United States · United States Congress · 9 May 1994
Requires the Secretary of Commerce to issue necessary regulations to ensure that no person is required to complete or submit to the Bureau of Census or any other Federal department, agency, or instrumentality, specified quarterly financial reports of the Bureau unless the person is entitled to fair and reasonable monetary compensation based on the time and effort required to complete such forms.
United States · United States Congress · 26 April 1994
Directs that the eulogies offered concerning the life of the Honorable Richard M. Nixon, former President of the United States, be bound and printed as a Senate document.
United States · United States Congress · 21 April 1994
Prohibits the President or any other member of the executive branch from interfering with the transfer of arms to the Government of Bosnia and Herzegovina. Requires the President to terminate the U.S. arms embargo of such government upon receipt from such government of a request for assistance in exercising its right of self-defense under the United Nations Charter.
United States · United States Congress · 22 March 1994
TABLE OF CONTENTS: Title I: Statement of Congressional Purpose Title II: Binding Budget Law Title III: Enforcement Mechanics 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 in the course of the Federal budget process. (Sec. 102) 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. (Sec. 103) 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. (Sec. 202) Makes it out of order in the House of Representatives of 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. (Sec. 203) Amends the Congressional Budget Act of 1974 to prohibit baseline budgeting. (Sec. 204) 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 three-fifths majority vote in the House and the Senate to consider any spending bill prior to the enactment of the budget law. (Sec. 302) 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 three-fifths affirmative vote in the House and the Senate to consider over-budget spending bills. Requires a three-fifths 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. (Sec. 309) 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 three-fifths 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. (Sec. 403) 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 · 15 March 1994
Abolishes the Medicare and Medicaid Coverage Data Bank established under the Omnibus Budget Reconciliation Act of 1993. Directs the Secretary of Health and Human Services to study and report to the Congress on how to achieve the former objectives of such entity in the most cost-effective manner.
United States · United States Congress · 8 March 1994
Establishes the Augusta Canal National Heritage Area in Georgia. Establishes the Augusta Canal Commission. Requires the Commission to prepare and submit to the Secretary of the Interior for review and approval a plan for the management of the Area, based on existing Federal, State, and local plans in existence on the date of enactment of this Act. Directs the Commission to coordinate and combine such plans and present an integrated and cooperative approach for the protection, enhancement, and interpretation of the Area's cultural, natural, scenic, and recreational resources. Prohibits Federal agencies from promulgating an occupational, safety, conservation, or environmental regulation for the Area that is more stringent than existing applicable regulations, solely as a result of the establishment of the Area. Authorizes appropriations.
United States · United States Congress · 25 February 1994
National Security Budgeting and Deficit Control Act of 1994 - Amends the Balanced Budget and Emergency Deficit Control Act of 1985 (Gramm-Rudman-Hollings Act) to extend the caps on defense and nondefense discretionary spending through FY 1998.
