United States · United States Congress · 6 October 1994
TABLE OF CONTENTS: Title I: Assuring Availability and Continuity of Health Coverage Subtitle A: Insurance Reforms Subtitle B: Benefits Subtitle C: Employer Responsibilities Subtitle D: Standards and Certification; Enforcement; Preemption Subtitle E: Multiple Employer Health Benefits Protection and Related Provisions Subtitle F: Definitions; General Provisions Title II: Removal of Financial Barriers to Access Subtitle A: Tax Deductibility for Individuals and Self- Employed Subtitle B: Premiums and Cost-Sharing Subsidy Program for Low-Income Individuals Title III: Medicaid Reforms Subtitle A: Treatment of Acute Care Benefits for AFDC and Non-cash Beneficiaries Subtitle B: Flexibility in Expenditures for Supplemental Benefits for AFDC and Non-cash Beneficiaries Subtitle C: Increased State Flexibility in Contracting for Coordinated Care Subtitle D: Additional Medicaid Reforms Title IV: Access Improvements Subtitle A: Expanding Access in Underserved Areas Subtitle B: Improved Access in Rural Areas Subtitle C: Academic Health Centers Subtitle D: United States-Mexico Border Health Commission Title V: Health Care Quality Enhancement Subtitle A: Quality Assurance Subtitle B: Primary Care Provider Education Title VI: Market Incentives to Containing Costs Subtitle A: Facilitating Establishment of Health Plan Purchasing Organization (HPPOs) Subtitle B: Preemption of State Benefit Mandates and Anti-Managed Care Laws Subtitle C: Malpractice Reform Subtitle D: Administrative Simplification Subtitle E: Fair Health Information Practices Subtitle F: Antitrust Subtitle G: Fraud and Abuse Subtitle H: Billing for Laboratory Services Title VII: Medicare Subtitle A: Increased Beneficiary Choice; Improved Program Efficiency Subtitle B: Savings Title VIII: Incentives to Purchase Long-Term Care Insurance Subtitle A: Establishment of Federal Standards for Long-term Care Insurance Subtitle B: Tax Treatment of Long-term Care Insurance Title IX: Department of Veterans Affairs Title X: Miscellaneous Savings Provisions Subtitle A: Automobile Insurance Coordination Subtitle B: Prefunding Government Health Benefits Contributions Bipartisan Health Care Reform Act of 1994 - Title I: Assuring Availability and Continuity of Health Coverage - Subtitle A: Insurance Reform - Part 1: Guaranteed Access to Health Coverage - Requires carriers that offer health insurance coverage in the individual-small group market in a fair rating area to make available qualified standard coverage and high-deductible coverage to qualifying individuals or small employers. (Sec. 1001) Exempts federally qualified health maintenance organizations (HMOs) and HMOs or managed care organizations recognized by State laws from the requirement to provide high-deductible coverage. Prohibits the offer of high-deductible coverage unless the carrier also makes standard coverage available with identical benefits and the individual or employee demonstrates that they have available assets equal to at least the deductible amount under the high-deductible coverage. Requires carriers to provide for coverage of benefits for items and services furnished throughout the fair rating area. Prohibits carriers from limiting coverage to portions of interstate metropolitan statistical areas (MSAs), requiring them to provide coverage throughout the entire MSA. Requires coverage offers to include a family coverage option. Prohibits carriers from requiring employers under group health plans to impose waiting periods for health coverage or require conditions on health coverage based on an individual's: (1) health status; (2) claims experience; (3) receipt of health care; (4) medical history; (5) receipt of public subsidies; or (6) lack of evidence of insurability. (Sec. 1002) Requires carriers to accept every small employer and qualifying individual that applies for enrollment during the required enrollment period. Provides that in the case of coverage offered by carriers or under group health plans that provide benefits through a managed care arrangement, the carriers or plans: (1) need not establish health care facilities throughout the fair rating area if the facilities are located in a manner that does not discriminate on the basis of health status of individuals residing in proximity to such facilities; and (2) may deny coverage under certain conditions. Permits carriers to deny coverage if they do not have the necessary financial reserves. (Sec. 1003) Prohibits carriers from denying, cancelling, or refusing to renew health coverage except on the basis of nonpayment of premiums or fraud or because they are not providing a particular coverage option in the market. Sets limitations on market exit and re-entry by carriers. Establishes similar conditions for cancellation or denial by multiemployer plans and multiple employer health plans. (Sec. 1004) Prohibits carriers or group health plans from excluding coverage with respect to services provided for preexisting conditions, except as provided by this Act. Provides for exclusion periods of up to six months subject to certain conditions. Makes exclusions inapplicable to pregnancy, newborns, adopted children, and certain individuals enrolled or enrolling during an open enrollment period. (Sec. 1005) Sets forth provisions regarding enrollment periods. Part 2: Provision of Benefits - Establishes: (1) standards for managed care arrangements and requirements and utilization review programs; and (2) requirements for arrangements with essential community providers. (Sec. 1014) Provides for the establishment of medical savings accounts. Makes the account beneficiary the owner of the account and includes distributions not used for qualified medical expenses in the beneficiary's gross income. Sets forth uses and limitations for such accounts. Excludes: (1) employer contributions to any medical savings account of an eligible employee from gross income (to the extent such contributions do not exceed the excess of premiums for standard coverage over the premiums for high-deductible coverage); and (2) health benefit payments made by employers from employment taxes. Part 3: Fair Rating Practices - Provides that the premium rate established by carriers for health insurance coverage in the individual-small group market may not vary except by the following: (1) age; (2) geographic area; (3) family class; (4) benefit design of coverage and by type of coverage option; and (5) permitted expense category. (Sec. 1022) Directs carriers and group health plans to accept and apply premium certificates issued under State premium assistance programs under title XXI of the Social Security Act (as established by this Act). (Sec. 1023) Requires the Secretary of Health and Human Services to request the National Association of Insurance Commissioners (NAIC) to develop a model risk adjustment system under which premiums applicable to coverage in the individual-small group market and coverage under small employer pooling arrangements and multiple employer welfare arrangements that are fully insured would be adjusted to take into account factors to predict the future need and efficient use of services by covered individuals in the market. Incorporates such model into a rule that specifies risk adjustment mechanisms. Requires each State to develop systems that conform with the Federal model. Part 4: Consumer Protections - Requires carriers and group health plans to provide information relating to their performance in providing coverage to specified individuals, including prospective enrollees. (Sec. 1032) Prohibits carriers from varying the commission or other remuneration to a person based on the claims experience or health status of individuals enrolled by or through such person. Subtitle B: Benefits - Sets forth provisions regarding standard coverage, preventive benefits to be covered without any deductible or cost-sharing, and high-deductible coverage. (Sec. 1105) Sets forth conditions under which supplemental benefits may be provided. (Sec. 1106) Requires carriers and group health plans to provide for an option under which children under 26 (without regard to whether they are students or disabled) will be treated as family members. Authorizes additional premiums for such option. (Sec. 1107) Includes coverage provided by Christian Science practitioners or in a Christian Science sanitorium within benefits under standard coverage. Subtitle C: Employer Responsibilities - Requires employers to make available to qualifying employees coverage under a group health plan that meets specified requirements, including: (1) an annual offering of coverage; (2) a choice of coverage and family coverage options; (3) an annual enrollment period; and (4) payroll withholding of premiums. (Sec. 1201) Provides that an employer is not required, subject to provisions regarding an equal contribution rule, to make any contribution to the cost of health coverage. Makes requirements regarding choice of coverage inapplicable if a group health plan is in effect as of July 1, 1994, and the employer makes contributions on behalf of employees under a collective bargaining agreement or similar contract. Excludes from this subtitle's requirements certain new and small employers. (Sec. 1202) Imposes an excise tax for failures of employers to comply with this subtitle. Subtitle D: Standards and Certification; Enforcement; Preemption; General Provisions - Directs the Secretary to request the NAIC to develop model regulations that specify standards with respect to this subtitle for carriers and health insurance coverage. (Sec. 1304) Imposes a tax on carriers that fail to comply with Parts 1 through 4 of Subtitle A and Subtitle B of this title unless a State has in effect a regulatory mechanism that provides sanctions. (Sec. 1305) Prohibits a single employer plan from offering health coverage other than through a carrier unless the plan has at least 100 eligible employees. Subtitle E: Multiple Employer Health Benefits Protections and Related Provisions - Part 1: Multiple Employer Health Benefits Protections - Amends the Employee Retirement Income Security Act of 1974 (ERISA) to establish certification standards under title I (Protection of Employee Benefit Rights) for multiple employer welfare arrangements (MEWAs) providing health benefits. (Sec. 1401) Treats as employee welfare benefits plans, and exempts from certain restrictions on preemption, a MEWA which provides benefits consisting solely of specified medical care, which is not fully insured, and which applies for and receives a specified certification. Requires certain disclosures to participating employers. Requires certified MEWAs which are not fully insured to maintain excess-stop loss coverage and specified types of reserves. Sets forth corrective actions which such MEWAs' operating committees must take: (1) to avoid depletion of reserves; or (2) in connection with termination of the MEWA. Provides for review of actions by the Secretary of Labor with respect to denials of applications for, or suspensions or revocations of, such certifications. Requires, in cases where coverage is provided under a multiple employer health plan and more than ten percent of the participating employers are small employers, that the arrangement is maintained in the form of a small employer pooling arrangement. Sets forth requirements for such arrangements. (Sec. 1402) Revises ERISA with respect to: (1) a specified exemption from preemption; (2) treatment of single employer arrangements; and (3) treatment of certain collectively bargained arrangements. (Sec. 1405) Sets forth ERISA requirements relating to employee leasing health care arrangements (ELHAs). Provides for treatment of ELHAs as MEWAs, with certain exceptions. Sets forth special rules under which an ELHA may receive a MEWA certification. (Sec. 1408) Allows delegation to a State of some or all of the Secretary's enforcement authority with respect to MEWAs with certifications. Directs the Secretary to provide enforcement and technical assistance to the States with respect to MEWAs. Part 2: Simplifying Filing of Reports for Employers Covered under Multiple Employer Welfare Arrangements Providing Fully Insured Coverage Consisting of Medical Care - Directs the Secretary to prescribe an alternative method for the filing of a single annual report for all participating employers under MEWAs under which all coverage consists of medical care and is fully insured. Subtitle F: Definitions; General Provisions - Part 1: Definitions - Sets forth specified definitions. (Sec. 1905) Makes this title effective for plan years beginning on or after 1997 with respect to group health plans and as of January 1, 1997, with respect to carriers (for coverage other than under a group health plan). Part 2: Report and Recommendations on Health Coverage and Access - Provides that it is an objective of this Act to assure by 2002 that: (1) all eligible individuals in the United States have access to health coverage; and (2) at least 95 percent of such individuals have such coverage. (Sec. 1912) Requires the Secretary of Health and Human Services to report to the Congress on the extent to which eligible individuals have, or have access to, health care coverage. Title II: Removal Of Financial Barriers To Access - Subtitle A: Tax Deductibility for Individuals and Self-Employed - Amends the Internal Revenue Code to: (1) increase on a graduated basis the tax deduction for health insurance costs of self-employed individuals; (2) make the deduction permanent; (3) allow a tax deduction, regardless of whether the taxpayer itemizes other deductions, for health insurance costs of non-self-employed individuals not eligible to participate in any subsidized employer health plan; and (4) subject to taxation certain health benefits provided through cafeteria plans and flexible spending arrangements. Subtitle B: Premium and Cost-Sharing Subsidy Program for Low-Income Individuals - States that the amendments made by this subtitle and title III below provide for a transition from the current Medicaid system to a new system of acute care low-income assistance. (Sec. 2101) Amends the Social Security Act (SSA) to add a new title XXI providing for the establishment of new State programs under which, as a requirement for State participation in Medicaid, certain low-income eligible individuals who are not Medicare beneficiaries, SSI recipients, prison inmates, or unlawful aliens will be eligible for premium and cost-sharing assistance for use in obtaining qualifying coverage of the standard and preventive health benefits discussed above under title I of this Act. Sets forth specific requirements for such programs, allowing waivers in the case of any demonstration project which in the judgment of the Secretary of Health and Human Services is likely to assist in promoting the objectives of new SSA title XXI. Creates in the Treasury the Health Care Assurance Trust Fund to contain the savings resulting from this Act and other specified amounts for use in paying States operating subsidy and supplemental acute care benefits programs. Establishes a mechanism for financing such programs that is designed to be deficit neutral. Prohibits the use of funds appropriated to carry out new SSA title XXI to provide premium or cost-sharing assistance or supplemental acute care benefits under part B added below in connection with any abortion, except in cases where an abortion is necessary to save the life of the mother or where the pregnancy results from rape or incest. Title III: Medicaid Reforms - Subtitle A: Treatment of Acute Care Benefits for AFDC and Non-Cash Beneficiaries - Amends SSA title XIX (Medicaid) to: (1) establish Medicaid rules for benefits for acute medical services for AFDC recipients and non-cash Medicaid beneficiaries; (2) provide for the division of acute medical service benefits into core benefits and supplemental acute care benefits; (3) limit the amount of Federal financial participation for benefits for acute medical services for AFDC recipient and non-cash Medicaid beneficiaries; (4) condition Federal financial participation on State maintenance-of-effort; and (5) provide for the continuation of State Medicaid eligibility categories. Subtitle B: Flexibility in Expenditures for Supplemental Benefits for AFDC and Non-Cash Beneficiaries - Amends new SSA title XXI to require each State to establish a State supplemental acute care benefits program. Subtitle C: Increased State Flexibility in Contracting for Coordinated Care - Amends SSA title XIX to modify Federal requirements to allow States more flexibility in contracting for coordinated care services. Subtitle D: Additional Medicaid Reforms - Amends SSA title XIX to make various specified changes providing for: (1) a reduction in the amount of payment adjustments for disproportionate share hospitals; (2) elimination of the medically needy program for individuals not in an institution; and (3) elimination of the Medicaid pediatric immunization program, and establishment of alternative delivery programs. Title IV: Access Improvements - Subtitle A: Expanding Access in Underserved Areas - Amends SSA title XI to provide for community health authorities demonstration projects for providing access to cost-effective preventive and primary care and related services for various areas and populations, including low-income residents of medically underserved areas or for medically underserved populations. Amends the Public Health Service Act to authorize the Secretary to make grants to migrant and community health centers for the development of health service networks for serving high impact areas, medically underserved areas, or medically underserved populations within the area they serve. Subtitle B: Improved Access in Rural Areas - Part 1: Grants to Encourage Community Rural Health Networks - Directs the Secretary of Health and Human Services to make grants to an eligible State for the development of plans to increase access to health care services for residents of areas in the State designated as chronically underserved areas. Provides for technical assistance for entities establishing or enhancing a community rural health network in an underserved rural area. Provides financial assistance to entities to provide for the development and implementation of community rural health networks. Authorizes appropriations. Part 2: Incentives for Health Professionals to Practice in Rural Areas - Subpart A: National Health Service Corps Program - Amends the Internal Revenue Code to exclude National Health Service Corps Loan Repayments from gross income. (Sec. 4113) Increases the authorization of appropriations for the National Health Service Corps