug Abuse and Mental Services Block Grant) of title XIX of the Public Health Service Act. (Sec. 3503) Authorizes the Secretary to make loans for the capital costs incurred in the development of non-acute, residential treatment centers and community-based ambulatory clinics. (Sec. 3521) Requires the establishment of a pilot program demonstrating the integration of the mental illness and substance abuse services of the States with the services included under title I of this Act. Subtitle G: Comprehensive School Health Education; School-Related Health Services - Authorizes appropriations for the programs of this subtitle. States that the purposes of the programs shall be to: (1) support, in kindergarten through grade 12, the provision of comprehensive health educator programs; (2) establish a national framework within which States can create comprehensive school health education programs that target the health risk behaviors of youth, including tobacco use, alcohol and drug abuse, sexual behaviors resulting in infections, injury prevention, dietary patterns, and sedentary lifestyles; (3) pay the initial costs of planning and establishing such programs; (4) support related Federal demonstrations and training; (5) motivate youth to stay in school, avoid teen pregnancy, and strive for success; (6) improve the knowledge of health education among youth; and (7) further the National Education Goals set forth in title I of the Goals 2000: Educate America Act. Defines "comprehensive school health education program." Requires such programs to be sensitive to cultural and ethnic issues, promote involvement by families, and promote personal responsibility. Sets forth requirements for applying for grants and selection of grantees. Subtitle H: Public Health Service Initiative - Establishes a Public Health Service Initiative consisting of specified amounts authorized to be appropriated for the Initiative. States that: (1) the Initiative includes the programs of subtitles C through G of this title and the programs of subtitle D of title VIII; and (2) amounts appropriated to carry out the Initiative, including subtitles A through F of this title, are available to carry out specific programs for which the amounts are appropriated. Subtitle I: Coordination with COBRA Continuation Coverage - Amends title XXII (Requirements for Certain Group Health Plans for Certain State and Local Employees) of the Public Health Service Act to provide for coordination with COBRA continuation coverage. Repeals such title XXII upon implementation of this Act. Title IV: Medicare and Medicaid - Subtitle A: Medicare and the Alliance System - Amends title XVIII of the Social Security Act to provide for optional State integration of Medicare beneficiaries into regional alliance plans. (Sec. 4002) Allows individuals to elect to remain in certain plans. (Sec. 4003) Provides for payments to regional alliances on behalf of certain Medicare-eligible individuals. (Sec. 4004) Extends protections for working aged and disabled individuals to group health plans of all employers. Repeals the limitation on the period of protection for individuals with end stage renal disease. Prohibits Medicare payment for items and services provided under any health plan under this Act. Simplifies Medicare benefit coordination in cases where the individual is also eligible for benefits under this Act's health plans. (Sec. 4011) Makes various changes concerning eligible organization and Medicare supplemental policy enrollment and comparative informational materials, eligible organization outlier payments, and participating provider point-of-service networks. (Sec. 4022) Provides for expanded Medicare coverage for physician assistant, nurse practitioner, and clinical nurse specialist services. (Sec. 4031) Amends title XI of the Social Security Act to: (1) provide for termination of the separate Medicare peer review program upon adoption of the National Quality Management Program above under subtitle A of title V of this Act; and (2) repeal provisions on surgical procedure review and second opinions. (Sec. 4032) Amends title XVIII of the Social Security Act to provide for mandatory assignment for all Medicare part B services. (Sec. 4033) Directs the Secretary of Health and Human Services to take such steps as may be necessary to consolidate administration of Medicare parts A and B and supersedes certain conflicting requirements to the extent required to achieve such purpose. (Sec. 4035) Prohibits the Secretary from implementing any change in procedures for billing and processing Medicare claims within six months of implementing any previous change. Adds advanced notification to providers as a requirement for carriers and fiscal intermediaries under Medicare. (Sec. 4041) Amends title XI of the Social Security Act to: (1) provide for civil monetary penalties for kickback violations under Medicare and State health care programs (the programs); (2) make other penalty-related changes, including increases in criminal and civil monetary penalties, a new criminal penalty exception for certain providers, additional civil monetary penalty offenses related to alliance systems, and requirements for the deposit of penalties collected into the All-Payer Account established above under title V of this Act; (3) revise exclusion provisions, with changes establishing a minimum period of exclusion for certain individuals and entities subject to permissive exclusion from the programs, and providing for program exclusions based on actions under alliance systems; and (4) modify sanction provisions, with changes removing certain conditions for imposing sanctions and setting specified civil money penalties for use in lieu of authorized sanctions. (Sec. 4042) Amends title XVIII of the Social Security Act to revise the limitations on physician self-referrals. (Sec. 4051) Provides for the termination of payments under Medicare for medical education costs and directs the Secretary to make specified transfers from certain Medicare trust funds to the new accounts established above for funding physician training programs and academic health centers. (Sec. 4061) Amends title XVIII of the Social Security Act to provide for the treatment of: (1) uniformed services and VA health plans as eligible organizations under Medicare; and (2) health care facilities of the Department of Veterans Affairs as providers under Medicare. Subtitle B: Savings in Medicare Program - Amends title XVIII of the Social Security Act to provide for: (1) reductions in the update