United States · United States Congress · 10 February 1994
TABLE OF CONTENTS: Title I: Saving the Taxpayers Money Subtitle A: Specific Spending Cuts Subtitle B: Reducing the Size of Government Subtitle C: Eliminating Government Printing Monopoly Title II: Streamlining the Federal Bureaucracy Subtitle A: Department of Agriculture Reorganization Subtitle B: Procurement Streamlining Subtitle C: Other Streamlining Reforms Title III: Improving Government Performance and Accountability Title IV: Improving the Legislative Process Title V: Enforcement Government Downsizing, Performance, and Accountability Act of 1994 - Title I: Saving The Taxpayers Money - Subtitle A: Specific Spending Cuts - Rescinds 7.5 percent of remaining FY 1994 appropriations for the legislative branch (except the House of Representatives and the Executive Office of the President). (Sec. 1003) Amends the Legislative Reorganization Act of 1946 to limit annual cost of living adjustments (COLAs) for Members of Congress to those for other Federal employees. (Sec. 1004) Rescinds certain FY 1994 appropriations to provide for reductions in FY 1994 budgetary outlays for, and thereafter through FY 1996 sets general obligational limits on, various specified agency administrative expenses (except Department of Defense (DOD) and other specified expenses), as determined by the Director of the Office of Management and Budget (OMB). (Sec. 1005) Makes specified rescissions in current FY 1994 appropriations for: (1) the Agency for International Development's (AID) Development Assistance Fund; (2) Department of State Diplomatic and Consular Programs; and (3) salaries and expenses of the United States Information Agency (USIA) and USIA's North/South Center. (Sec. 1006) Raises the minimum threshold for application of the prevailing wage requirements of the Davis-Bacon Act from $2,000 to $100,000 for Federal or District of Columbia contracts within the geographical limits of the 48 contiguous States. Prohibits artificially splitting contracts above the $100,000 threshold into contracts smaller than $100,000 for the purpose of evading such Act. (Sec. 1007) Permits the use of funds under the Department of Labor Appropriations Act, 1994 to implement or administer certain regulations pertaining to utilization of helpers on Federal construction projects subject to the Davis-Bacon Act. (Sec. 1008) Amends the National Foundation on the Arts and the Humanities Act of 1965 to phase-in through FY 1998 a ten percent reduction in Federal funding for the National Endowments for the Arts and the Humanities. Requires a phase-in of eight percent funding reductions for the Smithsonian Institution, the National Gallery of Art, and Corporation for Public Broadcasting. (Sec. 1009) Places a one-year moratorium on construction of new Federal buildings and agency leasing of building space, except construction of buildings primarily used for education, and certain pending projects. Rescinds a specified amount of FY 1994 obligational authority from the Federal Buildings Fund for new construction and acquisitions. (Sec. 1010) Makes specified rescissions of FY 1994 funding for: (1) the Appalachian Regional Commission; (2) the Legal Services Corporation; (3) community development block grant programs; (4) the Tennessee Valley Authority; (5) public housing; (6) the Economic Development Administration; (7) the International Developmental Association (IDA); (8) the International Bank for Reconstruction and Development; and (9) United Nations (UN) peacekeeping. (Sec. 1012) Amends the Housing and Community Development Act of 1974 to reauthorize at slightly increased levels and extend through FY 1998 the community development grant program for States, local governments, and Indian tribes. (Sec. 1014) Replaces programs providing Federal assistance for the construction of new non-Indian-related public housing with a tenant-based voucher assistance program. (Sec. 1016) Expands the program which assists Federal employees permanently disabled on the job in order to help them find new employment. Authorizes the Secretary of Labor to expand the Federal Employees' Compensation Act Periodic Roll Management Projects to all offices of the Department of Labor's Office of Workers' Compensation Program. Amends the Foreign Operations, Export Financing, and Related Programs Appropriations Act, 1994 to impose limitations on the availability of funding for the IDA in FY 1994 and 1995. (Sec. 1018) Amends the National Energy Conservation Policy Act to allow the use of any cogeneration process for other than federally owned buildings or other federally owned facilities when entering into contracts for achieving energy savings at Federal agencies. (Sec. 1019) Amends the National Housing Act to revise mortgage refinancing provisions to authorize the Secretary of the Department of Housing and Urban Development (HUD) to use amounts recaptured under such provisions for the refinancing incentives and costs payments authorized under them. Subtitle B: Reducing the Size of Government - Alaska Power Administration Sale Authorization Act - Authorizes the Secretary of Energy, in accordance with specified purchase agreements, to sell: (1) the Snettisham Hydroelectric Project to Alaska; and (2) the Eklutna Hydroelectric Project to the Anchorage Municipal Light and Power, the Chugach Electric Association, Inc., and the Matanuska Electric Association, Inc. (Sec. 1101) Directs the Secretary to: (1) close out the Alaska Power Administration; (2) report to the Congress on the sales; and (3) return to the Treasury unused balances of funds appropriated for the Alaska Power Administration. Repeals specified Federal law concerning water resources investigations in Alaska by the Secretary of the Interior. (Sec. 1102) Rescinds a specified amount of funds available for the National Oceanic and Atmospheric Administration fleet for research. (Sec. 1103) Directs the Secretary of Veterans Affairs to phase-out and close certain Department of Veterans Affairs supply depots in New Jersey, Illinois, and California and transfer funding back to the Treasury. (Sec. 1104) Repeals the State Justice Institute Act of 1984, thereby terminating the State Justice Institute. Rescinds half the FY 1994 appropriations for salaries and expenses of the State Justice Institute. (Sec. 1105) Eliminates the National Small Business Tree Planting Program. (Sec. 1106) Amends Federal law to: (1) permit DOD to contract for certain non-core functions such as data processing, billing, and payroll; (2) authorize appropriations out of a special fund credited with a portion of the delinquent debts collected in order to improve debt collection activities; (3) allow the U.S. Customs Service to utilize private debt collection companies; (4) subject the Internal Revenue Service, the Social Security Administration, and the U.S. Customs Service to statutorily prescribed debt collection reporting requirements; and (5) repeal requirements pertaining to Department of Justice contracting for private legal services in connection with indebtedness cases. Subtitle C: Eliminating Government Printing Monopoly - Government Information Dissemination and Printing Improvement Act of 1994 - Transfers the position of Superintendent of Documents (SD) and all its functions to the Library of Congress, to be carried out by an official of the same title under the direction of the Librarian of Congress. (Sec. 1202) Revokes all existing authorized printing plant charters. (Sec. 1203) Requires all Government publications to be available for use throughout the Government. (Sec. 1204) Requires each department, agency, and other entity of the Government to: (1) establish a comprehensive inventory of its publications; (2) make it available via the electronic directory; and (3) furnish its publications to the SD. (Sec. 1205) Imposes additional specified responsibilities on the: (1) Public Printer with respect to the executive and judicial branches; and (2) SD with respect to dissemination of Government publications. (Sec. 1206) Requires the head of a Government department, agency, or entity to furnish any of its publications to the SD. (Sec. 1207) Requires the SD to make Government publications available to designated depository libraries and State libraries. Title II: Streamlining The Federal Bureaucracy - Subtitle A: Department of Agriculture Reorganization - Directs the Secretary of Agriculture to: (1) consolidate field, regional, and national offices within the Department of Agriculture; and (2) reduce personnel in order to achieve a specified expenditure reduction by FY 2000. Subtitle B: Procurement Streamlining - Replaces armed forces provisions giving preference to nondevelopmental items in supply procurements with provisions for the acquisition of commercial items (property regularly used by the general public or non-governmental entities for non-governmental purposes) in equipment or supply procurements. Authorizes the Secretary of Defense to develop and acquire non-commercial equipment or supplies only if no commercial items are available. Makes cost accounting standards under the Office of Federal Procurement Policy Act (OFPPA) inapplicable to acquisitions of commercial items. (Sec. 2052) Amends the Federal Property and Administrative Services Act of 1949 (FPASA) to make similar changes with respect to civilian agency acquisitions. (Sec. 2061) Amends OFPPA to raise the small purchase threshold (renamed the simplified acquisition threshold (SAT)) to $100,000. Makes the same change with regard to armed services acquisitions, except with regard to the contingency operation exception for certain contracts and purchases. Extends the new threshold under OFPPA to FPASA. (Sec. 2066) Requires simplified procedures under the Federal Acquisition Regulation (FAR) for SAT acquisitions. (Sec. 2068) Amends OFPPA and the Small Business Act to: (1) repeal references to "the small purchase threshold" and continue existing notice thresholds for procurements over $25,000 (except that the requirement to allow 30 days for bid and proposal submission