Scholarship and Loan Repayment Programs. Subpart B: Incentives Under Other Programs - Amends title XVIII (Medicare) of the Social Security Act to provide incentives under such Act to physicians in former shortage areas. Directs the Secretary to develop and publish a model law for adoption by States to increase the access of individuals residing in underserved rural areas to health care services by expanding the services which non-physician health care professionals may provide in such areas. Part 3: Assistance for Institutional Providers - Subpart A: Community and Migrant Health Centers - Extends and increases the authorizations of appropriations for migrant health centers and community health centers. Subpart B: Emergency Medical Systems - Revises title XII (Trauma Care) of the Public Health Service Act. Renames such title Emergency Medical and Trauma Care Services. Directs the Secretary to establish the Office of Emergency Medical and Trauma Care Services. Requires the Secretary to: (1) conduct and support research and demonstration projects; (2) foster development of appropriate modern systems of services; (3) assist States; and (4) coordinate and sponsor related activities. Requires that activities meet the unique needs of underserved inner-city and rural areas. (Sec. 4141) Authorizes grants to States to improve the availability and quality of emergency medical services through the operation of State offices of emergency medical services. Authorizes appropriations for emergency medical services. (Sec. 4142) Directs the Secretary to make grants to assist States in the creation or enhancement of air medical transport systems that provide victims of medical emergencies in rural areas with access to treatments for injuries resulting from such emergencies. Authorizes appropriations. Subpart C: Assistance to Rural Providers Under Medicare - Amends title XVIII (Medicare) of the Social Security Act to: (1) increase by two the number of States eligible to participate in the essential access community hospital program; and (2) make other revisions concerning such program, including permitting the participation of hospitals in urban areas and the participation of hospitals in States adjoining participating States. Extends, by three years, the deadline for the development of prospective payment systems for both inpatient and outpatient rural primary care hospital services. (Sec. 4152) Defines a rural emergency access care hospital and rural emergency access care hospital services for purposes of title XVIII. Provides for the coverage of such services under part B (Supplementary Medical Insurance) of title XVIII. Subpart D: Demonstration Projects to Encourage Primary Care and Rural-Based Graduate Medical Education - Directs the Secretary to establish and conduct a demonstration project to increase the number and percentage of medical students entering primary care practice. Authorizes appropriations. Part 4: Hospital Affiliated Primary Care Center - Requires the Secretary to make grants and provide technical assistance to community hospitals for the development and operation of primary care services in medically underserved areas. Provides for a plan to allow primary care centers to retain income earned from operation under certain conditions. Authorizes appropriations. Subtitle C: Academic Health Centers - Directs the Secretary to study and report to the Congress on: (1) the feasibility and desirability of making payments to facilities that are not hospitals for the costs of graduate medical education attributable to residents trained at such facilities; and (2) determining the funding needs of health professions schools. Subtitle D: United States-Mexico Border Health Commission - Authorizes the President to conclude an agreement with Mexico to establish a binational commission to be known as the United States-Mexico Border Health Commission. (Sec. 4302) Declares that it should be the duty of the Commission to: (1) conduct a needs assessment in the U.S.-Mexican border area to identify and resolve health problems that affect the general population of the area; and (2) formulate recommendations for a fair method by which the government of one country could reimburse a public or private entity in the other country for the cost of a health care service furnished to a citizen of the first country who is unable to pay for the service. States that the Commission should establish at least two regional border offices in selected locations. Title V: Health Care Quality Enhancement - Subtitle A: Quality Assurance - Directs the Secretary to establish a Health Quality Advisory Council to develop an initial set of quality measures to be used to assess the quality of carriers, group health plans, and multiple employer welfare arrangements. Provides for auditing of such entities to determine compliance with certain quality measure and reporting requirements. Subtitle B: Primary Care Provider Education - Amends the Public Health Service Act to extend through FY 1999 authorized funding for training for certain health service providers. Title VI: Market Incentives to Containing Costs - Subtitle A: Facilitating Establishment of Health Plan Purchasing Organization (HPPOs) - Part 1: Health Plan Purchasing Organizations - Authorizes the establishment of health plan purchasing organizations (HPPOs) in accordance with this part. (Sec. 6002) Requires HPPOs to enter into agreements with carriers that desire to make health coverage available through HPPOs. (Sec. 6004) Requires HPPOs to offer enrollment for coverage for carriers. Authorizes HPPOs to impose administrative fees for enrollment. (Sec. 6006) Requires States to: (1) review the access of residents who are not employees of large employers or Medicare beneficiaries to obtain standard health insurance coverage through an HPPO; and (2) take actions to ensure that public or private entities provide access to residents who are unable to obtain such coverage. Part 2: Encouragement of Multiple Employer Arrangements Providing Basic Health Benefits - Amends the Internal Revenue Code to eliminate the commonality of interest or geographic location requirement for tax exempt trust status for certified multiple employer health plans, fully-insured multiple employer welfare arrangements, and other specified plans described by ERISA. Part 3: Tax Exemption for High Risk Pools - Provides tax-exempt status to corporations or similar legal entities created by States or political subdivisions to establish risk pools to provide health insurance coverage to persons unable to obtain such insurance because of health conditions. Subtitle B: Preemption of State Benefit Mandates and Anti-Managed Care Laws - Preempts State laws that: (1) mandate health insurance benefits; (2) restrict managed care arrangements and utilization review programs; and (3) prohibit two or more employers from obtaining coverage that is fully-insured under multiple employer health plans. (Sec. 6105) Prohibits States from enforcing standards for health insurance coverage that differ from those established under title I of this Act. (Sec. 6106) Directs the Comptroller General to study and report to the Congress on the benefits and cost effectiveness of the use of managed care in the delivery of health care services. Subtitle C: Malpractice Reform - Part 1: Uniform Standards for Malpractice Claims - Makes this part applicable to any medical malpractice liability action brought in a Federal or State court and to any medical malpractice claim subject to an alternative dispute resolution (ADR) system that is initiated on or after January 1, 1996. (Sec. 6202) Prohibits a medical malpractice liability action from being brought in any State court during a calendar year unless the relevant claim has been initially resolved (i.e., a decision has been reached on whether the defendant is liable to the plaintiff for damages and on the amount of damages) under a certified ADR system or an alternative Federal system. Prohibits a medical malpractice liability action from being brought in Federal court based on diversity of citizenship during a calendar year unless the relevant claim has been initially resolved under such a system in the State whose law applies. Directs the Attorney General to establish an ADR process for tort claims consisting of medical malpractice liability claims brought against the United States. Prohibits a medical malpractice liability action based on such a claim from being brought in any Federal court unless the claim has been initially resolved under such process. Sets forth procedures for filing actions. (Sec. 6203) Authorizes States to develop specialty clinical practice guidelines to be certified by the Secretary. (Sec. 6204) Limits to $250,000 the amount of noneconomic damages that may be awarded to a claimant and family members in a medical malpractice liability action. (Sec. 6206) Sets forth provisions regarding: (1) limits on attorney fees and other costs; and (2) statutes of limitations. (Sec. 6208) Specifies that in the case of a medical malpractice claim relating to services provided during labor or the delivery of a baby, if the health care professional or provider did not previously treat the claimant for the pregnancy, the trier of fact may not find that the defendant committed malpractice nor assess damages unless the malpractice is proven by clear and convincing evidence. (Sec. 6210) Provides that this part preempts State law, except for State law that imposes greater restrictions than those provided in this part. Part 2: Requirements for State Alternative Dispute Resolution Systems (ADR) - Lists requirements for State ADR systems, including that such a system: (1) applies to all medical malpractice liability claims under the jurisdiction of the courts of that State; (2) requires that a written opinion resolving the dispute be issued within six months after each party against whom the claim is filed has received notice of the claim; (3) is approved by the State or local governments; (4) provides for the transmittal to the State agency responsible for monitoring or disciplining health care professionals and providers of any findings of malpractice; and (5) provides for the regular transmittal of information on disputes resolved under the system to the Administrator for Health Care Policy and Research in a manner that protects the identity of the parties involved. (Sec. 6222) Directs the Secretary to certify State ADR systems that meet such requirements on an annual basis. Requires the Secretary to establish an alternative Federal ADR system for the resolution of medical malpractice liability claims in States that do not have in effect a certified ADR system. (Sec. 6223) Directs the Secretary to submit to the Congress a report describing and evaluating State ADR systems and the alternative Federal system. Part 3: Definitions - Sets forth definitions for this subtitle. Subtitle D: Administrative Simplification - Part 1: Standards for Data Elements and Transactions - Directs the Secretary to adopt standards for: (1) the electronic transmission of health information data; and (2) information transactions. Part 2: Requirements with Respect to Certain Transactions and Information - Lists transactions to be considered as standard transactions with respect to plan sponsors and HPPOs. (Sec. 6322) Requires certified health information security organizations to make available to Federal or State agencies, pursuant to a cost-type contract, any non-identifiable health information that is held by the service, consists of data elements that are subject to a standard under part 1, and is requested by such an agency to fulfill a requirement under this Act. (Sec. 6323) Directs the Secretary to establish a procedure under which a plan sponsor or health provider that does not have the ability to transmit standard data elements and does not have access to a certified health information network may comply with this part. Part 3: Miscellaneous Provisions - Requires the Secretary to establish standards and a certification procedure for health information network services. (Sec. 6333) Provides that this subtitle supersedes State law. Prohibits the enforcement of any State law that requires medical or health plan records to be maintained or transmitted in written rather than electronic form, except as provided by the Secretary. (Sec. 6334) Authorizes the Secretary to make grants for demonstration projects to promote the development and use of electronically integrated community-based clinical information systems and computerized patient medical records. Part 4: Assistance to the Secretary - Establishes the Health Care Information Advisory Committee to: (1) provide assistance to the Secretary in complying with the requirements imposed on the Secretary under this subtitle and subtitle E; (2) be responsible for advising the Secretary and the Congress on the status of the health information network; and (3) make recommendations to correct any problems that may occur in the network's implementation and operations and to refine and improve the network. Subtitle E: Fair Health Information Practices - Part 1: Duties of Health Information Trustees - Sets forth rights of individuals with respect to inspection of protected health information maintained by a health information trustee (specified entities, including health care providers, health benefit plan sponsors, and public health authorities). Makes exceptions to inspection rights if: (1) the information relates to mental health treatment notes or persons other than the protected individual; (2) the inspection could be expected to threaten an individual's life or personal safety; (3) the information could lead to the identification of a confidential source; (4) the information is used solely for administrative purposes or is duplicative; or (5) the information is compiled principally in anticipation of a legal proceeding. (Sec. 6402) Sets forth conditions under which a trustee must correct or amend information at the request of a protected individual. (Sec. 6404) Provides for: (1) recordkeeping with respect to health information disclosures; and (2) safeguards to ensure confidentiality and protection of information. Part 2: Use and Disclosure of Protected Health Information - Permits a health information trustee to use protected health information only for a purpose that is compatible with and related to the purpose for which the information was collected or received or for which the trustee is authorized to disclose under this subtitle. (Sec. 6411) Limits the use or disclosure of protected health information by a health information trustee to the minimum amount of information necessary. (Sec. 6412) Authorizes a health information trustee to disclose protected health information pursuant to an authorization executed by the individual who is the subject of the information if specified requirements are met. (Sec. 6413) Authorizes the disclosure of protected health information, subject to specified restrictions: (1) in connection with treatment and payment; or (2) for use in an action against or investigation of an individual relating to receipt of or payment for health care. (Sec. 6414) Sets forth provisions regarding the disclosure of protected health information to next of kin and others. (Sec. 6415) Establishes requirements with respect to the reporting of protected health information: (1) to a public health authority; (2) for a health research project; (3) in emergency circumstances; (4) for judicial and administrative purposes; (5) to a law enforcement agency; (6) pursuant to subpoena or warrant; and (7) to a health information service organization. Part 3: Access Procedures and Challenge Rights - Sets forth access procedures and challenge rights with respect to attempts to obtain protected health information. Part 4: Miscellaneous Provisions - Provides that if a protected individual pays a health information trustee for health care by presenting a debit, credit, or other payment card or by other electronic means, the trustee may only disclose protected health information as is necessary for the processing of the payment transaction. (Sec. 6442) Sets forth conditions under which protected health information may be released to persons outside the United States. (Sec. 6443) Directs the Secretary to establish standards with respect to the creation, transmission, receipt, and maintenance, in electronic and magnetic form, of documents required or authorized under this subtitle. (Sec. 6444) Sets forth duties of affiliated persons to whom health information trustees are authorized to provide protected health information. (Sec. 6445) Sets forth the rights of persons acting as agents or attorneys of protected individuals or on behalf of minors. Part 5: Enforcement - Authorizes persons whose rights under this subtitle have been knowingly or negligently violated to maintain civil actions. Sets forth penalty provisions. (Sec. 6453) Directs the Secretary to develop alternative dispute resolution methods for use by individuals, health information trustees, and others in resolving claims made in civil actions. (Sec. 6454) Amends the Federal criminal code to provide penalties for offenses related to protected health information. Part 6: Amendments to Title 5, United States Code - Requires Federal agencies that are health information trustees to promulgate rules to exempt systems of records within such agencies, to the extent that such systems contain protected health information, from certain provisions regarding access and other requirements with respect to an individual's records. Part 7: Regulations, Research, and Education; Effective Dates; Applicability; and Relationship to Other Laws - Directs the Secretary to prescribe regulations to carry out this subtitle. (Sec. 6471) Authorizes the Secretary to sponsor: (1) research relating to the privacy and security of protected health information; (2) the development of consent forms governing the disclosure of such information; and (3) the development of technology to implement standards regarding such information. Directs the Secretary to establish education and awareness programs to: (1) foster security practices by health information trustees; (2) train personnel of health information trustees respecting their duties with respect to such information; and (3) inform individuals and employers who purchase health care respecting their rights with respect to such information. (Sec. 6474) Prohibits States from enforcing any law that is inconsistent with certain requirements of this subtitle or imposes additional requirements with respect to health information trustees. Subtitle F: Antitrust - Directs the Attorney