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 · 22 September 1994
Amends the Omnibus Budget Reconciliation Act of 1990 to extend from three years to five years the period during which Medicare select policies may be issued.
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 · 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 · 28 July 1994
Rail Grade Crossing Safety Enhancement Act of 1994 - Permits the Secretary of Transportation, in lieu of reallocating certain funds from States without motorcycle helmet and safety belt use laws to highway safety programs, to transfer such funds to programs for railway-highway crossing improvements for such States. Conditions such authority on the request of the chief executive of the State concerned.
United States · United States Congress · 29 June 1994
Directs the Secretary of Agriculture to pursue specified steps to enhance agricultural exports and related domestic programs, including aggressive utilization of Commodity Credit Corporation funds and commodities in the maximum amounts allowed under the Uruguay Round Agreement.
United States · United States Congress · 23 June 1994
Amends the Internal Revenue Code to allow a taxpayer to elect to include in income crop insurance proceeds and disaster payments in the year of destruction or in the following year. Revises the method of determining the inflation adjustment applicable to the luxury automobile excise tax.
United States · United States Congress · 22 June 1994
Egg Products Inspection Act Technical Amendments of 1994 - Amends the Egg Products Inspection Act with regard to egg shell temperature and handling (with exceptions for small producers). Subjects imported eggs to similar requirements.
United States · United States Congress · 17 June 1994
Expresses the sense of the House of Representatives that: (1) June 21, 1994, is designated as Freedom Summer Remembrance Day; and (2) it reaffirms the goal of removing remaining barriers to full voter participation in this Nation.
United States · United States Congress · 10 June 1994
Official Travel Reform Resolution - Requires any travel award that accrues by reason of official travel of a Member, officer, or employee of the House of Representatives to be used only with respect to official travel.
United States · United States Congress · 9 June 1994
TABLE OF CONTENTS: Title I: Grants to Encourage Establishment of Community Rural Health Networks Title II: Incentives for Health Professionals to Practice in Rural Areas Subtitle A: National Health Service Corps Program Subtitle B: Incentives Under Other Programs Title III: Assistance for Institutional Providers Subtitle A: Community and Migrant Health Centers Subtitle B: Emergency Medical Systems Subtitle C: Assistance to Rural Providers Under Medicare Subtitle D: Demonstration Projects to Encourage Primary Care and Rural-Based Graduate Medical Education Title IV: United States-Mexico Border Health Commission Title V: Hospital Antitrust Fairness Title VI: Financing Rural Health Delivery System Development Act of 1994 - Title I: Grant to Encourage Establishment of 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. Title II: Incentives for Health Professionals to Practice in Rural Areas - Subtitle A: National Health Service Corps Program - Amends the Internal Revenue Code to exclude National Health Service Corps Loan Repayments from gross income. (Sec. 202) Amends the Public Health Service Act to take into consideration, when designating an area as a health professional shortage area, the number of individuals in the area paying through Medicare or Medicaid, the number of individuals who are uninsured, and the number of physicians who will accept additional Medicare and Medicaid patients. (Sec. 203) Increases the authorization of appropriations for the National Health Service Corps Scholarship and Loan Repayment Programs. Subtitle B: Incentives Under Other Programs - Amends title XVIII (Medicare) of the Social Security Act and the Higher Education Act of 1965 to provide incentives under those Acts to physicians informer shortage areas and to primary care physicians, in addition to those provided in Subtitle A. 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. Title III: Assistance for Institutional Providers - Subtitle A: Community and Migrant Health Centers - Extends and increases the authorizations of appropriations for migrant health centers and community health centers. Subtitle B: Emergency Medical Systems - Revises title XII (Trauma Care) of the Public Health Service Act. Renames such title Emergency Health Services. Directs the Secretary to establish the Office of Emergency Medical Services to: 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 innercity and rural areas. Authorizes grants to States in order 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 and trauma care. (Sec. 312) 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. Subtitle 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. 331) 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. Subtitle 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 nonprimary care practice. Authorizes appropriations. Title IV: United States - Mexico Border Health Commission - Authorizes the President to conclude an agreement with Mexico to establish a binational commission known as the United-States-Mexico Border Health Commission which shall: (1) conduct a needs assessment in the United States-Mexico border area to identify, evaluate, prevent, and resolve health problems that affect the general population of the area; (2) implement actions recommended by the assessment; and (3) formulate recommendations concerning payment for such health care. Title V: Hospital Antitrust Fairness - Exempts the merger or attempted merger of hospitals from the application of the antitrust laws; if specified conditions are met, including that: (1)a hospital be located outside of a city or in a city of less than 150,000; and (2) consumer costs would not increase and access would not be reduced if there was a merger. Title VI: Financing - Amends the Internal Revenue Code to impose a tax based on the Medicare part B premium for individuals with a modified adjusted gross income exceeding $100,000 or $125,000 in the case of a joint return.
United States · United States Congress · 26 May 1994
Social Security Access to Information Act of 1994 - Amends title XI (General Provisions and Peer Review) of the Social Security Act to require annual social security account statements to: (1) express wages, contributions, and benefits in terms of actual dollars and in terms of current dollars; and (2) contain the total amount of benefits paid to date to the eligible individual as well as the total paid to date to all beneficiaries on the basis of the individual's wages and self-employment income, expressed in terms of actual dollars and in terms of current dollars. Requires the Secretary to provide such annual statements to all eligible individuals who have attained age 60, regardless of whether they are receiving old age, survivors and disability insurance benefits.
United States · United States Congress · 25 May 1994
Authorizes the President to present, on behalf of the Congress, to the Lubavitcher rebbe, Rabbi Menachem Mendel Schneerson, a gold medal in recognition of his outstanding and enduring contributions toward world education, morality, and acts of charity. States that no appropriations are authorized to implement this Act. Declares that the medals struck pursuant to this Act are national medals.
United States · United States Congress · 20 May 1994
National Community Service Commemorative Coin Act - Directs the Secretary of the Treasury to issue one-dollar silver coins to commemorate students who volunteer to perform community service. Mandates that all surcharges received from such coin sales be paid to the National Community Service Trust to fund innovative community service programs at American universities, including the service, research, and teaching activities of the faculty and students involved in such programs.
United States · United States Congress · 17 May 1994
TABLE OF CONTENTS: Title I: Elimination of Baseline Budgeting Title II: Changes in Discretionary Spending Limits Title III: Expedited Rescissions and Targeted Tax Benefits Title IV: Treatment of Emergency Spending Common Cents Budget Reform Act of 1994 - Title I: Elimination of Baseline Budgeting - Amends the Balanced Budget and Emergency Deficit Control Act of 1985 (Gramm-Rudman-Hollings Act) with respect to the baseline to remove requirements for inflation adjustments, except for purposes of adjusting discretionary spending limits. Removes the requirement that adjustments made for expiring housing contracts be sequential and cumulative. Requires the President's budget to include: (1) estimated expenditures and appropriations for the current year; (2) new budget authority in budget outlay comparisons; and (3) a certain comparison of levels of estimated expenditures and proposed appropriations that includes the proposed increase or decrease in spending in percentage terms. Amends the Congressional Budget Act of 1974 to make conforming changes to the development of the concurrent resolution on the budget. Requires the Congressional Budget Office to include in reports to budget committees certain current year comparisons and a table on sources of spending growth under current law in total mandatory spending for the budget year and the ensuing four fiscal years. Requires the Director of the Congressional Budget Office to report annually to the Congress on all programs and activities with permanent or indefinite spending authority or those programs for which budget authority is not provided for in advance by appropriation Acts. Title II: Changes in Discretionary Spending Limits - Reduces discretionary spending limits for new budget authority for any fiscal year by the amount in the Deficit Reduction Account. Requires each appropriation or rescission bill to contain a Deficit Reduction Account containing amounts resulting from reduced spending. Title III: Expedited Rescissions and Targeted Tax Benefits - Amends the Congressional Budget and Impoundment Control Act of 1974 to provide for the expedited consideration of proposed rescissions of budget authority or repeals of targeted tax benefits. Title IV: Treatment of Emergency Spending - Limits emergency appropriations and legislation to the matter of emergency. Allows such a statute to contain other offsetting provisions that reduce spending or non-emergency appropriations for the designated emergency. Makes it out of order in the House of Representatives or the Senate to consider any bill or joint resolution containing an emergency designation, if the legislation provides an appropriation for any other item or matter.
United States · United States Congress · 12 May 1994
Requires the head of any Federal agency to differentiate between fats, oils, and greases of animal, marine, or vegetable origin, and other oils and greases in issuing certain regulations.