for inpatient hospital services and the adjustment for indirect medical education costs, in payments for capital-related costs for inpatient hospital services; (2) revisions to payment adjustments for disproportionate share hospitals in States participating under this Act; and (3) an extension of the freeze on updates to routine service costs of skilled nursing facilities. (Sec. 4111) Amends title XVIII of the Social Security Act to provide for: (1) establishment of cumulative expenditure goals for physician services; (2) use of real gross domestic product for volume adjustments; (3) repeal of restrictions on the maximum reduction permitted in default update; (4) reduction in the conversion factor for the physician fee schedule for 1995; (5) place limitations on payment for physicians' services furnished by high-cost hospital medical staffs; (6) requirements for physicians to identify the hospital at which the service was furnished; (7) an increase in practice expense relative value units for certain services while assuring budget neutrality; (8) a study and report to the Congress by the Secretary on a resource-based system for determining practice expense relative value units for each physician's service; (9) an increase in work relative value units for office visits while assuring budget neutrality; (10) a reduction in relative values for office consultations; (11) adjustment of outlier intensity of relative values; (12) changes in underserved area bonus payments; (13) elimination of formula-driven payments for certain outpatient hospital services; (14) copayments for laboratory services; and (15) competitive acquisition procedures for Medicare part B items and services (including clinical diagnostic laboratory tests). (Sec. 4131) Makes changes with respect to: (1) Medicare as secondary payer; (2) payments for health maintenance organizations and competitive medical plans with risk-sharing contracts; and (3) routine cost limits and copayments for, respectively, home health services and visits. (Sec 4135) Directs the Secretary to use a competitive process to contract with centers of excellence for cataract surgery, coronary artery by-pass surgery, and such other services as the Secretary determines to be appropriate. (Sec. 4141) Amends title XVIII of the Social Security Act to revise Medicare part B premium provisions. (Sec. 4151) Requires the Secretary to submit a report to the Congress on the growth in spending under Medicare for FY 2000 through 2003. Subtitle C: Medicaid - Amends title XIX (Medicaid) of the Social Security Act to provide that if a State Medicaid plan provides for payment to regional alliances of the amounts required above it is not required to provide payment for items and services covered under the comprehensive benefit package for alliance eligible individuals and will receive no Federal financial assistance with respect to such items and services. (Sec. 4211) Provides for: (1) spenddown eligibility and increased income and resource disregard for nursing facility residents; and (2) informing such residents about the availability of assistance for home and community-based services. (Sec. 4221) Provides for: (1) treatment of items and services not covered under the comprehensive benefit package; and (2) establishment of a program under Medicare of noncovered items and services for poor children. (Sec. 4231) Discontinues certain payment policies under Medicaid. (Sec. 4241) Limits the frequency of changes in a State's billing and claims processing system, and provides for advance notification to providers of any major billing change. (Sec. 4251) Establishes the Medicaid Commission to study, report, and make recommendations with respect to options involving block grant use, integration of long-term care services, and consolidation of institutional and home- and community-based long-term care in relation to the Medicaid program. Authorizes appropriations. Subtitle D: Increase in SSI Personal Needs Allowance - Amends title XVI (Supplemental Security Income) (SSI) to provide for an increase in the SSI personal needs allowance. Title V: Quality and Consumer Protection - Subtitle A: Quality Management and Improvement - Requires the National Health Board to establish and oversee a performance-based program of quality management and improvement designed to enhance the quality, appropriateness, and effectiveness of heath care services and access to such services which will be called the National Quality Management Program. (Sec. 5002) Establishes the National Quality Management Council which shall: (1) administer the National Quality Management Program; (2) perform any other duty specified in this subtitle; and (3) advise the National Health Board with respect to its duties under this subtitle. Requires the Council to develop a set of national measures of quality performance to be used in the assessment of and the provision of access to health care services. Requires the Council, in addition, to: (1) recommend to the Board establishing goals for performance by health plans and health care providers on a subset of national measures of quality performance; (2) direct the Administrator for Health Care Policy and Research to develop, review, and disseminate practice guidelines to determine how diseases can most effectively be prevented, diagnosed, treated, and managed; and (3) direct the Administrator for Health Care Policy and Research to support research related to a five year priority list of performance measures. (Sec. 5008) Directs the National Health Board to: (1) establish and oversee regional professional foundations to perform such duties as develop lifetime learning programs for health professionals and conduct research on health care quality; and (2) establish the National Quality Consortium to perform such duties as establishing continuing education for health professionals and provide advice on research priorities. (Sec. 5012) Requires each regional alliance and each corporate alliance to: (1) disseminate specified information to consumers; and (2) ensure that performance and quality standards are continually improved. Subtitle B: Information Systems, Privacy, and Administrative Simplification - Directs the National Health Board to develop and implement a health information system, in consultation with Federal agencies, States, employers, health plans, and others, by which the Board shall collect, report, and regulate the collection and dissemination of health care information which shall be used for: (1) health care