General to: (1) provide for the development of guidelines on the application of antitrust laws to the activities of health plans; and (2) establish a review process under which a health plan may request the Department of Justice's opinion on the plan's conformity with the Federal antitrust laws. (Sec. 6502) Requires the Attorney General to issue a certificate of public advantage to each eligible health care collaborative activity that complies with this section's requirements. Provides that such activity shall not be liable under the antitrust laws for conduct described in the certificate if such conduct occurs while the certificate is in effect. Directs the Attorney General to issue such a certificate if: (1) the benefits that are likely to result from the activity outweigh the reduction in competition that is likely to result; and (2) such reduction is necessary to obtain such benefits. Sets forth activity eligibility requirements. (Sec. 6503) Directs the Attorney General to report annually to the Congress as part of the annual budget oversight proceedings concerning the Antitrust Division of the Department of Justice. Requires the report to enable the Congress to determine how enforcement of antitrust laws is affecting the formation of efficient, cost-saving joint ventures and if the certificate of public advantage procedure has resulted in undesirable reduction in competition in the health care marketplace. Subtitle G: Fraud and Abuse - Directs the Attorney General to establish a program to: (1) coordinate Federal, State, and local law enforcement programs to control fraud and abuse with respect to the delivery of and payment for health care in the United States; (2) conduct investigations, audits, evaluations, and inspections relating to the delivery of and payment for health care in the United States; and (3) facilitate the enforcement of certain SSA title XI mandatory exclusion and other provisions applicable to health care fraud and abuse. Requires the Attorney General in carrying out such program to provide for coordination with law enforcement agencies, State Medicaid Fraud Control Units, State licensing agencies, as well as with third party insurers. (Sec. 6602) Authorizes additional appropriations for the Attorney General to investigate allegations of health care fraud and otherwise carry out the program established above. (Sec. 6603) Creates in the Treasury the Anti-Fraud and Abuse Trust Fund consisting of Federal health anti-fraud and abuse penalties for use in: (1) carrying out the program above; (2) supporting educational activities to prevent the occurrence of violations of anti-fraud and abuse laws; and (3) repaying beneficiaries for cost- sharing. (Sec. 6611) Amends SSA title XI to revise current sanctions for health care fraud and abuse, among other changes, providing for: (1) mandatory exclusion from participation in Medicare and State health care programs of any individuals convicted of a felony relating to fraud or the unlawful manufacture, distribution, prescription, or dispensing of a controlled substance; and (2) establishment of a minimum period of exclusion for certain individuals and entities subject to permissive exclusion from Medicare and State health care programs. (Sec. 6615) Amends SSA title XVIII to modify the limitations on physician self-referral. (Sec. 6616) Directs the Comptroller General to study and report to the Congress on the costs incurred by eligible organizations with risk-sharing contracts of complying with the requirement of entering into a written agreement with an entity providing peer review services with respect to services provided by the organization. (Sec. 6621) Amends the Federal criminal code to provide for: (1) penalties for health care fraud, including making it a felony; (2) rewards for information leading to prosecution relating to health care fraud; and (3) broadened application of mail fraud statute provisions. (Sec. 6631) Amends SSA titles XI and XVIII to authorize the issuance of advisory opinions by the Secretary according to specified guidelines. (Sec. 6641) Requires each State to establish and maintain a State agency to act as a Health Care Fraud and Abuse Control Unit for: (1) investigating and prosecuting violations under any Federally-funded or mandated health care program relating to fraud under State laws; (2) reviewing complaints of abuse or neglect involving patients of facilities receiving Federal payments and, where appropriate, investigate and prosecute such complaints; and (3) providing for the collection, or referral for collection, of overpayments made under any such program and found by the Unit. Subtitle H: Billing for Laboratory Services - Amends the Public Health Service Act to make it unlawful for any person who furnishes ancillary health services to present a bill or demand for payment to any person other than the patient receiving such services, with specified exceptions. Exempts ancillary health services for which payment may be made under Medicare. (Sec. 6701) Defines "ancillary health services" as clinical laboratory services, diagnostic x-rays and other diagnostic tests, durable medical equipment, and physical therapy services. Sets forth conditions under which a person who furnishes ancillary health services may present a bill or demand for payment to specified entities other than the patient. Imposes civil penalties for repeated and knowing demands for payment in violation of this subtitle. Provides for other sanctions for such violations, including the suspension of laboratory certifications and exclusion from participation in Medicare programs. Title VII: Medicare - Subtitle A: Increased Beneficiary Choice; Improved Program Efficiency - Amends SSA title XVIII to revise provisions for payments to health maintenance organizations (HMOs) to: (1) provide for the use of metropolitan statistical areas to determine adjusted average per capita cost; (2) require the Secretary to develop additional specified model packages of health benefits providing coverage for catastrophic illness, prescription drugs, and preventive services which an HMO may provide at its option; and (3) make various specified changes in HMO membership requirements, including changes in associated waiver provisions, and enrollment periods. (Sec. 7002) Amends the Omnibus Budget Reconciliation Act of 1990 to permit Medicare supplemental policies in all States. Modifies Medicare supplemental policy provisions. (Sec. 7003) Includes notice of available HMOs and carriers offering Medicare supplemental policies in the annual notice of Medicare benefits mailed to Medicare beneficiaries. (Sec. 7004) Directs the Secretary to: (1) develop and submit to the Congress a proposal for legislation which provides for the voluntary enrollment of Medicare beneficiaries in private health insurance plans; (2) provide for a monthly payment to a qualified private health insurance plan on behalf of enrolled Medicare beneficiaries who choose to enroll in such a plan (with the enrollee paying any difference between the monthly premium charged under the plan and the amount paid for under Medicare for the enrollee's class, while maintaining budget-neutrality); and (3) take such steps as may be necessary to consolidate the administration of Medicare parts A (Hospital Insurance) and B (Supplementary Medical Insurance). (Sec. 7003) Includes notice of an individual's rights under State law with regard to the formulation of advance directives in the annual notice of Medicare benefits mailed to Medicare beneficiaries. Subtitle B: Savings - Amends Medicare provisions relating to Medicare part A to provide for reductions in: (1) the update for payments for inpatient hospital services; and (2) payments for capital-related costs for inpatient hospital services. (Sec. 7111) Amends Medicare part B provisions on payment for physicians' services to provide for: (1) use of cumulative performance standards; (2) treatment of default update; (3) use of real GDP to adjust for volume and intensity; (4) repeal of restriction on maximum reduction under conversion factor update adjustment provisions; and (5) reduction in the conversion factor for the physician fee schedule for 1995. (Sec. 7112) Provides for the imposition of coinsurance on laboratory services. (Sec. 7113) Amends the Internal Revenue Code to provide for an increase in the Medicare part B premiums for high-income individuals. (Sec. 7114) Amends Medicare to provide for: (1) the extension of the 25 percent part B premium; (2) a reduction in hospital outpatient services and home health services through the establishment of a prospective payment system; and (3) various specified changes with regard to Medicare as secondary payer. Title VIII: Incentives to Purchase Long-Term Care Insurance - Subtitle A: Establishment of Federal Standards for Long-Term Care Insurance - Amends SSA to provide for model standards incorporating specified requirements for sales practices, benefits, and other matters that long-term care insurance policies must meet. Establishes civil monetary penalties for violations. Requires the National Association of Insurance Commissioners to issue guidelines for endorsements of long-term care insurance policies, or that permit such policies to be offered for sale through the organization or association. Subtitle B: Tax Treatment of Long-Term Care Insurance - Amends the Internal Revenue Code to provide for the treatment of long-term care insurance contracts as accident or health insurance contracts generally, with qualified long-term services treated as medical care, among other changes with regard to long-term care insurance. Subtitle C: Studies - Requires the Comptroller General to conduct a study on the feasibility of: (1) encouraging health care providers to donate their services to homebound patients; and (2) providing heads of households who care for elderly family members in their homes with a tax credit. (Sec. 8203) Directs the Secretary to conduct a study and report to the Congress on: (1) case management of current long-term care benefits; and (2) subacute care. Title IX: Department of Veterans Affairs - Authorizes each veteran residing in the United States, certain surviving spouses and children of such veterans (also living in the United States) who are not otherwise eligible for medical care under the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), and family members thereof to be enrolled with a Department of Veterans Affairs (VA) health care plan. Requires the payment of appropriate premiums, deductibles, copayments, or coinsurance with respect to such family members. Continues the eligibility of family members after the death of the veteran originally enrolled. Directs the Secretary of Veterans Affairs (Secretary, for purposes of this title) to establish enrollment ceilings to limit the number of eligible individuals enrolling for such coverage. Requires conformity of such plans with health plan requirements set forth in this Act and inclusion of all the items and services in the standard coverage under this Act. Directs the Secretary to continue to provide to veterans authorized VA care and services which are not included in the standard coverage provided under this Act. Provides for the continuation in the VA of specialized disabled veteran treatment and rehabilitative needs and facilities and requires a report on such continuation from the Secretary to specified congressional committees. Allows such plans to offer supplemental health benefits and cost-sharing policies consistent with this Act. Provides a limitation with regard to veterans who elect not to enroll to obtain such coverage. Prohibits the imposition of a cost-share charge of any kind upon a veteran for the treatment of a service-connected disability that requires specialized treatment by the VA. Prohibits funds appropriated to carry out this title from being used to provide abortions except when necessary to save the life of the mother or when the pregnancy is the result of rape or incest. Prohibits the imposition of cost-sharing charges of any kind upon veterans who are disabled to a degree of ten percent or more, veterans released from service due to a service-connected disability, veterans receiving disability compensation from the VA, former prisoners of war, veterans of the Mexican border period or World War I, and veterans unable to defray the costs of such care. Directs the Secretary to establish rates for premiums and other applicable charges with respect to all other enrollees. Empowers the Secretary to recover from third parties the cost of providing such care and services if such care and services would have been required to be provided by such third party. Establishes in the Treasury the Department of Veterans Affairs Health Coverage Fund to be used for VA health plan payments and services. Preserves existing health care benefits for facilities not offering qualified health coverage under this Act. Authorizes the Secretary to organize VA health plans and facilities as plans and facilities offering qualified health coverage under this Act. Requires any health insurance program provided for Federal employees to include as an option enrollment to obtain VA coverage. Requires the Secretary to take appropriate steps to ensure the financial solvency and stability of the VA coverage and of the contractors and subcontractors providing services as part of such coverage. Preempts certain State action with respect to standards and requirements of such coverage. Requires VA health care facilities to serve as providers to individuals residing in a State that operates as a single payer system, with appropriate reimbursement. Authorizes the head official offering VA health coverage or the director of a VA health care facility to enter into agreements with health care plans, insurers, health care providers, and other entities to furnish or obtain any health-care resource. Provides certain other administrative and personnel flexibility to the Secretary in providing or obtaining such services. Directs the Secretary of the Treasury to: (1) credit to a special fund specified amounts for FY 1995 and 1996 to be used for providing VA health coverage under this Act; and (2) report to the Congress on the operation of the VA health care system with respect to national health care reform as set forth under this Act. Authorizes the Secretary to apply for and accept grants and other forms of assistance to meet the needs of special populations. (Sec. 9003) Makes veterans enrolled with a VA plan under this title eligible for nursing home care, outpatient care, and care provided to obviate the need for hospital admission. (Sec. 9004) Makes any herbicide-exposed veteran eligible for hospital and nursing home care for any disease for which the National Academy of Sciences has determined: (1) that there is a positive association between disease occurrence and herbicide exposure; (2) that there is evidence suggesting such an association, though the evidence is limited; or (3) that available studies are insufficient to permit a conclusion about the presence or absence of such an association. Limits the authorized length of such care for eligible veterans. (Sec. 9005) Extends the authority to provide priority outpatient health care to veterans for exposure to environmental hazards until October 1, 1998, for any disability which becomes manifest before October 1, 1996. (Sec. 9006) Directs the Secretary to report to the Congress on the desirability and feasibility of waiving any requirement for cost-sharing under a VA health plan in the case of medical care provided to a family member of a Persian Gulf War veteran for any disease or disability which may be related to such service. (Sec. 9007) Directs the Secretary, during FY 1995 through 1997, to carry out and report to specified congressional committees on a study of the effect of telemedicine on the delivery of VA health care services. (Sec. 9008) Directs the Secretary of Health and Human Services to develop and submit to the Congress a proposal for legislation which provides for obtaining VA health coverage for Medicare beneficiaries who are veterans. (Sec. 9009) Directs the Secretary to carry out a pilot program to reduce waiting times for patients seeking health-care services in VA outpatient clinics and the traveling distance to such clinics by providing for operation of approximately 20 new outpatient clinics around two VA medical centers. Authorizes appropriations for FY 1998 through 2004. Title X: Miscellaneous Savings Provisions - Subtitle A: Automobile Insurance Coordination - Requires individuals enrolled in a health plan to receive automobile insurance medical services exclusively through the health plan. Makes such services subject to all quality, cost containment, and anti-fraud and abuse provisions that apply generally to medical services provided by or through health plans. (Sec. 10002) Permits an individual and an automobile insurance carrier to agree that treatment for bodily injury sustained in an automobile accident shall be provided by other than the health plan through which such individual is enrolled. Authorizes States to require such carriers to make direct payment to health care providers for automobile insurance medical services that are covered by Medicare or Medicaid and an automobile insurance contract that provides for direct payment of medical services regardless of fault. (Sec. 10003) Requires carriers liable for payment for automobile insurance medical services to make payment to health plans to the extent of obligations under the contract. Grants federally funded health care plans first priority to receive payment pursuant to any obligation under an automobile insurance policy covering such medical services. (Sec. 10004) Directs States to establish systems for prompt payment for automobile insurance medical services by such carriers to health plans, including mechanisms for resolution of disputes. Requires sanctions to be prescribed for failures to comply with this subtitle's requirements. (Sec. 10005) Requires the Secretary of Health and Human Services to provide for allotments to States for administrative expenses in carrying out this subtitle. Subtitle B: Prefunding Government Health Benefits Contributions - Directs each Federal agency within the executive branch whose receipts and disbursements are not generally included in the totals of the Government budget submitted by the President, effective FY 1994 (or February 1, 1995, in the case of the agency with the greatest number of employees), to prepay the Government contributions which will be required in connection with providing health-benefits coverage for annuitants of such agency.