United States · United States Congress · 12 May 1994
TABLE OF CONTENTS: Title I: Amendments to Magnuson Fishery Conservation and Management Act Title II: Amendments to the Atlantic Tunas Convention Act Marine Fish Conservation Amendments of 1994 - Title I: Amendments to Magnuson Fishery Conservation and Management Act - Amends the Magnuson Fishery Conservation and Management Act to declare that it is the policy of the Congress to: (1) assure that the national fishery conservation and management program encourages development of practical measures that reduce bycatch (the incidental catch, take, or harvest of certain fish, marine mammals, and other specified animals) to insignificant levels approaching zero; and (2) ensure that all State and Federal actions are consistent with the conservation and management of fisheries under such Act. (Sec. 105) Revises national standards for fishery conservation and management to require conservation and management measures to: (1) provide an adequate margin of safety to act as a buffer against overfishing; and (2) reduce bycatch to the lowest level practicable and avoid unnecessary waste of fish. (Sec. 106) Revises requirements for Regional Fishery Management Councils to direct the Secretary of Commerce to ensure that at least 25 percent of the appointed members of each Council are persons selected for their fisheries expertise, as demonstrated by university, environmental organization, or other non-user group affiliation and by past actions and accomplishments. Provides for removal of a Council member for cause upon the Secretary's determination of a conflict of interest. Requires that each Council decision be recorded by roll call vote registered and forwarded to the Secretary for review. Authorizes each Council to request the Secretary to initiate consultation with a Federal agency about certain agency activity which may affect the essential fishery habitat of a fishery under its jurisdiction designated in a fishery management plan. Revises financial disclosure requirements for Council members to include financial interests held by children, grandchildren, parents, or siblings. Requires any Council member holding a financial interest requiring disclosure to recuse him or herself from voting on or participating in all Council actions that would affect such interest. Authorizes Council members and the public to challenge, in writing to the Secretary, any vote of a Council member alleged to have been made in violation of such recusal requirement. (Sec. 107) Requires any fishery management plan to: (1) specify an objective definition of overfishing for each fish species or population involved in the fishery; (2) contain a recovery plan for any overfished fishery; (3) specify allowable gear types for the fishery, requiring the use of types which minimize bycatch and associated mortality; (4) provide for the stationing on U.S. fishing vessels of observers to gather reliable data; (5) establish a system of fees to pay for plan implementation; (6) assess the bycatch of all gear types used in the fishery; and (7) contain conservation and management measures to minimize or eliminate the adverse impacts of fishing gear and practices on habitat for fish. Requires the Secretary to review each existing fishery management plan for compliance with the definition of overfishing in this Act. (Sec. 108) Specifies plan review, plan preparation, and overfishing determination duties of the Secretary. Mandates the contents of regulations establishing a system to collect fees to pay for fishing vessel observers. Establishes a National Fishery Observer Fund. Directs the Secretary to publish in the Federal Register a list of fish species, populations, and population complexes that are overfished and the objective definition of overfishing used to make that determination. Requires the Secretary to develop a research plan to identify and gather needed data on fish species, populations, and population complexes for which information is insufficient. Revises the approval voting requirements for a management plan for any fishery under the authority of more than one Council. Declares that any Secretary-prepared fishery management plan or amendment addressing a highly migratory species fishery, which was in effect on July 1, 1993, shall remain in effect until superseded by a plan or amendment prepared by the appropriate Councils and approved by the Secretary. Sets forth procedures for adoption of a recovery plan addressing overfishing with respect to fish species, populations, or population complexes subject to a fishery management plan. Directs the Secretary to provide for the elimination of bycatch through fees and incentive programs, including cooperative efforts with the Federal Government on research and development of selective fishing gear and other technological devices for the reduction of bycatch. Directs the Secretary to publish in the Federal Register and submit to the Congress a report on the cumulative impacts on fishery habitats of the actions authorized, funded, or carried out by Federal agencies, including an assessment of how fishery habitats identified in approved fishery management plans are affected. Directs the Secretary to review: (1) the feasibility of establishing a risk sharing pool through a reasonable fee to provide coverage for vessels and vessel owners against liability from civil suits by observers; and (2) the availability of comprehensive commercial insurance for vessel and owner liability against such suits. Requires the Secretary to establish such a pool unless such insurance is available to all fishing vessels and U.S fish processors required to have observers, and it will provide a greater measure of coverage at a lower cost. Requires the Secretary to establish an alternative observation program for vessels on which facilities for quartering of an observer, or for carrying out observer functions, are inadequate to ensure the health or safety of the observer or the safe operation of the vessel. (Sec. 109) Authorizes the Secretary or the appropriate Council (subject to the Secretary's approval) to adopt regulations as an interim measure in the absence of a fishery management plan. Prescribes general requirements for such regulations. Requires the Secretary to comment on and make recommendations concerning any actual or proposed action authorized, funded, or carried out by a State or Federal agency that may result in the destruction or adverse modification of the essential habitat designated in a fishery management plan. Prescribes guidelines for Federal agency response to such comments or recommendations. Authorizes the Secretary to prohibit any such Federal agency actions. Provides for: (1) citizen suits to enforce such Act; and (2) citizen petitions to compel the Secretary to make a finding or determination or take any other action authorized by such Act. Title II: Amendments to the Atlantic Tunas Convention Act - Amends the Atlantic Tunas Convention Act of 1975 to require the Director of the National Marine Fisheries Service (or his or her designee) to be one of the three U.S. Commissioners on the International Commission for the Conservation of Atlantic Tunas. (Sec. 201) Prohibits any U.S. Commissioner from having a financial interest or from serving as an officer, director, trustee, partner, or employee with an organization with a financial interest in any catching, harvesting, processing, or marketing activity undertaken within any fishery over which the Commission has jurisdiction. Repeals certain knowledge and experience requirements, with respect to commercial and recreational fishing, for non-governmental Commissioners. Allows regulations to carry out Commission recommendations which may have the effect of decreasing any allocation or quota of fish to the United States.
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
Senior Citizens Against Marketing Scams Act of 1994 - Amends the Federal criminal code to provide for enhanced penalties for telemarketing fraud that targets or victimizes persons over age 55. Directs the court to order offenders to: (1) pay restitution to persons who sustained losses as a result of the fraudulent activity; and (2) forfeit to the United States property constituting or derived from proceeds obtained as a result of the offense. Requires the U.S. Sentencing Commission to review and, if necessary, amend the sentencing guidelines to ensure that victim related adjustments for fraud offenses against persons over age 55 are adequate. Authorizes the Attorney General to make awards for furnishing information leading to the prosecution and conviction of telemarketing fraud offenders. Authorizes appropriations. Makes the mail fraud statute applicable to matter sent or delivered by any private or commercial interstate carrier. Sets forth provisions regarding fraud and related activity in connection with access devices. Directs the Attorney General to establish a national, toll-free telemarketing fraud hotline.
United States · United States Congress · 10 May 1994
Social Security Access to Information Act of 1994 - Amends title XI (General Provisions and Peer Review) of the Social Security Act to require annual social security account statements to: (1) express wages, contributions, and benefits in terms of actual dollars and in terms of current dollars; and (2) contain the total amount of benefits paid to date to the eligible individual as well as the total paid to date to all beneficiaries on the basis of the individual's wages and self-employment income, expressed in terms of actual dollars and in terms of current dollars. Requires the Secretary to provide such annual statements to all eligible individuals who have attained age 60, regardless of whether they are receiving old age, survivors and disability insurance benefits.
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 · 14 April 1994
Dairy Producer Market Stabilization and Export Development Act of 1994 - Directs the Secretary of Agriculture (Secretary) to establish the national Class IV Pool (Pool), which shall establish a blend price for milk used in commercially exported dairy products; and (2) the Dairy Export Marketing Board (Board) which shall administer the Pool and work to expand dairy exports and markets. Directs the Board to: (1) establish a settlement fund to operate the Pool; and (2) prepare an annual Pool plan. Amends the Agricultural Act of 1949 to revise excess purchase milk price reduction provisions. Extends: (1) the milk price support program (including the support rate); and (2) the dairy transfer program to the military and veterans' hospitals. Amends the Agriculture and Food Act of 1981 to extend Federal milk marketing order authority. Amends Federal law to extend the dairy indemnity program. Amends the Food Security Act of 1985 to extend the dairy export incentive program. Amends the Agricultural Act of 1949 to extend the Secretary's requirement to estimate Commodity Credit Corporation milk and milk products purchases, but stipulates that such estimates be made prior to Pool effects or purchase price revisions are determined. Amends provisions of the Agricultural Adjustment Act, reenacted by the Agricultural Marketing Agreement Act of 1937 to include certain milk handler reimbursement provisions among the terms of Federal milk marketing orders.
United States · United States Congress · 24 March 1994
Agricultural Mediation Improvement Act of 1994 - Amends the Agricultural Credit Act of 1987 to expand the types of agricultural issues covered by State mediation programs. Extends the authorization of appropriations for such programs.
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
Farmers Home Administration Improvement Act of 1994 - Amends the Consolidated Farm and Rural Development Act to authorize the Secretary of Agriculture to use the Attorney General, the General Counsel of the Department of Agriculture, or a private attorney to collect delinquent Farmers Home Administration obligations.
United States · United States Congress · 17 March 1994
Youth Development Block Grant Act of 1993 - Establishes a youth development block grant program. Authorizes appropriations. Sets forth formulas for allocation of funds to States and for distribution of funds through State commissions to local boards for community-based youth development services. Requires establishment of county or multicounty Local Youth Development Boards to receive such assistance. Requires establishment of a State Youth Development Commission in each State desiring to receive such assistance. Establishes a National Youth Development Commission to advise the Assistant Secretary for Children and Families of the Department of Health and Human Services on implementation of this Act.
United States · United States Congress · 16 March 1994
Deficit Reduction Lock Box Act of 1994 - Establishes the Deficit Reduction Trust Fund consisting of amounts contained in deficit reduction lock box provisions of appropriations Acts. Reduces discretionary spending limits by amounts transferred to the Fund. Amends the Congressional Budget Act of 1974 to require that amounts resulting from reduced spending under general appropriations bills be placed in the Fund. Requires the Congressional Budget Office to score all general appropriations measures as passed by the House and Senate and to publish such scorecard in the Congressional Record.
United States · United States Congress · 23 February 1994
1995 Special Olympics World Games Commemorative Coin Act - Directs the Secretary of the Treasury to issue one-dollar silver coins emblematic of the 1995 Special Olympics World Games. Mandates that the surcharges collected from the sale of such coins be paid to the 1995 Special Olympics World Games Organizing Committee, Inc.
United States · United States Congress · 11 February 1994
Amends the Interstate Commerce Act to direct the Interstate Commerce Commission (ICC) to require a fair and equitable arrangement for protection of the interests of railroad employees who may be affected by an ICC order approving an application for construction or acquisition and operation of a railroad line. Requires such arrangement to be no less fair and beneficial to the interests of such employees than those established under specified provisions for employee protective arrangements in transactions involving rail carriers.
United States · United States Congress · 7 February 1994
Expresses the sense of the Congress that: (1) the Low-Income Home Energy Assistance Program (LIHEAP) should be a high priority; (2) all FY 1995 appropriations made for LIHEAP should be expended; and (3) LIHEAP expenditures for FY 1996 should ensure the provision of services at or above the level provided in FY 1995.
United States · United States Congress · 3 February 1994
Rural Consumer Protection Act of 1994 - Amends the Rural Electrification Act of 1936 to extend specified association service curtailment protections to electric loan borrowers. Stipulates that such protections may be limited if: (1) waived by the borrower; or (2) in the public interest.
United States · United States Congress · 2 February 1994
Prohibits the Department of Transportation or any other Federal department, agency, or instrumentality from requiring any State or political subdivision to convert highway signs to metric units.
United States · United States Congress · 1 February 1994
Amends the Internal Revenue Code to allow a taxpayer to elect to include in income crop insurance proceeds and disaster payments in the year of the disaster or in the following year.
United States · United States Congress · 25 January 1994
Expresses the sense of the Congress that a postage stamp should be issued to honor the 100th anniversary of the Jewish War Veterans of the United States and that the Citizens' Stamp Advisory Committee of the U.S. Postal Service should make such recommendation to the Postmaster General.
