United States · United States Congress · 6 October 1994
Firearms Licensing Act of 1994 - Requires the Director of the Bureau of Justice Assistance to reduce by 25 percent the annual allocation to a State for a fiscal year under title I of the Omnibus Crime Control and Safe Streets Act of 1968 unless the State has in effect laws and procedures which provide for: (1) a records check before issuance of a driver's license and identification documents, and the use of magnetic strips to identify prohibited persons; (2) the seizure and voiding of the driver's license of a person convicted of a felony or adjudicated mentally incompetent, and the use of a magnetic strip identifying the licensee as a prohibited person to be attached to future licenses; (3) the funding of records checks by increasing fines imposed upon convicted felons; and (4) a requirement that the State maintain and update a computerized list of prohibited persons. Directs the Attorney General to: (1) create a national, computerized list of prohibited persons; (2) incorporate State criminal history records into the Federal criminal records system maintained by the Federal Bureau of Investigation; (3) develop hardware and software systems to link State lists of prohibited persons with the national list; and (4) provide any responsible State agency with access to the national list upon request. Sets forth provisions regarding: (1) procedures for correcting erroneous records; and (2) judicial review. Amends the Federal criminal code to prohibit a person from possessing a firearm unless the person is carrying an identification document that is issued to the person by the State transportation agency where the person resides and affixed with a magnetic strip on which is encoded information that identifies the licensee as a person who is not a prohibited person. Makes it unlawful for any licensed dealer to: (l) knowingly transfer a firearm to an unlicensed individual unless the dealer has used an electronic device to read such strip; or (2) fail to notify local law enforcement authorities within 72 hours of any attempt to purchase a firearm by a person who is identified as a prohibited person through the use of such a device. Sets penalties for violations. Directs the court, upon conviction of such illegal possession of a firearm, to offer the defendant the opportunity to seek enlistment or appointment in the armed forces (and if the defendant immediately accepts, to impose a probationary sentence on the defendant, conditioned on the defendant becoming enlisted or appointed within 60 days after imposition of such sentence and completing the minimum period of obligated active service required under the enlistment or appointment).
United States · United States Congress · 23 September 1994
Encourages and authorizes the States to study and adopt interstate insurance regulatory compacts to address regulatory issues, including the regulation of alien insurers and reinsurers, insurer solvency, rehabilitation and liquidation, guaranty fund protection, and insurance agent licensing. Declares that the States which have a majority of property and liability insurance premiums paid in the United States should adopt an interstate compact relating to the certification of alien insurers and reinsurers within two years of this Act's enactment. Requires such compact to establish minimum standards for alien insurers and reinsurers to be certified to do business within such States within three years. Sets forth reporting requirements.
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 · 22 September 1994
Centennial of Flight Commemoration Act - Establishes the Centennial of Flight Commission to commemorate the first manned airplane flight by the Wright brothers. Authorizes appropriations.
United States · United States Congress · 4 August 1994
Makes in order, in the consideration of H.R. 3600 (Health Security Act), an amendment substituting the text of H.R. 3080 and including a title providing for assistance for the purpose of health insurance.
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 · 29 July 1994
Small Business Incentive Act of 1993 - Amends the Securities Act of 1933 to increase from $5 million to $10 million the size of small business offerings that are exempt from the registration requirements of the Act. Amends the Investment Company Act of 1940 to exclude from its definition of "investment company" any issuer all of whose securities are held by certain investors whom the Securities and Exchange Commission (SEC) has determined possess such financial sophistication, net worth, and other specified factors as not to need the protections of such Act. Empowers the SEC to define such "qualified purchasers." Sets forth conditions under which certain business and industrial development companies that are already subject to regulation by the State in which they are organized are exempt from the regulatory constraints of such Act. Increases to $10 million the maximum aggregate amount of proceeds that certain interstate closed-end investment companies may receive from the sale of their outstanding securities and still retain their exempt status under such Act. Expands the definition of "eligible portfolio company" to include any company which does not have total assets in excess of $4 million and capital and surpluses in excess of $2 million. Declares that a "business development company" is not required to make available significant managerial assistance with respect to any eligible portfolio company or any other company that meets certain SEC criteria. Permits a business development company to acquire the securities of an eligible portfolio company from persons other than such portfolio company itself. Requires a business development company to file with the SEC a written evaluation of the risk factors involved in investment due to the nature of the company's capital structure.
United States · United States Congress · 19 July 1994
Expresses the sense of the Congress that the United States should not undertake any military action against Haiti unless the President first certifies to the Congress that there exists a clear and present danger to the citizens of the United States and that U.S. interests require such action.
United States · United States Congress · 16 June 1994
United States-China Act of 1994 - Declares that if nondiscriminatory treatment (most-favored-nation treatment) is not granted to China by reason of the enactment of a congressional disapproval resolution, such treatment shall continue to apply to goods that are produced by a person that is not a state-owned Chinese enterprise, but not apply to any goods that are produced by a state-owned Chinese enterprise. Provides that if nondiscriminatory treatment is granted to China for a 12-month period on July 3, 1994, such treatment shall not apply to: (1) any good that is produced by the People's Liberation Army or a Chinese defense industrial trading company; or (2) any nonqualified good that is produced by a state-owned Chinese enterprise. Provides that in order for such treatment to be granted to China, the Secretary of the Treasury shall consult with American businesses that have significant trade with or investment in China, to encourage them to adopt a voluntary code of conduct that: (1) follows internationally recognized human rights principles; (2) ensures the employment of Chinese citizens is not discriminatory in terms of sex, ethnic origin, or political belief; (3) ensures that no convict, forced, or indentured labor is knowingly used; (4) recognizes the rights of workers to freely organize and bargain collectively; and (5) discourages mandatory political indoctrination on business premises. Requires the Secretary to determine, and publish in the Federal Register, which persons are state-owned Chinese enterprises and Chinese defense industrial trading companies. Authorizes the President to waive any condition or prohibition imposed under this Act if he determines and reports to the Congress that its continued imposition would have a serious adverse effect on vital U.S. national security interests. Declares that if the President recommends in 1995 that the waiver of human rights and emigration requirements for nondiscriminatory treatment for China be continued, he shall state in a specified report to the Congress the extent to which China has made progress with respect to: (1) adhering to the provisions of the Universal Declaration of Human Rights; (2) ceasing the exportation to the United States of products made with convict, forced, or indentured labor; (3) ceasing unfair and discriminatory trade practices which restrict and unreasonably burden American businesses; and (4) adhering to the guidelines of the Missile Technology Control Regime and the controls adopted by the Nuclear Suppliers Group and the Australia Group.
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 · 26 May 1994
Expresses the sense of the House of Representatives that for purposes of issuing final guidelines under title VII of the Civil Rights Act of 1964 relating to unlawful harassment in employment, the Equal Employment Opportunity Commission should exclude harassment based on religion.
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 · 11 May 1994
Grant's Tomb National Memorial Act of 1994 - Redesignates General Grant National Memorial, located at Riverside Drive and West 122d Street, New York, New York, as Grant's Tomb National Memorial. Requires the Secretary of the Interior to: (1) design and construct a visitors center at the Memorial to aid in its interpretation and to maintain its historical significance; and (2) acquire from the city of New York non-Federal lands located within the boundaries of the Memorial. Authorizes the Secretary to lease such lands or enter into a cooperative agreement for the management of them. Requires the Secretary to establish a study commission to review security and maintenance at the Memorial as well as plan for interpretive programs and for the complete restoration of it and to submit a written report regarding such study to the Secretary. Directs the Secretary to: (1) submit a final plan for such projects consistent with such report to the Congress; and (2) in coordination with the Secretary of Defense, acting through the Secretary of the Army, to provide at least three military guards to protect the Memorial and the Site on a 24-hour basis every day in perpetuity. Authorizes appropriations.
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 · 13 April 1994
Requires the establishment of a budget reserve account for the funding for natural disasters and national security emergencies. Amends the Congressional Budget Act of 1974 to include such funding in the budget process. Amends the Balanced Budget and Emergency Deficit Control Act of 1985 (Gramm-Rudman-Hollings Act) to repeal provisions relating to emergency appropriations. Requires annual reports to the Congress on expenditures from such account.
United States · United States Congress · 22 March 1994
Miscellaneous Tariff Act of 1993 - Amends the Harmonized Tariff Schedule of the United States to suspend, through December 31, 1995, the duty on certain organic chemicals.
United States · United States Congress · 16 March 1994
TABLE OF CONTENTS: Title I: Eligible Shareholders of S Corporation Subtitle A: Number of Shareholders Subtitle B: Persons Allowed as Shareholders Subtitle C: Other Provisions Title II: Qualification and Eligibility Requirements for S Corporations Subtitle A: One Class of Stock Subtitle B: Elections and Terminations Subtitle C: Other Provisions Title III: Taxation of S Corpporation Shareholders Title IV: Effective Date S Corporation Reform Act of 1993 - Title I: Eligible Shareholders of S Corporation - Subtitle A: Number of Shareholders - Amends the Internal Revenue Code to increase from 35 to 50 the maximum number of shareholders of an S corporation (small business corporation). Allows members of a family to be treated as one shareholder. Subtitle B: Persons Allowed as Shareholders - Allows the following entities to be shareholders of S corporations: (1) certain tax-exempt organizations; (2) financial institutions that do not use the reserve method of accounting for bad debts; (3) nonresident aliens; and (4) certain small business trusts. Subtitle C: Other Provisions - Extends the post-death qualification for certain trusts to be permitted as shareholders from 60 days to two years. Title II: Qualification and Eligibility Requirements for S Corporation - Subtitle A: One Class of Stock - Allows an S corporation to issue qualified preferred stock. Permits financial institutions to hold safe harbor debt. Subtitle B: Elections and Terminations - Revises the rules on inadvertent terminations by certain trusts of the election to be an S corporation. Authorizes the Secretary of the Treasury to treat certain late elections as timely and to provide an automatic waiver procedure for certain inadvertent terminations. Expands the post-termination transition period until 120 days after a determination is made that the election had terminated in a prior year. Repeals excessive passive investment income as a termination event. Increases the tax imposed on such excessive income. Subtitle C: Other Provisions - Permits an S corporation to own more than 80 percent of another corporation's stock. Repeals the requirement that partnership rules apply for fringe benefit purposes (making C corporation rules applicable). Provides for the treatment of distributions during loss years. Provides a consent dividend for S corporation elections to by-pass amounts in the accumulated adjustments account when making distributions. Eliminates the need to keep records of certain generally small amounts of earnings arising before 1983. Allows S corporations to make charitable contributions of inventory and scientific property. Title III: Taxation of S Corporation Shareholders - Treats losses on liquidations of S corporations as ordinary to the extent the loss created by ordinary income pass-through triggered the liquidation. Title IV: Effective Date - Makes this Act effective after December 31, 1994.
United States · United States Congress · 9 March 1994
Supplemental Appropriations Rescissions Act of 1994 - Rescinds FY 1994 funds made available to: (1) the Federal Bureau of Investigation for the automation of fingerprint identification services; (2) the Federal Railroad Administration for the conversion of a post office to a train station and commercial center; and (3) the Department of Housing and Urban Development for assistance to sugarcane mills on the Hilo-Hamakua Coast of Hawaii. Repeals the authority of the Secretary of Transportation to use specified funds to relocate, repair, and lay up the nuclear ship SAVANNAH.
United States · United States Congress · 9 March 1994
Amends rule XI of the Rules of the House of Representatives to apply primary expense resolution requirements and personnel ceilings to the Committee on Appropriations and the Committee on the Budget. Repeals provisions authorizing the Committees to appoint committee staff. Requires funds for the appointment of committee staff to be provided by primary and additional expense resolutions. Provides that by the beginning of the 106th Congress, not less than one-third of the funding made available to each standing, select, special, ad hoc, or other House committee shall be allocated to the minority party. Exempts the Committee on Standards of Official Conduct.
United States · United States Congress · 2 March 1994
Ethics in Billing Act - Amends the Public Health Service Act to make it unlawful for any person to present a bill, claim, or demand for payment to any person other than the patient receiving services. Makes it unlawful for any physician to present a bill for ancillary health services to any recipient of such services unless the services were furnished personally by: (1) the referring physician; (2) a physician who is a member of the same group practice as the referring physician; or (3) individuals employed by such physician or group practice who are supervised by such physician or another physician in the group practice. Makes such prohibitions inapplicable with respect to ancillary health services for which payment may be made under title XVIII (Medicare) of the Social Security Act. Provides exceptions to such prohibitions, including demands for payments made to immediate family members or designated payors of the patient, a health maintenance organization in which a recipient is enrolled, and other exceptions. Provides sanctions against those collecting payment in violation of this Act. Allows the Secretary of Health and Human Services to suspend, revoke, or limit a laboratory certification as part of such sanctions. Defines "ancillary health services" as clinical laboratory services, diagnostic x-rays and other diagnostic imaging services and tests, durable medical equipment, and physical therapy services.