United States · United States Congress · 30 September 1994
Directs the Secretary of Defense (Secretary) to establish a centralized personnel locator service that includes the addresses of each member of the armed forces. Requires addresses of members of the Coast Guard to be included upon request of the Secretary of Transportation. Requires the Secretary to update the locator service within 30 days after a listed member establishes a new address. Directs the Secretary to make such information available, upon request, to the Federal Parent Locator Service. Directs the Secretary of each military department (and the Secretary of Transportation with respect to the Coast Guard when it is not operating as a service in the Navy) to prescribe regulations to facilitate the granting of leave for purposes of attending court hearings to determine either parentage or an obligation to provide child support. States that it is not necessary that the date of a certification of the authenticity or completeness of a copy of a court order for child support received by the Secretary concerned (such support to be paid through the retired pay of the member involved) be recent. Allows the Secretary concerned to make required child support payments to a State when a spouse or former spouse assigns to a State the right to receive support. Empowers the Secretary concerned to pay child support arrearages through the disposable retired pay of the responsible member.
United States · United States Congress · 19 September 1994
George Washington Boyhood Home Commemorative Coin Act of 1994 - Directs the Secretary of the Treasury to issue one-dollar silver coins emblematic of a profile of George Washington and a depiction of his xboyhood home. Declares that all surcharges received from coin sales shall be paid to the George Washington Boyhood Home Foundation.
United States · United States Congress · 19 August 1994
Weather Service Modernization Performance Review Act of 1994 - Directs the Secretary of Commerce to: (1) ensure that the implementation of the National Implementation Plan (Plan) for modernization of the National Weather Service does not result in service degradation in any specific geographic area; and (2) provide for an independent review of the Plan by the National Research Council of the National Academy of Sciences.
United States · United States Congress · 17 August 1994
Amends the Mississippi River Corridor Study Commission Act of 1989 to extend until June 30, 1996, the deadline for the Mississippi River Corridor Study Commission to make its final report.
United States · United States Congress · 10 August 1994
Fairness in Musical Licensing Act of 1994 - Exempts from copyright infringement the communication of a performance or work by television or radio sets located in a business establishment, or the performance of a nondramatic musical work by a choral group of a nonprofit educational institution choral group, unless persons are charged to see or hear the performance. Provides that in any civil action for copyright infringement involving a nondramatic musical work that is licensed by a performing rights society or other organization authorized to license public performances of such works, if the defendant admits liability but contests the amount of the license fee charged by such society or organization, the dispute may, if requested by either party, be submitted to arbitration under the Federal judicial code. Requires such societies or organizations to make available, free of charge, to licensees or those negotiating licenses, on-line computer access to their entire repertoire, including information regarding the title of the work, the name, address, and telephone number of the author and the copyright owner (if different), and the names of any artists known to have performed the work.
United States · United States Congress · 5 August 1994
TABLE OF CONTENTS: Title I: Hydrogen Energy Research Program Title II: Fusion Energy Research Program Title III: High Energy and Nuclear Physics Title IV: Miscellaneous Provisions Hydrogen, Fusion, and High Energy and Nuclear Physics Research Act of 1994 - Title I: Hydrogen Energy Research Program - Hydrogen Future Act of 1994 - Directs the Secretary of Energy to support specified hydrogen research, development, and demonstration programs in the areas of: (1) production; (2) storage; (3) use; (4) transportation; (5) innovative technologies; and (6) technology transfer. Authorizes appropriations. Title II: Fusion Energy Research Program - Directs the Secretary to: (1) carry out a fusion energy research program; (2) contract with the National Academy of Sciences for studies of fusion technologies and other energy sources; and (3) study the advantages and disadvantages of siting the International Thermonuclear Experimental Reactor within or outside the United States. Authorizes appropriations for: (1) the fusion energy research program; (2) the alternative fusion research program; and (3) the Tokamak physics experiment. Title III: High Energy and Nuclear Physics - Department of Energy High Energy and Nuclear Physics Authorization Act of 1994 - Authorizes appropriations for Department of Energy programs of: (1) high energy physics; and (2) nuclear physics. Limits related major construction projects. Directs the Secretary to enter into negotiations with the European Organization for Nuclear Research (CERN) concerning U.S. participation in the Large Hadron Collider project. Title IV: Miscellaneous Provisions - Directs the Secretary to combine the Nuclear Engineering Research and Education program, the University Research Reactor program, and the University Reactor Fuel Assistance program into a new University Radiation Science and Technology program as a separate part of the University and Science Education program. Authorizes appropriations.
United States · United States Congress · 3 August 1994
Expresses the sense of the Congress that the President is: (1) required to obtain the prior approval of the Congress before U.S. armed forces may undertake offensive military action against the military leadership of Haiti in accordance with United Nations Security Council Resolution 940; and (2) recognized as having the inherent authority to use such forces to protect or evacuate U.S. citizens from imminent danger or for humanitarian purposes.
United States · United States Congress · 26 July 1994
Amends the Federal criminal code to prohibit the exclusion of evidence in a proceeding in a U.S. court on the ground that the search and seizure was in violation of the Fourth Amendment if carried out in circumstances justifying an objectively reasonable belief that it was in conformity with such amendment. Specifies that the fact that evidence was obtained pursuant to and within the scope of a warrant constitutes prima facie evidence of the existence of such circumstances. Prohibits the exclusion of evidence in such a proceeding on the ground that it was obtained in violation of a statute, administrative rule or regulation, or rule of procedure unless exclusion is expressly authorized by statute or rule prescribed by the Supreme Court pursuant to statutory authority.
United States · United States Congress · 26 July 1994
Establishes the National Commission on Fairness in Military Compensation to: (1) determine the extent to which military personnel or their dependents rely on food stamps, the special supplemental food program under the Child Nutrition Act of 1966, and other Federal or local assistance programs as a necessary supplement to their regular military compensation, and the circumstances that lead to such dependence; and (2) submit to the President and the Congress a report on its findings and its recommendations on possible changes in the military pay structure so that military personnel will receive adequate compensation and no longer rely on such other forms of assistance. Limits to $750,000 the total authorized expenses of the Commission. Requires the Comptroller General to audit Commission books and records in order to ensure compliance with such expense limit. Terminates the Commission 30 days after submission of its report.
United States · United States Congress · 20 July 1994
Amends the Communications Act of 1934 to prohibit a calling party from being charged for a call to, or information provided by, an 800 number by means of a charge included on, or transmitted with, a bill for telephone exchange service or telephone toll service.
United States · United States Congress · 12 July 1994
Congratulates: (1) the people of Germany on the unification of the nation and the city of Berlin; and (2) the U.S. armed forces, civilian administrators, and American people for five decades of sacrifice and support for Berlin. Recognizes and salutes the contribution of British and French allies in the defense of Berlin. Reaffirms the North Atlantic Treaty Organization obligations of the United States and America's continued support for a free, democratic, and united Germany. Welcomes the further enrichment of the relationship between the United States and Berlin based on fostering new traditions in economic and cultural links.
United States · United States Congress · 30 June 1994
Department of Energy High Energy and Nuclear Physics Authorization Act of 1994 - Authorizes appropriations for FY 1996 through 1999 for high energy physics and nuclear physics activities of the Department of Energy (DOE). Instructs the Secretary of Energy to: (1) enter into negotiations with the European Organization for Nuclear Research (CERN) regarding U.S. participation in the planning and construction of the Large Hadron Collider project; (2) submit an operations plan to certain congressional committees subsequent to enactment of appropriations for DOE high energy or nuclear activities; (3) contract with an independent organization to review the governance of DOE high energy and nuclear physics programs; and (4) report to the Congress on a mandated long-range plan prepared jointly with the Director of the National Science Foundation regarding Federal high energy and nuclear physics programs based on current and projected funding levels. Mandates that each of the President's annual budget requests for DOE high energy and nuclear physics activities distinguish between the budget for capital expenditures and other activities.