United States · United States Congress · 22 November 1993
Expresses the sense of the Congress that: (1) the President shall not enter into any trade agreement requiring changes in U.S. antidumping laws which would reduce their effectiveness as a remedy against injurious dumped imports; (2) the U.S. Government shall not condone distorting subsidies by foreign governments, including development subsidies, that cause material injury to U.S. industries; and (3) the United States not enter into any trade agreement on dispute settlement contained in the Draft Final Act embodying the Results of the Uruguay Round of Multilateral Trade Negotiations (Negotiations) of December 21, 1991, unless, with respect to the review of countervailing duty and antidumping duty actions taken by General Agreement on Tariffs and Trade (GATT) members, the settlement mechanisms and procedures shall not allow specified review actions. Expresses the sense of the Congress that the principal U.S. negotiating objective regarding situations of global structural excess capacity is to negotiate multilateral rules to permit rapid realignment of capacity to demand. Urges the President to review antidumping duty provisions contained in the Negotiations and to seek changes in such provisions that are necessary to maintain the effectiveness of U.S. antidumping laws, including, but not limited to, changes proposed by the United States in December 1992, any changes needed to clarify the right to cumulate and cross-cumulate imports under investigation, and the prohibition of procedures to sunset dumping and countervailing duty orders.
United States · United States Congress · 22 November 1993
Expresses the sense of the Congress that the national policy of the United States should be to: (1) increase energy efficiency, as specified; (2) increase renewable energy technologies to 20 percent of the overall national energy mix by 2010; and (3) achieve these goals by adopting a specified national strategy.
United States · United States Congress · 20 November 1993
TABLE OF CONTENTS: Title I: Health Care Security Subtitle A: Universal Coverage and Individual Responsibility Subtitle B: Benefits Subtitle C: State Responsibilities Subtitle D: Health Alliances Subtitle E: Health Plans Subtitle F: Federal Responsibilities Subtitle G: Employer Responsibilities Subtitle J (sic): General Definitions; Miscellaneous Provisions Title II: New Benefits Subtitle A: Medicare Outpatient Prescription Drug Benefit Subtitle B: Long-Term Care Title III: Public Health Initiatives Subtitle A: Workforce Priorities Under Federal Payments Subtitle B: Academic Health Centers Subtitle C: Health Research Initiatives Subtitle D: Core Functions of Public Health Programs; National Initiatives Regarding Preventive Health Subtitle E: Health Services for Medically Underserved Populations Subtitle F: Mental Health; Substance Abuse Subtitle G: Comprehensive School Health Education; School-Related Health Services Subtitle H: Public Health Service Initiative Subtitle I: Coordination With COBRA Continuation Coverage Title IV: Medicare and Medicaid Subtitle A: Medicare and the Alliance System Subtitle B: Savings in Medicare Program Subtitle C: Medicaid Subtitle D: Increase in SSI Personal Needs Allowance Title V: Quality and Consumer Protection Subtitle A: Quality Management and Improvement Subtitle B: Information Systems, Privacy, and Administrative Simplification Subtitle C: Remedies and Enforcement Subtitle D: Medical Malpractice Subtitle E: Fraud and Abuse Subtitle F: McCarran-Ferguson Reform Title VI: Premium Caps; Premium-Based Financing; and Plan Payments Subtitle A: Premium Caps Subtitle B: Premium-Related Financing Subtitle C: Payments to Regional Alliance Health Plans Title VII: Revenue Provisions Subtitle A: Financing Provisions Subtitle B: Tax Treatment of Employer-Provided Health Care Subtitle C: Employment Status Provisions Subtitle D: Tax Treatment of Funding of Retiree Health Benefits Subtitle E: Coordination with COBRA Continuing Care Provisions Subtitle F: Tax Treatment of Organizations Providing Health Care Services and Related Organizations Subtitle G: Tax Treatment of Long-term Care Insurance and Services Subtitle H: Tax Incentives for Health Services Providers Subtitle I: Miscellaneous Provisions Title VIII: Health and Health-Related Programs of the Federal Government Subtitle A: Military Health Care Reform Subtitle B: Department of Veterans Affairs Subtitle C: Federal Employees Health Benefits Program Subtitle D: Indian Health Service Subtitle E: Amendments to the Employee Retirement Income Security Act of 1974 Subtitle F: Special Fund for WIC Program Title IX: Aggregate Government Payments to Regional Alliances Subtitle A: Aggregate State Payments Subtitle B: Aggregate Federal Alliance Payments Subtitle C: Borrowing Authority to Cover Cash-Flow Shortfalls Title X: Coordination of Medical Portion of Workers Compensation and Automobile Insurance Subtitle A: Workers Compensation Insurance Subtitle B: Automobile Insurance Subtitle C: Commission on Integration of Health Benefits Subtitle D: Federal Employees' Compensation Act Subtitle E: Davis-Bacon Act and Service Contract Act Subtitle F: Effective Dates Title XI: Transitional Insurance Reform Health Security Act - Title I: Health Care Security - Subtitle A: Universal Courage and Individual Responsibility - Entitles each eligible individual to: (1) the benefit provided under subtitle B through the applicable health plan in which the individual is enrolled; and (2) a health security card to be issued by the alliance or other entity that offers the applicable health plan in which the individual is enrolled. Defines an eligible individual as an individual who resides in the United States and is: (1) a citizen or national of the United States; (2) an alien permanently residing in the U.S. under color of law; or (3) a long-term nonimmigrant. Entitles a Medicare-eligible individual to benefits under Medicare instead of the above provisions of this Act. (Sec. 1002) Requires each eligible individual to enroll in an applicable health plan and pay any required premium. Prohibits disenrollment of an eligible individual until the individual is either enrolled in another plan or in Medicare. (Sec. 1003) States that nothing in this Act shall be construed as prohibiting: (1) an individual from purchasing any health services; (2) an individual from purchasing supplemental insurance; (3) an individual who is not an eligible individual from purchasing health insurance; or (4) employers from providing additional coverage. (Sec. 1004) States that a regional alliance health plan is the applicable plan for a family, unless a family member is eligible for a corporate alliance health plan. Allows military personnel, veterans, and Indians to enroll either with an alliance or with a military, veteran, or Indian plan respectively. (Sec. 1005) Prohibits an undocumented alien from enrolling in a health plan under this Act. (Sec. 1011) Defines a family as an eligible individual's eligible spouse and children. Defines couple as meaning an individual and the individual's spouse. Defines a child as being under age 18, or under age 24 in the case of a full-time student. Subtitle B: Benefits - Includes the following terms and services in the comprehensive benefit package: (1) hospital services; (2) services of health professionals; (3) emergency and ambulatory medical and surgical services; (4) clinical preventive services; (5) mental illness and substance abuse services; (6) family planning services and services for pregnant women; (7) hospice care; (8) home health care; (9) extended care services; (10) ambulance services; (11) outpatient laboratory, radiology, and diagnostic services; (12) outpatient prescription drugs and biologicals; (13) outpatient rehabilitation services; (14) durable medical equipment and prosthetic and orthotic devices; (15) vision care; (16) dental care; (17) health education classes; and (18) investigational treatments. Describes such items and services. (Sec. 1131) Requires each health plan to offer to its enrollees only one of the following cost sharing schedules: (1) lower cost sharing; (2) higher cost sharing; or (3) combination cost sharing. Provides that the annual maximum out-of-pocket expenses for an individual in any of the plans shall be $1500 and for a family the annual maximum shall be $3000. (Sec. 1135) Sets forth a table of copayments and coinsurance. (Sec. 1141) Excludes the following items and services: (1) an item or service that is not medically necessary or appropriate; (2) an item or service that the National Health Board may determine is not medically necessary or appropriate; (3) custodial care, except hospice care; (4) surgery performed solely for cosmetic purposes, unless required to correct a congenital anomaly or performed to correct a part of the body injured by either disease or accident; (5) hearing aids; (6) eyeglasses and contact lenses for individuals at least 18 years of age; (7) in vitro fertilization; (8) sex change surgery and related services; (9) private duty nursing; (10) personal comfort items, except in the case of hospice care; and (11) any dental procedures involving orthodontic care, inlays, gold or platinum fillings, bridges, crowns, pin/post retention, dental implants, surgical periodontal procedures, or the preparation of the mouth for the fitting or continued use of dentures, except as specified. (Sec. 1151) Gives the National Health Board the authority to promulgate such regulations or establish such guidelines as necessary to assure uniformity in the application of the comprehensive benefit package across all health plans. Permits the Board to expand the benefit package. (Sec. 1162) Permits a health professional or facility to refuse to provide a benefit if the professional or facility objects on the basis of a religious belief or moral conviction. Subtitle C: State Responsibilities - Requires a State, in order to be approved as a participating State, to submit a document describing the State's health care system. (Sec. 1201) Requires a participating State to: (1) establish one or more regional alliances; (2) establish and publish the criteria used in the certification of its health plan; (3) meet minimum financial solvency requirements for health plans established by the National Health Board; (4) designate an agency or official to coordinate State responsibilities under this Act; (5) conform State laws to meet the requirements of title X of this Act with respect to workers' compensation and automobile insurance; and (6) carry out all the responsibilities of a participating State specified in this Act. (Sec. 1221) Permits a State, with the Board's approval, to operate a single-payer system if specified requirements are met. Subtitle D: Health Alliances - Provides for regional alliances and corporate alliances. (Sec. 1302) Requires a regional alliance to be governed by a Board of Directors consisting of: (1) employers, including self-employed individuals; and (2) members who represent individuals purchasing coverage. Requires each regional alliance to establish a provider advisory board consisting of health care providers and professionals. (Sec. 1311) Includes in a corporate alliance an eligible sponsor who is either a large employer (more than 5,000 full-time employees) or a multiemployer plan (a plan with more than 5000 active participants). Excludes: (1) an employer whose primary business is employee leasing; (2) the Federal Government (other than the U.S. Postal Service); and (3) a State or local government. Excludes from corporate alliance eligibility the following classes of individuals: (1) AFDC recipients; (2) SSI recipients; (3) military personnel and families, veterans, and Indians who elect to enroll in specified plans specifically designed for them; and (4) seasonal or temporary employees. (Sec. 1321) Directs each regional alliance to enter into a contract with any State-certified health plan to contract with the alliance for the enrollment under the plan of eligible individuals. (Sec. 1322) Requires each regional alliance to offer a choice of health plans, including at least one fee-for-service plan. (Sec. 1326) Requires each regional alliance to establish and maintain an office of an ombudsman to assist consumers in dealing with problems that arise with health plans and the alliance. (Sec. 1329) Permits a regional alliance to adjust payments to plans or use other financial incentives to encourage health plans to expand into areas that have inadequate health services. (Sec. 1341) Set forth provisions concerning the collection of funds by regional alliances from individuals, employers, and others. (Sec. 1351) Requires each regional alliance to compute a blended plan per capita payment amount for each regional alliance health plan for enrollment in the alliance. (Sec. 1353) Requires each regional alliance to make payments to the Federal Government for academic health centers and graduate medical education. (Sec. 1361) Requires each regional alliance to comply with specified standards relating to the management of finances, maintenance of records, accounting practices, auditing procedures, financial reporting, and employer payments. (Sec. 1371) Provides for a reduction in cost sharing for low-income families. (Sec. 1373) Provides for premium discounts and reduction in liabilities for low-income families. (Sec. 1381) Permits each corporate alliance to: (1) offer coverage under either an appropriate self-insured health plan; or (2) negotiate with a State-certified plan to enter into a contract with the plan. (Sec. 1382) Requires each corporate alliance to provide a choice of health plans, including at least one fee-for-service plan and two health plans that are not fee-for-service plans. (Sec. 1385) Requires each corporate alliance to make an additional contribution towards the enrollment in health plans of the alliance by certain low-wage families. (Sec. 1386) Sets forth provisions relating to corporate alliances concerning: (1) consumer information and marketing; (2) plan and information requirements; (3) management of funds; (4) cost control; (5) payments by corporate alliance employers to corporate alliances; (6) ERISA; (7) disclosure and reserve requirements; (8) trusteeship of insolvent corporate alliance health plans; (9) imposition and collection of periodic assessments on self-insured corporate alliance plans; and (10) payments to the Federal Government by multiemployer corporate alliances for academic health centers and gradual medical education. Subtitle E: Health Plans - Requires a health plan to: (1) be either a self-insured plan (meaning a group health plan as defined by a the Employee Retirement Income Security Act of 1974) or a State-certified plan (meaning a plan certified by a State or the National Health Board); and (2) meet the applicable regulatory requirements. (Sec. 1402) Requires each health plan offered by either a regional or corporate alliance to accept for enrollment every alliance eligible individual, unless the plan has reached its enrollment limit. Prohibits the limit from being imposed on the basis of any personal characteristics of enrollees such as health status, need for health care, age, occupation, or affiliation with any person or entity. Prohibits a plan from: (1) restricting or terminating coverage for any reason, including nonpayment of premiums; (2) cancelling coverage for any eligible individual until that individual is enrolled in another plan; (3) excluding an eligible individual because of an existing medical condition; (4) imposing a waiting period before coverage begins; or (5) imposing a rider that excludes the coverage of particular eligible individuals. Prohibits discrimination by a health plan on the basis of race, national origin, sex, language, socio-economic status, age, disability, health status, or anticipated need for health services. (Sec. 1405) Requires each plan to have a grievance procedure. (Sec. 1421) Permits an entity to offer a supplemental insurance policy if the policy and the entity meet specified requirements. (Sec. 1431) Requires each health plan, with respect to each electing essential community provider located within the plan's service area, to either: (1) enter into a written provider participation agreement; or (2) enter into a written agreement under which the plan will make payment to the provider as specified. Provides a special rule for providers of school health services. Makes the provisions of the proceeding sentence applicable only to health plans offered by a health alliance during the five year period beginning with the first year in which any health plan is offered by the alliance. Directs the Secretary of Health and Human Services to study essential community providers and to make recommendations concerning such providers to the Congress. Provides that such recommendations shall apply unless a joint resolution of disapproval is enacted by the Congress. (Sec. 1441) Requires each health plan to meet specified requirements of title X of this Act with respect to workers' compensation and automobile medical liability services. Subtitle F: Federal Responsibilities - Establishes the National Health Board in the Executive Branch. Directs the President to appoint the Board's seven members. (Sec. 1503) Directs the Board to: (1) interpret the comprehensive benefit package; (2) adjust the delivery of preventive services; (3) take steps to assure that the comprehensive benefit package is available on a uniform national basis; (4) recommend to the President and the Congress appropriate revisions to the package; (5) oversee cost containment requirements; (6) develop and implement eligibility standards; (7) establish a performance based system of quality management; (8) develop and implement standards for a national health information system; (9) establish State requirements and monitor State compliance; (10) establish premium class factors; (11) develop a methodology for the risk-adjustment of premium payments; (12) establish financial requirements for guaranty funds; (13) establish standards for health plan grievance procedures; and (14) report annually to the President and the Congress. (Sec. 1506) Authorizes appropriations for the Board. (Sec. 1511) Requires the Board to approve a State health care system if the system meets the applicable requirements of this Act. Prohibits approval of a State health care system prior to 1996. (Sec. 1512) Provides for sanctions for States failing to meet conditions for compliance. (Sec. 1515) Provides for planning grants to States for implementation assistance. (Sec. 1521) Provides for the Federal assumption of responsibilities in the absence of a State system. Provides for increased premiums of 15 percent during Federal operation of a State system to provide reimbursement for the Federal cost of operating the system. (Sec. 1541) Directs the Board to develop a risk adjustment and reinsurance methodology. Sets forth guidelines for developing such methodology. (Sec. 1543) Directs the Board to establish an advisory committee to provide technical advice and recommendations regarding the risk adjustment and reinsurance methodology. (Sec. 1551) Directs the Board to establish minimum capital requirements for regional alliance health plans under which at least $500,000 of capital must be maintained for each plan in the area. Permits the Board to require additional capital. (Sec. 1552) Requires the Board to establish standards for guaranty funds established by the States. (Sec. 1571) Sets forth the responsibilities of the Secretary of Health and Human Services. Directs the Secretary to administer and implement all provisions of this Act, except those duties delegated to the Board, any other executive agency, or to any State. (Sec. 1572) Directs the Secretary to appoint an Advisory Council on Breakthrough Drugs that will examine the reasonableness of launch prices of new breakthrough drugs. (Sec. 1581) Provides for the certification of essential community providers. Sets forth the following categories of providers automatically certified (under provisions of the Public Health Service Act): (1) migrant health centers; (2) community health centers; (3) homeless program providers; (4) public housing providers; (5) family planning clinics; and (6) AIDS providers under the Ryan White Act. Includes as automatically certified (under other Acts) following: (1) Indian health programs under the Indian Health Act; and (2) maternal and child health providers and a federally qualified health center or rural health clinic under the Social Security Act. Includes as automatically certified (under provisions of this Act) the following: (1) providers of school health services; and (2) a qualified community practice network. Provides for the setting of standards for additional health providers. (Sec. 1591) Sets forth the responsibilities of the Secretary of Labor. Includes among those responsibilities the following: (1) enforcement requirements applicable to employers; (2) elections to become corporate alliances; (3) temporary assumption of insolvent self-insured corporate alliance health plans; (4) establishment and administration of the Corporate Alliance Health Plan Insolvency Fund; and (5) administering title I of ERISA as it relates to group health plans maintained by corporate alliances. Subtitle G: Employer Responsibilities - Requires employers to provide for the payments required under title VI of this Act. Sets forth other employer responsibilities including: (1) information reporting requirements; (2) requirements relating to new employees; (3) recordkeeping requirements; and (4) antidiscrimination requirements. (Sec. 1606) Prohibits self-funding of cost sharing benefits by regional alliance employers. (Sec. 1607) Requires an employer to make equal employer premium payments to all qualifying employees, if a voluntary premium payment is made. Places a limit on such voluntary employer premium payments. (Sec. 1608) Sets forth an employer's obligation to a qualifying retired beneficiary where the employer, as of October 1, 1993, was providing a threshold payment. (Sec. 1609) Authorizes the Secretary of Labor to impose a civil penalty of up to $10,000 for each violation of this subtitle with respect to each individual. Subtitle J (sic): General Definitions; Miscellaneous Provisions - Sets forth the definitions and rules used in this Act. Subtitle B: Miscellaneous Provisions (sic) - (Sec. 1911) Grants the National Health Board, the Secretary of Health and Human Services, and the Secretary of Labor authority to issue regulations as necessary to permit the timely implementation of this Act. Title II: New Benefits - Subtitle A: Medicare Outpatient Prescription Drug Benefit - (Secs. 2001 through 2005) Amends title XVIII of the Social Security Act to provide for: (1) Medicare coverage of covered outpatient prescription drugs and biologicals as well as home infusion drug therapy services; (2) payment rules and related requirements, such as those pertaining to deductibles, for covered outpatient prescription drugs; (3) manufacturer rebates to the Secretary under Medicare part B for covered outpatient prescription drugs; and (4) determination of the Medicare part B premium attributable to covered outpatient prescription drugs. Subtitle B: Long-Term Care - Establishes requirements for State plans for home and community-based services to individuals with disabilities. Includes among those requirements the following: (1) a prohibition of limiting eligibility of individuals with disabilities based on income, age, geography, severity of disability, residential setting, or other grounds specified by the Secretary; (2) a requirement to serve low-income individuals; (3) a requirement to specify how Federal and State funds will be managed; (4) quality assurance requirements; and (5) reporting requirements. Requires a State to consult with individuals and groups of individuals with disabilities when developing the plan in order to have the plan approved. (Sec. 2103) Defines "individuals with disabilities" to mean any individual within one or more of the following four categories: (1) individuals requiring help with the activities of daily living; (2) individuals with severe cognitive or mental impairment; (3) individuals with severe or profound mental retardation; and (4) severely disabled children. (Sec. 2104) Requires a State plan to specify the services available. Requires each individualized plan to be developed in close consultation with the individual and the individual's family. Prohibits a State plan from covering: (1) room and board; (2) services furnished in a hospital, nursing facility, intermediate care facility for the mentally retarded, or other specified institutional setting; or (3) items or services to the extent coverage is provided for an individual under a health plan or Medicare. (Sec. 2105) Sets forth provisions relating to: (1) cost sharing; (2) quality assurance and safeguards; (3) advisory groups; (4) payments to States; and (5) the total Federal budget for State plans and allotments to States. (Sec. 2301) directs the Secretary, with the advice and assistance of the National Long-Term Care Insurance Advisory Council to promulgate regulations as necessary to implement provisions concerning private long-term care insurance. Directs the Secretary to make appointments to such Council. Authorizes appropriations for such Council. (Sec. 2321) Directs the Secretary, after considering the Council's recommendations to promulgate regulations designed to: (1) standardize formats and terminology used in long-term care policies; (2) require insurers to provide information to customers on the range of public and private long-term care coverage available; and (3) establish other requirements promoting consumer understanding of benefits. (Sec. 2322) Directs the Secretary to promulgate regulations establishing requirements with respect to the terms of and benefits under long-term care policies, which shall include the following requirements that the policy may not: (1) limit coverage based on a preexisting condition, subject to an exception for a six month period; (2) condition eligibility for benefits based on the need or receipt of any other service; (3) condition eligibility for any benefit on any particular diagnosis; (4) condition eligibility for benefits by providers on compliance with requirements not required by State or Federal law; and (5) condition coverage of any service by a provider on the provision of such service at a higher level of care than required by the insured individual. Prohibits discrimination by diagnosis in the treatment of: (1) Alzheimer's disease; (2) any organic or inorganic mental illness; (3) mental retardation or any other cognitive or mental impairment; or (4) HIV infection or AIDS. Sets forth other requirements for such policies, including requirements related to: (1) premiums; (2) sales practices; (3) continuation, renewal, replacement, conversion, and cancellation