would apply only to contracts or orders in excess of SAT); and (2) prescribe additional contents for notices with respect to contracts between $25,000 and $100,000. (Sec. 2071) Exempts: (1) subject agency (National Aeronautics and Space Administration, Coast Guard, DOD, and respective military departments) contracts below SAT from contingent fee certifications, prohibitions on limiting subcontractor direct sales and doing business with certain contractors, and requirements for audits, supplier and supply source identification, and use of U.S. vessels for supply transportation; (2) civilian agency contracts below SAT from similar requirements with regard to subcontractor direct sales; (3) prime contracts below SAT from procedural and other requirements of the Anti-Kickback Act of 1986; and (4) contracts below SAT from the Miller Act (MA), the Contract Work Hours and Safety Standards Act, Service Contract Act of 1965, and Drug-Free Workplace Act of 1988, requirements regarding certain disabled veterans, and specified requirements under the Rehabilitation Act of 1973, Buy American Act, and Davis-Bacon Act. Requires the FAR to provide various alternative payment protections, including payment bonds, for suppliers of labor and materials on certain contracts under MA. (Sec. 2081) Requires the Federal Acquisition Regulatory Council to review the FAR to identify and amend regulations applicable to acquisitions below SAT. Requires agency heads to take similar action with respect to applicable supplemental regulations, policies, and procedures. Subtitle C: Other Streamlining Reforms - Amends the Copeland Act to require employers on contracts covered by the Davis-Bacon Act to certify compliance with applicable labor law standards at least once monthly, instead of weekly, to the Department of Labor. (Sec. 2102) Consolidates into the Block Grants to States for Social Services program under title XX of the Social Security Act (SSA) various social services programs under the Community Services Block Grant Act, the Child Care and Development Block Grant Act of 1990, titles III (Grants for State and Community Programs on Aging) and VII (Nutrition Program for the Elderly) of the Older Americans Act of 1965, the State Dependent Care Development Grants Act, and the SSA title IV part A (Aid to Families With Dependent Children) program for at-risk children. (Sec. 2103) Amends SSA title XVIII (Medicare) to revise the contractor system under Medicare, including eliminating the Railroad Retirement Board's authority to contract for processing the Medicare claims of railroad retirees, in order to provide for increased flexibility in contracting for Medicare claims processing. (Sec. 2104) Amends SSA title II (Old Age, Survivors and Disability Insurance) to restructure the current program for death information exchange: (1) to use, for example, a Federal Clearinghouse on Death Information as the vehicle for all such exchanges; and (2) in the case of individuals with respect to whom federally funded benefits are provided by (or through) a Federal or State agency other than under SSA, to require such agency to pay a set fee to cover all costs connected with the provision of such information for them. Ends the exemption from Internal Revenue Code requirements for Social Security Administration sharing of State collected death information with Federal, State, and local agencies granted to two States under the Omnibus Budget Reconciliation Act of 1993. (Sec. 2105) Amends SSA title II to earmark specified levels of administrative funding for continuing disability reviews of disabled beneficiaries. (Sec. 2106) Amends SSA title XI to authorize the Secretary of Veterans Affairs (VA) to use the Medicare and Medicaid Coverage Data Bank (renamed the Health Care Coverage Data Bank) to determine whether veterans receiving VA health care benefits have private insurance. (Sec. 2107) Amends the Housing and Community Development Amendments of 1978 to revise requirements for the management and disposition of Department of Housing and Urban Development (HUD)-held multifamily properties and mortgages. Title III: Improving Government Performance and Accountability - Requires that all authorization and appropriation legislation contain performance goals for any programs they fund. Provides for waivers from such requirement under certain conditions. (Sec. 3002) Amends Federal civil service law to: (1) link Federal within-grade pay increases to job performance; (2) provide for the modification of reduction-in-force (RIF) regulations to give an employee's efficiency or performance rating greater weight than tenure of employment and length of service during a RIF. (Sec. 3003) Requires the Federal Accounting Standards Advisory Board to recommend comprehensive and uniform Federal accounting and financial standards to the Congress and the President. (Sec. 3005) Revises current law regarding annual agency financial statements and agency audits, with changes requiring audited statements covering all accounts and associated