planning by Federal, State, and local government; (2) establishing and monitoring payments for health services; (3) assessing and improving the quality of health care; (4) managing and containing costs at the alliance and plan levels; and (5) other specified purposes. Requires the establishment of an electronic data network to collect, compile, and transmit information. (Sec. 5120) Sets forth provisions providing for health information privacy standards. (Sec. 5130) Directs the National Health Board to develop the following standard health care benefit forms: (1) an enrollment and disenrollment form; (2) a clinical encounter record; and (3) a claim form. (Sec. 5140) Establishes the National Privacy and Health Data Advisory Council in order to advise the National Health Board with respect to its duties under this subtitle. (Sec. 5141) Sets forth monetary penalties for violating health information system standards. Subtitle C: Remedies and Enforcement - Sets forth provisions with respect to the review of benefit determinations for enrolled individuals, including provisions: (1) regulating the time limits for notice of disposition of a claim; (2) governing a plan's duty to review claim denials; (3) concerning urgent requests for preauthorization; and (4) concerning other time limits with respect to time limits and notice. (Sec. 5202) Requires each State to establish a complaint review office for each regional alliance established by a State. Permits aggrieved individuals to file complaints with the appropriate review office. (Sec. 5205) Provides for a Federal Health Plan Review Board to review the decisions of complaint review office hearing officers. (Sec. 5207) Sets monetary penalties for a plan which unreasonably denies or delays payment or provision of benefits. (Sec. 5211) Directs each State to establish and maintain an Early Resolution Program in each complaint review office. Requires a program to include: (1) forums for mediation disputes; and (2) other forums of alternative dispute resolution as may be prescribed. Establishes guidelines for the eligibility of cases for submission to the Early Resolution Program. States that conclusions of the mediation proceedings shall be treated as nonbinding and shall not affect any rights to review. (Sec. 5231) Sets forth additional remedies and enforcement provisions. Subtitle D: Medical Malpractice - Prohibits any medical malpractice liability action until the final resolution of the claim under alternative dispute resolution. Requires each regional alliance health plan and corporate alliance health plan to adopt at least one specified method of alternative dispute resolution. Prohibits an individual from bringing a medical malpractice liability action unless the individual submits an affidavit that includes a report by a qualified specialist that states that there is a meritorious cause for filing the action. (Sec. 5311) Directs the Secretary to establish: (1) a project to demonstrate whether substituting liability for medical malpractice on the part of the health plan in which a physician participates for the personal liability of the physician will result in improvements in the quality of care, reductions in defense medical practices, and better risk management; (2) a pilot program under which the Secretary provides funds to one or more eligible States to determine the effect of applying practice guidelines in the resolution of medical malpractice liability actions. Subtitle E: Fraud and Abuse - Directs the Secretary and the Attorney General to establish a program: (1) to coordinate the functions of the Attorney General, the Secretary, and other organizations with respect to the prevention, detection, and control of health care fraud and abuse; (2) to conduct investigations, audits, evaluations, and inspections relating to the delivery of and payment for health care; and (3) to facilitate the enforcement of this and other statutes applicable to health care fraud. (Sec. 5402) Creates, in the Treasury, the All-Payer Health Care Fraud and Abuse Control Account which shall consist of: (1) gifts and bequests; (2) administrative penalties and assessments and portions of civil monetary penalties imposed under provisions of the Social Security Act; (3) all criminal fines imposed in cases involving a Federal health care offense; (4) penalties imposed under the False Claims Act involving claims related to the provision of health care items and services; and (5) amounts resulting from the forfeiture of property by reason of Federal health care offense. States that amounts in the fund may be used to cover costs incurred in operating the Program. (Sec. 5411) Excludes from participation in any health plan any individual or entity excluded from participation in a public program under provisions of the Social Security Act. (Sec. 5413) Sets forth physician self-referral limitations. (Sec. 5431) Amends the Federal criminal code to set penalties for knowingly executing a scheme or artifice to: (1) defraud any health alliance, health plan, or other person (alliance) in connection with the delivery of, or payment for, health care benefits, items, or services (benefits); and (2) obtain, by false or fraudulent means, money or property owned by, or under the custody of control of, any such alliance in connection with the delivery of, or payment for, health care benefits. (Sec. 5432) Amends: (1) the Federal criminal code to require the court, in imposing sentence on a person convicted of a Federal health care offense that poses a serious threat to the health of any person or has a significant detrimental impact on the health care system, to order such person to forfeit property used in the commission of the offense or that constitutes, or is derived from, proceeds traceable to the commission of the offense which is of a value proportionate to the seriousness of the offense; and (2) the Federal judicial code to require that all proceeds of forfeiture relating to Federal health care offenses be deposited into the Department of Justice Assets Forfeiture Fund. (Sec. 5433) Amends the Federal criminal code to set penalties for: (1) knowingly and willfully falsifying, concealing, or covering up a material fact, making any false, fictitious, or fraudulent statements or representations, or making or using any false writing or document knowing it to contain any false, fictitious, or fraudulent statement or entry, in any matter involving a health alliance or health plan; and (2) bribery of, and graft by, a health care official. (Sec. 