United States · United States Congress · 13 June 1994
TABLE OF CONTENTS: Title I: Locate and Case Tracking Title II: Establishment Title III: Parentage Title IV: Enforcement Title V: Collection and Distribution Title VI: Federal Role Title VII: State Role Child Support Responsibility Act of 1994 - Title I: Locate and Case Tracking - Directs the Secretary of Health and Human Services (the Secretary) to establish a Federal registry of child support orders or modifications issued by any State court or administrative order or both. Provides for State access to such registry. (Sec. 102)Amends part D (Child Support and Establishment of Paternity) of title IV of the Social Security Act (SSA) to include among the functions of the Federal Parent Locator System: (1) establishing parentage; and (2) establishing, modifying, enforcing child support obligations. Directs the Secretary of the Treasury to provide prompt access to the Secretary of all Federal income tax returns filed by individuals. Instructs the Secretary to expand the Parent Locator Service to establish a national network based on the comprehensive statewide child support enforcement systems to expand State access to the national parent locator network. (Sec. 103) Directs the Secretary of the Treasury to establish a national reporting system on employees and their child support obligations through the mandatory inclusion of certain child support information on W-4 forms (including the availability of health care insurance). (Sec. 104) Requires State plans for child and spousal support to have in effect statutory mechanisms which: (1) establish a child support order registry to transmit abstracts of State child support orders to the Federal Registry and distribute child support proceeds withheld from a delinquent parent's wages; and (2) allow an individual to bring an action against an employer or State official for noncompliance with this Act. Prescribes parameters for direct wage withholding, State agency access to various data bases, and expanded interaction with the National Parent Locator Network. (Sec. 105) Amends the Internal Revenue Code to integrate child support obligations and payments within the structure of income tax returns, including: (1) assessment and collection of child support arrearages; and (2) payment to State registries of child support amounts collected by the Secretary of the Treasury. Title II: Establishment - Amends part D of SSA title IV (Child Support and Establishment of Paternity) to set forth procedural guidelines for service of process on Federal employees and members of the armed services in connection with proceedings relating to child support and parentage obligations. (Sec. 204) Establishes the National Child Support Guidelines Commission to: (1) study and report to the Congress on the advisability of a national child support guideline; (2) develop such a guideline, if advisable. (Sec. 205) Includes among the requisite components of approved State plans: (1) a specified duration of child support; (2) electronic transmittal of State documents; (3) telephonic appearance in interstate cases; (4) uniform terms in child support orders; (5) social security numbers on marriage licenses, divorce decrees, parentage decrees, and birth certificates; (6) administrative subpoena powers; (7) State-conducted surveys and outreach programs for underserved populations; and (8) State guidelines for child health care insurance. (Sec. 213) Amends the Federal judicial code to set forth rules governing modification of sister State child support orders. Title III: Parentage - Requires approved State plans to include prescribed procedures for paternity acknowledgment. Title IV: Enforcement - Requires approved State plans to include prescribed procedures for garnishment of wages for parents in arrears for child support, including: (1) Federal death benefits; (2) black lung benefits; (3) veterans benefits, and (4) workers' compensation. (Sec. 404) Amends the Consumer Credit Protection Act to provide that: (1) its garnishment restrictions neither pre-empt State law, nor exempt any person from complying with State or Federal laws permitting garnishment for the purpose of securing child support; and (2) a garnishment intended to satisfy a child support debt takes priority over competing debts owed to the Federal government. (Sec. 405) Mandates that approved State plans include procedures to satisfy child support arrearages which: (1) prohibit a State court from applying the doctrine of election of remedies to prevent a custodial parent from collecting child support from the noncustodial parent; (2) prohibit State and Federal occupational licensing or regulating agencies from issuing or renewing occupational, professional or business licenses to individuals who fail to appear or are delinquent in child support cases; (3) prohibit State motor vehicle departments from issuing or renewing a driver's license or vehicle registration to such individuals; (4) require placement of child support liens on certificates of vehicle title; (5) permit attachment of bank accounts; (6) impose liens upon lottery winnings, insurance, court and other settlements; (7) presume fraudulent intent in any property transfer; (8) permit attachment of public and private retirement plans; (9) eliminate statutes of limitations in child support cases; and (10) require child support enforcement agencies to assess and collect interest on child support judgments. (Sec. 418) Amends Federal bankruptcy law to: (1) except from its automatic stay provisions proceedings establishing parentage and debts for child support; (2) require a bankruptcy plan to provide for full payment when due of debts for child support; (3) declare that a debt for child support includes State public debts and assigned child support based on provision of expenditures with respect to aid to families with dependent children (AFDC) and foster care and adoption assistance; (4) include among prioritized claims allowed unsecured claims for child support; (5) preclude a debtor from avoiding the fixing of judicial liens for child support; (6) except from discharge a debt pursuant to divorce or separation; and (7) prohibit trustee avoidance of a transfer that was a bona fide payment of a debt for child support. (Sec. 419) Prescribes procedural mandates for the Secretary of Defense to cooperate with the States in the enforcement of child support obligations of members and former members of the Armed Forces. (Sec. 420) Requires each State to have in effect laws which adopt the officially approved version of the Uniform Interstate Family Support Act. (Sec. 421) Authorizes the Secretary of State to deny or restrict passport privileges to child support debtors subject to State arrest warrants. Denies Federal benefits, loans, guarantees, and employment to debtors with child support arrearages exceeding specified amounts. (Sec. 423) Amends part D of SSA title IV (Child Support and Establishment of Paternity) to mandate that approved State plans include procedures to satisfy child support arrearages by permitting State courts to order: (1) assignments of life insurance benefits; and (2) assignment of an interest in jointly held property. (Sec. 425) Expresses the sense of the Congress that the U.S. should ratify the United Nations Convention of 1956. Mandates that the States treat international child support cases in the same manner as interstate child support cases. (Sec. 426) Prescribes guidelines for shielding depository institutions from liability for providing financial records to State enforcement agencies in child support cases. (Sec. 427) Mandates that approved State plans include procedures to ensure: (1) cost-of-living adjustments in child support orders; (2) annual exchange of financial information by parties to a child support order; and (3) criminal penalties for failure to pay child support and the granting of use immunity may be granted to compel testimony in specified civil child support proceedings. Title V: Collection and Distribution - Prescribes priorities in the distribution of collected child support pursuant to an approved State plan. Directs the Comptroller General to report to the Congress on studies and pilot projects of systems under which States would be required to pay child support to the individuals to whom it is owed before making reimbursements to any State for AFDC provided with respect to such child. (Sec. 502) Mandates that approved State plans include procedures which limit State claims against the noncustodial parent to the assistance provided to the child. (Sec. 503) Revises the fee guidelines for State child support collection and paternity determination services. Title VI: Federal Role - Directs the Secretary to establish the Office of Child Support Enforcement under the direction of an Assistant Secretary. Expands the training programs for State child support enforcement programs. (Sec. 604) Directs the Secretary to develop the methodology for determining each State child support and paternity establishment program's staffing requirements. (Sec. 605) Amends the Employee Retirement Income Security Act of 1974 to revise the definition of "medical child support order". (Sec. 606) Instructs the Secretary to: (1) contract for a study of the audit process of the Office of Child Support Enforcement; and (2) make grants to the States for demonstration projects implementing a system of assured minimum child support payments. Authorizes appropriations. (Sec. 608) Amends the Internal Revenue Code to create the Children's Trust Fund for making expenditures to implement this Act. (Sec. 609) Instructs the Comptroller General to study and report to the Congress on: (1) the causes for nonpayment of child support; and (2) the efficacy of processing child support and parentage cases in States that use administrative processes as compared to those that use judicial or quasi-judicial processes. (Sec. 611) Directs the Office of Child Support Enforcement to: (1) produce and update a certain compendium entitled "A Guide to State Child Support and Paternity Laws" and (2) establish a permanent advisory committee on child support matters. Title VII: State Role - Mandates that State plans for child and spousal support include: (1) agency advocacy promoting the greatest economic security possible for children; (2) certain information on plan services for dissemination to each custodial parent; (3) an administrative procedure as the sole procedure for change of payee; and (4) conflict-of-interest restrictions upon State modification of a child support order. (Sec. 705) Provides for increased payments to States under the Child Support and Establishment of Paternity program, repealing provisions for State incentive payments.
United States · United States Congress · 13 June 1994
Expresses the sense of the Congress that: (1) trafficking in persons violates human dignity and forced prostitution involving physical coercion or debt bondage constitutes a form of forced labor and a slavery-like practice; (2) the U.S. State Department should continue to press the Government of Thailand to strictly enforce all laws that can lead to the prosecution of those involved in trafficking and forced prostitution, ensure that Thai police participants in U.S. Government-sponsored police training programs are systematically vetted to exclude those implicated in such activities, urge the Thai Government to protect the rights and safety of Burmese women and girls in Thailand who are freed from brothels or arrested as illegal immigrants because their status as trafficking victims is unclear, appoint a senior advisor on women's human rights to the Undersecretary for Global Affairs to ensure that U.S. foreign policy addresses women's human rights violations, and report to the Congress; (3) the executive branch should take steps to assure that weapons and equipment provided or sold to the Thai police do not become available to members of those forces who might be involved in trafficking, forced prostitution, or abuse of women who are apprehended; (4) the U.S. Trade Representative should extend the evaluation of a petition on Thailand's labor rights situation that was filed last year to include a review of Thai official involvement in trafficking and forced prostitution; and (5) the U.S. Agency for International Development should target a portion of its assistance to Thailand for AIDS prevention and control to the foreign population in Thailand, particularly Burmese women in the Thai sex industry.
United States · United States Congress · 8 June 1994
Persian Gulf War Veterans' Compensation Act of 1994 - Directs the Secretary of Veterans Affairs to: (1) develop and implement a uniform case assessment protocol to ensure thorough assessment, diagnosis, and treatment of all Persian Gulf War (War) veterans suffering from illnesses the origins of which are currently unkown but which may be attributable to service in the Southwest Asia theater of operations during such War; (2) develop case definitions or diagnoses for such illnesses; and (3) implement a comprehensive outreach program, including a newsletter and a toll-free telephone number, to inform War veterans and their families of the medical care and other benefits that may be provided by the Department of Veterans Affairs as a result of service in such War. Directs the Secretary to pay compensation to a War veteran suffering from a disability resulting from an undiagnosed illness if such disability becomes manifest to a degree of ten percent or more within three years of separation from active military service. Provides exceptions to the payment of such compensation (i.e., when there is a preponderance of evidence to show that the disability was not incurred during such service or occurred after such service). Allows the Secretary to cease such payments after providing specified congressional committees with a scientific report showing that such disabilities are not connected to service in the War. Directs the Secretary to enter into: (1) an agreement with the Secretary of Defense for access to all clinical data on War veterans who remain on active duty, and to continually compile such data (with a required annual report); and (2) a contract for the conduct of an epidemiological study designed to assess the short- and long-term health consequences of service in such War (with appropriate oversight, a status report, and annual and final reports). Authorizes appropriations for FY 1995 through 2000 for such study. Authorizes appropriations to the Department for FY 1995 through 1998 for the conduct of research to advance the understanding of health risks and effects of service in the Gulf during such War and the means of treating such health effects.
United States · United States Congress · 25 May 1994
Safe Highways and Infrastructure Preservation Act of 1994 - Amends the Surface Transportation Assistance Act of 1982 to prohibit States from allowing the operation on federally assisted highways of any trailer, semi-trailer, container, or other cargo carrying unit longer than 53 feet, with specified exceptions. Declares that nothing in this Act shall be construed to affect State laws with respect to such vehicles less than 53 feet long. (Sec. 3) Amends Federal highway law to prohibit States from allowing the operation of any vehicle or combination (other than longer combination vehicles) that are not in conformance with the Interstate weight limits, unless the Department of Transportation, another Federal agency, or the State has determined such vehicles could lawfully operate on July 1, 1956 (except in the case of the overall gross weight of any group of two or more consecutive axles on the date of the enactment of the Federal-Aid Highway Amendments of 1974.) Prohibits the operation of such vehicles on the basis that a State law could have authorized such operation at some prior date by permit or otherwise. Declares that nothing in this Act shall be construed to prevent a State from reducing its gross vehicle weight limitation or its single or tandem axle weight limitations on the Interstate System for operations under the exception; but in no event shall such reduction fall below specified weight limits for vehicles operating on such System. Subjects all vehicles or combinations operating under the exception to routing-specific, commodity-specific, and weight-specific designations in force in a State before January 1, 1994. (Sec. 4) Directs the Secretary of Transportation (Secretary) to determine the meaning of the term "vehicles and loads which cannot be easily dismantled or divided" (including a commodity-specific definition of such term) as it relates to provisions concerning vehicle weight limitations. Declares that it is the policy of this Act to promote conformity with the Interstate weight limits for the benefit and safety of all motorists. (Sec. 5) Declares that the gross vehicle weight limitations and axle loading limitations with respect to vehicles and combinations on any non-Interstate highway on the National Highway System (NHS) shall be those set by State statute as of January 1, 1994, except that those limitations applicable to non-Interstate segments not in existence upon enactment of this Act shall be the Interstate weight limits. Directs the Secretary to determine and publish a list of: (1) the State's gross vehicle weight limitations and axle loading limitations as of January 1, 1994, with respect to non-Interstate highways on the NHS; and (2) operations not in conformance with such limitations with respect to vehicles and combinations on such highways of such State before January 1, 1994, and which were in lawful operation on a regular or periodic basis, including seasonal operations, before that date. Subjects all vehicles or combinations included on the non-conforming operations list to routing-specific, commodity-specific, and weight-specific designations in force in a State on December 31, 1993.
United States · United States Congress · 24 May 1994
Amends the Dingell-Johnson Sport Fish Restoration Act to increase the amounts transferred from State fish restoration and management project appropriations for grants for recreational boating safety programs. Revises funding from the same appropriations for grants to coastal and inland States for: (1) the construction and renovation of pumpout stations and waste reception facilities; and (2) education of recreational boaters about the problems of human body waste discharges from vessels.
United States · United States Congress · 23 May 1994
Directs the Administrator of the Environmental Protection Agency to study and report to the Congress on future funding options for financing infrastructure projects under the Federal Water Pollution Control Act. Authorizes appropriations.