United States · United States Congress · 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 · 22 November 1993
Amends the Outer Continental Shelf Lands Act to authorize the Secretary of the Interior to negotiate an agreement for use of Outer Continental Shelf sand, gravel, and shell resources.
United States · United States Congress · 22 November 1993
TABLE OF CONTENTS: Title I: Basic Reforms to Expand Access to Health Insurance Coverage and to Ensure Universal Coverage Subtitle A: Universal Access Subtitle B: Qualified General Access Plans in the Small Employer and Individual Marketplace Subtitle C: Qualified Health Plans in the Large Employer Marketplace Subtitle D: Benefits; Benefits Commission Subtitle E: State and Federal Responsibilities in Relation to Qualified Health Plans Subtitle F: Universal Coverage Subtitle G: Definitions Title II: Tax and Enforcement Provisions Subtitle A: General Tax Provisions Subtitle B: Provisions Relating to Acceleration of Death Benefits Subtitle C: Long-Term Care Tax Provisions Subtitle D: Enforcement Provisions Title III: Quality Assurance and Simplification Subtitle A: Quality Assurance Subtitle B: Administrative Simplification Title IV: Judicial Reforms Subtitle A: Medical Liability Reform Subtitle B: Anti-Fraud and Abuse Control Program Subtitle C: Treatment of Certain Activities Under the Antitrust Laws Title V: Special Assistance for Frontier, Rural, and Urban Underserved Areas Subtitle A: Frontier, Rural, and Urban Underserved Areas Subtitle B: Primary Care Provider Education Subtitle C: Programs Relating to Primary and Preventive Care Services Title VI: Treatment of Existing Federal Programs Subtitle A: Medicaid Program Subtitle B: Medicare Title VII: Patient's Right to Self-Determination Regarding Health Care Health Equity and Access Reform Today Act of 1993 - Title I: Basic Reforms to Expand Access to Health Insurance Coverage and to Ensure Universal Coverage - Subtitle A: Universal Access - Provides access to health insurance coverage under a qualified health plan for every citizen and lawful permanent resident of the United States. (Sec. 1003) Establishes a program under which persons with low incomes (and who are not eligible for Medicaid) will receive vouchers to buy insurance through purchasing groups. (Sec. 1004) Requires each employer to make available, either directly, through a purchasing group, or otherwise, enrollment in a qualified health plan to each eligible employee. Subtitle B: Qualified General Access Plan in the Small Employer and Individual Marketplace - Requires the National Association of Insurance Commissioners to develop specific standards to implement requirements concerning: (1) guaranteed eligibility, availability, and renewability of health insurance coverage; (2) nondiscrimination based on health status; (3) benefits offered; (4) insurer financial solvency; (5) enrollment process; (6) premium rating limitations; (7) risk adjustment; and (8) consumer protection. (Sec. 1119) Requires each qualified general access plan to: (1) establish and maintain a quality assurance program and a mediation procedures program; and (2) contain assurances of service to designated underserved areas. (Sec. 1141) Provides for individuals and small employers to form purchasing groups. (Sec. 1161) Requires brokers or insurers to provide specified information to prospective enrollees. (Sec. 1162) Prohibits insurers from creating improper financial incentives and from selling duplicate coverage. Subtitle C: Qualified Health Plans in the Large Employer Marketplace - Requires the Secretary of Health and Human Services, in consultation with the Secretary of Labor, to establish standards for large employer plans similar to requirements applicable to small employer plans. (Sec. 1203) Requires large employers to offer to employees at least a standard package and a catastrophic package. (Sec. 1205) Allows two or more large employers to form purchasing groups, but not through an individual or small employer purchasing group. (Sec. 1206) Requires a semi-annual review of each large employer plan to determine whether requirements are being met and what corrective actions need to be taken. (Sec. 1221) Amends the Employee Retirement Income Security Act of 1974 and the Public Health Service Act to revise provisions to conform to this Act. Subtitle D: Benefits; Benefits Commission - Requires each qualified health plan to provide a standard package and a catastrophic package. Specifies items and services to be covered. (Sec. 1311) Establishes the Benefits Commission to develop and propose legislation that provides a clarification of covered items and services and includes specifications for cost sharing. (Sec. 1314) Provides for congressional consideration and implementation of such legislation. Subtitle E: State and Federal Responsibilities in Relation to Qualified Health Plans - Requires each State to establish a program to: (1) certify insured health plans; (2) disseminate information on health care coverage areas; (3) establish procedures for purchasing groups; (4) prepare information concerning plans and purchasing groups; (5) provide for a risk adjustment program, including an adjustment for differences in nonpayments among qualified insured health plans; (6) develop a binding arbitration process; and (7) specify an annual general enrollment period. (Sec. 1421) Allows the waiver of specified requirements. (Sec. 1431) Provides preemptions from certain State laws. (Sec. 1441) Specifies the Federal responsibilities with respect to multi-state employer plans and in case of State defaults. Subtitle F: Universal Coverage - Requires each citizen or lawful permanent resident to be covered under a qualified health plan or equivalent health care program by January 1, 2005. Provides an exception for any individual who is opposed for religious reasons to health plan coverage, including those who rely on healing using spiritual means through prayer alone. Subtitle G: Definitions - Defines terms used in this Act. Title II: Tax and Enforcement Provisions - Subtitle A: General Tax Provisions - Amends the Internal Revenue Code to exclude from an employee's gross income employer-provided coverage under a qualified health plan or employer-provided contributions to the employee's medical savings account. Includes excess employer contributions in such gross income. (Sec. 2002) Allows a business expense deduction for employer costs of qualified health plans or contributions to an employee's medical savings account. Increases the allowable deduction (from 25 percent to 100 percent) for the qualified health insurance costs of self-employed individuals. Makes such deduction permanent. (Sec. 2003) Allows individuals a tax deduction for contributions made to a medical care savings account established for the benefit of an eligible individual. Allows such deduction whether or not an individual itemizes deductions. Disallows distributions from such accounts as medical expense deductions. Excludes employer contributions to such accounts from employment taxes. Establishes an excise tax for excess contributions to medical care savings accounts. (Sec. 2004) Eliminates the commonality of interest and geographic location requirements with respect to group purchasing by large tax-exempt organizations. (Sec. 2005) Revises and repeals provisions concerning continuation coverage requirements of group health plans upon implementation of this Act. Subtitle B: Provisions Relating to Acceleration of Death Benefits - Requires payment under a life insurance contract on the life of an insured who is terminally ill to be treated as a death benefit, making such payment eligible for tax exclusion from gross income. (Sec. 2102) Provides that any reference to life insurance shall be treated as referring to a qualified terminal illness rider. Subtitle C: Long-Term Care Tax Provisions - Treats qualified long-term care services as medical care for purposes of the medical expense deduction. (Sec. 2202) Provides for the treatment of long-term care insurance as accident and health insurance. (Sec. 2301) Sets forth consumer protection provisions to be satisfied by qualified long-term care insurance contracts, including the model regulation and Act promulgated by National Association of Insurance Commissioners (NAIC). Requires NAIC to promulgate standards for the use of uniform language and definitions in such policies, with certain variations permitted. Subtitle D: Enforcement Provisions - Amends part A (General Provisions) of Social Security Act title XI to establish the Health Insurance Coverage Data Bank to: (1) further the purposes of coverage requirements under this Act; and (2) collect certain information reported by employers about individual employee group health plan coverage for purposes of identifying and collecting from responsible third parties any amounts owed to reimburse Medicare or Medicaid for health care items and services furnished to their beneficiaries. (Replaces the Medicare and Medicaid Coverage Data Bank.) (Sec. 2402) Amends the Internal Revenue Code to impose excise taxes on failures by employers and insurers to comply with provisions of this Act. (Sec. 2411) Amends the Employee Retirement Income Security Act of 1974 to make conforming changes regarding enforcement of employer failures. Title III: Quality Assurance and Simplification - Subtitle A: Quality Assurance - Directs the Secretary of Health and Human Services, in consultation with relevant agencies, to develop and publish standards for quality assurance programs and ensure that appropriate performance measures are established. Requires the standards to contain provider risk programs to prevent or provide early warning of practices that may result in injury. (Sec. 3002) Provides for the standardization of information through a national health data system. (Sec. 3003) Requires the Secretary to establish measures to determine quality of care in specialized centers of care. (Sec. 3004) Authorizes appropriations to examine the feasibility of creating an Agency for Clinical Evaluations by consolidating the responsibilities of specified other offices. (Sec. 3005) Requires the Secretary to report annually to the Congress on factors affecting universal coverage and make recommendations for increasing such coverage. (Sec. 3006) Requires the Secretary to monitor the reinsurance market for qualified health plans and periodically report to Congress on the financial implications. (Sec. 3101) Amends the Public Health Service Act to establish within the Agency for Health Care Policy and Research a clearinghouse for information and research data concerning clinical trials. Requires the appointment of a fund investigator for the Agency. (Sec. 3201) Amends the Internal Revenue Code to establish the National Fund for Medical Research and provide for the designation of tax overpayments to such fund. Subtitle B: Administrative Simplification - Establishes a health care data interchange system to make data available on a uniform basis to all participants in the health care system. (Sec. 3302) Requires the Health Care Data Panel to develop regulations for the operation of an integrated electronic health care data interchange system. (Sec. 3304) Sets forth requirements for such system including: data and transaction standards, uniform, working files, code sets, unique identifiers, standards for confidentiality, rules for the transfer of information, and periodic reviews. (Sec. 3313) Establishes the Health Care Data Panel and a National Health Informatics Commission to advise the Panel on its activities. Title IV: Judicial Reforms - Subtitle A: Medical Liability Reform - Requires a qualified health plan to provide effective mediation procedures for hearing and resolving health care malpractice claims. (Sec. 4013) Requires each State to adopt an alternative dispute resolution method for the resolution of health care malpractice claims and consumer grievances. (Sec. 4021) Establishes provisions with respect to liability under health care malpractice actions brought in State or Federal courts. (Sec. 4022) Limits attorney contingency fees and award amounts for noneconomic damages. (Sec. 4024) Establishes a two-year statute of limitations for health care malpractice claims, except in the case of minors. (Sec. 4025) Requires each State to establish a set of specialty clinical guidelines. Allows the use of such guidelines as a rebuttable presumption in a claim or action, if the service provided was the appropriate standard of medical care. (Sec. 4026) Prohibits the award of punitive damages against the producer of a drug or device that is approved by the Food and Drug Administration. (Sec. 4027) Requires a report to the appropriate congressional committees on the operation of this subtitle. Subtitle B: Anti-Fraud and Abuse Control Program - Requires the Secretary to establish in the Office of the Inspector General of the Department of Health and Human Services a program to control fraud and abuse under the universal health care plan. Establishes the Anti-Fraud and Abuse Trust Fund. (Sec. 4102) Amends title XI of the Social Security Act (SSA) to provide for the application of the penalties for Medicare and Medicaid fraud to all health care programs. (Sec. 4103) Requires the Secretary to establish a program through which Medicare-eligible individuals may report instances of suspected fraud under Medicare. (Sec. 4111) Revises current SSA title XI sanctions for fraud and abuse involving Medicare and State health care programs, with changes providing for: (1) program exclusion for individuals convicted of a felony relating to fraud or the unlawful manufacture or dispensing of a controlled substance; (2) new offenses under civil monetary penalty provisions, such as the presenting of claims for items or services which are not medically necessary; (3) establishment of a minimum period of exclusion for practitioners and persons who fail to meet statutory obligations; (4) intermediate sanctions on eligible health maintenance organizations for program violations; and (5) procedures for imposing such sanctions. Directs the Attorney General to establish a national health care fraud and abuse data collection program for