5435) Authorizes: (1) the Attorney General to commence a civil action in Federal court to enjoin a Federal health care offense; and (2) a person privy to certain grand jury information concerning a health law violation to disclose that information to an attorney for the Government to use in any civil proceeding related to a Federal health care offense. (Sec. 5437) Sets penalties for: (1) theft or embezzlement in connection with a health alliance, health plan, or fund connected with such alliance or plan; and (2) misuse of a health security card issued, or unique identifier provided, pursuant to this Act. (Sec. 5441) Makes provisions of the Civil False Claims Act applicable to the use of false records or statements made to a health plan. Includes within the definition of "claim" for purposes of such Act any request or demand for money or property which is made or presented to a health plan. Subtitle F: McCarran-Ferguson Reform - Amends the McCarran-Ferguson Act to repeal the exemption under specified antitrust laws for the business of insurance to the extent that such business relates to the provision of health benefits. Title VI: Premium Caps; Premium-Based Financing; and Plan Payments - Subtitle A: Premium Caps - Sets forth provisions which provide for the computation of factors that limit the growth of premiums for the comprehensive benefit package in regional alliance health plans, including the computation of a: (1) regional alliance inflation factor; and (2) general health care inflation factor. (Sec. 6002) Directs the Board to determine: (1) a national per capita baseline premium target; (2) the national average per capita current coverage health expenditures; and (3) current health care expenditures. (Sec. 6003) Directs the Board to determine a regional alliance per capita premium. (Sec. 6004) Requires a regional alliance to annually obtain premium bids from each plan seeking to participate as a regional alliance health plan with respect to the alliance. (Sec. 6005) Permits any participating State to assume responsibility for containment of health care expenditures in the State consistent with this Act. (Sec. 6006) Directs the chair of the Board to establish an advisory commission on regional variations in health expenditures. Requires the commission to examine methods of eliminating variation in regional alliance per capita premium targets due to variation in practice patterns, not due to other factors. Requires the Board to submit its recommendations to the Congress. Requires such recommendations to apply unless a joint resolution of disapproval is passed. (Sec. 6011) Subjects each noncomplying regional alliance health plan for a year to a reduction in plan payment as specified, in order to assure that payments to regional alliance health plans by a regional alliance are consistent. Defines a noncomplying plan to include a plan in which the final accepted bid exceeds the maximum complying bid for the per capita target premium. Defines "maximum complying bid." (Sec. 6021) Directs the Board to develop a methodology for calculating an annual per capita expenditure equivalent for amounts paid for coverage for the comprehensive benefit package within a corporate alliance. (Sec. 6022) Terminates a corporate alliance with two excess years in a three year period. Provides that employers that were corporate alliance employers with respect to a terminated alliance shall become regional alliance employers. Defines an excess year as one in which the rate of increase for the corporate alliance exceeds the national corporate inflation factor. Defines rate of increase and national corporate inflation factor. (Sec. 6031) Sets forth special rules for a single-payer State. (Sec. 6041) Directs the Secretary to establish a program to monitor prices and expenditures in the U.S. health care system. Subtitle B: Premium-Related Financings - Makes each family enrolled in a regional health alliance plan or in a corporate alliance health plan in a class of family enrollment responsible for payment of the family share of premium payable for enrollment. Provides for income related discounts and specified credits. (Sec. 6102) Establishes the formula for determining the premiums. (Sec. 6111) Provides for the repayment of credit by certain families. (Sec. 6114) Provides for the special treatment of certain retirees and qualified spouses and children. (Sec. 6121) Requires each regional alliance employer to pay a monthly premium to the regional alliance for a qualifying employee. Sets forth provisions for determining such premium. Varies the premium depending upon such factors as the employer's size and average wages paid. (Sec. 6126) Sets forth provisions applicable to self-employed individuals. (Sec. 6131) Sets forth provisions for determining the corporate employer premium. Subtitle C: Payments to Regional Alliance Health Plans - Sets forth provisions to determine the computation of: (1) the blended plan per capita payment amount; and (2) the plan bid, AFDC, and SSI proportions. Title VII: Revenue Provisions - Subtitle A: Financing Provisions - Amends the Internal Revenue Code to increase the excise taxes on cigarettes and other tobacco products. (Sec. 7113) Imposes an excise tax on the manufacture or importation of roll-your-own tobacco. (Sec. 7121) Imposes an assessment on each corporate alliance employer and a temporary assessment on employers with retiree health benefit costs. Requires such assessments to be paid in the same manner as employment taxes. (Sec. 7131) Provides for the recapture of certain health care subsidies received by high-income individuals. Transfers such amounts to the Supplemental Medical Insurance Trust Fund. (Sec. 7141) Requires certain shareholders of S corporations and limited partners who materially participate in corporate activities to include their share of income or loss from such corporation when determining net earnings from self-employment. (Sec. 7142) Provides for extending Medicare coverage and applying the hospital insurance tax to all State and local government employees. Subtitle B: Tax Treatment of Employer-Provided Health Care - Provides exceptions to the exclusion of employer-provided contributions to an accident or health plan from the gross income of an employee. (Sec. 7202) Prohibits the provision of health benefit under cafeteria plans. (Sec. 7203) Makes permanent the deduction for health insurance costs of self-employed individuals. Increases such deduction to 100 percent of the basic coverage purchased from a