United States · United States Congress · 12 May 1994
TABLE OF CONTENTS: Title I: Time-Limited Transitional Assistance Title II: Make Work Pay Subtitle A: Health Care Subtitle B: Earned Income Tax Credit Subtitle C: Child Care Subtitle D: AFDC Work Disregards Subtitle E: AFDC Asset Limitations Title III: The Work First Program Subtitle A: AFDC Subtitle B: Targeted Jobs Tax Credit Title IV: Family Responsibility and Improved Child Support Enforcement Subtitle A: Enhancement of Ability to Identify and Locate Noncustodial Parents Subtitle B: Paternity Establishment Subtitle C: Improvement of Child Support Order Establishment Process Subtitle D: Child Support Enforcement Title V: Teen Pregnancy and Family Stability Subtitle A: Federal Role Subtitle B: State Role Title VI: Program Simplification Subtitle A: Increased State Flexibility Subtitle B: Coordination of AFDC and Food Stamp Programs Subtitle C: Fraud Reduction Title VII: Financing Subtitle A: Ineligibility of certain Aliens for certain Social Services Subtitle B: Other Provisions Relating to Aliens Subtitle C: Limitation on Emergency Assistance Expenditures Subtitle D: Family Day Care Homes Program Improvements Subtitle E: Collection of Certain State and Local Taxes on Out-of-State Sales Title VIII: Effective Date Independence for Families Act of 1994 - Title I: Time-Limited Transitional Assistance - Amends part A (Aid to Families with Dependent Children) (AFDC) of title IV of the Social Security Act (SSA) to: (1) require States opting below to have work first programs to make ineligible for AFDC any family with a member who has participated in such work program for two years; (2) condition eligibility for AFDC on participation in job search activities except during unsubsidized full-time private sector employment; (3) provide transitional child care for families cut off AFDC after two years; and (4) direct the Secretary of Health and Human Service (Secretary) to establish a database of work first and community service programs participants for use by States opting to have work first programs. Title II: Make Work Pay - Amends SSA titles XIX (Medicaid) and IV part A (AFDC), as well as the Internal Revenue Code (IRC) and other specified Federal law, to make various specified changes with regard to, among others, extended Medicaid enrollment for former AFDC recipients, increased AFDC earned income disregards, limited AFDC income and resource disregards of savings for education, first time home or automobile purchase, microenterprise initiatives, increased child care funding and transitional benefits for two parent families, and refundable tax credits for dependent care and other expenses connected with gaining employment in order to enable AFDC recipients to become self-sufficient. (Sec. 229) Expresses the sense of the Congress that: (1) the Child Care Development and Block Grant Act should be reauthorized to allow States greater flexibility to use their funds to strengthen child care; and (2) States should institute a child care voucher system to enable families on AFDC to purchase child care services, create Consumer Information Centers for providing information on eligible child care providers, and loosen their regulations to allow for reimbursement of certain provider costs. Title III: The Work First Program - Amends SSA title IV to: (1) replace the current Job Opportunities and Basic Skills Training Program under part F with a new Work First Program that allows participating States to establish work programs similar to those operated by Riverside County, California and the State of Oregon; (2) add a new part G (Community Service Program); (3) include a work supplementation component under each such program that provides for subsidized private sector or State or local government jobs; (4) give States the option of having such programs; and (5) require States exercising such option to provide participants with the necessary case management services to ensure integrated benefits and services provided under such programs. (Sec. 311) Amends IRC to provide for an increase in the minimum period of employment required to receive a targeted jobs tax credit. Title IV: Family Responsibility And Improved Child Support Enforcement - Amends SSA title IV parts A and D (Child Support and Establishment of Paternity) to make specified changes with regard to AFDC recipient cooperation in establishing paternity of illegitimate children, locate services for enforcing child support orders, parenting services for new fathers, and distribution of child support proceeds. (Sec. 411) Expresses the sense of the Congress that: (1) certain actions pursuant to a child support order, such as the denial of visitation rights, should be treated as irrelevant in actions brought to enforce other provisions of the order; (2) the Secretary should investigate accessing certain Federal data banks not linked to the Parent Locator Service; (3) the national network established under this title for handling locate requests should be used to access State records only through the agency administering the State part D plan; (4) social services should be provided in hospitals to women whose pregnancy results from rape or incest; and (5) States should implement methods for verifying locate information and develop programs like the State of Wisconsin's program for noncustodial parents unable to meet support obligations. (Sec. 421) Establishes the National Child Support Guidelines Commission to: (1) study and develop a national child support guideline if one proves advisable; and (2) submit a report on the study's results to the President and the Congress. (Sec. 431) Requires the Secretary of the Treasury to establish a system for enabling child support information to be obtained at the workplace via W-4 form reporting by employees. Amends IRC to require employers to: (1) deduct and withhold child support obligations from employee wages; (2) pay withholdings to the appropriate payee; and (3) include withheld obligations on the employee's W-2 form. Makes various other specified changes to SSA title IV part D involving: (1) State procedures for comparing information in the national registry of child support orders (NR) established under this title with information obtained above from W-4 form reporting, and for imposing monetary penalties on employees who fail to report support obligations; (2) development of uniform withholding orders; (3) garnishment of certain Federal benefits and seizure of lottery winnings and other payouts to satisfy support arrearages; (4) State reporting of support obligations to credit bureaus; and (5) liability of grandparents for financial support of children of their minor children. Title V: Teen Pregnancy and Family Stability - Amends SSA title IV part A (AFDC) with respect to Federal and State roles in reducing teenage pregnancy and promoting family stability; by: (1) requiring States to deny AFDC for additional children (except those born as a result of rape or incest) of AFDC families unless the State plan explicitly provides for such additional children; and (2) providing for unmarried minors who are pregnant or who have children to live under adult supervision in order to receive AFDC. (Sec. 503) Directs the Secretary of Education to establish a task force to reduce teenage pregnancy. (Sec. 511) Expresses the sense of the Congress that: (1) children should be educated about the risks of early parenthood; (2) reproductive family planning and education should be made available to potential parents; and (3) States should use SSA title XX (Block Grants to States for Social Services) funds to provide comprehensive services to high-risk youth and work with schools for early identification and referral of such children. Title VI: Program Simplification - Amends SSA titles IV part A and XI, as well as the Food Stamp Act of 1977, to give States increased flexibility in providing AFDC benefits (including restoring those wrongfully terminated) through, among other means, use of electronic benefit transfers, quicker action on waiver requests, and coordination with food stamp rules. (Sec. 631) Expresses the support of the Congress for certain efforts by the Social Security Administration to reduce fraud and abuse in the Supplemental Security Income (SSI) Program under SSA title XVI. (Sec. 632) Requires the Secretary to study and report to the Congress on the feasibility of issuing a single counterfeit-resistant ID card to replace the current social security card and any health security card issued under health reform legislation. Title VII: Financing - Amends the SSA, the IRC, and the Food Stamp Act of 1977 to make certain aliens ineligible for AFDC, SSI, Medicaid, food stamps, and the earned income tax credit. (Sec. 711) Sets forth special rules concerning aliens and general public assistance. (Sec. 714) Authorizes appropriations for financial assistance to States for assistance to resident aliens. Specifies the annual allocation of such Federal financial assistance for each State and the District of Columbia through FY 1988. (Sec. 721) Amends SSA title IV part A (AFDC) to revise: (1) the definition of "emergency assistance to needy families with children"; and (2) the limitation on State expenditures for such assistance. (Sec. 731) Amends the National School Lunch Act to: (1) modify family and group day care home reimbursement provisions under the child and adult care food program; and (2) provide grants to States for making grants to family and day care homes. Tax Fairness for Main Street Business Act of 1994 - States that the Congress: (1) recognizes that some States will be adversely affected by provisions of this Act which deny immigrants certain public assistance; (2) pledges to help those States offset the potential cost shift; and (3) encourages States, in authorizing them below to require out-of-State companies to collect sales taxes on certain purchases, to use increased revenues resulting from such collections to offset such cost shift and design assistance programs addressing special needs of immigrants. (Sec. 744) Authorizes a State or local jurisdiction to require certain out-of-State businesses to collect sales taxes on tangible personal property sold to residents of the State or local jurisdiction. (Sec. 745) Provides an in-lieu fee rate where local taxes are not uniform. (Sec. 746) Prohibits a State from requiring out-of-State businesses to file reporting returns more than once every calendar quarter. (Sec. 749) Requires a State to establish toll-free information services to provide such businesses with necessary forms and instructions. Title VIII: Effective Date - Sets forth the effective date of this Act.
United States · United States Congress · 12 May 1994
Amends the Flood Control Act of 1968 to allow user fees to be collected at lakes and reservoirs under the jurisdiction of the U.S. Army Corps of Engineers (Corps) only from users of highly developed facilities requiring continuous presence of maintenance and supervision personnel and to prohibit the collection of such fees for access to or use of water areas, shoreland, sites, drives, or boat launching ramps which are undeveloped or lightly developed or where no mechanical or hydraulic equipment is provided.
United States · United States Congress · 11 May 1994
Veterans' Persian Gulf War Benefits Act - Directs the Secretary of Veterans Affairs to: (1) develop and expeditiously implement a uniform case assessment protocol that will ensure thorough assessment, diagnosis, and treatment of all Persian Gulf War veterans suffering from illnesses attributed to service in the Persian Gulf theater of operations during the Persian Gulf War; (2) expedite efforts to develop case definitions or diagnoses for illnesses associated with such service; and (3) develop and implement a comprehensive outreach program to inform such veterans and their families of health-care services, including comprehensive medical evaluations, that may be available through the Department of Veterans Affairs or the Department of Defense. Directs the Secretary to pay compensation to Persian Gulf War veterans suffering from a chronic disability resulting from an undiagnosed illness that became manifest to a degree of ten percent or more within one year after completion of active duty in the Gulf War, with exceptions. Terminates compensation payments three years after the date of enactment of this Act. Authorizes appropriations to the Department of Veterans Affairs for: (1) FY 1995 through 1997 for conducting research of the health risk and effects of service during the Gulf War and the treatment of such effects; and (2) FY 1995 for a survey of Persian Gulf veterans as to the incidence and nature of health problems occurring in such veterans and their families.
United States · United States Congress · 5 May 1994
Consumer Information Privacy Act - Requires businesses that compile consumer lists for sale to other businesses to notify such consumers of the sale of such lists. Declares that violations of this Act constitute an unfair or deceptive act or practice subject to enforcement under the Federal Trade Commission Act.
United States · United States Congress · 28 April 1994
Risk Assessment Improvement Act of 1994 - Establishes a Risk Assessment Program in the Environmental Protection Agency (EPA). Requires the Director of the Program to: (1) develop a process to conduct scientific peer review of all risk assessment guidelines developed by EPA; and (2) provide recommendations to the EPA Administrator on risk assessment, research needs, and development of guidelines. Directs the Director to regularly develop, issue, and, not less than every three years for each guideline, review the need to update guidelines that establish methods for conducting scientifically sound risk assessment. Sets forth contents of such guidelines. Requires the Director to oversee the use of risk assessment guidelines by EPA Program and Regional Offices and ensure consistency in the use of such guidelines as is appropriate in application to various environmental media or hazards. Permits departures from guidelines under specified conditions. Requires the Director to regularly develop, issue, and update guidance within EPA for any risk characterizations that may be conducted by EPA. Sets forth contents of such guidance. Requires the Director to: (1) promote open dialogue to improve the use of risk assessments by decisionmakers and to accurately and clearly communicate risk characterizations; and (2) regularly evaluate risk assessment research and training needs of EPA and develop a strategy and schedule for carrying out such research and training. Provides for, as part of the Program, a two-year pilot project using comparative risk analysis to rank dissimilar environmental risks and provide a common basis for evaluating strategies for reducing or preventing such risks. Requires the Director of the Office of Science and Technology Policy to: (1) periodically survey the manner in which Federal agencies are conducting risk assessment; (2) provide recommendations to the President based on such surveys; and (3) establish interagency mechanisms to promote coordination of Federal risk assessment and mechanisms between Federal and State agencies to communicate state-of-the-art risk assessment practices.
United States · United States Congress · 21 April 1994
Osteoporosis Risk Reduction Act of 1994 - Mandates review of: (1) the relationship between dietary calcium intake, bone mineral density, and the onset of osteoporosis; and (2) the recommended daily allowances for calcium. Requires development of optimum daily intake levels and, as appropriate, a proposed amendment to the standard of identity for enriched flour for the fortification of bread, cereal, and other grain products.
United States · United States Congress · 21 April 1994
Amends title XVI (Supplemental Security Income) (SSI) of the Social Security Act to substitute vouchers in lieu of cash payments for SSI benefits for a blind or disabled child who has not attained 18 years of age. Prescribes guidelines under which the Social Security Administration must provide a written notification of cooperation in suspected cases of fraud to the Inspector General of the Department of Health and Human Services and the appropriate State agency counterpart.
United States · United States Congress · 21 April 1994
Amends Federal law (known as the Intergovernmental Personnel Act) to treat the assignment: (1) of a Federal agency employee to another organization (especially a federally funded research and development center (FFRDC)) in the same way as an assignment of a Federal agency employee to a State or local government; and (2) of an employee of any other organization (especially an FFRDC) in the same way as an assignment of a State or local government employee to a Federal agency.
United States · United States Congress · 20 April 1994
Health Research Act of 1994 - Establishes in the Treasury the National Fund for Health Research. Requires regional and corporate health alliances formed under a comprehensive health care reform program to set aside and transfer specified amounts each calendar year into the Fund. Amends the Internal Revenue Code to authorize individuals (other than nonresident aliens) to designate for payment into the Fund at least $1 of a cash contribution or of any tax overpayment made. Requires the Secretary of Health and Human Services to distribute specified amounts from the Fund for various health research activities of the National Institutes of Health and the National Center for Research Resources. Excludes Fund amounts from any budget enforcement procedures under the Congressional Budget Act of 1974 or the Balanced Budget Emergency Deficit Control Act of 1985 (Gramm-Rudman-Hollings Act).
United States · United States Congress · 20 April 1994
National Security Budgeting and Deficit Control Act of 1994 - Amends the Balanced Budget and Emergency Deficit Control Act of 1985 (Gramm-Rudman-Hollings) to extend the caps on defense and nondefense discretionary spending through FY 1998. Requires the special budget authority adjustment required in the final sequestration report for FY 1995 under such Act to be equally divided between the defense and nondefense categories for each applicable fiscal year.
United States · United States Congress · 19 April 1994
Home Worker Tax Relief Act of 1994 - Amends the Internal Revenue Code to provide that a home office qualifies as a principal place of business for purposes of the deductibility of expenses if the office is the location where the taxpayer's essential administrative, management or telecommuting activities are conducted on a regular and systematic (and not incidental) basis. Allows individuals who work at home to deduct a proportionate amount of the equipment they use to telecommute.
United States · United States Congress · 24 March 1994
Credit Card Interest Rate Cap Act of 1994 - Expresses the sense of the Congress that: (1) low interest rates have reduced interest rates for consumer loans; (2) such low rates have not led to corresponding steep reductions in credit card interest rates; and (3) consumers are therefore paying credit card interest rates far in excess of what is warranted by economic conditions. Amends the Truth in Lending Act to prescribe a formula for a maximum credit card interest rate.
United States · United States Congress · 24 March 1994
United States Botanic Garden Commemorative Coin Act of 1995 - Directs the Secretary of the Treasury to: (1) issue one-dollar silver coins to commemorate the 175th anniversary of the founding of the United States Botanic Garden; and (2) pay all surcharges received from such coin sales to the National Fund for the United States Botanic Garden.
United States · United States Congress · 24 March 1994
Calls for the United States, at the International Conference on Population and Development, to: (1) place the highest priority on the success of the Conference by actively participating, particularly through the President's personal participation; (2) propose or support an initiative concerning the financing of global cooperation on efforts to slow rapid population growth that takes into account the costs of slowing growth and the basic development goals of developing countries and that increases accountability for the use of funds provided for family planning purposes; (3) seek to initiate a process of regular high-level intergovernmental consultations on the issues under consideration at the Conference and establish improved organizational and procedural means to implement its objectives; (4) support the effective implementation of a global action plan to raise the economic, educational, and leadership status of women and programs that provide maternal and child health care, education, and training for women and voluntary family planning; and (5) promote public participation, especially by women, at all levels of formulation and implementation of family planning and sustainable development policy and programs.
United States · United States Congress · 23 March 1994
Prohibits any person from taking (or threatening to take) an unfavorable personnel action or withholding (or threatening to withhold) a favorable personnel action as a reprisal against a member of the armed forces for making or preparing a communication alleging sexual harassment or unlawful discrimination against such member. Requires the Inspector General of either the Department of Defense or the Department of Transportation (for Coast Guard members when such service is not operating as a service in the Navy) to expeditiously investigate such allegations and report results to the Secretary of Defense or Transportation, as appropriate.