the reporting by each government agency and health care plan of final adverse actions against health care providers, suppliers, and practitioners. (Sec. 4122) Amends SSA title XI to require the Secretary to publish in the Federal Register a listing of all final adverse actions taken during the quarter. (Sec. 4131) Amends the Federal criminal code to establish penalties for a health care provider that knowingly engages in any scheme or artifice to defraud a person in connection with the provision of health care. (Sec. 4132) Extends the application of the mail fraud statute to cover matter sent or delivered by private or commercial carriers. (Sec. 4133) Authorizes appropriations to hire, equip, and train no fewer than: (1) 275 Federal Bureau of Investigation special agents and support staff to investigate health care fraud cases; and (2) 50 assistant U.S. attorneys and staff to prosecute such cases. (Sec. 4134) Authorizes the Attorney General to pay a reward of up to $10,000 to a person who furnishes information unknown to the Government relating to a possible prosecution for health care fraud, with exceptions. (Sec. 4135) Directs the court to order a person convicted of a Federal health care offense that poses a serious threat to the health of any individual or that has a significant detrimental impact on the health care system, to forfeit property that was used in the commission of the offense or that constitutes or was derived from proceeds traceable to the offense and that is of a value proportionate to the seriousness of the offense. (Sec. 4136) Authorizes the Attorney General to commence a civil action in Federal court to enjoin a violation constituting a Federal health care offense. Subtitle C: Treatment of Certain Activities Under the Antitrust Laws - Exempts from the antitrust laws specified "safe harbor" activities related to the provision of health care services. Sets forth provisions regarding the award of attorney fees and costs of suit to the prevailing party in an action based on a claim involving activity found to be exempt. (Sec. 4202) Lists as safe harbors specified: (1) activities relating to health care services of combinations of health care providers with market share below a specified threshold; (2) activities of medical self-regulatory entities relating to standard setting or enforcement activities not conducted for purposes of financial gain; (3) participation of a health care provider in a written survey of the prices of services, reimbursement levels, or the compensation and benefits of employees and personnel; (4) activities relating to health care joint ventures for high technology and costly equipment and services; (5) activities relating to hospital mergers; (6) joint purchasing arrangements; and (7) negotiations. (Sec. 4203) Directs the Attorney General to publish a notice in the Federal Register soliciting proposals for additional safe harbors and to review and report to the Congress on proposed safe harbors. Sets forth criteria in establishing safe harbors, including: (1) the extent to which a competitive or collaborative activity will accomplish an increase in health care access and quality, the establishment of cost efficiencies, and increased ability of health care facilities to provide services in medically underserved areas or to underserved populations; and (2) whether designation as a safe harbor will result in specified desirable outcomes. (Sec. 4204) Directs the Attorney General to issue certificates of review for providers of health care services and to assist persons in applying for such certificates. Sets forth provisions regarding applications for, revocation of, and review of determinations regarding such certificates. Limits the disclosure of information. (Sec. 4205) Sets forth provisions regarding notifications providing for a reduction in certain penalties under the antitrust laws for health care cooperative ventures. (Sec. 4206) Directs the Attorney General to: (1) review the safe harbors and certificates of review periodically; and (2) promulgate such rules, regulations, and guidelines as necessary to carryout provisions of this subtitle. (Sec. 4208) Establishes within the Department of Health and Human Services an Office of Health Care Competition Policy. Title V: Special Assistance for Frontier, Rural, and Urban Underserved Areas - Subtitle A: Frontier, Rural, and Urban Underserved Areas - Amends the Public Health Service Act to establish a program of allotments to States for grants for community-based primary health services to low-income or medically underserved populations regarding infant mortality and referrals for the health management of infants and pregnant women. Earmarks for the allotments specified percentages of appropriations under certain provisions added by this Act. (Sec. 5002) Mandates grants to federally qualified health centers (FQHCs) and other entities for providing access to services for medically underserved populations or in high impact areas not currently being served by a FQHC. Authorizes appropriations. Directs the Secretary to report to the appropriate congressional committees on the relationship and interaction between community health centers and hospitals in providing services to such populations. (Sec. 5003) Amends the Internal Revenue Code to: (1) allow a nonrefundable credit for certain primary health services providers for mandatory service periods in health professional shortage areas; (2) exclude from gross income qualified loan repayments to the National Health Service Corps; (3) increase the dollar limitation allowed for expensing medical equipment used in rural health shortage areas; and (4) allow a deduction for student loan payments by medical professionals practicing in rural areas. (Sec. 5004) Amends title XVIII (Medicare) of the Social Security Act (SSA) to provide for: (1) establishment of rural emergency access care hospitals under Medicare; and (2) coverage of and payment for rural emergency access care hospital services under Medicare part B (Supplementary Medical Insurance). (Sec. 5005) Amends the Public Health Service Act to direct the Secretary to make grants to States to assist in the creation or enhancement of air medical transport systems that provide victims or medical emergencies in rural areas with access to treatments. Sets forth provisions regarding: (1) application and State plan requirements; (2) considerations in awarding grants; (3) State administration and use of grants; (4) the number of grants; and (5) reporting requirements. Authorizes appropriations. (Sec. 5006) Authorizes the Secretary to conduct a demonstration project and grant program to encourage the development and operation of rural health networks. Authorizes appropriations. (Sec. 5007) Requires the Secretary to report to the Congress on improving access to benefits under qualified health plans for individuals residing in rural areas. Subtitle B: Primary Care Provider Education - Requires the Secretary to provide for the establishment of demonstration projects to evaluate mechanisms to increase the number and percentage of medical students entering primary care practice through funds otherwise available for direct graduate medical education costs under the Medicare program. (Sec. 5102) Allows funding under Medicare for training in nonhospital-owned facilities. (Sec. 5103) Increases authorized funding for the National Health Service Corps Scholarship and Loan Repayment Programs. Authorizes funding through FY 1998. (Sec. 5104) Increases and extends through FY 1997 authorized funding for training for certain health service providers. Subtitle C: Programs Relating to Primary and Preventive Care Services - Authorizes appropriations for a grant program to improve coordination of maternal and infant care. (Sec. 5202) Amends the Elementary and Secondary Education Act of 1965 to authorize appropriations to carry out a comprehensive school health education and prevention program for elementary and secondary school students. (Sec. 5203) Allows frontier States (including Alaska, Wyoming and Montana) to implement proposals and participate in demonstration projects which give special consideration to their diverse needs. Title VI: Treatment of Existing Federal Programs - Subtitle A: Medicaid Program - Gives States the option of allowing the enrollment of Medicaid-eligible individuals (including a limited number of AFDC- and SSI-eligible individuals) in the standard benefit package under a qualified health plan, instead of enrollment in the State's Medicaid program. (Sec. 6001) Sets forth requirements for States exercising such option. Places a cap on Federal payments for acute medical services furnished under a State's Medicaid program. (Sec. 6011) Discontinues reimbursement standards for inpatient hospital services. Revises the Federal medical assistance percentage for certain States. Modifies Federal requirements to allow States more flexibility in contracting for coordinated care services under Medicaid. (Sec. 6021) Provides for waivers from requirements on coordinated care programs. Gives States the option to guarantee the continued Medicaid eligibility of individuals enrolled with risk contracting and other managed care entities. (Sec. 6031) Provides for phased-in elimination of Medicaid hospital disproportionate share adjustment payments. Subtitle B: Medicare - Requires the Secretary to: (1) submit to the Congress a proposal for legislation which provides for the enrollment of Medicare beneficiaries in qualified health plans; and (2) provide for a monthly payment to a qualified health plan on behalf of enrolled Medicare beneficiaries. (Sec. 6111) Amends the Omnibus Budget Reconciliation Act of 1990 (OMBRA '90) to revise provisions for a modified payment methodology for risk contractors. (Sec. 6112) Requires the Secretary to provide for adjustment in Medicare capitation payments to take into account secondary payer status. Authorizes the Secretary to make additional payments to eligible organizations with risk-sharing contracts. (Sec. 6121) Amends OMBRA '90 to: (1) make permanent the Medicare select policy program; and (2) allow access to Medicare select policies in all States. Amends Medicare to revise the Medicare select policy program and provide for a civil penalty for misrepresentations made in connection with such a policy. (Sec. 6131) Makes specified changes with regard to monthly Medicare part B premium determinations for part B enrollees. (Sec. 6132) Amends the Internal Revenue Code to provide for an increase in the Medicare part B premium for individuals with high income. (Sec. 6133) Makes permanent certain payment reductions relating to outpatient hospital services furnished under Medicare. (Sec. 6135) Imposes copayments for laboratory services and certain home health visits provided under Medicare. (Sec. 6137) Provides for phased-in elimination of Medicare disproportionate share hospital payments. (Sec. 6138) Directs the Secretary to discontinue hospital reimbursements for costs relating to the recovery of bad debts. (Sec. 6139) Makes specified changes with regard to Medicare as secondary payer. Title VII: Patient's Right to Self-Determination Regarding Health Care - Provides for the treatment of advance directives and other measures, including a study by the Secretary on issues relating to health care decisions by the patient, in addressing the patient's right to self-determination regarding health care.
United States · United States Congress · 22 November 1993
Health Plan Purchasing Cooperative Act of 1993 - Provides for a system whereby States establish voluntary health plan purchasing cooperatives (HPPCs), in which individuals without insurance and small employers could enroll and select from competing health plans providing a standard benefit plan (with a managed care, fee-for-service, and medisave option). (Sec. 2) Directs the Secretary of Health and Human Services to establish standards relating to the establishment of HPPCs, qualifications for Accountable Health Plans (AHPs) (carriers designated by a State insurance commissioner), the role of States, and a standard benefit package for small employers. Authorizes an HPPC to sue or be sued and to accept and expend grants or funds from public or private agencies. Sets forth limitations on an HPPC's authority. (Sec. 3) Requires each: (1) State to establish boundaries for HPPC areas and HPPCs for each area and a process whereby a carrier demonstrates that it has the capability to fulfill specified requirements; and (2) HPPC to establish bylaws, enter into contracts and hold policies with AHPs, provide for enrollment of eligible employees and individuals in qualified health benefit plans (HBPs), establish requirements for participation, and establish dispute resolution procedures, a fixed overhead allowance percentage, and uniform administrative and accounting procedures. (Sec. 7) Specifies that a health plan is not a qualified HBP unless the plan meets applicable financial requirements established under State law, is marketed only in accordance with specified standards, and submits to the HPPC data in accordance with uniform standards to be established by the Secretary. (Sec. 8) Requires each HPPC to use efficient and standardized means to notify small employers of the availability of health coverage through the HPPC. (Sec. 9) Directs each HPPC to submit to the State specified data on eligible employers, enrolled employers, eligible individuals, and premium ranges. (Sec. 10) Requires each State to designate an entity to monitor adverse selection in enrollment among qualified HBPs offered through HPPCs and the need for risk adjustment mechanisms. (Sec. 11) Sets forth provisions regarding: (1) oversight, dispute resolution, assuring availability of coverage and comparable treatment in and out of HPPCs, and certain antitrust protection of HPPCs; and (2) medisave coverage requirements and tax treatment of such coverage.
United States · United States Congress · 22 November 1993
Federal Regulation Cost-Benefit Assessment Act of 1993 - Provides for the application of Executive Order 12291 of February 17, 1981, as in effect on that date, to each agency, with respect to the issuance and review of Federal regulations.