activities of each office, bureau, and activity of the concerned agency. (Sec. 3006) Amends the Federal Employees' Compensation Act (FECA) to: (1) make it a felony to lie on FECA benefit applications; (2) bar from FECA program participation those individuals convicted of defrauding it; and (3) generally cut off FECA benefits to individuals in correctional facilities who have been convicted of a felony. (Sec. 3007) Allows Federal agencies to reduce employees or positions below mandated personnel levels. Title IV: Improving the Legislative Process - Amends the Congressional Budget and Impoundment Control Act of 1974 to require that each line-item in an appropriations bill and each tax expenditure in a revenue bill be enrolled as a separate bill to be presented to the President (effectively giving the President line-item veto authority over such measures while ensuring that the override provisions of the U.S. Constitution apply). (Sec. 4002) Amends rule XVI of the Standing Rules of the Senate to allow a point of order against reception or consideration of any appropriations bill or amendment containing a provision that has not been previously authorized by law within the preceding five years. (Sec. 4003) Amends the Congressional Budget Act of 1974 to make congressional consideration of emergency legislation subject to the same budgetary points of order and super-majority waiver requirements as other legislation. Title V: Enforcement - Provides that none of the changes in direct spending and receipts resulting from this Act shall be reflected in OMB estimates under the Balanced Budget and Emergency Deficit Control Act of 1985 (Gramm-Rudman-Hollings Act). Directs the Director of OMB, upon enactment of this Act, to make specified downward adjustments in discretionary spending limits under the Congressional Budget Act of 1974 for FY 1994 through 1999. Makes specified reductions in budget outlays and authority for the House and Senate Committees on Appropriations under the Congressional Budget Act of 1974. Authorizes and directs each Committee on Appropriations to adjust its suballocations among its subcommittees for FY 1994 to reflect the lower allocations provided above. Amends the Congressional Budget Act of 1974 and the Gramm-Rudman-Hollings Act to provide for the establishment of a defense firewall through FY 1998.
United States · United States Congress · 8 February 1994
Directs the President to award a medal of honor to a named individual for outstanding service to the Nation during World War II, notwithstanding time limitations otherwise applicable.
United States · United States Congress · 31 January 1994
Senate Office Savings Act (SOS Act) - Amends the Supplemental Appropriations Act, 1973 to authorize a Senator to direct that funds that are appropriated to the Senate for a fiscal year and allocated to the Senator's personal office and that remain unexpended and unobligated be paid into the sinking fund for retiring and canceling bonds and notes at the close of such fiscal year. Provides that such excess funds shall be used to reduce the public debt.
United States · United States Congress · 27 January 1994
TABLE OF CONTENTS: Title I: Portable and Permanent Private Health Insurance Subtitle A: Portability Subtitle B: Permanence Title II: Expansion of Health Care Choices Subtitle A: Employer-Provided Health Insurance Subtitle B: Medical Savings Accounts Title III: Equal Tax Treatment for Health Insurance of Self-Employed and Uninsured Title IV: Small Business Health Insurance Pools Title V: Assistance to Individuals With Preexisting Conditions in Purchasing Health Insurance Title VI: Encourage Responsible Behavior by the Financially Capable Title VII: Assistance to Low-Income Workers to Purchase Health Insurance Title VIII: Reward Preventive Medicine and Healthy Lifestyles Title IX: Reform Medicaid and Expand Choices Under Medicare Subtitle A: Medicaid Subtitle B: Medicare Title X: Enhanced Efficiency Through Paperwork Reduction Title XI: Meaningful Medical Liability Reform Title XII: Antitrust Reforms Title XIII: Expenditure Targets for the Medicaid and Medicare Programs Comprehensive Family Health Access and Savings Act - Title I: Portable and Permanent Private Insurance - Subtitle A: Portability - Amends the Internal Revenue Code to modify required continuation coverage of group health plans by allowing the offering of annual deductibles for such coverage. Terminates such continuation coverage after an individual is eligible for employer-based coverage for more than 90 days. (Sec. 102) Allows penalty-free withdrawals from qualified retirement plans to pay for health insurance during a continuation period. Subtitle B: Permanence - Prohibits an insurer from cancelling an individual or group health insurance plan or denying renewal of coverage except for specified reasons. Prohibits an employer from cancelling a self-insured group health plan or denying renewal of coverage except for similar reasons. (Sec. 112) Requires individual health insurance plans and group health