of policies; and (4) payment of benefits. (Sec. 2342) Provides for grants to States to enforce the Federal standards concerning long-term care policies. Sets forth requirements for receiving such grants. Authorizes appropriations. Prohibits the sale of a long-term care policy in a State without a regulatory program. (Sec. 2361) Authorizes the Secretary to make grants for the development and implementation of long-term care information, counseling, and other programs to: (1) States; (2) regional alliances (at the option of States within which such alliances are located; and (3) national organizations representing insurance consumers, long-term care providers, and insurers. Authorizes appropriations for such grants. (Sec. 2601) Authorizes the Secretary to conduct a demonstration program to test the effectiveness of various approaches to financing and providing integrated acute and long-term care services for the chronically ill and disabled. Sets forth the services and benefits to be provided, including: (1) all benefits of the comprehensive benefit package provided under title I of this Act; (2) transitional benefits, including assessment and home care; (3) long-term care benefits, including adult day care, home-delivered meals, and nursing facility services in specialized care units; and (4) habilitation services. Permits any of the following to be eligible for such services under criteria to be established by the Secretary: (1) individuals with disabilities under a State program; (2) individuals entitled to benefits under the Medicare program; and (3) individuals entitled to Medicaid and who are also either entitled to Medicare or Supplemental Security Income benefits. Requires reports to the Congress on the demonstration program. Title III: Public Health Initiatives - Subtitle A: Workforce Priorities Under Federal Payments - Establishes within the Department of Health and Human Services the National Council on Graduate Medical Education. Directs the National Council to designate for each academic year the number of individuals nationwide who are authorized to be enrolled in each specified approval physician training program for each medical specialty. Sets forth provisions specifying: (1) Federal formula payments to approved physician training programs; (2) application for payments; and (3) amount of payments. (Sec. 3061) Directs the Secretary to carry out a program with respect to graduate nurse training programs that is equivalent to the program for approved physician training programs. Establishes a National Council on Graduate Nurse Education. (Sec. 3071) Authorizes appropriations for the following programs: (1) primary care physician and physician assistant training; (2) training of underrepresented minorities and disadvantaged persons; and (3) nurse training. (Sec. 3072) Authorizes appropriations for the following programs: (1) a program of skill upgrading and occupational retraining for health care workers; (2) a demonstration program to assist workers in health care institutions in obtaining advanced career positions; (3) a program to develop and operate health-worker job banks in local employment services agencies, subject to certain conditions; (4) a program to provide joint labor-management decision-making in the health care sector on workplace matters related to the restructuring of the health care delivery system of this Act; and (5) a program to facilitate the comprehensive workforce adjustment initiative. (Sec. 3073) Directs the Secretary of Health and Human Services and the Secretary of Labor to jointly establish the National Institute for Health Care Workforce Development. States that the Director of the Institute shall make recommendations to the Secretaries regarding: (1) the supply of health care workers; (2) the impact of this Act; and (3) the development and implementation of high-performance, high-quality health care delivery systems. Directs the Secretaries to establish an advisory board to assist in the development of such recommendations. Subtitle B: Academic Health Centers - Directs the Secretary to make payments to a qualified academic health center or qualified teaching hospital in order to assist such eligible institutions with costs that are not routinely incurred by other entities in providing health services, but are incurred by such institutions by virtue of the academic nature of such institutions. States that such costs include: (1) costs resulting from reduced staff productivity due to teaching responsibilities; (2) the uncompensated costs of clinical research; and (3) exceptional costs associated with an institutions specialized expertise. Provides that the funding for such payments will come from transfers from the Federal Hospital Insurance Trust Fund, payments made by regional alliances to the Federal government for academic health centers and graduate medical education, and payments from corporate alliances. (Sec. 3131) Provides for the access of regional and corporate alliance patients to academic health centers. Subtitle C: Health Research Initiatives - Amends the Public Health Service Act to ensure that the National Institutes of Health conducts and supports biomedical and behavioral research on promoting health and preventing diseases, disorders, and other health conditions. Provides for health services research. Authorizes appropriations for such research. Subtitle D: Core Functions of Public Health Programs; National Initiatives Regarding Preventive Health - Authorizes appropriations for the core functions of public health programs and national initiatives regarding health promotion and disease prevention. (Sec. 3312) Authorizes the Secretary to make grants to States to carry out one or more of the following core functions: (1) data collection; (2) activities to protect the environment and to assure the safety of housing, workplaces, and food and water; (3) investigation and control of adverse health conditions; (4) public information and education programs to reduce risks to health such as use of tobacco, alcohol, and drugs, sexual activities that increase the risk of HIV transmission and other sexually transmitted diseases, poor diet, physical inactivity, and low childhood immunization levels; (5) accountability and quality assurance activities; (6) provision of public health laboratory services to complement private clinical laboratory services that screen for diseases and conditions; (7) training and education to assure provision of care by all health professionals; and (8) leadership policy development and administrative activities. (Sec. 3331) Authorizes the Secretary to make grants to agencies of State or local government, private nonprofit organizations, and coalitions that link two or more of these groups for the purpose of carrying out projects to develop and implement innovative community-based strategies to provide for health promotion and disease prevention activities for which there is a significant need. Subtitle E: Health Services for Medically Underserved Populations - Directs the Secretary to make grants to migrant health centers and community health centers, which shall be in addition to other funds available to such centers. Authorizes appropriations. (Sec. 3412) Authorizes appropriations for: (1) grants and contracts for the development of qualified community health plans and practice networks; and (2) loans and guaranteeing the principal and interest to Federal and non-Federal lenders on behalf of public and private entities for the capital costs of developing qualified community health plans and practice networks. (Sec. 3461) Authorizes the Secretary to make grants and enter into contracts with qualified community health groups to provide enabling services such as transportation, community and patient outreach, patient education, and translation services in order to increase the capacity of individuals to utilize the items and services under title I of this Act. Authorizes appropriations. (Sec. 3471) Authorizes appropriations for: (1) the National Health Service Corps; and (2) such amounts as are necessary to ensure that at least 20 percent of participants in the Scholarship Program or the Loan Repayment Program of the Corps are nurses. (Sec. 3481) Entitles a hospital with a low-income utilization rate in a base year of at least 25 percent to a payment as specified. Requires 75 percent of the total available to be allocated to hospitals for low-income assistance. Requires 25 percent of the total available to be allocated to hospitals for assistance in furnishing inpatient hospital services that are not covered services under title I of this Act. Subtitle F: Mental Health; Substance Abuse - Authorizes appropriations to carry out this part. Provides for grants to: (1) increase access to mental health and substance abuse services; (2) improve State and local capacity to coordinate and monitor such services; (3) provide incentives to integrate public and private service systems; and (4) supplement any activity under part B (Alcohol and Drug Abuse and Mental Services Block Grant) of title XIX of the Public Health Service Act. (Sec. 3503) Authorizes the Secretary to make loans for the capital costs incurred in the development of non-acute, residential treatment centers and community-based ambulatory clinics. (Sec. 3521) Requires the establishment of a pilot program demonstrating the integration of the mental illness and substance abuse services of the States with the services included under title I of this Act. Subtitle G: Comprehensive School Health Education; School-Related Health Services - Authorizes appropriations for the programs of this subtitle. States that the purposes of the programs shall be to: (1) support, in kindergarten through grade 12, the provision of comprehensive health educator programs; (2) establish a national framework within which States can create comprehensive school health education programs that target the health risk behaviors of youth, including tobacco use, alcohol and drug abuse, sexual behaviors resulting in infections, injury prevention, dietary patterns, and sedentary lifestyles; (3) pay the initial costs of planning and establishing such programs; (4) support related Federal demonstrations and training; (5) motivate youth to stay in school, avoid teen pregnancy, and strive for success; (6) improve the knowledge of health education among youth; and (7) further the National Education Goals set forth in title I of the Goals 2000: Educate America Act. Defines "comprehensive school health education program." Requires such programs to be sensitive to cultural and ethnic issues, promote involvement by families, and promote personal responsibility. Sets forth requirements for applying for grants and selection of grantees. Subtitle H: Public Health Service Initiative - Establishes a Public Health Service Initiative consisting of specified amounts authorized to be appropriated for the Initiative. States that: (1) the Initiative includes the programs of subtitles C through G of this title and the programs of subtitle D of title VIII; and (2) amounts appropriated to carry out the Initiative, including subtitles A through F of this title, are available to carry out specific programs for which the amounts are appropriated. Subtitle I: Coordination with COBRA Continuation Coverage - Amends title XXII (Requirements for Certain Group Health Plans for Certain State and Local Employees) of the Public Health Service Act to provide for coordination with COBRA continuation coverage. Repeals such title XXII upon implementation of this Act. Title IV: Medicare and Medicaid - Subtitle A: Medicare and the Alliance System - Amends title XVIII of the Social Security Act to provide for optional State integration of Medicare beneficiaries into regional alliance plans. (Sec. 4002) Allows individuals to elect to remain in certain plans. (Sec. 4003) Provides for payments to regional alliances on behalf of certain Medicare-eligible individuals. (Sec. 4004) Extends protections for working aged and disabled individuals to group health plans of all employers. Repeals the limitation on the period of protection for individuals with end stage renal disease. Prohibits Medicare payment for items and services provided under any health plan under this Act. Simplifies Medicare benefit coordination in cases where the individual is also eligible for benefits under this Act's health plans. (Sec. 4011) Makes various changes concerning eligible organization and Medicare supplemental policy enrollment and comparative informational materials, eligible organization outlier payments, and participating provider point-of-service networks. (Sec. 4022) Provides for expanded Medicare coverage for physician assistant, nurse practitioner, and clinical nurse specialist services. (Sec. 4031) Amends title XI of the Social Security Act to: (1) provide for termination of the separate Medicare peer review program upon adoption of the National Quality Management Program above under subtitle A of title V of this Act; and (2) repeal provisions on surgical procedure review and second opinions. (Sec. 4032) Amends title XVIII of the Social Security Act to provide for mandatory assignment for all Medicare part B services. (Sec. 4033) Directs the Secretary of Health and Human Services to take such steps as may be necessary to consolidate administration of Medicare parts A and B and supersedes certain conflicting requirements to the extent required to achieve such purpose. (Sec. 4035) Prohibits the Secretary from implementing