United States · United States Congress · 10 November 1993
TABLE OF CONTENTS: Title I: AFDC Transition and Work Program Title II: Paternity Establishment Title III: Expansion of Statutory Flexibility of States Title IV: Expansion of State and Local Flexibility Title V: Child Support Enforcement Title VI: Welfare Restrictions for Aliens Title VII: Controlling Welfare Costs Title VIII: Consolidated Block Grant to States for Food Assistance Title IX: Miscellaneous Responsibility and Empowerment Support Program Providing Employment, Child Care, and Training Act - Title I: AFDC Transition and Work Program - Amends part F (Job Opportunities and Basic Skills Training Program) (JOBS) of title IV of the Social Security Act (SSA) to give the JOBS program the new purpose of assuring that needy families with children obtain not only the education and training needed to prepare them for a life without welfare, but the work experience as well. (Sec. 101) Requires State JOBS programs to include a transition component and a work supplementation component that: (1) are each allowed to include any State work experience program approved by the Secretary; and (2) with respect to the first component, must include the State's job search program, and, with respect to the second component, may include the State's work supplementation or community work experience program. Amends part A (Aid to Families with Dependent Children) (AFDC) of SSA title IV to revise State AFDC plan participation requirements to incorporate participation in the two JOBS program components above under specified guidelines as a requirement for qualified individuals to receive AFDC. Imposes sanctions for a qualified individual's failure to participate in the JOBS program as required under such guidelines, which include a reduction in AFDC benefits and eventual benefit termination for repeated failures. Revises the exemptions from JOBS program participation requirements. Extends to all States the option to limit AFDC-UP. Increases State JOBS program and work program participation rates with regard to, respectively, AFDC-eligible individuals and unemployed parents. Provides for additional payments to States for JOBS programs. (Sec. 102) Amends community work experience and work supplementation program provisions. Title II: Paternity Establishment - Amends SSA title IV part A to: (1) provide for denial or reduction of AFDC for children whose paternity is not established; and (2) require unmarried individuals under 19 who are eligible for AFDC and are pregnant or with dependent children under their care to reside at home in order to receive AFDC. (Sec. 203) Amends SSA title IV part D (Child Support and Establishment of Paternity) to require earlier specified paternity establishment efforts by States. Expresses the encouragement of the Congress for States to develop procedures in public hospitals and clinics to facilitate the acknowledgment of paternity. (Sec. 204) Increases the paternity establishment percentage. Title III: Expansion of Statutory Flexibility of States - Amends SSA title IV part A to give States the option to: (1) convert AFDC into a block grant program; (2) exempt themselves from otherwise mandatory denial of AFDC where either parent is a minor; (3) treat families moving interstate who apply for AFDC in their new State of residence (where they have resided for less than on year) under the AFDC rules of their former State of residence; (4) reduce AFDC for parents under 21 who have dropped out of school and dependent children who, without good cause, do not maintain minimum school attendance; (5) exempt themselves from otherwise mandatory denial of AFDC for additional children; (6) modify certain AFDC income disregard rules; (7) provide for a married couple transitional benefit in cases where an AFDC recipient marries an individual who is not a parent of the recipient's child, and the resulting family would become ineligible for AFDC by reason of the marriage; (8) disregard certain savings and income of a family on AFDC designated for education, training, employability, home purchase, or residence change in determining eligibility for AFDC; and (9) condition the receipt of AFDC on the recipient's attendance at parenting and money management classes and prior approval of any action requiring a change in the educational institution attended by the recipient's dependent child. Title IV: Expansion of State and Local Flexibility -Establishes an Interagency Waiver Request Board in order to provide a focal point within the Federal Government for the development and coordination of waiver requests to improve opportunities for low-income individuals and families. (Sec. 402) Prescribes contents of applications to implement Federal assistance plans, as well as the review, approval, implementation, and evaluation processes. (Sec. 405) Requires any entity applying for plan approval to establish a Public Private Partnership Committee to advise it on plan development and implementation. Title V: Child Support Enforcement - Provides for a national system for employee reporting of any child support owed, the obligee involved, and other specified related information on W-4 forms for employer withholding and distribution of support owed, and reporting of related information to the State involved for availability to other States through the Interstate Locate Network established under this title. (Sec. 502) Makes various changes with regard to State child support order registries, the Parent Locater Service, regulations for sharing child support information, withholding orders, and noncustodial parents with child support arrearages who are receiving certain public welfare assistance. Title VI: Welfare Restrictions for Aliens - Makes aliens (except refugees, permanent residents, and certain current residents) ineligible for various specified types of public welfare assistance, including non-emergency related assistance under Medicaid, food stamps, and job training assistance. (Sec. 602) Amends part A (Aid to Families with Dependent Children) (AFDC) of title IV of the Social Security Act (SSA) to require State AFDC agencies to provide information on illegal aliens to the Immigration and Naturalization Service. Title VII: Controlling Welfare Costs - Amends the Congressional Budget Act of 1974, the Balanced Budget and Emergency Deficit Control Act of 1985 (Gramm-Rudman-Hollings Act), and other Federal law to establish various specified measures for controlling welfare costs, including Federal spending caps. Title VIII: Consolidated Block Grant to States for Food Assistance - Repeals the Food Stamp Act of 1977, National School Lunch Act, Commodity Distribution Reform Act and WIC Amendments of 1987, and other specified Federal laws and replaces them with a: (1) State food assistance block grant program to provide food assistance to economically disadvantaged individuals and families (eligible populations); and (2) new food coupon program. Authorizes appropriations. (Sec. 803) Grants the Secretary of Agriculture and the Commodity Credit Corporation the authority to sell surplus commodities and foodstuffs to the States to provide food assistance to eligible populations. Title IX: Miscellaneous - Amends SSA title IV part A to require AFDC applicants and recipients to undergo any necessary substance abuse treatment as a condition of receiving AFDC. (Sec. 902) Amends SSA title XVI (Supplemental Security Income) (SSI) to: (1) make ineligible for SSI benefits individuals receiving SSI on the basis of a disability resulting from illegal drug addiction who continue to use illegal drugs or refuse to be tested for them; and (2) make representative payee changes. (Sec. 903) Directs the Secretary of Health and Human Services to: (1) conduct research projects to evaluate the impact of education and training programs on the ability of individuals to end participation in the AFDC program; (2) conduct demonstration projects and report to the Congress on whether providing benefits based on need through the use of electronic cards and automatic teller machines would reduce administrative costs and fraud; and (3) establish a commission to determine the cost and feasibility of creating an interstate system to compare the social security numbers of all AFDC recipients in order to identify those recipients receiving AFDC from multiple States. (Sec. 904) Amends SSA to require State AFDC applicants to participate in job search activities while the application is pending, unless a State by law exempts itself from this requirement. (Sec. 906) Public Housing Rent Reform and Empowerment Act - Amends the United States Housing Act of 1937 with regard to the determination of income and rent charges. Authorizes the Secretary of Housing and Urban Development to allow, upon request, under certain circumstances, a public housing agency or resident management corporation to carry out a demonstration program to determine the feasibility and desirability of providing such entities with the authority to establish policies for agency-administered public housing projects, without regard to the public housing requirements of the United States Housing Act of 1937. (Sec. 907) Amends SSA title IV part A to deny AFDC for certain children who have not received appropriate medical examinations and immunizations. Amends the Child Care and Development Block Grant Act with regard to childhood immunizations. Requires the Surgeon General to issue and periodically revise recommendations for the immunization of children under age six.
United States · United States Congress · 10 November 1993
United States Military Academy Bicentennial Commemorative Coin Act of 1993 - Directs the Secretary of the Treasury to issue five-dollar gold coins, one-dollar silver coins, and half dollar clad coins emblematic of the U.S. Military Academy. Mandates that surcharges collected from coin sales be paid to the Association of Graduates, U.S. Military Academy, to assist its efforts to provide direct support to the Corps of Cadets, U.S. Military Academy.
United States · United States Congress · 1 November 1993
Federal Mandate Reduction, Reform, and Budget Act of 1993 - Amends the Congressional Budget Act of 1974 to set forth reporting requirements for the Office of Management and Budget and the Congressional Budget Office (CBO) with respect to reducing the direct costs to States and local governments of complying with Federal mandates. Requires concurrent resolutions on the budget to provide for such reductions until such costs do not exceed three percent of the estimated gross national product for the same fiscal year as the costs will be incurred. Requires CBO to prepare an analysis of mandated costs for States and local governments for each public bill or resolution reported in the Congress (except those from Appropriations Committees). Requires a similar analysis in the President's annual budget submissions. Requires initial regulatory flexibility analyses for proposed rules that establish or implement new Federal mandates to contain a description of the nature and amount of monetary costs to be incurred by State and local governments. Requires Federal agencies to prepare a cost estimate and cost benefit analysis of such mandates that would cost State and local governments at least $10 million for a fiscal year.
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 · 26 October 1993
Crime Victims' Restitution Act of 1993- Amends the Federal criminal code to require (current law authorizes) the court to order restitution of the victim when a convicted defendant is being sentenced for specified offenses. Authorizes a court to order restitution of any person who, as shown by a preponderance of the evidence, was harmed physically, emotionally, or pecuniarily by unlawful conduct of the defendant during the offense or during the course of a scheme, conspiracy, or pattern of unlawful activity related to the offense. Directs the court: (1) to order restitution in the full amount of the victim's losses without consideration of the economic circumstances of the offender or the fact that a victim is entitled to receive compensation from insurance or any other source; and (2) upon determination of the amount owed to each victim, to specify in the restitution order the manner of, and schedule for, restitution in consideration of the financial resources and other assets, projected earnings and other income, and financial obligations of the offender. Specifies that: (1) a restoration order may direct the offender to make a single, lump-sum payment, partial payments at specified intervals, or such in-kind payments as may be agreeable to the victim and the offender; and (2) such in-kind payments may be in the form of the return or replacement of property, or services rendered to the victim or another person or organization. Provides that when the court finds that more than one: (1) offender has contributed to the loss of a victim, the court may make each offender liable for payment of the full amount or may apportion liability among the offenders to reflect the level of contribution and economic circumstances of each offender; and (2) victim has sustained a loss requiring restitution by an offender, the court shall order full restitution of each victim but provide for different payment schedules to reflect the economic circumstances of each victim. Sets forth provisions regarding: (1) compensation with respect to losses from insurance or other sources; (2) set-offs against amounts later recovered as compensatory damages by the victim in Federal and State civil proceedings; and (3) payment by the offender to the clerk of the court for accounting and payment in accordance with this Act. Specifies that a restitution order shall constitute a lien against all property of the offender. Makes compliance with a restitution order a condition of any probation, parole, or other form of release of an offender. Specifies actions the court may take, including revocation of probation or supervised release, if a defendant fails to comply. Provides for enforcement of restitution orders. Authorizes: (1) a victim or the offender to petition the court to modify a restitution order in view of a change in the economic circumstances of the offender; and (2) the court to refer any issue arising in connection with a proposed restitution order to a magistrate or special master for proposed findings of fact and recommendations as to disposition, subject to a de novo determination of the issue by the court.
United States · United States Congress · 20 October 1993
Expresses the sense of the House of Representatives that the Department of Justice should repudiate its reinterpretation of Federal child pornography laws, defend the conviction won in lower courts in Knox v. United States, and vigorously prosecute sexual exploitation of children.
United States · United States Congress · 6 October 1993
TABLE OF CONTENTS: Title I: Managed Competition in Employer-Based Health Plans: Incentives to Control Costs Subtitle A: Use of Tax Incentives to Purchase Cost-Effective Plans Subtitle B: Health Plan Purchasing Cooperatives (HPPCs) Subtitle C: Accountable Health Plans (AHPs) Subtitle D: Health Care Standards Commission Subtitle E: Managed Competition in Rural and Urban Underserved Areas Subtitle F: Treatment of Chronically Underserved Areas Subtitle G: Repeal of COBRA Continuation Requirements Subtitle H: Definitions Title II: Low-Income Assistance for Health Coverage Subtitle A: Low-Income Assistance Subtitle B: Long-Term Care Phase-Down Assistance to States Subtitle C: Financing Subtitle D: Repeal of Medicaid Program Title III: Training and Education of Health Care Professionals Subtitle A: Reform of Federal Funding for Medical Residency Training Subtitle B: Other Medical Education Grants and Programs Title IV: Preventive Health and Individual Responsibility Subtitle A: Expansion of Public Health Programs Subtitle B: Medicare Title V: Malpractice Reform Subtitle A: Findings; Purpose; Definitions Subtitle B: Uniform Standards for Malpractice Claims Subtitle C: Requirements for State Alternative Dispute Resolution Systems (ADR) Subtitle D: Grants to States for Development of Practice Guidelines Title VI: Paperwork Reduction and Administrative Simplification Title VII: Additional Benefits On a Pay-As-You-Go Basis Managed Competition Act of 1993 - Title I: Managed Competition in Employer-Based Health Plans: Incentives to Control Costs - Subtitle A: Use of Tax Incentives to Purchase Cost-Effective Plans - Amends the Internal Revenue Code to impose a tax on the excess health plan expenses of any employer which are health plan expenses exceeding specific limits under an accountable health plan for a defined geographical area. (Sec. 1002) Increases to 100 percent and makes permanent the deduction for health plan premium expenses of self-employed individuals. (Sec. 1003) Permits the deduction for medical, dental, etc. expenses without regard to the limitation on such deduction with respect to amounts paid for premiums under an accountable health plan. (Sec. 1004) Provides for the exclusion from gross income of contributions by a partnership or S corporation to a health plan covering partners or shareholders. (Sec. 1006) Eliminates the commonality of interest and geographic location requirements with respect to group purchasing by large tax-exempt organizations. Subtitle B: Health Plan Purchasing Cooperatives (HPPCs) - Provides for the establishment of Health Plan Purchasing Cooperatives (HPPCs). Considers each State to be a HPPC, except that a State may subdivide into HPPC areas, and that there may be interstate HPPCs, as specified. Requires HPPCs to enter into agreements with accountable health plans and small employers, offer enrollment in accountable health plans, and charge premiums. Subtitle C: Accountable Health Plans (AHPs) - Directs the Health Care Standards Commission to provide a process whereby a health plan may be registered with the Commission