health alliance with limitations. Subtitle C: Employment Status Provisions - Requires the Secretary of the Treasury to prescribe regulations defining an employee for employment tax purposes. (Sec. 7302) Increases the penalty for failure to file correct returns involving payments for services. (Sec. 7303) Sets forth rules to limit retroactive employment tax reclassifications. Subtitle D: Tax Treatment of Funding of Retiree Health Benefits - Requires additional reserves for post-retirement medical and life insurance benefits to cover not less than ten years of the working lives of covered employees and to be maintained as separate accounts. (Sec. 7402) Terminates the authority of pension plans to maintain health benefits accounts. Subtitle E: Coordination with COBRA Continuing Care Provisions - Repeals provisions concerning continuation coverage requirements of group health plans upon implementation of this Act. Subtitle F: Tax Treatment of Organizations Providing Health Care Services and Related Organizations - Provides for the tax treatment of charitable organizations providing health care services, insurance provided by health maintenance organizations, and certain private foundations. (Sec. 7602) Sets forth transitional rules for taxing certain organizations providing health insurance and other prepaid health care services as insurance companies other than life insurance companies. (Sec. 7603) Exempts regional alliances from income tax. Subtitle G: Tax Treatment of Long-term Care Insurance and Services - Treats qualified long-term care services as medical care for purposes of the medical expense deduction. (Sec. 7702) Provides for the treatment of long-term care insurance as accident and health insurance. (Sec. 7703) Allows accelerated death benefits under life insurance contracts to be paid to terminally ill individuals. Subtitle H: Tax Incentives for Health Service Providers - Allows a tax credit for certain qualified individuals who provide primary health services full time in a health professional shortage area. (Sec. 7802) Increases the allowable depreciation deduction for expensing certain medical equipment. Subtitle I: Miscellaneous Provisions - Allows a tax credit for the cost of personal assistance services required by an employed individual who for medical reasons is unable to engage in substantial gainful activity. (Sec. 7902) Denies tax-exempt status for private activity bonds of regional alliances, corporate alliances, or guaranty funds established under this Act. Title VIII: Health and Health-Related Programs of the Federal Government - Subtitle A: Military Health Care Reform - Directs the Secretary of Defense to establish one or more uniformed services health plans in order to provide health care services to members of the armed forces on active duty for 30 or more days as well as their covered beneficiaries. Requires conformity of such plans with health plan requirements set forth in this Act. (Sec. 8001b) Allows any such plan to rely upon the use of military health care facilities, supplemented by civilian health care providers or health plans under agreements entered into by the Secretary. Requires at least the items and services in the comprehensive benefit package under this Act to be included in each such plan. Preempts any conflicting State health plan requirements. Provides for plan enrollment, effect of failure to enroll, and choosing between a uniformed services health plan and other available plans. Prohibits the imposition of plan charges to an active-duty member other than subsistence charges, but allows the Secretary to impose limited charges for covered beneficiaries. Establishes in the Department of Defense a financial account for payments received in connection with a uniformed services health plan, allowing such funds to be used only for purposes directly related to the delivery and financing of health care services under this Subtitle. Subtitle B: Department of Veterans Affairs - Allows each veteran who is an eligible individual under this Act and individuals currently enrolled in a health plan under the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) to be enrolled with a Department of Veterans Affairs (VA) health plan. Requires conformity of such plans with health plan requirements set forth in this Act, with all the items and services of the comprehensive benefit package under this Act included. Allows such plans to offer supplemental health benefits and cost-sharing policies as consistent with this Act. Provides a limitation with regard to veterans enrolled with health plans outside the VA. Prohibits the imposition of any plan enrollment charges upon service-connected disabled veterans, veterans receiving disability compensation from the VA, former prisoners of war, and veterans unable to defray the costs of such care. Allows the Secretary of Veterans Affairs to establish plan charges for other veterans. Deems a VA facility to be a Medicare provider for purposes of any program administered by the Secretary of Health and Human Services. Allows for the recovery of certain care and services provided under a VA plan in the case of an individual who has coverage under another plan. Establishes in the Treasury the Department of Veterans Affairs Health Plan Fund to be used for VA health plan payments and services. Preserves existing benefits for VA facilities not operating within a health plan certified under this Act. (Sec. 8102) Directs the Secretary of Veterans Affairs to organize health plans and operate VA facilities as, or within, health plans under this Act. Preempts existing State health plan standards or requirements. Authorizes the Secretary to contract for the provision of services by a VA health plan when cost-effective, or to share resources with other health care plans, providers, or organizations. Authorizes appropriations to the VA for FY 1995 through 1997 for VA health plans under this Subtitle, subject to availability of appropriations. Requires a report from the Secretary to the Congress concerning the operation of the VA health care system within the requirements of this Act. Authorizes the Secretary to accept and use grants for health care services provided to special populations if used by the VA while operating under a VA health plan. Subtitle C: Federal Employees Health Benefits Programs - (Secs. 8202 through 8204) Provides for termination of the Federal Employees Health Benefits Program (FEHB) and treatment of Federal employees, annuitants, and other individuals (including those