any change in procedures for billing and processing Medicare claims within six months of implementing any previous change. Adds advanced notification to providers as a requirement for carriers and fiscal intermediaries under Medicare. (Sec. 4041) Amends title XI of the Social Security Act to: (1) provide for civil monetary penalties for kickback violations under Medicare and State health care programs (the programs); (2) make other penalty-related changes, including increases in criminal and civil monetary penalties, a new criminal penalty exception for certain providers, additional civil monetary penalty offenses related to alliance systems, and requirements for the deposit of penalties collected into the All-Payer Account established above under title V of this Act; (3) revise exclusion provisions, with changes establishing a minimum period of exclusion for certain individuals and entities subject to permissive exclusion from the programs, and providing for program exclusions based on actions under alliance systems; and (4) modify sanction provisions, with changes removing certain conditions for imposing sanctions and setting specified civil money penalties for use in lieu of authorized sanctions. (Sec. 4042) Amends title XVIII of the Social Security Act to revise the limitations on physician self-referrals. (Sec. 4051) Provides for the termination of payments under Medicare for medical education costs and directs the Secretary to make specified transfers from certain Medicare trust funds to the new accounts established above for funding physician training programs and academic health centers. (Sec. 4061) Amends title XVIII of the Social Security Act to provide for the treatment of: (1) uniformed services and VA health plans as eligible organizations under Medicare; and (2) health care facilities of the Department of Veterans Affairs as providers under Medicare. Subtitle B: Savings in Medicare Program - Amends title XVIII of the Social Security Act to provide for: (1) reductions in the update for inpatient hospital services and the adjustment for indirect medical education costs, in payments for capital-related costs for inpatient hospital services; (2) revisions to payment adjustments for disproportionate share hospitals in States participating under this Act; and (3) an extension of the freeze on updates to routine service costs of skilled nursing facilities. (Sec. 4111) Amends title XVIII of the Social Security Act to provide for: (1) establishment of cumulative expenditure goals for physician services; (2) use of real gross domestic product for volume adjustments; (3) repeal of restrictions on the maximum reduction permitted in default update; (4) reduction in the conversion factor for the physician fee schedule for 1995; (5) place limitations on payment for physicians' services furnished by high-cost hospital medical staffs; (6) requirements for physicians to identify the hospital at which the service was furnished; (7) an increase in practice expense relative value units for certain services while assuring budget neutrality; (8) a study and report to the Congress by the Secretary on a resource-based system for determining practice expense relative value units for each physician's service; (9) an increase in work relative value units for office visits while assuring budget neutrality; (10) a reduction in relative values for office consultations; (11) adjustment of outlier intensity of relative values; (12) changes in underserved area bonus payments; (13) elimination of formula-driven payments for certain outpatient hospital services; (14) copayments for laboratory services; and (15) competitive acquisition procedures for Medicare part B items and services (including clinical diagnostic laboratory tests). (Sec. 4131) Makes changes with respect to: (1) Medicare as secondary payer; (2) payments for health maintenance organizations and competitive medical plans with risk-sharing contracts; and (3) routine cost limits and copayments for, respectively, home health services and visits. (Sec 4135) Directs the Secretary to use a competitive process to contract with centers of excellence for cataract surgery, coronary artery by-pass surgery, and such other services as the Secretary determines to be appropriate. (Sec. 4141) Amends title XVIII of the Social Security Act to revise Medicare part B premium provisions. (Sec. 4151) Requires the Secretary to submit a report to the Congress on the growth in spending under Medicare for FY 2000 through 2003. Subtitle C: Medicaid - Amends title XIX (Medicaid) of the Social Security Act to provide that if a State Medicaid plan provides for payment to regional alliances of the amounts required above it is not required to provide payment for items and services covered under the comprehensive benefit package for alliance eligible individuals and will receive no Federal financial assistance with respect to such items and services. (Sec. 4211) Provides for: (1) spenddown eligibility and increased income and resource disregard for nursing facility residents; and (2) informing such residents about the availability of assistance for home and community-based services. (Sec. 4221) Provides for: (1) treatment of items and services not covered under the comprehensive benefit package; and (2) establishment of a program under Medicare of noncovered items and services for poor children. (Sec. 4231) Discontinues certain payment policies under Medicaid. (Sec. 4241) Limits the frequency of changes in a State's billing and claims processing system, and provides for advance notification to providers of any major billing change. (Sec. 4251) Establishes the Medicaid Commission to study, report, and make recommendations with respect to options involving block grant use, integration of long-term care services, and consolidation of institutional and home- and community-based long-term care in relation to the Medicaid program. Authorizes appropriations. Subtitle D: Increase in SSI Personal Needs Allowance - Amends title XVI (Supplemental Security Income) (SSI) to provide for an increase in the SSI personal needs allowance. Title V: Quality and Consumer Protection - Subtitle A: Quality Management and Improvement - Requires the National Health Board to establish and oversee a performance-based program of quality management and improvement designed to enhance the quality, appropriateness, and effectiveness of heath care services and access to such services which will be called the National Quality Management Program. (Sec. 5002) Establishes the National Quality Management Council which shall: (1) administer the National Quality Management Program; (2) perform any other duty specified in this subtitle; and (3) advise the National Health Board with respect to its duties under this subtitle. Requires the Council to develop a set of national measures of quality performance to be used in the assessment of and the provision of access to health care services. Requires the Council, in addition, to: (1) recommend to the Board establishing goals for performance by health plans and health care providers on a subset of national measures of quality performance; (2) direct the Administrator for Health Care Policy and Research to develop, review, and disseminate practice guidelines to determine how diseases can most effectively be prevented, diagnosed, treated, and managed; and (3) direct the Administrator for Health Care Policy and Research to support research related to a five year priority list of performance measures. (Sec. 5008) Directs the National Health Board to: (1) establish and oversee regional professional foundations to perform such duties as develop lifetime learning programs for health professionals and conduct research on health care quality; and (2) establish the National Quality Consortium to perform such duties as establishing continuing education for health professionals and provide advice on research priorities. (Sec. 5012) Requires each regional alliance and each corporate alliance to: (1) disseminate specified information to consumers; and (2) ensure that performance and quality standards are continually improved. Subtitle B: Information Systems, Privacy, and Administrative Simplification - Directs the National Health Board to develop and implement a health information system, in consultation with Federal agencies, States, employers, health plans, and others, by which the Board shall collect, report, and regulate the collection and dissemination of health care information which shall be used for: (1) health care planning by Federal, State, and local government; (2) establishing and monitoring payments for health services; (3) assessing and improving the quality of health care; (4) managing and containing costs at the alliance and plan levels; and (5) other specified purposes. Requires the establishment of an electronic data network to collect, compile, and transmit information. (Sec. 5120) Sets forth provisions providing for health information privacy standards. (Sec. 5130) Directs the National Health Board to develop the following standard health care benefit forms: (1) an enrollment and disenrollment form; (2) a clinical encounter record; and (3) a claim form. (Sec. 5140) Establishes the National Privacy and Health Data Advisory Council in order to advise the National Health Board with respect to its duties under this subtitle. (Sec. 5141) Sets forth monetary penalties for violating health information system standards. Subtitle C: Remedies and Enforcement - Sets forth provisions with respect to the review of benefit determinations for enrolled individuals, including provisions: (1) regulating the time limits for notice of disposition of a claim; (2) governing a plan's duty to review claim denials; (3) concerning urgent requests for preauthorization; and (4) concerning other time limits with respect to time limits and notice. (Sec. 5202) Requires each State to establish a complaint review office for each regional alliance established by a State. Permits aggrieved individuals to file complaints with the appropriate review office. (Sec. 5205) Provides for a Federal Health Plan Review Board to review the decisions of complaint review office hearing officers. (Sec. 5207) Sets monetary penalties for a plan which unreasonably denies or delays payment or provision of benefits. (Sec. 5211) Directs each State to establish and maintain an Early Resolution Program in each complaint review office. Requires a program to include: (1) forums for mediation disputes; and (2) other forums of alternative dispute resolution as may be prescribed. Establishes guidelines for the eligibility of cases for submission to the Early Resolution Program. States that conclusions of the mediation proceedings shall be treated as nonbinding and shall not affect any rights to review. (Sec. 5231) Sets forth additional remedies and enforcement provisions. Subtitle D: Medical Malpractice - Prohibits any medical malpractice liability action until the final resolution of the claim under alternative dispute resolution. Requires each regional alliance health plan and corporate alliance health plan to adopt at least one specified method of alternative dispute resolution. Prohibits an individual from bringing a medical malpractice liability action unless the individual submits an affidavit that includes a report by a qualified specialist that states that there is a meritorious cause for filing the action. (Sec. 5311) Directs the Secretary to establish: (1) a project to demonstrate whether substituting liability for medical malpractice on the part of the health plan in which a physician participates for the personal liability of the physician will result in improvements in the quality of care, reductions in defense medical practices, and better risk management; (2) a pilot program under which the Secretary provides funds to one or more eligible States to determine the effect of applying practice guidelines in the resolution of medical malpractice liability actions. Subtitle E: Fraud and Abuse - Directs the Secretary and the Attorney General to establish a program: (1) to coordinate the functions of the Attorney General, the Secretary, and other organizations with respect to the prevention, detection, and control of health care fraud and abuse; (2) to conduct investigations, audits, evaluations, and inspections relating to the delivery of and payment for health care; and (3) to facilitate the enforcement of this and other statutes applicable to health care fraud. (Sec. 5402) Creates, in the Treasury, the All-Payer Health Care Fraud and Abuse Control Account which shall consist of: (1) gifts and bequests; (2) administrative penalties and assessments and portions of civil monetary penalties imposed under provisions of the Social Security Act; (3) all criminal fines imposed in cases involving a Federal health care offense; (4) penalties imposed under the False Claims Act involving claims related to the provision of health care items and services; and (5) amounts resulting from the forfeiture of property by reason of Federal health care offense. States that amounts in the fund may be used to cover costs incurred in operating the Program. (Sec. 5411) Excludes from participation in any health plan any individual or entity excluded from participation in a public program under provisions of the Social Security Act. (Sec. 5413) Sets forth physician self-referral limitations. (Sec. 5431) Amends the Federal criminal code to set penalties for knowingly executing a scheme or artifice to: (1) defraud any health alliance, health plan, or other person (alliance) in connection with the delivery of, or payment for, health care benefits, items, or services (benefits); and (2) obtain, by false or fraudulent means, money or property owned by, or under the custody of control of, any such alliance in connection with the delivery of, or payment for, health care benefits. (Sec. 5432) Amends: (1) the Federal criminal code to require the court, in imposing sentence on a person convicted of a Federal health care offense that poses a serious threat to the health of any person or has a significant detrimental impact on the health care system, to order such person to forfeit property used in the commission of the offense or that constitutes, or is derived from, proceeds traceable to the commission of the offense which is of a value proportionate to the seriousness of the offense; and (2) the Federal judicial code to require that all proceeds of forfeiture relating to Federal health care offenses be deposited into the Department of Justice Assets Forfeiture Fund. (Sec. 5433) Amends the Federal criminal code to set penalties for: (1) knowingly and willfully falsifying, concealing, or covering up a material fact, making any false, fictitious, or fraudulent statements or representations, or making or using any false writing or document knowing it to contain any false, fictitious, or fraudulent statement or entry, in any matter involving a health alliance or health plan; and (2) bribery of, and graft by, a health care official. (Sec. 5435) Authorizes: (1) the Attorney General to commence a civil action in Federal court to enjoin a Federal health care offense; and (2) a person privy to certain grand jury information concerning a health law violation to disclose that information to an attorney for the Government to use in any civil proceeding related to a Federal health care offense. (Sec. 5437) Sets penalties for: (1) theft or embezzlement in connection with a health alliance, health plan, or fund connected with such alliance or plan; and (2) misuse of a health security card issued, or unique identifier provided, pursuant to this Act. (Sec. 5441) Makes provisions of the Civil False Claims Act applicable to the use of false records or statements made to a health plan. Includes within the definition of "claim" for purposes of such Act any request or demand for money or property which is made or presented to a health plan. Subtitle F: McCarran-Ferguson Reform - Amends the McCarran-Ferguson Act to repeal the exemption under specified antitrust laws for the business of insurance to the extent that such business relates to the provision of health benefits. Title VI: Premium Caps; Premium-Based Financing; and Plan Payments - Subtitle A: Premium Caps - Sets forth provisions which provide for the computation of factors that limit the growth of premiums for the comprehensive benefit package in regional alliance health plans, including the computation of a: (1) regional alliance inflation factor; and (2) general health care inflation factor. (Sec. 6002) Directs the Board to determine: (1) a national per capita baseline premium target; (2) the national average per capita current coverage health expenditures; and (3) current health care expenditures. (Sec. 6003) Directs the Board to determine a regional alliance per capita premium. (Sec. 6004) Requires a regional alliance to annually obtain premium bids from each plan seeking to participate as a regional alliance health plan with respect to the alliance. (Sec. 6005) Permits any participating State to assume responsibility for containment of health care expenditures in the State consistent with this Act. (Sec. 6006) Directs the chair of the Board to establish an advisory commission on regional variations in health expenditures. Requires the commission to examine methods of eliminating variation in regional alliance per capita premium targets due to variation in practice patterns, not due to other factors. Requires the Board to submit its recommendations to the Congress. Requires such recommendations to apply unless a joint resolution of disapproval is passed. (Sec. 6011) Subjects each noncomplying regional alliance health plan for a year to a reduction in plan payment as specified, in order to assure that payments to regional alliance health plans by a regional alliance are consistent. Defines a noncomplying plan to include a plan in which the final accepted bid exceeds the maximum complying bid for the per capita target premium. Defines "maximum complying bid." (Sec. 6021) Directs the Board to develop a methodology for calculating an annual per capita expenditure equivalent for amounts paid for coverage for the comprehensive benefit package within a corporate alliance. (Sec. 6022) Terminates a corporate alliance with two excess years in a three year period. Provides that employers that were corporate alliance employers with respect to a terminated alliance shall become regional alliance employers. Defines an excess year as one in which the rate of increase for the corporate alliance exceeds the national corporate inflation factor. Defines rate of increase and national corporate inflation factor. (Sec. 6031) Sets forth special rules for a single-payer State. (Sec. 6041) Directs the Secretary to establish a program to monitor prices and expenditures in the U.S. health care system. Subtitle B: Premium-Related Financings - Makes each family enrolled in a regional health alliance plan or in a corporate alliance health plan in a class of family enrollment responsible for payment of the family share of premium payable for enrollment. Provides for income related discounts and specified credits. (Sec. 6102) Establishes the formula for determining the premiums. (Sec. 6111) Provides for the repayment of credit by certain families. (Sec. 6114) Provides for the special treatment of certain retirees and qualified spouses and children. (Sec. 6121) Requires each regional alliance employer to pay a monthly premium to the regional alliance for a qualifying employee. Sets forth provisions for determining such premium. Varies the premium depending upon such factors as the employer's size and average wages paid. (Sec. 6126) Sets forth provisions applicable to self-employed individuals. (Sec. 6131) Sets forth provisions for determining the corporate employer premium. Subtitle C: Payments to Regional Alliance Health Plans - Sets forth provisions to determine the computation of: (1) the blended plan per capita payment amount; and (2) the plan bid, AFDC, and SSI proportions. Title VII: Revenue Provisions - Subtitle A: Financing Provisions - Amends the Internal Revenue Code to increase the excise taxes on cigarettes and other tobacco products. (Sec. 7113) Imposes an excise tax on the manufacture or importation of roll-your-own tobacco. (Sec. 7121) Imposes an assessment on each corporate alliance employer and a temporary assessment on employers with retiree health benefit costs. Requires such assessments to be paid in the same manner as employment taxes. (Sec. 7131) Provides for the recapture of certain health care subsidies received by high-income individuals. Transfers such amounts to the Supplemental Medical Insurance Trust Fund. (Sec. 7141) Requires certain shareholders of S corporations and limited partners who materially participate in corporate activities to include their share of income or loss from such corporation when determining net earnings from self-employment. (Sec. 7142) Provides for extending Medicare coverage and applying the hospital insurance tax to all State and local government employees. Subtitle B: Tax Treatment of Employer-Provided Health Care - Provides exceptions to the exclusion of employer-provided contributions to an accident or health plan from the gross income of an employee. (Sec. 7202) Prohibits the provision of health benefit under cafeteria plans. (Sec. 7203) Makes permanent the deduction for health insurance costs of self-employed individuals. Increases such deduction to 100 percent of the basic coverage purchased from a health alliance with limitations. Subtitle C: Employment Status Provisions - Requires the Secretary of the Treasury to prescribe regulations defining an employee for employment tax purposes. (Sec. 7302) Increases the penalty for failure to file correct returns involving payments for services. (Sec. 7303) Sets forth rules to limit retroactive employment tax reclassifications. Subtitle D: Tax Treatment of Funding of Retiree Health Benefits - Requires additional reserves for post-retirement medical and life insurance benefits to cover not less than ten years of the working lives of covered employees and to be maintained as separate accounts. (Sec. 7402) Terminates the authority of pension plans to maintain health benefits accounts. Subtitle E: Coordination with COBRA Continuing Care Provisions - Repeals provisions concerning continuation coverage requirements of group health plans upon implementation of this Act. Subtitle F: Tax Treatment of Organizations Providing Health Care Services and Related Organizations - Provides for the tax treatment of charitable organizations providing health care services, insurance provided by health maintenance organizations, and certain private foundations. (Sec. 7602) Sets forth transitional rules for taxing certain organizations providing health insurance and other prepaid health care services as insurance companies other than life insurance companies. (Sec. 7603) Exempts regional alliances from income tax. Subtitle G: Tax Treatment of Long-term Care Insurance and Services - Treats qualified long-term care services as medical care for purposes of the medical expense deduction. (Sec. 7702) Provides for the treatment of long-term care insurance as accident and health insurance. (Sec. 7703) Allows accelerated death benefits under life insurance contracts to be paid to terminally ill individuals. Subtitle H: Tax Incentives for Health Service Providers - Allows a tax credit for certain qualified individuals who provide primary health services full time in a health professional shortage area. (Sec. 7802) Increases the allowable depreciation deduction for expensing certain medical equipment. Subtitle I: Miscellaneous Provisions - Allows a tax credit for the cost of personal assistance services required by an employed individual who for medical reasons is unable to engage in substantial gainful activity. (Sec. 7902) Denies tax-exempt status for private activity bonds of regional alliances, corporate alliances, or guaranty funds established under this Act. Title VIII: Health and Health-Related Programs of the Federal Government - Subtitle A: Military Health Care Reform - Directs the Secretary of Defense to establish one or more uniformed services health plans in order to provide health care services to members of the armed forces on active duty for 30 or more days as well as their covered beneficiaries. Requires conformity of such plans with health plan requirements set forth in this Act. (Sec. 8001b) Allows any such plan to rely upon the use of military health care facilities, supplemented by civilian health care providers or health plans under agreements entered into by the Secretary. Requires at least the items and services in the comprehensive benefit package under this Act to be included in each such plan. Preempts any conflicting State health plan requirements. Provides for plan enrollment, effect of failure to enroll, and choosing between a uniformed services health plan and other available plans. Prohibits the imposition of plan charges to an active-duty member other than subsistence charges, but allows the Secretary to impose limited charges for covered beneficiaries. Establishes in the Department of Defense a financial account for payments received in connection with a uniformed services health plan, allowing such funds to be used only for purposes directly related to the delivery and financing of health care services under this Subtitle. Subtitle B: Department of Veterans Affairs - Allows each veteran who is an eligible individual under this Act and individuals currently enrolled in a health plan under the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) to be enrolled with a Department of Veterans Affairs (VA) health plan. Requires conformity of such plans with health plan requirements set forth in this Act, with all the items and services of the comprehensive benefit package under this Act included. Allows such plans to offer supplemental health benefits and cost-sharing policies as consistent with this Act. Provides a limitation with regard to veterans enrolled with health plans outside the VA. Prohibits the imposition of any plan enrollment charges upon service-connected disabled veterans, veterans receiving disability compensation from the VA, former prisoners of war, and veterans unable to defray the costs of such care. Allows the Secretary of Veterans Affairs to establish plan charges for other veterans. Deems a VA facility to be a Medicare provider for purposes of any program administered by the Secretary of Health and Human Services. Allows for the recovery of certain care and services provided under a VA plan in the case of an individual who has coverage under another plan. Establishes in the Treasury the Department of Veterans Affairs Health Plan Fund to be used for VA health plan payments and services. Preserves existing benefits for VA facilities not operating within a health plan certified under this Act. (Sec. 8102) Directs the Secretary of Veterans