by its sponsor as an accountable health plan. Sets forth requirements for a plan to be registered, including: (1) coverage for a specified uniform set of benefits, including cost-sharing for low-income individuals; (2) standard premiums for the uniform benefits; (3) grievance procedures; (4) collecting and providing specified information; (5) prohibiting discrimination in enrollment or benefits; and (6) financial solvency. (Sec. 1208) Sets forth additional requirements for open AHPs, which is any plan which is not closed. Defines a closed plan as one limited by structure or law to one or more large employers. (Sec. 1211) Requires each AHP to provide for payment of one percent of gross premium receipts to the National Medical Education Fund. (Sec. 1221) Sets forth provisions concerning the preemption of State laws for AHPs. (Sec. 1231) Directs the President to provide for the development and publication of guidelines on the application of Federal antitrust laws to AHPs. (Sec. 1232) Provides for the issuance of certificates of public advantage by the Attorney General to eligible health care joint ventures which, if followed, exempt such ventures from antitrust liability. Subtitle D: Health Care Standards Commission - Establishes, as an independent agency in the Executive Branch, a Health Care Standards Commission. Requires the Commission to transmit annually to the Congress recommendations for the uniform set of effective benefits. States that such recommendations shall apply unless the Congress passes a joint resolution of disapproval. (Sec. 1303) Directs the Commission to provide for the initial organization, as a nonprofit corporation, of the Benefits, Evaluations, and Data Standards Board in order to make recommendations to the Commission concerning the uniform set of effective benefits and matters related to the evaluation of health care services. (Sec. 1304) Directs the Commission to provide for the initial organization, as a nonprofit organization of the Health Plan Standards Board in order to make recommendations to the Commission concerning the standards for AHPs and concerning its assessment of risk-adjustment factors. (Sec. 1305) Sets forth provisions concerning the registration of AHPs. (Sec. 1306) Directs the Commission to establish rules for the process of risk-adjustment of premiums among AHPs by HPPCs. (Sec. 1307) Directs the Commission to publish information concerning procedures, their prices, and their quality. (Sec. 1309) Establishes, within the Department of Health and Human Services, the Agency for Clinical Evaluations which shall assume the responsibilities of the Director of the Office of Medical Applications of Research at the National Institutes of Health, the Director of the Office of Research and Demonstrations of the Health Care Financing Administration (insofar as such responsibilities relate to clinical evaluations), the Administrator for Health Care Policy and Research under title IX of the Public Health Service Act, as well as other specified responsibilities. Authorizes appropriations. (Sec. 1311) Prohibits the Commission from establishing or enforcing any controls on health care spending. (Sec. 1313) Authorizes appropriations for the Commission through FY 2000. Terminates the Commission on December 31, 1999. Subtitle E: Managed Competition in Rural and Urban Underserved Areas - Authorizes the Governor of any State to designate rural and urban areas of a State as underserved areas. Permits a HPPC serving such an area to require AHPs offered by the HPPC and with a service area adjoining such area to include the area as part of their service area. (Sec. 1411) Authorizes appropriations for: (1) technical assistance for entities seeking to establish a network plan in an underserved area; (2) financial assistance to eligible entities in order to provide for the development and implementation of AHPs in rural areas; and (3) under the Public Health Service Act, migrant health centers and community health centers. (Sec. 1422) Provides coverage under part B of title XVIII (Medicare) of the Social Security Act for rural emergency access care hospital services. (Sec. 1431) Directs the Secretary of Health and Human Services to make payments for transitional assistance to eligible hospitals. Requires any hospital accepting such assistance to provide a significant volume of services to persons unable to pay for services. Authorizes appropriations. Subtitle F: Treatment of Chronically Underserved Areas - Directs the Health Care Standards Commission to develop standards for the identification of chronically underserved areas. Makes provisions for addressing health care delivery in such areas. Subtitle G: Repeal of COBRA Continuation Requirements - Repeals the COBRA continuation requirements for group health plans and title XXII of the Public Health Service Act. Subtitle H: Definitions - Sets forth definitions for this title and title II. Title II: Low-Income Assistance for Health Coverage - Subtitle A: Low-Income Assistance - Provides premium assistance for very-low income individuals and moderately low-income individuals. Provides for nominal cost-sharing for such individuals and special assistance for certain items and services. Subtitle B: Long-Term Care Phase-Down Assistance to States - Provides for long-term care phase-down assistance to eligible States for each calendar quarter in 1995 through 1998. Subtitle C: Financing - Amends title XVIII (Medicare) of the Social Security Act to achieve savings under such program by: (1) reducing the update for inpatient hospital services; (2) reducing the conversion factor for the physician fee schedule for non-primary care services; and (3) reducing hospital outpatient services through establishing a prospective payment system. (Sec. 2204) Amends the Internal Revenue Code to impose a Medicare part B premium tax on higher-income individuals. (Sec. 2205) Achieves additional Medicare savings through the: (1) phased-in elimination of Medicare disproportionate share adjustment payments; (2) reduction of routine cost limits for home health services; (3) reduction in routine cost limits for extended care services; and (4) reductions in payments for hospice services. Subtitle D: Repeal of Medicaid Program - Repeals title XIX (Medicaid) of the Social Security Act. Title III: Training and Education of Health Care Professionals - Subtitle A: Reform of Federal Funding for Medical Residency Training - Directs the Health Care Standards Commission to approve a resident training position in medical residency program for purposes of funding approved medical residency training programs under this title. Provides funding, in addition, for physician retraining. Sets forth provisions concerning: (1) the allocation of entry positions among programs; and (2) the general distribution of positions among specialties. (Sec. 3004) Requires payment by AHPs of one percent of gross premium receipts to the National Medical Education Fund. Requires payments from the Medicare trust funds to the National Medical Education Fund. (Sec. 3005) Establishes the National Medical Education Fund. Subtitle B: Other Medical Education Grants and Programs - Authorizes appropriations under the Public Health Service Act for medical education programs, including: (1) the scholarship and loan repayment programs of the National Health Service Corps; (2) area education centers; (3) public health and preventive medicine; (4) family medicine; (5) general internal medicine and pediatrics; (6) physician assistants; (7) allied health projects grants and contracts; and (8) nurse practitioner and nurse midwife programs. Title IV: Preventive Health and Individual Responsibility - Subtitle A: Expansion of Public Health Programs - Authorizes appropriations under the Public Health Service Act for the following public health programs: (1) immunizations against vaccine-preventable diseases; (2) prevention, control, and elimination of tuberculosis; (3) lead poisoning prevention; (4) preventive health measures with respect to breast and cervical cancers; (5) the Office of Disease Prevention and Health Promotion; (6) the Office of Minority Health; (7) preventive health and health services block grant; (8) categorical grants for early intervention regarding acquired immune deficiency syndrome; and (9) programs of the Centers for Disease Control regarding the smoking of tobacco products. Directs the Office of Disease Prevention and Health Promotion to promote individual responsibility in personal health care and in the use of valuable health care resources. Subtitle B: Medicare - Provides Medicare coverage for: (1) screening fecal-occult blood tests and screening flexible sigmoidoscopies for the purpose of the early detection of cancer; (2) tetanus-diphtheria boosters; (3) well-child services; and (4) an annual screening mammography for women over age 64. Title V: Malpractice Reform - Subtitle A: Findings; Purpose; Definitions - Sets forth the findings, purpose, and definitions for this title. Subtitle B: Uniform Standards for Malpractice Claims - Prohibits bringing a medical malpractice liability action in a State court unless there has been an initial resolution under an alternative dispute resolution system. Limits the total noneconomic damages in such actions to $250,000. Sets limits on attorney's fees. Makes special provision for obstetric services. Subtitle C: Requirements for State Alternative Dispute Resolution Systems (ADR) - Establishes requirements for State alternative dispute resolution systems. Provides for grants to States to assist in implementation of such systems. Subtitle D: Grants to States for Development of Practice Guidelines - Directs the Secretary to make grants to States for the development of medical practice guidelines for health care professionals that may be applied to resolve medical malpractice liability claims. Title VI: Paperwork Reduction and Administrative Simplification - Preempts State quill pen laws. Ensures the confidential treatment of electronic health care information. Sets forth provisions which provide for: (1) the standardization of electronic health information; (2) uniform claims forms; (3) the liability of insurers when benefits are payable under two or more plans; and (4) the uniformity of the availability of information among health plans when benefits are payable under two or more plans. (Sec. 6007) Amends the Internal Revenue Code to impose a tax on a health plan not in compliance with specified requirements of this title. Title VII: Additional Benefits On a Pay-As-You-Go Basis - Expresses the sense of the Congress that additional benefits should be provided by the Federal Government to the extent that additional financing is made available on a pay-as-you-go basis.
United States · United States Congress · 6 October 1993
Provides that any comprehensive health care reform legislation should be considered on the floor of the House of Representatives under an open rule that authorizes any Representative to offer one or more amendments.
United States · United States Congress · 29 September 1993
Prohibits, with exceptions, the refugee admission into the United States of persons who served in the Iraqi armed forces during the Persian Gulf conflict.
United States · United States Congress · 15 September 1993
TABLE OF CONTENTS: Title I: Improved Access to Affordable Health Care Subtitle A: Increased Availability and Continuity of Health Coverage for Employees and Their Families Subtitle B: Reform of Health Insurance Marketplace for Small Business Subtitle C: Preemption Subtitle D: Health Deduction Fairness Subtitle E: Improved Access to Community Health Services Subtitle F: Improved Access to Rural Health Services Subtitle G: State Flexibility in the Medicaid Program: The Medical Health Allowance Program Title II: Health Care Cost Containment and Quality Enhancement Subtitle A: Medical Malpractice Liability Reform Subtitle B: Administrative Cost Savings Subtitle C: Deduction for Cost of Catastrophic Health Plan; Medical Savings Accounts Subtitle D: Anti-Fraud Subtitle E: Medicare Payment Changes; Part B Premium Tax for High-Income Individuals Subtitle F: Removing Anti-Trust Impediments Subtitle G: Encouraging Enforcement Activities of Medical Self-Regulatory Entities Subtitle H: Prefunding Government Health Benefits for Certain Annuitants Subtitle I: Miscellaneous Provisions Title III: Long-Term Care Subtitle A: Tax Treatment of Long-Term Care Insurance Subtitle B: Protection of Assets Under Medicaid Through Use of Qualified Long-Term Care Insurance Subtitle C: Studies Subtitle D: Volunteer Service Credit Demonstration Projects Affordable Health Care Now Act of 1993 - Title I: Improved Access to Affordable Health Care - Subtitle A: Increased Availability and Continuity of Health Coverage for Employees and Their Families - Part 1: Required Coverage Options for Eligible Employees, Spouses, and Dependents - Requires each employer to make available to each eligible employee a group health plan under which: (1) coverage of each eligible individual with respect to such employee may be elected on an annual basis; (2) coverage is provided for at least the required coverage specified; and (3) employees may elect to have premiums collected through payroll deduction. Does not require employer contributions to the cost of coverage under such a plan. Provides for the exclusion of: (1) employers who have been employers for less than two years or who have no more than two eligible employees or no more than two eligible employees not covered under any group health plan; and (2) family members under specified circumstances. Specifies that a group health plan shall not be treated as failing to meet the requirements of this Act solely because a period of service by an eligible employee of not more than 60 days is required for coverage. Specifies that the required coverage is standard coverage, except that in the case of a small employer that has not contributed during the previous plan year to the cost of coverage for any eligible employee under any group health plan, the required coverage for the plan year is coverage under a MedAccess standard, MedAccess catastrophic, and MedAccess medisave plan. Provides for a five-year transition for existing group health plans. (Sec. 1002) Sets forth provisions regarding: (1) compliance with applicable requirements through multiple employer health arrangements; and (2) coverage options under a State medical health allowance program. Part 2: Preexisting Conditions and Continuity of Coverage; Renewability - Prohibits a group health plan from imposing (and an insurer from requiring an employer from imposing through a waiting period for coverage under a plan or similar requirement) a limitation or exclusion of benefits relating to treatment of a preexisting condition if: (1) the condition relates to a condition that was not diagnosed or treated within three months before the date of coverage under the plan; or (2) the limitation or exclusion extends over more than six month after the date of coverage, applies to an individual who, as of the date of birth, was covered under the plan, or relates to pregnancy. Specifies that, in the case of an individual who is eligible for coverage under a plan but for a waiting period imposed by the employer, the individual shall be treated as having been covered under the plan as of the earliest date of the beginning of the waiting period. (Sec. 1012) Requires each group health plan to waive any period applicable to a preexisting condition for similar benefits with respect to an individual to the extent that the individual, prior to enrollment in such plan, was covered for the condition under any other health plan. (Sec. 1013) Prohibits: (1) a multiemployer plan and an exempted multiple employer health plan from canceling or denying renewal of coverage under such a plan for an employer other than for nonpayment of contributions, fraud or other misrepresentation, noncompliance with plan provisions, or misuse of a provider network provision, or because the plan is ceasing to provide any coverage in a geographic area; (2) an insurer from canceling a health insurance plan or denying renewal of coverage other than as prescribed above; and (3) an insurer who terminates the offering of health insurance plans in an area from offering such a plan to any employer in the area until five years after the date of the termination. Part 3: Enforcement; Effective Dates; Definitions - Makes provisions of the Employee Retirement Income Security Act of 1974 applicable with respect to enforcement of this Act (by the Department of Labor). Amends the Internal Revenue Code (Code) to impose a tax ($100 per day for each individual involved, subject to specified limitations) on the failure of an insurer to comply with the requirements under part 2 unless the Secretary of Health and Human Services (Secretary) determines that the State has in effect a regulatory enforcement mechanism that provides adequate sanctions. Subtitle B: Reform of Health Insurance Marketplace for Small Business - Requires each insurer that makes available a health insurance plan to a small employer in a State to make available to each small employer in the State a MedAccess standard, MedAccess catastrophic, and MedAccess medisave plan, with exceptions for health maintenance organizations (HMOs) and if a State provides for guaranteed availability (rather than guaranteed issue). Requires each insurer that offers a MedAccess plan to a small employer in a State to accept: (1) every small employer in the State that applies for coverage; and (2) every eligible individual who applies for enrollment on a timely basis. Sets forth provision regarding: (1) special rules for HMOs; (2) timely enrollment requirements; and (3) enrollment of spouses and dependents. Makes such requirements inapplicable in a State that has provided (in accordance with specified standards) a mechanism under which each insurer offering a health insurance plan to a