United States · United States Congress · 16 March 1994
TABLE OF CONTENTS: Title I: Comprehensive Program for Worker Reemployment Title II: One-Stop Career Center System Title III: National Labor Market Information System Title IV: Reinvention Labs for Job Training for the Economically Disadvantaged Reemployment Act of 1994 - Establishes: (1) a comprehensive program for worker reemployment; (2) a one-stop career center system; (3) a national labor market information system; and (4) reinvention labs for job training for the economically disadvantaged. (Sec. 4) Authorizes appropriations for titles I, III, and IV of this Act. Title I: Comprehensive Program for Worker Reemployment - Allots funds among States and reserves certain funds for national activities. (Sec. 103) Makes certain permanently laid-off workers and long-term unemployed individuals (as well as workers facing imminent plant shutdowns and self-employed individuals unemployed because of community economic conditions or natural disasters) eligible for services under this title. Makes dislocated homemakers eligible if a State Governor deems this appropriate and certain conditions are met. Part A: State and Substate Delivery System - Makes States responsible for administrative and management systems under this title. (Sec. 112) Requires the Governor to designate or establish a dislocated worker unit at the State level, with specified rapid response, information, and coordination functions. Directs such unit to coordinate with substate grantees and career centers, and to promote worker-management transition assistance committees. Provides for rapid response coverage of certain layoffs, State funding of preliminary assessments of worker buyouts of plants, prohibition of State transfer of rapid response functions, and Federal oversight of such functions. (Sec. 113) Requires the Governor to develop and maintain a comprehensive labor market information system in the State that meets certain requirements relating to the national system of effective labor market information. (Sec. 114) Requires the Governor to coordinate programs under this title with the worker profiling system under the Social Security Act and the retraining income support program under this Act. (Sec. 115) Authorizes the Governor to award supplementary grants to eligible entities to provide authorized services to eligible individuals in areas of the State experiencing substantial increases in numbers of such individuals due to plant closures, base closures, and mass layoffs. Allows such grant funds to be used to establish additional service centers, including on-site transition centers. (Sec. 116) Authorizes the Governor to award job retention project grants for: (1) upgrading skills of workers at risk of permanent layoff; and (2) retraining workers in new technologies and work processes to help convert or restructure businesses into high performance work organizations and avert plant closings or substantial layoffs. Requires State and employer contributions. Requires consultation with unions. (Sec. 117) Requires establishment of substate area administrative structures. (Sec. 118) Requires each designated substate grantee to establish one or more career centers in that area. Allows additional, temporary on-site transition centers. (Sec. 119) Authorizes the use of substate area funds for the following services for eligible individuals: (1) basic reemployment services; (2) intensive reemployment services; (3) education and training services; (4) retraining income support; (5) supportive services; and (6) supplemental wage allowances for older workers. (Sec. 120) Allows a career center to issue a certificate of continuing eligibility for services to eligible individuals who are accepting employment at a significantly lower wage than their previous one or in an occupation significantly different from their previous one. Part B: Federal Service Delivery System - Directs the Secretary of Labor to establish a program of national discretionary grants to address large-scale economic dislocations resulting from plant closures, base closures, or mass layoffs. Allows the use of such grants to: (1) provide comprehensive planning services to assist communities in addressing and reducing the impact of an economic dislocation; and (2) establish on-site transition centers. (Sec. 132) Directs the Secretary to make funds available for disaster relief employment assistance to States for substate allocation. (Sec. 133) Directs the Secretary to provide for: (1) evaluation of programs under this title; (2) research on addressing economic dislocation, facilitating the transition of permanently laid-off workers to reemployment, and upgrading skills of employed workers; and (3) demonstration projects to develop and improve methods of addressing economic dislocation and promoting worker adjustment. (Sec. 134) Directs the Secretary to provide staff training and technical assistance to various entities to enhance their capacity to develop and deliver adjustment assistance services to workers, and to avert plant closings or substantial layoffs. Requires integration of such activities with those of the Capacity Building and Information and Dissemination Network. (Sec. 135) Directs the Secretary to provide for delivery of programs, activities, and services under this title in any State that chooses not to participate. Part C: Performance Standards and Quality Assurance Systems - Directs the Secretary to establish a process, including an annual meeting, in each State to promote development of a customer service compact among parties administering programs under this title. (Sec. 152) Directs the Secretary to prescribe performance standards relating separately to the substate grantees and the career centers. Directs Governors to prescribe adjustments to such standards and award incentive grants to grantees and centers exceeding such standards. (Sec. 153) Requires each substate grantee to establish methods for obtaining customer feedback from eligible individuals and employers who have received services from a career center. (Sec. 154) Makes providers of education and training services eligible to receive funds under this title if they are eligible to participate under student aid provisions of the Higher Education Act of 1965 or are determined eligible under alternative procedures established by Governors, and if they provide performance-based information. Exempts on-the-job training providers from such requirements. Part D: General Requirements - Sets forth general requirements for programs under this title, including provisions for benefits, labor standards, and grievance procedures. Part E: Fiscal Administrative Provisions - Sets forth various administrative provisions, including ones for program year, prompt allocation of funds, monitoring, fiscal controls and sanctions, reports, recordkeeping, and investigations, administrative adjudication, nondiscrimination, judicial review, nondiscrimination, and criminal provisions. Part F: Miscellaneous Provisions - Provides for transition, on July 1, 1995, to programs authorized under this title from the following programs, which this Act repeals, under employment and training assistance for dislocated workers provisions of the Job Training Partnership Act (JTPA): (1) Economic Dislocation and Worker Adjustment Assistance program; (2) Defense Conversion Adjustment Program; (3) Defense Diversification Program; and (4) Clean Air Employment Transition Assistance Program. Terminates the Disaster Relief Employment Assistance program under JTPA. Title II: One-Stop Career Center System - Part A: Components of Voluntary One-Stop Career Center System - Requires a State's one-stop career center system, in order to receive a grant or waiver under this title, to include: (1) local workforce investment boards; (2) one-stop career centers established in accordance with specified procedures; (3) provision of specified services; (4) participation of specified Federal programs; (5) operating agreements for such centers; (6) quality assurance systems; and (6) a State Human Resource Investment Council. (Sec. 212) Directs the Governor to designate one-stop service areas within the State. Directs local officials to establish a workforce investment board for each such area. (Sec. 213) Directs the Governor and local officials to jointly select a consortium option or a multiple independent operator option as the method for establishing one-stop career centers for each service area. (Sec. 214) Requires each center to make available: (1) certain basic services to the public free of charge; and (2) certain intensive services to participants in the title I comprehensive program for worker reemployment who are unable to obtain employment through the basic services (and, optionally, to other individuals in accordance with the written agreement). Authorizes each center to provide specialized services to employers and additional services specified in the agreement. Authorizes charging fees under specified conditions, with all program income to be used to expand or enhance services. (Sec. 215) Requires the following programs to be made available to participants through the centers (and to participate in operation of such centers as parties to the agreement): (1) comprehensive programs for worker reemployment under title I of this Act; (2) Wagner-Peyser Act programs (employment services); (3) job counseling, training, and placement for veterans; (4) training services for the disadvantaged under title II of JTPA; (5) community service employment for older Americans programs under title V of the Older Americans Act; and (6) programs authorized under Federal and State unemployment compensation laws. Allows other human resource programs to provide services through and participate in operation of the centers, under specified conditions, including the Job Opportunities and Basic Skills program for AFDC recipients, the Food Stamp Employment and Training program, the Job Corps, veterans' employment programs under JTPA, and programs under the Carl D. Perkins Vocational and Applied Technology Education Act, Adult Education Act, Vocational Rehabilitation Act, and School-to-Work Opportunities Act. (Sec. 216) Sets forth requirements for operating agreements and quality assurance systems. (Sec. 218) Requires each State to establish a State human resource investment council that meets specified JTPA requirements and carries out certain additional functions including advising on development and implementation of the one-stop career center system. Part B: Grants and Waivers to Promote the Development and Implementation of One-Stop Career Center System - Authorizes the Secretary to establish programs of competitive grants to States for planning and development and for implementation of comprehensive statewide networks of one-stop career centers. (Sec. 233) Allows a State, at any point during such development or implementation, to request from the Secretary a waiver of one or more statutory or regulatory provisions. Sets forth waiver criteria. Subjects to such waiver authority the mandatory participating programs of the centers. (Sec. 234) Provides for pooling of administrative resources. Part C: Additional Activities in Support of One-Stop Career Center Systems - Directs the Secretary to establish a process, with each State implementing the one-stop career center system, including an annual meeting, to promote development of a customer service compact among the parties administering the system. (Sec. 235) Makes each State implementing such a system responsible for administration, management, monitoring, and technical assistance. (Sec. 236) Makes the Secretary responsible for monitoring compliance, staff training and technical assistance (integrated with the Capacity Building and Information Dissemination Network under JTPA), a national logo and name, and evaluation of one-stop career center programs. Part D: Effective Date - Sets forth effective dates for this title and for performance standards. Title III: National Labor Market Information System - Directs the Secretary to develop, in coordination with other Federal, State, and local entities, a strategy to establish a nationwide system of local labor market information. (Sec. 303) Directs the Secretary, in cooperation with such other entities and public-private partnerships, to develop such system to make available specified types of information. Requires certain technical standards, consumer reports, and evaluation. (Sec. 304) Directs the Secretary to provide for coordination and integration of such system and appropriate dissemination of information. Title IV: Reinvention Labs for Job Training for the Economically Disadvantaged - Amends the Job Training Partnership Act (JTPA) to establish a five-year Reinvention Labs program to: (1) encourage innovative program designs to improve provision of services to and labor market outcomes for economically disadvantaged youth and adults; (2) develop, through service delivery areas (SDAs) and States, knowledge of effective approaches to providing employment and training to the economically disadvantaged; and (3) provide SDAs with increased flexibility in operating job training programs, in exchange for greater accountability. (Sec. 401) Sets forth requirements for SDA applications for waivers of Federal requirements relating to JTPA programs for employment and training of the economically disadvantaged. Authorizes the Secretary to waive certain of such requirements under specified conditions and to provide technical assistance to SDAs, States, and service providers for Reinvention Labs programs. (Sec. 402) Modifies the definition of tuition under JTPA.
United States · United States Congress · 11 March 1994
Tax Fairness for Displaced Workers Act - Amends the Internal Revenue Code to permit qualified separation payments to be included in gross income ratably over a four-year period.
United States · United States Congress · 9 March 1994
Protection from Sexual Predators Act of 1994 - Expresses the sense of the Congress that States should: (1) more seriously consider the relatively high recidivism rate of sexual offenders when deciding whether to plea bargain with first-time sexual offenders and whether to grant parole to sexual offenders; and (2) review their treatment and parole supervision programs for sexual offenders to assure that such programs are fulfilling their goals. Amends the Federal criminal code to provide that whoever violates provisions regarding aggravated sexual abuse (or engages in conduct in or affecting interstate or foreign commerce that would be a violation of such provisions if the offense had occurred in the special maritime and territorial jurisdiction of the United States) after previously having been convicted of another State or Federal sexual abuse offense (or conduct which would have been such an offense if the offense had occurred in such jurisdiction) shall be imprisoned for life. Directs the Attorney General to establish guidelines for State programs requiring: (1) any person who is convicted of a sex offense to register and keep up to date a current address with a designated State law enforcement agency (LEA) for ten years after being released from prison or placed on parole, supervised release, or probation; and (2) each State to provide information obtained about the registered person to the Attorney General on a prompt and regular basis and in a uniform format. Requires the Attorney General to: (1) maintain on-line availability of information obtained under this Act for use by authorized LEAs in carrying out their functions; and (2) provide for the privacy of such information. Directs each State to implement the registration provisions within three years. Makes States not in compliance after such time subject to a reduction of funds under title I (drug control and system improvement grants) of the Omnibus Crime Control and Safe Streets Act of 1968. Requires the National Institute of Justice to carry out a study of persistent sexual predators and to report to the Congress and the President.
United States · United States Congress · 8 March 1994
Expresses the sense of the Congress that any national health care reform legislation should cover all preventive and treatment services relating to breast and cervical cancers, sexually transmitted diseases, and general gynecological services, including several specified services.