Affairs to organize health plans and operate VA facilities as, or within, health plans under this Act. Preempts existing State health plan standards or requirements. Authorizes the Secretary to contract for the provision of services by a VA health plan when cost-effective, or to share resources with other health care plans, providers, or organizations. Authorizes appropriations to the VA for FY 1995 through 1997 for VA health plans under this Subtitle, subject to availability of appropriations. Requires a report from the Secretary to the Congress concerning the operation of the VA health care system within the requirements of this Act. Authorizes the Secretary to accept and use grants for health care services provided to special populations if used by the VA while operating under a VA health plan. Subtitle C: Federal Employees Health Benefits Programs - (Secs. 8202 through 8204) Provides for termination of the Federal Employees Health Benefits Program (FEHB) and treatment of Federal employees, annuitants, and other individuals (including those residing abroad) who would otherwise have been eligible for FEHBP under this Act's health plans. Subtitle D: Indian Health Service - Makes qualifying Indians eligible to enroll in a comprehensive benefits health program of the Indian Health Service. (Sec. 8303) Authorizes appropriations for supplemental Indian health care benefits. (Sec. 8305) Exempts tribal governments and organizations from making employer payments. (Sec. 8306) Sets forth provisions regarding health service to non-enrollees and non-Indians. (Sec. 8311) Requires each health program of the Indian Health Service to establish a comprehensive benefit package fund. (Sec. 8313) Authorizes appropriations for the Indian Health Service programs. Subtitle E: Amendments to the Employee Retirement Income Security Act of 1974 - Amends the Employee Retirement Income Security Act of 1974 (ERISA) to revise and limit the coverage of group health plans under ERISA. Makes certain ERISA provisions inapplicable with respect to State-certified health plans. Provides for an exception from ERISA civil action provisions where review is otherwise available under the Health Security Act (this Act, HSA). (Sec. 8402) Establishes ERISA requirements for expeditious reporting and disclosure applicable to group health plans, through special rules consistent with ERISA and HSA purposes. Excludes plans maintained by regional alliances from treatment as multiple employer welfare arrangements. (Sec. 8403) Revises certain ERISA provisions relating to continuation coverage under group health plans. Repeals such provisions upon implementation of HSA. (Sec. 8404) Makes ERISA standards for group health plans regarding: (1) cases of adoption applicable except to the extent otherwise provided in regulations of the National Health Board under HSA; and (2) coverage of pediatric vaccines inapplicable to a group health plan upon its becoming a corporate alliance health plan under HSA. (Sec. 8405) Requires group health plans under ERISA to comply with HSA requirements relating to health plan claims procedure. Subtitle F: Special Fund for WIC Program - Authorizes appropriations through FY 2000 for the special supplemental food program for women, infants, and children under the Child Nutrition Act of 1966. Title IX: Aggregate Government Payments - Subtitle A: Aggregate State Payments - Sets forth provisions which have formulas for determining each participating State's payment to regional alliances within the State. Provides two different formulas. Establishes one payment formula for non-cash assistance recipients. Establishes another formula relating to cash assistance recipients. Defines a non-cash assistance adult as an individual who is: (1) over 21 years; (2) a U.S. citizen or lawful alien; and (3) is not an AFDC or SSI recipient or a Medicare-eligible individual. (Sec. 9022) Directs the National Health Board to review appropriateness of such payments. Subtitle B: Aggregate Federal Alliance Payments - Sets forth the formula for determining Federal payments to regional alliances for cash assistance recipients. (Sec. 9102) States that this section constitutes budget authority in advance of appropriation Acts and obligates the Federal Government to provide for the payment to regional alliances of a capped Federal alliance payment amount. Defines "capped Federal alliance payment amount." Subtitle C: Borrowing Authority to Cover Cash-flow Shortfalls - Authorizes the Secretary to make available loans to regional alliances to cover any period of temporary cash-flow shortfall attributable to: (1) any estimation discrepancy; (2) a period of temporary cash-flow shortfall attributable to an administrative error; or (3) a period of temporary cash-flow shortfall relating to the relative timing during the year in which amounts are received and payments are required. Sets forth loan terms and conditions. Title X: Coordination of Medical Portion of Workers Compensation and Automobile Insurance - Subtitle A: Workers Compensation Insurance - Requires each health plan that provides services to enrollees through participating providers to make arrangements to provide workers compensation to such enrollees. (Sec. 10002) Requires each workers' compensation carrier that is liable for payment for workers' compensation services furnished by or through a health plan, regardless of whether or not the services are included in the comprehensive benefit package, to make payment for such services. (Sec. 10011) Sets forth requirements for participating States. (Sec. 10031) Authorizes demonstration projects in one or more States with respect to the treatment of work-related injuries and illnesses. Subtitle B: Automobile Insurance - Requires an individual entitled to automobile insurance medical benefits and enrolled in a health plan to receive automobile insurance medical services through the provision of such services by the health plan. (Sec. 10102) Requires each automobile insurance carrier that is liable for payment for automobile insurance medical services furnished by or through a health plan, regardless of whether or not the services are included in the comprehensive benefit package, to make payment for such services. (Sec. 10111) Requires each participating State to develop a fee schedule applicable to payment for automobile insurance medical services for which a fee is not included in the applicable fee schedule. Subtitle C: Commission on Integration of Health Benefits - Establishes the Commission on Integration of Health Benefits which shall study and report on the feasibility and appropriateness of transferring financial responsibility for all medical benefits, including those currently covered by workers compensation and automobile insurance, to health plans. Authorizes appropriations. Subtitle D: Federal Employees' Compensation Act - Requires the Federal Employees' Compensation Act to be interpreted and administered consistent with the provisions of subtitle A. Subtitle E: Davis-Bacon Act and Service Contract Act - Amends the Davis-Bacon Act and the Service Contract Act of 1965 to require Health Security Act benefits. Subtitle F: Effective Dates - Sets forth effective date provisions. Title XI: Transitional Insurance Reform - Sets forth transitional provisions concerning: (1) enforcement; (2) preservation of current coverage; (3) restrictions on premium increases during transition; (4) portability requirements; (5) restrictions limiting benefit reductions; and (6) the establishment of the National Transitional Health Insurance Risk Pool.
United States · United States Congress · 19 November 1993
Propane Education and Research Act of 1993 - Directs the Secretary of Energy (the Secretary) to conduct a referendum among producers and retail marketers to authorize the creation of the Propane Education and Research Council and the levying of an assessment on odorized propane. Makes it the Council's mission to develop programs and enter into contracts for: (1) propane research and development; (2) consumer education; (3) propane market development; and (4) payment for program costs with funds collected under this Act. Prescribes guidelines under which the Council shall set annual assessments to cover program costs. Authorizes the Secretary to establish a program to coordinate Council operations with any State propane education and research council. Proscribes the use of Council funds for lobbying activities. Directs the Secretary to issue implementation regulations.
United States · United States Congress · 16 November 1993
Directs the Secretary of Energy to terminate the gas turbine-modular helium reactor program of the Department of Energy. Transfers funds appropriated for such program to the Deficit Reduction Fund.
United States · United States Congress · 10 November 1993
Cooperative Agricultural Programs Extended Retirement Credit Act of 1993 - Provides for crediting under certain conditions, service in certain Federal-State cooperative agricultural and other programs under the Civil Service Retirement System.
United States · United States Congress · 3 November 1993
Amends the Food Stamp Act of 1977 to redefine "retail food store" for purposes of food stamp program (program) eligibility as a store that sells food for home preparation and consumption and: (1) has 50 percent of its total sales volume in staple foods (as defined by this Act); or (2) offers on a continuous basis food in each of four staple food categories, including sales of perishable foods in at least two of such categories. Permits the use of program application information by Federal or State enforcement authorities and establishes fine and imprisonment penalties for information misuse. Directs the Secretary of Agriculture to use specified funds for demonstration projects aimed at coupon trafficking.
United States · United States Congress · 28 October 1993
Amends the Social Security Act, the Balanced Budget and Emergency Deficit Control Act of 1985 (Gramm-Rudman-Hollings Act), and the Congressional Budget Act of 1974 to provide for excluding the Unemployment Trust Fund from Federal budget calculations.
United States · United States Congress · 27 October 1993
Safe Drinking Water Act Amendments of 1993 - Amends the Safe Drinking Water Act to require the Administrator of the Environmental Protection Agency, in the case of specified contaminants listed in the Federal Register for which national primary drinking water regulations have not been promulgated, to: (1) publish maximum contaminant level goals and promulgate such regulations for those contaminants that occur in drinking water and are of public health concern; and (2) eliminate monitoring, compliance, and enforcement requirements for those contaminants that do not occur in drinking water at levels of public health concern. (Current law requires the promulgation of such goals and regulations for specified numbers of such contaminants by certain dates.) Directs the Administrator to promulgate such goals and regulations for new contaminants every five years. Requires the Administrator to establish in each national primary drinking water regulation best technology treatment techniques for public water systems serving fewer than 1,000, between 1,000 and 10,000, and more than 10,000 people, respectively. Directs the Administrator to promulgate national primary drinking water regulations for radionuclides, disinfection and corrosion byproducts, and sulfate. Revises provisions concerning variances from national drinking water regulations to permit the issuance of a variance by a State only if the water system cannot afford to install the best available technology to meet the maximum contaminant level and it is not feasible for the system to connect with another source of water that will meet the standards. Requires variances to be reviewed by the State at least every three years. Repeals provisions that authorize States to exempt public water systems from requirements respecting maximum contaminant levels or treatment techniques. Prohibits treated drinking water from being removed from a public water system or routed through any device or pipes outside the system and returned to the system. Includes such action in the definition of "tampering," a violation for which criminal penalties are imposed. Makes such prohibition inapplicable to pipes and devices totally within the control of one or more public water systems or to connections between water mains. Requires (currently, authorizes) the Administrator to conduct research relating to diseases and other impairments resulting from contaminants in drinking water or to the provision of a safe supply of drinking water. Authorizes appropriations. Extends the authorization of appropriations for grants for State public water system supervision programs. Requires the Administrator to promulgate revised regulations every five years that list up to 30 unregulated contaminants to be monitored by public water systems. Directs the Administrator to assemble a national drinking water occurrence data base to include information on the occurrence of regulated and unregulated contaminants.
United States · United States Congress · 21 October 1993
Establishes a toll-free number to inform consumers regarding: (1) whether a product is made in America; (2) where products may be purchased; and (3) the purchase of products. Allows registration of American-made products.
![Official portrait of Rep. Long, Jill L. [D-IN-4]](https://www.congress.gov/img/member/l000420_200.jpg)