residing abroad) who would otherwise have been eligible for FEHBP under this Act's health plans. Subtitle D: Indian Health Service - Makes qualifying Indians eligible to enroll in a comprehensive benefits health program of the Indian Health Service. (Sec. 8303) Authorizes appropriations for supplemental Indian health care benefits. (Sec. 8305) Exempts tribal governments and organizations from making employer payments. (Sec. 8306) Sets forth provisions regarding health service to non-enrollees and non-Indians. (Sec. 8311) Requires each health program of the Indian Health Service to establish a comprehensive benefit package fund. (Sec. 8313) Authorizes appropriations for the Indian Health Service programs. Subtitle E: Amendments to the Employee Retirement Income Security Act of 1974 - Amends the Employee Retirement Income Security Act of 1974 (ERISA) to revise and limit the coverage of group health plans under ERISA. Makes certain ERISA provisions inapplicable with respect to State-certified health plans. Provides for an exception from ERISA civil action provisions where review is otherwise available under the Health Security Act (this Act, HSA). (Sec. 8402) Establishes ERISA requirements for expeditious reporting and disclosure applicable to group health plans, through special rules consistent with ERISA and HSA purposes. Excludes plans maintained by regional alliances from treatment as multiple employer welfare arrangements. (Sec. 8403) Revises certain ERISA provisions relating to continuation coverage under group health plans. Repeals such provisions upon implementation of HSA. (Sec. 8404) Makes ERISA standards for group health plans regarding: (1) cases of adoption applicable except to the extent otherwise provided in regulations of the National Health Board under HSA; and (2) coverage of pediatric vaccines inapplicable to a group health plan upon its becoming a corporate alliance health plan under HSA. (Sec. 8405) Requires group health plans under ERISA to comply with HSA requirements relating to health plan claims procedure. Subtitle F: Special Fund for WIC Program - Authorizes appropriations through FY 2000 for the special supplemental food program for women, infants, and children under the Child Nutrition Act of 1966. Title IX: Aggregate Government Payments - Subtitle A: Aggregate State Payments - Sets forth provisions which have formulas for determining each participating State's payment to regional alliances within the State. Provides two different formulas. Establishes one payment formula for non-cash assistance recipients. Establishes another formula relating to cash assistance recipients. Defines a non-cash assistance adult as an individual who is: (1) over 21 years; (2) a U.S. citizen or lawful alien; and (3) is not an AFDC or SSI recipient or a Medicare-eligible individual. (Sec. 9022) Directs the National Health Board to review appropriateness of such payments. Subtitle B: Aggregate Federal Alliance Payments - Sets forth the formula for determining Federal payments to regional alliances for cash assistance recipients. (Sec. 9102) States that this section constitutes budget authority in advance of appropriation Acts and obligates the Federal Government to provide for the payment to regional alliances of a capped Federal alliance payment amount. Defines "capped Federal alliance payment amount." Subtitle C: Borrowing Authority to Cover Cash-flow Shortfalls - Authorizes the Secretary to make available loans to regional alliances to cover any period of temporary cash-flow shortfall attributable to: (1) any estimation discrepancy; (2) a period of temporary cash-flow shortfall attributable to an administrative error; or (3) a period of temporary cash-flow shortfall relating to the relative timing during the year in which amounts are received and payments are required. Sets forth loan terms and conditions. Title X: Coordination of Medical Portion of Workers Compensation and Automobile Insurance - Subtitle A: Workers Compensation Insurance - Requires each health plan that provides services to enrollees through participating providers to make arrangements to provide workers compensation to such enrollees. (Sec. 10002) Requires each workers' compensation carrier that is liable for payment for workers' compensation services furnished by or through a health plan, regardless of whether or not the services are included in the comprehensive benefit package, to make payment for such services. (Sec. 10011) Sets forth requirements for participating States. (Sec. 10031) Authorizes demonstration projects in one or more States with respect to the treatment of work-related injuries and illnesses. Subtitle B: Automobile Insurance - Requires an individual entitled to automobile insurance medical benefits and enrolled in a health plan to receive automobile insurance medical services through the provision of such services by the health plan. (Sec. 10102) Requires each automobile insurance carrier that is liable for payment for automobile insurance medical services furnished by or through a health plan, regardless of whether or not the services are included in the comprehensive benefit package, to make payment for such services. (Sec. 10111) Requires each participating State to develop a fee schedule applicable to payment for automobile insurance medical services for which a fee is not included in the applicable fee schedule. Subtitle C: Commission on Integration of Health Benefits - Establishes the Commission on Integration of Health Benefits which shall study and report on the feasibility and appropriateness of transferring financial responsibility for all medical benefits, including those currently covered by workers compensation and automobile insurance, to health plans. Authorizes appropriations. Subtitle D: Federal Employees' Compensation Act - Requires the Federal Employees' Compensation Act to be interpreted and administered consistent with the provisions of subtitle A. Subtitle E: Davis-Bacon Act and Service Contract Act - Amends the Davis-Bacon Act and the Service Contract Act of 1965 to require Health Security Act benefits. Subtitle F: Effective Dates - Sets forth effective date provisions. Title XI: Transitional Insurance Reform - Sets forth transitional provisions concerning: (1) enforcement; (2) preservation of current coverage; (3) restrictions on premium increases during transition; (4) portability requirements; (5) restrictions limiting benefit reductions; and (6) the establishment of the National Transitional Health Insurance Risk Pool.