United States · United States Congress · 3 March 1994
TABLE OF CONTENTS: Title I: Insurance Reform Subtitle A: Increased Availability and Continuity of Health Coverage for Employees and Their Families Subtitle B: Reform of Health Insurance Marketplace for Small Business Subtitle C: Preemption Subtitle D: Health Deduction Fairness Title II: Preventing Fraud and Abuse Subtitle A: Establishment of All-Payer Health Care Fraud and Abuse Control Program Subtitle B: Revisions to Current Sanctions for Fraud and Abuse Subtitle C: Administrative and Miscellaneous Provisions Subtitle D: Amendments to Criminal Law Title III: Malpractice Reform Subtitle A: Findings; Purpose; Definitions Subtitle B: Uniform Standards for Malpractice Claims Subtitle C: Requirements for State Alternative Dispute Resolution Systems (ADE) Title IV: Paperwork Reduction and Administrative Simplification Title V: Expanding Access/Preventive Care Subtitle A: Expanding Access Through Community Health Authorities Subtitle B: Expansion of Public Health Programs on Preventive Health Title VI: Antitrust Provisions Title VII: Prefunding Government Health Benefits for Certain Annuitants Health Reform Consensus Act of 1994 - Title I: Insurance Reform - Subtitle A: Increased Availability and Continuity of Health Coverage for Employees and Their Families - Requires each employer to make available to each eligible employee a group health plan under which: (1) coverage of each eligible individual with respect to such employee may be elected on an annual basis; (2) coverage is provided for at least the required coverage specified; and (3) employees may elect to have premiums collected through payroll deduction. Does not require employer contributions to the cost of coverage under such a plan. Provides for the exclusion of: (1) employers who have been employers for less than two years or who have no more than two eligible employees or no more than two eligible employees not covered under any group health plan; and (2) family members under specified circumstances. Specifies that a group health plan shall not be treated as failing to meet the requirements of this Act solely because a period of service by an eligible employee of not more than 60 days is required for coverage. Specifies that the required coverage is standard coverage, except that in the case of a small employer that has not contributed during the previous plan year to the cost of coverage for any eligible employee under any group health plan, the required coverage for the plan year is coverage under a standard plan and a catastrophic plan. Provides for a five-year transition for existing group health plans. (Sec. 1002) Sets forth provisions regarding: (1) compliance with applicable requirements through multiple employer health arrangements; and (2) coverage options under a State medical health allowance program. (Sec. 1011) Prohibits a group health plan from imposing (and an insurer from requiring an employer from imposing through a waiting period for coverage under a plan or similar requirement) a limitation or exclusion of benefits relating to treatment of a preexisting condition if: (1) the condition relates to a condition that was not diagnosed or treated within three months before the date of coverage under the plan; or (2) the limitation or exclusion extends over more than six month after the date of coverage, applies to an individual who, as of the date of birth, was covered under the plan, or relates to pregnancy. Specifies that, in the case of an individual who is eligible for coverage under a plan but for a waiting period imposed by the employer, the individual shall be treated as having been covered under the plan as of the earliest date of the beginning of the waiting period. (Sec. 1012) Requires each group health plan to waive any period applicable to a preexisting condition for similar benefits with respect to an individual to the extent that the individual, prior to enrollment in such plan, was covered for the condition under any other health plan. (Sec. 1013) Prohibits: (1) a multiemployer plan and an exempted multiple employer health plan from canceling or denying renewal of coverage under such a plan for an employer other than for nonpayment of contributions, fraud or other misrepresentation, noncompliance with plan provisions, failure to maintain minimum participation rates (in the case of a small employer) misuse of a provider network provision, or because the plan is ceasing to provide any coverage in a geographic area; (2) an insurer from canceling a health insurance plan or denying renewal of coverage other than as prescribed above; and (3) an insurer who terminates the offering of health insurance plans in an area from offering such a plan to any employer in the area until five years after the date of the termination. (Sec. 1021) Makes provisions of the Employee Retirement Income Security Act of 1974 applicable with respect to enforcement of this Act (by the Department of Labor). Imposes a civil penalty ($100 per day for each individual involved, subject to specified limitations) on the failure of an insurer to comply with the requirements of sections 1011 through 1013, unless the Secretary of Health and Human Services (Secretary) determines that the State has in effect a regulatory enforcement mechanism that provides adequate sanctions. Subtitle B: Reform of Health Insurance Marketplace for Small Business - Requires each insurer that makes available a health insurance plan to a small employer in a State to make available to each small employer in the State a standard plan and a catastrophic plan, with exceptions for health maintenance organizations (HMOs) and if a State provides for guaranteed availability (rather than guaranteed issue). Requires each insurer that offers a standard or catastrophic plan to a small employer in a State to accept: (1) every small employer in the State that applies for coverage; and (2) every eligible individual who applies for enrollment on a timely basis. Sets forth provision regarding: (1) special rules for HMOs; (2) timely enrollment requirements; and (3) enrollment of spouses and dependents. Makes such requirements inapplicable in a State that has provided (in accordance with specified standards) a mechanism under which each insurer offering a health insurance plan to a small employer in the State must participate in a program for assigning high-risk small employer groups (or individuals within such a group) among some or all such insurers, if the insurers comply. (Sec. 1102) Defines "health plan" as a health insurance plan that: (1) is designed to provide standard coverage with substantial cost-sharing or only catastrophic coverage; (2) meets applicable requirements relating to guaranteed issue; (3) meets specified consumer protection standards; and (4) meets any participation requirements with respect to an applicable reinsurance or allocation of risk mechanism. States that standard coverage includes: (1) inpatient and outpatient hospital care; (2) inpatient and outpatient physicians' services; (3) diagnostic tests; (4) specified preventive services; and (5) specified inpatient hospital care for mental disorders. Sets forth coverage scope, including that there be no limits on the amount, scope, or duration of items number one, two, and three in the preceding sentence. Sets forth exceptions. Sets forth limitations on deductibles, copayments and coinsurance, and out-of-pocket expenses. Defines a catastrophic benefits package. Provides for the determination of target actuarial values for standard and catastrophic coverage. (Sec. 1103) Directs the Secretary to request NAIC to develop model regulations that specify standards with respect to requirements: (1) that insurers make available health plans; (2) of guaranteed availability of health plans to small employers; (3) relating to limits on premiums and certain consumer protections; (4) relating to limitation of annual premium increases; and (5) for standard and catastrophic coverage. Requires the Secretary to review such standards and, if NAIC fails to specify standards meeting such requirements, to promulgate standards. Sets forth provisions regarding: (1) the application of health plan standards and consumer protection standards by the States; (2) the Federal role; and (3) consumer protection standards. (Sec. 1104) Sets forth provisions: (1) regarding limits on premiums and annual premium increases; and (2) requiring an insurer, at the time of offering a health insurance plan to a small employer, to fully disclose rating practices for health insurance plans, including rating practices for different populations and benefit designs. (Sec. 1106) Directs the Secretary to: (1) request NAIC to develop models for reinsurance or allocation of risk mechanisms for health insurance plans made available to small employers for whom an insurer is at risk of incurring high costs under the plan; and (2) review such models or specify models. Sets forth provisions regarding implementation of reinsurance or allocation of risk mechanisms by the States and the Federal role. (Sec. 1108) Directs the Secretary to establish an Office of Private Health Care Coverage. Requires the Office Director to submit to the Congress annual reports evaluating health care coverage reform. (Sec. 1109) Authorizes the Director to conduct: (1) research on the impact of this subtitle on the availability of affordable health coverage for employees and dependents in the small employers group health care coverage market and other specified topics; and (2) demonstration projects relating to such topics. Requires the Director to develop: (1) methods for measuring the relative health risks of eligible individuals in terms of the expected costs of providing benefits under health insurance plans and, in particular, health plans; (2) a model for equitably distributing health risks among insurers in the small employer health care coverage market. Authorizes appropriations. Subtitle C: Preemption - Prohibits: (1) State benefit mandates for group health plans; and (2) State or local law prohibitions against two or more employers obtaining coverage under an insured multiple employer health plan. (Sec. 1203) Preempts State restrictions concerning: (1) reimbursement rates or selective contracting; (2) differential financial incentives; and (3) utilization review methods. Directs the Comptroller General to conduct a study of the benefits and cost effectiveness of the use of managed care in the delivery of health services. (Sec. 1211) Amends the Employee Retirement Income Security Act of 1974 (ERISA) to allow a limited exemption under preemption rules for multiple employer plans providing health benefits subject to certain Federal standards. Relieves exempted multiple employer plans providing medical care benefits of certain restrictions on preemption of State law. Treats such plans as employee welfare benefit plans. Allows commencement of new arrangements only if such exemption is in effect or an application is pending and the Secretary of Labor determines that provisional protection is appropriate. Sets forth exemption procedures, eligibility requirements, and additional requirements applicable to exempted arrangements. Requires certain disclosures to participating employers, maintenance of reserves, and corrective actions. Provides for expiration, suspension, and revocation of exemptions, and for review of actions by the Secretary. (Sec. 1213) Revises provisions relating to scope of preemption rules, and to treatment of single employer arrangements and of certain collectively bargained arrangements. (Sec. 1215) Establishes special rules for employee leasing healthcare arrangements. Treats such arrangements as multiple employer welfare arrangements except when they are multiple employer health plans. (Sec. 1216) Sets forth enforcement provisions relating to multiple employer welfare arrangements and employee leasing health care arrangements. (Sec. 1217) Sets forth filing requirements for multiple employer welfare arrangements. (Sec. 1218) Provides for cooperation between Federal and State authorities in enforcing ERISA requirements for multiple employer welfare arrangements with the limited exemption. (Sec. 1221) Amends the Internal Revenue Code to eliminate the commonality of interest or geographic location requirement for tax exempt trust status for multiple employer health plans and insured multiple employer health plans if they meet certain requirements under ERISA and this Act. (Sec. 1231) Amends ERISA to direct the Secretary of Labor to prescribe an alternative method providing for a single annual report with respect to all employers who are covered under the same insured multiple employer health plan. (Sec. 1241) Provides for compliance with applicable coverage requirements through multiemployer plans and other multiple employer health arrangements. Subtitle D: Health Deduction Fairness - Amends the Internal Revenue Code to provide for a permanent extension and increase in the health insurance tax deduction for self-employed individuals. Title II: Preventing Fraud and Abuse - Subtitle A: Establishment of All-Payer Health Care Fraud and Abuse Control Program - Directs the Attorney General to establish a program to: (1) coordinate Federal, State, and local law enforcement programs to control health care fraud and abuse; (2) conduct investigations, audits, and inspections relating to the delivery of payment for health care; and (3) facilitate enforcement of provisions of the Social Security and other Acts applicable to health care fraud and abuse. Authorizes additional appropriations as necessary. (Sec. 2003) Establishes the Anti-Fraud and Abuse Trust Fund. Subtitle B: Revisions to Current Sanctions for Fraud and Abuse - Excludes from participation in Medicare and State health care programs any individual or entity convicted of: (1) fraud in connection the delivery of a health care item or service; or (2) a felony related to a controlled substance. (Sec. 2103) Subjects to a civil monetary penalty any individual or entity offering inducements to individuals to receive any service or supply from a particular provider. (Sec. 2104) Permits the imposition of intermediate sanctions in addition to the current option of termination, for Medicare health maintenance organizations. Subtitle C: Administrative and Miscellaneous Provisions - Directs the Secretary to establish a national health care fraud and abuse data collection program for the reporting of final adverse actions against health care providers, suppliers, or practitioners. Requires each government agency and health care plan to report to the Secretary any final adverse action taken against a health care provider, supplier, or practitioner. Subtitle D: Amendments to Criminal Law - Establishes a penalty of up to five years' imprisonment for knowingly: (1) defrauding any health care plan; or (2) fraudulently obtaining money or property in connection with the delivery of health care items, benefits, or services. Permits a payment of up to $10,000 to any person furnishing information relating to any such crime. Title III: Malpractice Reform - Subtitle A: Findings; Purpose; Definitions - Sets forth, for this title, findings, purposes, and definitions. Subtitle B: Uniform Standards for Malpractice Claims - Makes this subtitle applicable to any medical malpractice liability action brought in a Federal or State court and to any medical malpractice claim subject to an alternative dispute resolution system. (Sec. 3102) Prohibits bringing a medical malpractice liability action in either a State or Federal court unless there has been an initial resolution of the action under an alternative dispute resolution system. Directs the Attorney General to establish an alternative dispute resolution process for medical malpractice liability claims brought against the United States. (Sec. 3104) Sets limits on both noneconomic damages and punitive damages. (Sec. 3105) Provides for the periodic payment of future losses. (Sec. 3106) Limits attorney's fees. (Sec. 3108) Sets forth special provisions for certain obstetric services. Subtitle C: Requirements for State Alternative Dispute Resolution System (ADR) -Requires a State's alternative dispute resolution system, among other things to: (1) apply to all medical malpractice liability claims within the jurisdiction of the State's courts; (2) issue a written opinion resolving the dispute within six months of a defendant receiving notice; (3) qualify individuals who hear and resolve claims under the system; and (4) notify the appropriate State agency if there is a finding of malpractice, unless the provider contests the ADR decision. (Sec. 3202) Directs the Secretary to establish an Alternative Dispute Resolution Advisory Board in order to advise the Secretary regarding the establishment of State and Federal ADR systems. Provides for the certification of State ADR systems by the Board. Title IV: Paperwork Reduction and Administrative Simplification - Preempts State quill pen laws. (Sec. 4102) Provides for the confidentiality of electronic health care information. (Sec. 4003) Directs the Secretary to establish national goals for the health care industry concerning: (1) standardization for the electronic receipt and transmission of health plan information; (2) use of uniform health claims forms and identification numbers; (3) priority of insurers when benefits are payable under two or more health plans; and (4) availability of information among health plans when benefits are payable under two more plans. Requires the Secretary to promulgate requirements if the industry does not meet the goals. Provides for monetary penalties on any health plan that does not meet the Secretary's requirements. Title V: Expanding Access/Preventive Care - Subtitle A: Expanding Access Through Community Health Authorities - Amends title XIX (Medicaid) of the Social Security Act to direct the Secretary to operate a program under which States establish projects to demonstrate the effectiveness of various innovative health care delivery approaches through the operation of community health authorities. Requires a community health authority to be a nonprofit entity that: (1) serves a geographic area that includes those designated by the Public Health Service Act as medically underserved or as being in a health professions shortage area; (2) enrolls the Medicaid eligible; and (3) provides for the provision of at least preventive services, primary care services, inpatient and outpatient hospital services, and other services. (Sec. 5002) Authorizes the Secretary to make grants to migrant and community health centers for the development of health service networks to serve high impact areas, medically underserved areas, or medically underserved populations. Authorizes appropriations through FY 1999. Subtitle B: Expansion of Public Health Programs on Preventive Health - Authorizes appropriations, under the Public Health Service Act, for the following: (1) immunizations against vaccine-preventable diseases; (2) prevention, control, and elimination of tuberculosis; (3) lead poisoning prevention; (4) preventive health measures with respect to breast and cervical cancers; (5) the Office of Minority Health Disease Prevention and Health Promotion; and (6) the Office of Minority Health; and (7) the preventive health and health services block grant. Title VI: Antitrust Provisions - Directs the Attorney General to: (1) provide for the development and publication of explicit guidelines on the application of antitrust laws to the activities of health plans; and (2) establish a review process under which the administrator or sponsor of a health plan may submit a request to the Attorney General to obtain a prompt opinion from the Department of Justice on the plan's conformity with Federal antitrust laws. (Sec. 6002) Authorizes the issuance of a certificate of public advantage by the Attorney General to each eligible health care collaborative activity if there is a finding that the benefits that are likely to result from carrying out the activity outweigh any reduction in competition that is likely to result and such reduction is reasonably necessary. Title VII: Prefunding Government Health Benefits for Certain Annuitants - Requires certain executive branch agencies to prefund government health benefits contributors for their annuitants.
![Official portrait of Rep. Lloyd, Marilyn [D-TN-3]](https://www.congress.gov/img/member/l000381_200.jpg)