small employer in the State must participate in a program for assigning high-risk small employer groups (or individuals within such a group) among some or all such insurers, if the insurers comply. (Sec. 1102) Defines "MedAccess plan" as a health insurance plan that: (1) is designed to provide standard coverage with substantial cost-sharing, only catastrophic coverage, or medisave coverage; (2) includes only essential and medically necessary services; (3) meets applicable requirements relating to guaranteed issue; and (4) meets specifies consumer protection standards. Defines "MedAccess standard plan," "MedAccess catastrophic plan," and "MedAccess medisave plan" to mean a MedAccess plan that provides for at least standard coverage, for only catastrophic coverage, or medisave coverage, respectively. Requests the National Association of Insurance Commissioners (NAIC) to submit to the Secretary a set of rules which NAIC determines is sufficient for determining, in the case of any health insurance plan and for purposes of this subtitle, the actuarial value of the coverage offered by the plan. Directs the Secretary to certify such set of rules for use under this subtitle if they meet such requirements or establish such a set of rules. Specifies that a health insurance plan is considered to provide: (1) standard coverage if the benefits are determined, in accordance with certified rules of actuarial equivalence, to have a value that is within five percentage points of an established target actuarial value for standard coverage; (2) catastrophic coverage if benefits are available under the plan for a year only to the extent that expenses for covered services in a year exceed a deductible amount that is consistent with a specified requirement for a catastrophic health plan under the Code, and are determined, in accordance with certified actuarial equivalence rules, to have a value that is within five percentage points of an established target actuarial value for catastrophic coverage; and (3) medisave coverage if such plan consists of a catastrophic health plan within the meaning of the Code and a medical savings account. Requests NAIC to submit to the Secretary target actuarial values for standard and catastrophic coverage. Permits NAIC to submit periodic revisions of, and permits the Secretary to revise, the set of rules of actuarial equivalence and target actuarial values where necessary to take into account changes in the relevant types of health benefits provisions, in deductible levels for catastrophic coverage, or in relevant demographic conditions. (Sec. 1103) Directs the Secretary to request NAIC to develop model regulations that specify standards with respect to requirements: (1) that insurers make available MedAccess plans; (2) of guaranteed availability of MedAccess plans to small employers; (3) relating to limits on premiums and certain consumer protections; and (4) relating to limitation of annual premium increases. Requires the Secretary to review such standards and, if NAIC fails to specify standards meeting such requirements, to promulgate standards. Sets forth provisions regarding: (1) the application of MedAccess standards and consumer protection standards by the States; and (2) the Federal role. (Sec. 1104) Sets forth provisions: (1) regarding limits on premiums and annual premium increases; and (2) requiring an insurer, at the time of offering a health insurance plan to a small employer, to fully disclose rating practices for health insurance plans, including rating practices for different populations and benefit designs. (Sec. 1106) Directs the Secretary to: (1) request NAIC to develop models for reinsurance or allocation of risk mechanisms for health insurance plans made available to small employers for whom an insurer is at risk of incurring high costs under the plan; and (2) review such models or specify models. Sets forth provisions regarding implementation of reinsurance or allocation of risk mechanisms by the States and the Federal role. Amends the Code to provide for the imposition of a tax on any health insurance plan which covers any employee in a Federal reinsurance State. (Sec. 1108) Directs the Secretary to establish an Office of Private Health Care Coverage. Requires the Office Director to submit to the Congress annual reports evaluating health care coverage reform. (Sec. 1109) Authorizes the Director to conduct: (1) research on the impact of this subtitle on the availability of affordable health coverage for employees and dependents in the small employers group health care coverage market and other specified topics; and (2) demonstration projects relating to such topics. Requires the Director to develop: (1) methods for measuring the relative health risks of eligible individuals in terms of the expected costs of providing benefits under health insurance plans and, in particular, MedAccess plans; and (2) a model for equitably distributing health risks among insurers in the small employer health care coverage market. Authorizes appropriations. Subtitle C: Preemption - Part 1: Scope of State Regulation - Prohibits: (1) State benefit mandates for group health plans; and (2) State or local law prohibitions against two or more employers obtaining coverage under an insured multiple employer health plan. (Sec. 1203) Preempts State restrictions concerning: (1) reimbursement rates or selective contracting; (2) differential financial incentives; and (3) utilization review methods. Directs the Comptroller General to conduct a study of the benefits and cost effectiveness of the use of managed care in the delivery of health services. Part 2: Multiple Employer Health Benefits Protections - Amends the Employee Retirement Income Security Act of 1974 (ERISA) to allow a limited exemption under preemption rules for multiple employer plans providing health benefits subject to certain Federal standards. (Sec. 1212) Relieves exempted multiple employer plans providing medical care benefits of certain restrictions on preemption of State law. Treats such plans as employee welfare benefit plans. Allows commencement of new arrangements only if such exemption is in effect or an application is pending and the Secretary of Labor determines that provisional protection is appropriate. Sets forth exemption procedures, eligibility requirements, and additional requirements applicable to exempted arrangements. Requires certain disclosures to participating employers, maintenance of reserves, and corrective actions. Provides for expiration, suspension, and revocation of exemptions, and for review of actions by the Secretary. (Sec. 1213) Revises provisions relating to scope of preemption rules, and to treatment of single employer arrangements and of certain collectively bargained arrangements. (Sec. 1215) Establishes special rules for employee leasing healthcare arrangements. Treats such arrangements as multiple employer welfare arrangements except when they are multiple employer health plans. (Sec. 1216) Sets forth enforcement provisions relating to multiple employer welfare arrangements and employee leasing health care arrangements. (Sec. 1217) Sets forth filing requirements for multiple employer welfare arrangements. (Sec. 1218) Provides for cooperation between Federal and State authorities in enforcing ERISA requirements for multiple employer welfare arrangements with the limited exemption. Part 3: 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 multiple employer health plans and insured multiple employer health plans if they meet certain requirements under ERISA and this Act. Part 4: Simplifying Filing of Reports for Employers Covered under Insured Multiple Employer Health Plans - Amends ERISA to direct the Secretary of Labor to prescribe an alternative method providing for a single annual report with respect to all employers who are covered under the same insured multiple employer health plan. Part 5: Compliance with Coverage Option Requirements - Provides for compliance with applicable coverage requirements through multiemployer plans and other multiple employer health arrangements. Subtitle D: Health Deduction Fairness - Amends the Internal Revenue Code to provide: (1) for a permanent extension and increase in the health insurance tax deduction for self-employed individuals; and (2) that the deduction for certain health insurance costs be determined without regard to an adjusted gross income threshold. Disallows the deduction to individuals eligible for employer-subsidized coverage. Allows the deduction whether or not the individual itemizes other deductions. Subtitle E: Improved Access to Community Health Services - Part 1: Increased Authorization for Community and Migrant Health Centers - Directs the Secretary to provide for grants to migrant and community health centers to promote primary health care services for underserved individuals. Allows grants to be used to promote the provision of off-site services, to improve birth outcomes in areas with high infant mortality and morbidity, to establish primary care clinics in areas in need, and for recruitment and training costs of necessary providers and operating costs for unreimbursed services. Authorizes appropriations. Directs the Secretary to conduct a study of the impact of such grants on access to health care, birth outcomes, and the use of emergency room services. Part 2: Grants for Projects for Coordinating Delivery of Services - Amends the Public Health Service Act to authorize the Secretary to make grants to public and nonprofit private entities: (1) to carry out demonstration projects to increase access to outpatient primary health services in specified geographic areas (i.e., areas that are rational areas for the delivery of health services, have a population of not more than 500,000 individuals, and have been designated by the Secretary as areas with a shortage of personal health services or that have a significant number of individuals with low incomes or insufficient health care insurance through coordinating the delivery of such services under Federal, State, local, and private programs; and (2) for developing plans to carry out such projects. Authorizes appropriations. Subtitle F: Improved Access to Rural Health Services - Part 1: Establishment of Rural Emergency Access Care Hospitals Under Medicare - Amends title XVIII (Medicare) of the Social Security Act (SSA) to provide for: (1) establishment of rural emergency access care hospitals under Medicare; and (2) coverage of and payment for rural emergency access care hospital services under Medicare part B (Supplementary Medical Insurance). Part 2: Rural Medical Emergencies Air Transport - Amends the Public Health Service Act to direct the Secretary to make grants to States to assist in the creation or enhancement of air medical transport systems that provide victims of medical emergencies in rural areas with access to treatments. Sets forth provisions regarding: (1) application and State plan requirements; (2) considerations in awarding grants; (3) State administration and use of grants; (4) the number of grants; and (5) reporting requirements. Authorizes appropriations. Part 3: Emergency Medical Services Amendments - Amends the Public Health Service Act to direct the Secretary to: (1) establish an Office of Emergency Medical Services, headed by a Director; (2) engage in specified emergency medical services activities, including disseminating information obtained in carrying out specified activities to public and private entities, providing technical assistance to State and local agencies, coordinating Department of Health and Human Services (DHHS) activities with those of other Federal agencies; and (3) ensure that such activities are carried out consistent with certain requirements regarding maintaining an adequate number of health professionals with expertise in the provision of services, developing, periodically reviewing, and revising as appropriate guidelines for the provision of such services, appropriately using available technologies, and serving the unique needs of underserved inner-city and rural areas. (Sec. 1522) Authorizes the Secretary to make grants to States for the purpose of improving the availability and quality of emergency medical services through the operation of State offices of emergency medical services, subject to specified matching fund, budgetary, and other requirements. (Sec. 1523) Provides for demonstration projects to establish telecommunications between rural medical facilities and medical facilities with expertise or equipment. Directs the Secretary to ensure that the telecommunications technologies demonstrated include interactive video telecommunications, static video imaging transmitted through the telephone system, and facsimiles transmitted through such system. (Sec. 1524) Authorizes appropriations for: (1) emergency medical services (including for State offices of Emergency Medical Services and for telecommunications demonstrations); and (2) trauma care and certain other activities. Subtitle G: State Flexibility in the Medicaid Program: The Medical Health Allowance Program - Amends SSA title XIX (Medicaid) to provide for the establishment of State health allowance programs under which the State makes payments to a group health plan which provides coverage to an eligible individual as an allowance towards the costs of providing the individual with benefits under the plan. Subtitle H: Medicaid Program Flexibility - Amends SSA title XIX Medicaid) to modify: (1) Federal requirements to allow States more flexibility in contracting for coordinated care services under Medicaid; and (2) provisions regarding the extension of certain waivers. Title II: Health Care Cost Containment and Quality Enhancement - Subtitle A: Medical Malpractice Liability Reform - Part 1: General Provisions - Makes this subtitle applicable with respect to any medical malpractice liability claim and to any medical malpractice liability action brought in State or Federal court, except a claim or action for damages arising from a vaccine-related injury or death to the extent that title XXI of the Public Health Service Act applies. Sets forth provisions regarding: (1) preemption of State law; (2) effect on sovereign immunity and choice of law or venue; (3) jurisdiction; and (4) effective dates. Part 2: Medical Malpractice and Product Liability Reform - 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 alternative dispute resolution (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 under chapter 171 of the Federal judicial code (U.S. Court of Federal Claims). 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. 2012) 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. Sets limits on punitive damages and on periodic payments for future losses. (Sec. 2013) Set forth provisions regarding: (1) limits on attorney fees and other costs; (2) joint and several liability (generally, liability may be found only for those damages directly attributable to the person's proportionate share of fault or responsibility for the injury); (3) a statute of limitations of seven years; and (4) a uniform standard for determining negligence (the defendant's conduct at the time of providing the health care services was not reasonable). (Sec. 2017) Specifies that in the case of a medical malpractice liability claim relating to services provided during labor or the delivery of a baby, if the health care professional did not previously treat the injured individual 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. Part 3: Requirements for State Alternative Dispute Resolution Systems - 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. 2032) Directs the Secretary, by October 1 of each year, to certify State ADR systems that meet such requirements. Directs 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. 