United States · United States Congress · 18 November 1993
Code of Conduct on Arms Transfers Act of 1993 - Prohibits U.S. military assistance and arms transfers to a foreign government unless the President certifies to the Congress that the government: (1) meets specified conditions regarding democracy, including that it was chosen in free and fair elections and promotes civilian control of the military, the rule of law, and respect for individual rights; (2) does not engage in human rights violations, investigates and prosecutes those responsible for human rights violations, permits access to political prisoners by international organizations, and provides access to such organizations in situations of conflict or famine; (3) is not engaged in acts of armed aggression in violation of international law; and (4) is participating in the United Nations Register of Conventional Arms by annually reporting to the Register the number and type of conventional weapons possessed by, and transferred to and from, the country during the preceding year. Authorizes an exemption from such prohibition for a fiscal year if: (1) the President requests an exemption from the Congress stating that it is in the national security interest to provide military assistance and arms transfers to a government; and (2) the Congress enacts a law approving such request. Requires the President to submit initial certifications and requests for exemptions in conjunction with the submission of the annual request for enactment of authorizations and appropriations for foreign assistance. Expresses the sense of the Congress that the House Foreign Affairs Committee and the Senate Foreign Relations Committee should hold hearings on controversial certifications and all requests for exemptions.
United States · United States Congress · 18 November 1993
Expresses appreciation to W. Graham Claytor, Jr., upon his retirement from the National Railroad Passenger Corporation (Amtrak), where he served as President and Chairman of the Board.
United States · United States Congress · 16 November 1993
Directs the Secretary of Energy to terminate the gas turbine-modular helium reactor program of the Department of Energy. Transfers funds appropriated for such program to the Deficit Reduction Fund.
United States · United States Congress · 10 November 1993
United States Military Academy Bicentennial Commemorative Coin Act of 1993 - Directs the Secretary of the Treasury to issue five-dollar gold coins, one-dollar silver coins, and half dollar clad coins emblematic of the U.S. Military Academy. Mandates that surcharges collected from coin sales be paid to the Association of Graduates, U.S. Military Academy, to assist its efforts to provide direct support to the Corps of Cadets, U.S. Military Academy.
United States · United States Congress · 3 November 1993
Smoke-Free Environment Act of 1993 - Amends the Public Health Service Act to add a new title on smoke free environments. Requires the responsible entity for each public facility to adopt, implement, and post a policy prohibiting smoking in the facility and on facility property in the immediate vicinity of the facility's entrance. Allows designated smoking areas if: (1) the area is ventilated to exhaust directly to the outside; and (2) nonsmoking individuals do not have to enter the area for any purpose. Allows enforcement actions by any aggrieved person, any State or local government agency, or the Administrator of the Environmental Protection Agency. Provides for civil monetary penalties.
United States · United States Congress · 3 November 1993
Three-Time Loser Act of 1993 - Amends the Federal criminal code to require a court to sentence a defendant convicted of a Federal violent felony to life imprisonment if the defendant had previously been convicted of two or more other violent felonies, at least two of which occurred during separate criminal episodes. Specifies that this Act shall not be construed to prevent the imposition of the death penalty.