2033) Directs the Secretary, within five years, to submit to the Congress a report describing and evaluating State ADR systems and the alternative Federal system, including: (1) information on the effect of the ADR systems on health care costs, access to health care, and quality of care provided within the State; and (2) to the extent that such report does not provide information on no-fault systems operated by States as ADR systems, an analysis of the feasibility and desirability of establishing a system for resolving medical malpractice liability claims on a no-fault basis. Part 4: Other Provisions Relating to Medical Malpractice Liability - Authorizes a State agency responsible for disciplinary actions for a type of health care practitioner to enter into agreements with State or county professional societies to permit their participation in the licensing of such practitioner and to review any health care malpractice action, claims, or allegation, or other information concerning the practice patterns of any such practitioner. Sets forth agreement requirements. (Sec. 2042) Directs the Secretary to study incentives adopted by State and local governments, insurers, medical societies, and other entities to encourage physicians to volunteer to provide health care services in medically underserved areas. (Sec. 2043) Directs each State to require: (1) each health care professional and health care provider to participate in a risk management program to prevent, and provide early warning of, practices which may result in injuries to patients or endanger patient safety; and (2) each provider of health care professional and provider liability insurance in the State to establish risk management programs or sanction programs of risk management for health care professionals and providers provided by other entities, and require each such professional or provider, as a condition of maintaining insurance, to participate in one such program at least once in each three-year period. (Sec. 2044) Directs the Secretary to make grants: (1) for basic research in the prevention of, and compensation for, injuries resulting from health care professional or provider malpractice and for research of the outcomes of health care procedures; (2) to the States to assist in improving their ability to license and discipline health care professionals; and (3) to States and local governments, private nonprofit organizations, and health professional schools for educating the general public about the appropriate use of health care, realistic expectations of medical intervention, and the resources and role of health care professional licensing and disciplinary boards in investigating claims of incompetence or health care malpractice, and for developing programs of faculty training and curricula for educating health care professionals in quality assurance, risk management, and medical injury prevention. Authorizes appropriations. Subtitle B: Administrative Cost Savings - Part 1: Standardization of Claims Processing - Directs the Secretary to adopt standards relating to: (1) data elements for use in paper and electronic claims processing under health benefit plans and in utilization review and management of care; (2) uniform claims forms; and (3) uniform electronic transmission of the data elements. (Sec. 2102) Authorizes the Secretary, two years after standards are adopted for classes of services upon determining that a significant number of claims for benefits for such services under health benefit plans are not being submitted in accordance with such standards, to require that all providers of such services submit claims to health benefit plans in accordance with such standards. (Sec. 2103) Directs the Secretary to: (1) provide for the ongoing receipt and review of comments and suggestions for changes in the standards adopted and promulgated; (2) establish a schedule for the periodic review of such standards; and (3) revise such standards. Part 2: Electronic Medical Data Standards - Directs the Secretary to promulgate standards for hospitals concerning electronic medical data, including standards for transmission of such data and confidentiality of patient-specific information. Authorizes the Secretary to periodically revise such standards. (Sec. 2112) Sets forth requirements with respect to: (1) the sharing of hospital information under Medicare; (2) waiver of such requirements; and (3) application of such requirements to hospitals of the Department of Veterans Affairs. (Sec. 2113) Authorizes the head of a Federal agency to require a provider to present and transmit a required data element electronically in accordance with applicable presentation or transmission standard. (Sec. 2114) Sets forth limitations on data requirements where standards with respect to data elements are in effect. (Sec. 2115) Directs the Secretary to establish an advisory commission on the standards established under this part and operational concerns about the implementation of such standards. Authorizes appropriations. Part 3: Development and Distribution of Comparative Value Information - Directs the Secretary to determine whether each State is developing and implementing a health care value information program that meets specified criteria and a specified schedule. Authorizes the Secretary to: (1) make grants to enable each State to plan development and initiate implementation of its health care value information program; and (2) recover the amount of such a grant by offset against any other amount payable to the State under the Social Security Act under specified circumstances. Authorizes appropriations. (Sec. 2122) Directs the Secretary to take actions necessary to implement a comparable program in a State that fails to develop or implement a health care value information program in accordance with such criteria and schedule. Authorizes the Secretary to charge fees for the information materials provided pursuant to such a program. (Sec. 2123) Directs the head of each Federal agency with responsibility for the provision of health insurance or health care services to individuals to develop health care value information relating to each program that such head administers and covering the same types of data that a State program meeting such criteria would provide. (Sec. 2124) Directs the Secretary to: (1) develop model systems to facilitate the gathering of data on health care cost, quality, and outcome and the analysis of such data in a manner that will permit the valid comparison of such data among providers and among health plans; (2) support experimentation with different approaches to achieve such objectives in the most cost effective manner; and (3) evaluate the various methods to determine their relative success. Authorizes the Secretary to establish standards for the collective and reporting of data on health care cost, quality, and outcomes. Authorizes appropriations. Part 4: Additional Standards and Requirements; Research and Demonstrations - Directs the Secretary to: (1) adopt standards relating to the design and use of magnetized Medicare identification cards to assist health care providers in determining whether individuals are eligible for benefits for provided services under the Medicare program and in billing the Medicare program for covered services; (2) take steps to encourage and assist States in the design and use of magnetized Medicaid identification cards under their Medicaid plans; and (3) establish a Medicare and Medicaid information system to provide information on group health and other health benefit plans that are primary payors to the Medicare and Medicaid programs. Authorizes appropriations. (Sec. 2132) Specifies that, effective January 1, 1994, no effect shall be given to any provision of State law that requires medical or health insurance records (including billing information) to be maintained in written, rather than electronic, form. (Sec. 2133) Requires, effective January 1, 1995, each health benefit plan: (1) to use a beneficiary's social security number as the personal identifier for claims processing and related purposes (authorizes the Secretary to impose a civil money penalty on any plan that fails to do so); and (2) to use the unique identifier under title XVIII of the Social Security Act (Medicare) for a provider that furnishes health care items or services to a beneficiary under the plan as the identifier of that provider for claims processing and related purposes. (Sec. 2134) Directs the Secretary to: (1) determine, where benefits are payable under two or more health benefit plans, whether problems relating to the rules for determining the liability of plans or the availability of information among plans causes significant administrative costs; and (2) promulgate standards, if the implementation of standards would significantly reduce such administrative costs. Authorizes the Secretary to impose a civil money penalty on plans that fail to comply with such standards. (Sec. 2135) Directs the Secretary to provide grants to qualified entities for research on the application of comprehensive information systems in continuously monitoring and improving patient care. Authorizes the Secretary to make grants to: (1) two to five community organizations or coalitions of health care providers, health benefit plans, and purchasers to establish and document the efficacy of communication links between the information systems of health benefit plans and of health care providers; (2) two to five public or private nonprofit entities for the development of regional or community-based clinical information systems; and (3) public or private nonprofit entities to develop and test the definition of a comprehensive set of data elements and the specification and manner of presentation of the individual data elements of the set, for electronic medical data generated by physicians and other entities (other than hospitals) that provide health care services. Authorizes appropriations. Subtitle C: Deduction for Cost of Catastrophic Health Plan; Medical Savings Account - Amends the Internal Revenue Code to include under the medical expense deduction the portion of such expense attributable to coverage under a catastrophic health plan. (Sec. 2202) Allows individuals a tax deduction for percentage of contributions made to a medical care savings account established for the benefit of an eligible individual. Allows such deduction whether or not an individual itemizes deductions. Disallows distributions from such accounts as medical expense deductions. Excludes employer contributions to such accounts from employment taxes. Establishes an excise tax for excess contributions to medical care savings accounts. Subtitle D: Anti-Fraud - Part 1: Criminal Prosecution of Health Care Fraud - Amends the Federal criminal code to: (1) set penalties for health care providers who knowingly engage in any scheme or artifice to defraud any person in connection with the provision of health care; and (2) make activity which, if engaged in by the U.S. Postal Service, would be a violation of mail fraud provisions punishable to the same extent with respect to private or commercial interstate carriers. (Sec. 2303) Authorizes appropriations to hire, equip, and train no fewer than: (1) 225 special agents of the Federal Bureau of Investigation and support staff to investigate health care fraud cases; (2) 50 assistant United States Attorneys and support staff to prosecute such cases; and (3) 25 investigators in the Office of Inspector General, DHHS, to be devoted exclusively to health care fraud cases. (Sec. 2304) Amends the Federal criminal code to authorize the Attorney General to make payments of up to $10,000 to a person who furnishes information unknown to the Government relating to a possible prosecution of health care fraud, subject to specified requirements and exceptions. Part 2: Coordination of Health Care Anti-Fraud and Abuse Activities - Directs the Secretary to establish in the Office of the Inspector General of DHHS a program (all-payer fraud and abuse control 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 such delivery and payment; and (3) facilitate the enforcement of provisions of the Social Security Act and other statutes applicable to health care fraud and abuse. Directs the Secretary to establish standards to carry out such program, including standards relating to the furnishing of information by health insurers, providers, and other to enable the Secretary to carry out the program and procedures to assure that such information is provided and utilized in a manner that protects the confidentiality of the information and the privacy of individuals receiving health care services. Sets forth provisions regarding: (1) qualified immunity for providing information; (2) ensuring access to documentation; and (3) failure to comply as grounds for exclusion from the Medicare and Medicaid programs. (Sec. 2312) Authorizes additional appropriations to enable the Secretary to conduct investigations of allegations of health care fraud and to carry out the all-payor fraud and abuse control program. (Sec. 2313) Establishes in the Treasury an Anti-Fraud and Abuse Trust Fund to be used to assist the Inspector General of DHHS in carrying out the all-payor fraud and abuse control program in the fiscal year involved. Sets forth provisions regarding: (1) the deposit into the Fund of Federal health anti-fraud and abuse penalties; and (2) the use of such penalties to repay beneficiaries for cost-sharing. (Sec. 2314) Amends SSA title XI to provide for the application of Federal health anti-fraud and abuse sanctions to all fraud and abuse against private health benefit plans. Subtitle E: Medicare Payment Changes; Part B Premium Tax for High-Income Individuals: Part 1 - Medicare Payment Changes - Amends SSA title XVIII to: (1) eliminate the membership limitation for Medicare health maintenance organizations; and (2) revise the Medicare select policy program and provide for a civil money penalty for misrepresentations made in connection with a Medicare select policy. (Sec. 2402) Amends the Omnibus Budget Reconciliation Act of 1990 to: (1) make permanent the Medicare select policy program; and (2) allow access to Medicare select policies in all States. (Sec. 2403) Directs the Secretary of Health and Human Services to take such steps as may be necessary to consolidate the administration of Medicare parts A and B. Part 2: Part B Premium Tax for High-Income Individuals - (Sec. 2411) Amends the Internal Revenue Code to impose a tax on the Medicare part B premiums of high income individuals. Subtitle F: Removing Anti-Trust Impediments - Directs the Attorney General to promulgate guidelines under which a health care joint venture may submit an application requesting that the Attorney General provide the entities participating in the venture with an exemption under which: (1) monetary recovery on an antitrust claim brought against the entity shall be limited to actual damages if specified conditions are met; and (2) the conduct of the entity in making or performing a contract to carry out the venture shall not be deemed illegal per se. Requires the Attorney General to approve or disapprove the application within a specified time frame and to provide a statement explaining the reasons for any disapproval. Directs the Attorney General to approve the application if an entity participating in the venture submits to the Attorney General an application that contains the identities of the parties to the venture; the nature, objectives, and planned activities of the venture; and specified assurances and information. Sets forth provisions regarding: (1) revocation and renewal of exemptions and withdrawal of an application; (2) requirements relating to notice and publication of exemptions; and (3) issuance of health care certificates of public advantage to each eligible health care joint venture that complies with specified requirements. Establishes the Interagency Advisory Committee on Competition, Antitrust Policy, and Health Care to: (1) discuss and evaluate competition and antitrust policy and their implications regarding the performance of health care markets; (2) analyze the effectiveness of health care joint ventures receiving exemptions in reducing costs and expanding access; and (3) make recommendations to the Congress. Subtitle G: Encouraging Enforcement Activities of Medical Self-Regulatory Entities - Part 1: Application of the Clayton Act to Medical Self-Regulatory Entities - Provides that no damages, cost of suit, or attorney fee may be recovered under section 4, 4A, or 4C of the Clayton Act, or under any similar State law, except by a State or the United States, from any medical self-regulatory entity as a result of engaging in standard setting or enforcement activities that are: (1) designed to promote the quality of health care provided to patients; and (2) not conducted for purposes of financial gain. Directs the court to award the cost of such a suit, including a reasonable attorney fee, to a substantially prevailing defendant. Part 2: Consultation by Federal Agencies - Requires any Federal agency engaged in the establishment of medical profession standards to consult with appropriate medical societies or associations, specialty boards, or recognized accrediting agencies, if available, in carrying out medical professional standard setting and guidelines or standards relating to the practice of medicine. Subtitle H: Prefunding Government Health Benefit for Certain Annuitants - Requires that certain agencies prefund Government health benefits contributions for their annuitants. Subtitle I: Miscellaneous Provisions - Amends Civil Service and Federal Employees' Retirement Systems law to increase the minimum age required to be eligible for an immediate retirement annuity. Provides for the conformance of other Federal retirement systems with the minimum age increase made above. Title III: Long-Term Care - Subtitle A: Tax Treatment of Long-Term Care Insurance - Amends the Internal Revenue Code to provide for the treatment of qualified long-term care insurance as accident and health insurance for purposes of insurance company taxation. (Sec. 3002) Excludes from gross income benefits provided under a long-term care insurance contract. Includes in gross income employer-provided coverage for long-term care services. (Sec. 3003) Includes amounts paid for qualified long-term care services as medical expenses for individual itemized deductions. Includes any parent or grandparent as a dependent for purposes of such expenses. (Sec. 3004) Provides for the nonrecognition of gain or loss on the exchange of any life insurance contract or an endowment or annuity contract for a long-term care insurance contract. (Sec. 3005) Excludes from gross income certain amounts withdrawn from individual retirement accounts and certain employer cash or deferred arrangement to pay long-term care premiums. (Sec. 3006) Allows insurance companies to issue accelerated death benefit riders on life insurance contracts. Subtitle B: Protection of Assets Under Medicaid Through Use of Qualified Long-Term Care Insurance - Amends SSA title XIX to require State Medicaid plans to disregard some or all of the individual's assets attributable to coverage under a qualified long-term care insurance contract in determining the individual's eligibility for long-term care services. Subtitle C: Studies - Requires the Comptroller General to study 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 home with an income tax credit. (Sec. 3203) Requires the Secretary of Health and Human Services to study and report to the Congress on the feasibility of encouraging or requiring the use of a single designate public or nonprofit agency to coordinate, through case management, the provision of long-term care benefits under current Federal, State, and local programs in a geographic area. Subtitle D: Volunteer Service Credit Demonstration Projects - (Sec. 3301) Amends the Older Americans Act of 1965 to require the Commissioner of the Administration on Aging to establish and operate a volunteer service credit demonstration project in each State.