United States · United States Congress · 3 November 1993
TABLE OF CONTENTS: Title I: Privacy of Customer Proprietary Network Information Title II: Privacy of Calling Party Information Title III: Access to Telephone Records Title IV: Privacy of Subscriber Information Telephone Consumer Privacy Protection Act of 1993 - Title I: Privacy of Customer Proprietary Network Information - Amends the Communications Act of 1934 (the Act) to prohibit a local exchange carrier (LEC), except upon the customer's request, from: (1) using customer proprietary network information (CPNI) in the provision of any service other than telephone exchange or toll service, in the identification of solicitation of potential customers for any service other than the service from which such information is derived, or in the provision of customer premises equipment; or (2) disclosing such information to any affiliate of, or any other person that is not an employee of, such common carrier. Requires the common carrier to: (1) disclose such information to any customer designee at the customer's request; (2) notify the Federal Communications Commission (FCC) of the availability of aggregate customer proprietary information it provides or to any other person that is not an employee or affiliate of such carrier or to its personnel (any) that are engaged in providing any service that is not necessary to the provision of telephone exchange service or customer premises equipment; and (3) provide such aggregate information on reasonable terms and conditions to any other service or equipment provider, upon reasonable request. Prohibits the common carrier from discriminating between affiliated and unaffiliated service or equipment providers in providing individual and aggregate or compiled information. States that this Act shall not be construed to prohibit the disclosure of CPNI as necessary to render, bill, and collect for telephone exchange or toll service or for any other telecommunications service that the customer has requested. Requires an LEC that provides subscriber list information to any affiliated or unaffiliated service provider or person to provide such list on a timely and unbundled basis, under nondiscriminatory and reasonable rates, terms, and conditions, to any person upon reasonable request. Title II: Privacy of Calling Party Information - Amends the Act to require the FCC to prescribe regulations: (1) requiring any caller identification service offered through a common carrier to allow the caller to withhold the display of the caller's identity to the individual receiving the call; (2) prohibiting any charges for such service; and (3) requiring every common carrier to notify subscribers that their calls may be identified to a called party. Requires any common carrier or affiliate providing automatic number identification (ANI) services to any person to provide such services under a contract or tariff containing telephone subscriber information requirements that: (1) permit such person to use the information provided for billing and collection, completion of the customer's call or transaction, or for services directly related to the customer's call or transaction; (2) prohibit such person from reusing or selling the information provided without the customer's consent; and (3) prohibit such person from disclosing, without the customer's consent, any information derived from such service or from the analysis of the characteristics of a telecommunications transmission for any purpose other than performing the services or transactions that are the subject of the customer's call, ensuring network performance, security, and the effectiveness of call delivery, compiling, using, and disclosing aggregate information, and complying with applicable law or legal process. States that nothing in this Act shall be construed to prevent a common carrier from offering services enabling a telephone subscriber receiving a call to block the call where the caller has chosen to withhold display of the caller's identity. Title III: Access to Telephone Records - Amends the Act to require a common carrier that, pursuant to a subpoena or on demand of other lawful authority, divulges a subscriber's billing information or other information about any interstate or foreign communication by wire or radio, to inform such subscriber within ten days of the identity of the recipient, unless prohibited from doing so by the lawful authority. Title IV: Privacy of Subscriber Information - Requires the FCC to commence a proceeding to: (1) examine the impact on the privacy rights and remedies of consumers of the integration into interconnected communications networks of wireless telephone, cable, satellite, and other technologies; (2) examine the impact that the globalization of such integrated communications networks has on the international dissemination of consumer information and the privacy rights and remedies to protect consumers; (3) propose changes in the FCC's regulations to ensure that consumer privacy rights are protected in new telecommunications services; and (4) prepare recommendations to the Congress for any legislative changes required to correct defects in privacy rights and remedies.
United States · United States Congress · 27 October 1993
Safe Drinking Water Act Amendments of 1993 - Amends the Safe Drinking Water Act to require the Administrator of the Environmental Protection Agency, in the case of specified contaminants listed in the Federal Register for which national primary drinking water regulations have not been promulgated, to: (1) publish maximum contaminant level goals and promulgate such regulations for those contaminants that occur in drinking water and are of public health concern; and (2) eliminate monitoring, compliance, and enforcement requirements for those contaminants that do not occur in drinking water at levels of public health concern. (Current law requires the promulgation of such goals and regulations for specified numbers of such contaminants by certain dates.) Directs the Administrator to promulgate such goals and regulations for new contaminants every five years. Requires the Administrator to establish in each national primary drinking water regulation best technology treatment techniques for public water systems serving fewer than 1,000, between 1,000 and 10,000, and more than 10,000 people, respectively. Directs the Administrator to promulgate national primary drinking water regulations for radionuclides, disinfection and corrosion byproducts, and sulfate. Revises provisions concerning variances from national drinking water regulations to permit the issuance of a variance by a State only if the water system cannot afford to install the best available technology to meet the maximum contaminant level and it is not feasible for the system to connect with another source of water that will meet the standards. Requires variances to be reviewed by the State at least every three years. Repeals provisions that authorize States to exempt public water systems from requirements respecting maximum contaminant levels or treatment techniques. Prohibits treated drinking water from being removed from a public water system or routed through any device or pipes outside the system and returned to the system. Includes such action in the definition of "tampering," a violation for which criminal penalties are imposed. Makes such prohibition inapplicable to pipes and devices totally within the control of one or more public water systems or to connections between water mains. Requires (currently, authorizes) the Administrator to conduct research relating to diseases and other impairments resulting from contaminants in drinking water or to the provision of a safe supply of drinking water. Authorizes appropriations. Extends the authorization of appropriations for grants for State public water system supervision programs. Requires the Administrator to promulgate revised regulations every five years that list up to 30 unregulated contaminants to be monitored by public water systems. Directs the Administrator to assemble a national drinking water occurrence data base to include information on the occurrence of regulated and unregulated contaminants.
![Official portrait of Rep. Kreidler, Mike [D-WA-9]](https://www.congress.gov/img/member/k000328_200.jpg)