United States · United States Congress · 15 September 1993
General Aviation Revitalization Act of 1993 - Amends the Federal Aviation Act of 1958 to set forth a 15-year statute of limitations within which a person may bring a civil action against an aircraft manufacturer for damages for death or injury or damage to property arising from an aircraft accident.
United States · United States Congress · 8 September 1993
Constitutional Amendment - Declares that no person, under any law enacted by the Congress or any rule issued by a Federal entity, shall be liable for conduct occurring, or with respect to income accruing, before the date of enactment of the law or issuance of the rule.
United States · United States Congress · 8 September 1993
Amends rule XXI of the Rules of the House of Representatives to prohibit a bill or joint resolution carrying any provision providing for a retroactive tax increase from being reported in the House. Provides that no amendment in the House or proposed by the Senate carrying a retroactive tax measure shall be in order during the consideration of a bill or joint resolution. Allows a question of order to be raised at any time under this clause.
United States · United States Congress · 6 August 1993
Federal Regulation Reduction, Reform, and Budget Act of 1993 - Amends the Congressional Budget Act of 1974 to require the Office of Management and Budget (OMB) and the Congressional Budget Office (CBO) to jointly report to the President and the Congress on direct costs to the private sector of complying with Federal regulations. Requires such reports to be issued in five-year intervals. Provides for initial and subsequent annual reports to the President and the Congress on an aggregate regulatory baseline which is a projection of the aggregate direct cost to the private sector of complying with Federal regulations for budget years and outyears. Requires a concurrent resolution on the budget to include reconciliation directives specifying changes in laws and regulations necessary to reduce such direct costs and to reduce regulatory authority from the aggregate regulatory base. Provides for the allocation of aggregate two-year regulatory authority among congressional committees. Requires the CBO to submit to the appropriate committees (except the Committees on Appropriations) an analysis of private sector regulatory costs for each public bill or resolution. Requires the President's annual budget submissions to comply with reconciliation directives. Amends the Regulatory Flexibility Act to require Federal agencies to prepare an analysis of the costs that will be incurred by small entities, other businesses, and individuals in complying with proposed agency rules. Requires the submission to the Congress and CBO and OMB of a cost estimate and cost benefit analysis of any new proposed regulations that would have an aggregate direct cost to the private sector of at least $10 million for any fiscal year.
United States · United States Congress · 6 August 1993
Risk Communication Act of 1993 - Requires the Administrator of the Environmental Protection Agency to apply the following principles when preparing risk assessments to assure that such assessments are scientifically objective and inclusive of all relevant data: (1) explicitly distinguish scientific findings in such assessments from other considerations affecting the design and choice of regulatory strategies; (2) consider and discuss both negative and positive laboratory or epidemiological data when presenting assessments of human health risks; and (3) where the assessment process involves selection of any significant assumption, inference, or model: present a representative list and explanation of plausible and alternative assumptions, inferences, or models; explain the basis for any choices; and identify policy or value judgments. Directs the Administrator, in characterizing risk in any risk assessment document, regulatory proposal or decision, report to the Congress, or other document made available to the public, to: (1) characterize the populations or natural resources at risk; (2) explain the range of exposure scenarios used in the assessment and provide a statement of the size of the corresponding population at risk and the likelihood of the exposure scenarios; (3) provide appropriate comparisons with estimates of other risks; (4) include a statement of any known and significant substitution risks when a risk assessment or characterization for proposed and final regulatory actions is provided; and (5) present the summary of results of an assessment provided by a commenter in any case in which a public commment period is provided with respect to an assessment or regulation. Requires the Administrator to: (1) issue guidance consistent with the risk assessment principles of this Act and to provide a format for summarizing assessment results; (2) publish a plan to review and revise risk assessments with respect to which new information or methodologies that could significantly alter assessment results become available; and (3) report to the Congress on policy and value judgments which are made in risk assessments for programs under the Toxic Substances Control Act and the effect such judgments have on the regulatory decisions of such programs.
United States · United States Congress · 6 August 1993
Civilian Facilities Closure and Realignment Act of 1993 - Establishes the Civilian Facilities Closure and Realignment Commission. Requires the heads of executive agencies (except for the Secretary of Defense) to submit to the Commission recommendations for closing or realigning civilian facilities. Directs the Office of Management and Budget to submit to the Commission estimates of the administrative costs and savings that would result from the implementation of such recommendations. Requires the Commission to report its recommendations for closures and realignments of Federal facilities and proposed legislation to the President. Provides for presidential approval of the report. Sets forth procedures for congressional consideration of the proposed legislation. Requires proceeds from the sale of any agency's assets resulting from closures or realignments to be applied to reduce the Federal deficit and deposited in the Treasury and treated as general receipts. Expresses the sense of the Congress that: (1) in the fiscal year immediately following the submission of an agency's recommendation, there should be appropriated to each agency at least 25 percent of the amount of estimated administrative savings applicable to such agency in the three fiscal years following such submission; and (2) the appropriated amount should be in addition to funds which would otherwise be appropriated if not for this Act and made available for expenditure to improve the agency's management, efficiency, or productivity.
United States · United States Congress · 6 August 1993
TABLE OF CONTENTS: Title I: Statement of Congressional Purpose Title II: Binding Budget Law Title III: Enforcement Mechanics Subtitle A: Supermajority Required to Break Budget Law Subtitle B: Line Item Reduction Subtitle C: "Blank Check" Appropriations Prohibited Subtitle D: "Pay As You Go" Requirement for New Spending Title IV: Sustaining Mechanism Title V: Protection of Social Security Title VI: Timetable Title VII: Conforming Amendments Title VIII: Definitions and Rules of Interpretation Title IX: Effective Date Budget Process Reform Act - Title I: Statement of Congressional Purpose - Declares that the purpose of this Act is to facilitate rational, informed, and timely decisions by the Congress. Expresses the sense of the Congress that the Federal budget process should focus the attention of policymakers and the public on the aggregate impact of Federal spending on the economy, and on the tradeoffs that must be made among priorities in order to control overall levels of spending. Declares that the budget process should contain safeguards against delay and inaction, so that temporary shut-downs of the Government may be avoided. Title II: Binding Budget Law - Requires the Congress to enact a binding budget law, in the form of a joint resolution, by April 15 of the calendar year before that in which the fiscal period commences. Makes it out of order in the House of Representatives or the Senate to consider any spending bill affecting spending in a major functional category unless and until a joint resolution on the budget is enacted. Amends the Congressional Budget Act of 1974 to prohibit baseline budgeting. Requires the President to submit to the Congress on or before the 15th day after a joint resolution on the budget is enacted a detailed budget for the fiscal period beginning on October 1 of the current calendar year. Title III: Enforcement Mechanics - Subtitle A: Supermajority Required to Break Budget Law - Requires a two-thirds majority vote in the House and the Senate to consider any spending bill prior to the enactment of the budget law. Requires the Congressional Budget Office to provide to the Congress an estimate of the costs in each major functional category of certain spending bills as soon as practicable after its introduction. Requires a two-thirds affirmative vote in the House and the Senate to consider over-budget spending bills. Requires a two-thirds affirmative vote in the House and the Senate to waive any provision of this Act. Subtitle B: Limited Enhanced Rescission Authority - Amends the Impoundment Control Act of 1974 to limit the President's rescission authority to spending that is above the limits of the budget law. Subtitle C: "Blank Check" Appropriations Prohibited - Declares the intent of the Congress to end open-ended, "blank check" appropriations which typically authorize spending "such sums as may be necessary." Requires fixed-dollar appropriations for every account except social security and interest on the debt. Prohibits open-ended appropriations. Requires Executive agencies to adjust benefit levels to ensure that appropriations for entitlement programs are not exceeded. Restricts budget authority and entitlement authority to one fiscal period. Subtitle D: "Pay As You Go" Requirement for New Spending - Prohibits the Congress from considering any legislation which exceeds the budget ceiling unless it offsets such increased spending with an equal amount of reductions. Requires a two-thirds affirmative vote in the House and the Senate to waive such prohibition. Title IV: Sustaining Mechanism - Makes appropriations to provide for an automatic continuing resolution if for any account an appropriation for a fiscal period does not become law before the beginning of such period. Restricts legislation providing funding to the Committees on Appropriations. Title V: Protection of Social Security - Provides that no reduction in benefits under title II of the Social Security Act (Old Age, Survivors and Disability Insurance) shall be made as a consequence of this Act. Title VI: Timetable - Revises the timetable for the congressional budget process. Title VII: Conforming Amendments - Makes various technical and conforming amendments, including changing references to a concurrent resolution on the budget to references to a joint resolution on the budget. Title VIII: Definitions and Rules of Interpretation - Sets forth definitions for specified terms. Title IX: Effective Date - Declares the effective date of this Act to be January 1, 1995, applicable to fiscal years beginning after September 30, 1995.
United States · United States Congress · 4 August 1993
Natural Disaster Protection Act of 1993 - Amends the Robert T. Stafford Disaster Relief and Emergency Assistance Act (the Act) to require the Director of the Federal Emergency Management Agency to develop programs to carry out specified multihazard mitigation and emergency management initiatives, including the development of model building codes and other hazard mitigation measures for catastrophic natural disasters, training and research in such areas, hazard mitigation technology, and local emergency response operations. Allows local communities five years after the date of enactment of this Act to comply with multihazard building and safety codes outlined under this Act, after which public assistance funds will be withheld for noncompliance. Requires the Director to identify States which are prone to damages from hurricanes, windstorms, earthquakes, volcanic eruptions, and flooding (natural disasters), and to designate each State appropriately as hurricane-, windstorm-, earthquake-, volcanic eruption-, or flood-prone. Requires each State so designated to either: (1) adopt the relevant natural disaster hazard mitigation portions of the newest building codes for such State for all new or substantially modified building construction in such State; or (2) certify that the local communities have adopted building codes which meet or exceed such requirements. Requires each State designated as disaster-prone to either: (1) develop a hazard mitigation plan with accompanying schedules for improving the State's ability to reduce the hazards of future natural disasters; or (2) designate an existing plan which meets such requirements. Requires a completed plan to be submitted to the Director within two years after designation. Outlines State compliance procedures, and imposes penalties for hazard mitigation plan noncompliance. Establishes the Self-Sustaining Mitigation Fund for Federal and State support of hazard mitigation and emergency management activities, with amounts provided by the Director to each disaster-prone State for appropriate purposes. Establishes the Natural Disaster Mitigation and Planning Advisory Committee as an independent advisory committee to advise the Director on hazard mitigation and disaster planning, and to review hazard mitigation regulations issued by the Director. Requires the Director to establish and carry out a national multihazard insurance program (the Primary Insurance Program) to provide insurance against real or personal property loss in any State resulting from an earthquake or volcanic eruption. Requires the Director to evaluate the feasibility of including flood as a covered peril under the Primary Insurance Program. Outlines specified procedures for increased participation in the Federal flood insurance program under the National Flood Insurance Act, with a required report. Outlines further provisions with respect to the Primary Insurance Program, including program scope (initially limited to residential housing), terms and limitations, covered hazards, and insurance actuarial rates. Establishes in the Treasury the Primary Insurance Program Fund to carry out such Program. Provides for Fund uses, investments, and disbursements, authorizing the Director, when necessary, to borrow from the Treasury for Fund purposes. Requires the Director, in carrying out the Program, to provide certain insurance mitigation incentives, including the charging of lower premiums for residential property located in disaster-prone States. Requires the Director to make available to eligible entities excess reinsurance coverage for any direct and indirect losses that arise from a hurricane, earthquake, volcanic eruption, or tsunami (tidal wave). Outlines provisions concerning eligible entities and reinsurance coverage terms, limitations, and obligations, including the covered lines of insurance. Requires the establishment of actuarially sound rates for such coverage. Establishes in the Treasury the Reinsurance Fund for implementation of such reinsurance coverage. Requires the Director to develop a plan of operation to ensure the fair, reasonable, and equitable administration of the Primary Insurance Program Fund, the Reinsurance Fund, and other activities outlined in this Act. Establishes the Federal Insurance and Reinsurance Advisory Committee as an independent committee and requires the plan to be submitted to such Committee for review and recommendations. Requires a Committee report.
![Official portrait of Rep. McMillan, J. Alex [R-NC-9]](https://www.congress.gov/img/member/m000566_200.jpg)