plans to offer insureds the option to purchase new health insurance plans after enactment of this Act. Title II: Expansion of Health Care Choices - Subtitle A: Employer-Provided Health Insurance - Requires an employer-provided health insurance package to include one of the following options: (1) the health insurance coverage provided by the employer on the date of enactment of this Act; (2) coverage in a health maintenance organization, managed care arrangement, or preferred provider organization; or (3) a medical savings account. Subtitle B: Medical Savings Account - Allows a deduction from gross income for medical expenses attributable to coverage under a catastrophic health insurance plan. (Sec. 212) Allows individuals a tax deduction for contributions made to a medical care savings account established for the benefit of an eligible individual or such individual's spouse and dependents. 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 and for prohibited transactions. Title III: Equal Tax Treatment for Health Insurance of Self-Employed and Uninsured - Allows as an exclusion from gross income such self-employed health insurance costs as do not exceed the national per employee average of the employer-provided contribution excluded from gross income. Excludes certain health insurance costs from employment taxes. Title IV: Small Business Health Insurance Pools - Prohibits: (1) State restrictions on groups purchasing health insurance; (2) State benefit mandates for group health plans; and (3) for five years following enactment, specified State restrictions on managed care. Title V: Assistance to Individuals with Preexisting Conditions in Purchasing Health Insurance - Requires the Secretary to establish and administer a program providing allotments to States for the establishment of State-wide insurance risk pools to provide health insurance coverage to individuals with preexisting conditions. Authorizes appropriations. Title VI: Encourage Responsible Behavior by the Financially Capable - Prohibits any family with an income exceeding 200 percent of the poverty line or who is eligible for a catastrophic health insurance plan as defined in title VII of this Act, but who fails to purchase a plan providing such coverage within one year of enactment from being eligible for the insurance pool program under title V of this Act. Title VII: Assistance to Low-Income Workers to Purchase Insurance - Amends the Internal Revenue Code to allow a refundable tax credit for the cost of premiums for a catastrophic health insurance plan based upon family income and size. Allows the advance payment of such credit. Disallows the use of such credit amount as a medical expense deduction. (Sec. 702) Allows the collection of unpaid debts for medical expenses from individuals who are eligible for such credit but fail to claim it. Title VIII: Reward Preventive Medicine and Healthy Lifestyles - Provides that in the case of any health insurance plan, no provision of State or local law shall apply that restricts the reduction of premiums or the allowance of incentives with respect to such plans for individuals who pursue healthy lifestyles. Title IX: Reform Medicaid and Expand Choices Under Medicare - Subtitle A: Medicaid - Amends title XIX (Medicaid) of the Social Security Act to place a specified formula cap on the Federal payment made each year to a State for furnishing medical assistance to eligible individuals. (Sec. 902) Provides for waivers from Medicaid requirements in order for States to establish innovative and cost-effective programs for furnishing medical assistance to eligible individuals. Subtitle B: Medicare - Amends title XVIII (Medicare) of the Social Security Act to allow an individual to elect health care coverage through either a private health care arrangement or an eligible organization within one year after becoming entitled to benefits under Medicare part A (Hospital Insurance) or forgoing an employer health benefit plan. Details the election process for current Medicare part A beneficiaries. Provides for payments under Medicare to individuals enrolled with such arrangements or organizations, including additional amounts from the Medicare trust funds for individuals enrolled with such arrangements. Title X: Enhanced Efficiency Through Paperwork Reduction - Directs the Secretary of Health and Human Services to adopt standards to reduce the administrative and paperwork burdens of all Federal health care programs by 50 percent within the two-year period following the date of this Act's enactment (initial reduction), and by an additional 50 percent reduction over a subsequent three-year period (subsequent reduction), for a total reduction of 75 percent over the five-year period following such date. Requires the Secretary, to achieve the initial reduction, to adopt standards for Federal health care programs relating to: (1) data elements for use in paper and electronic claims processing under health insurance plans, as well as for use in utilization review and management of care; (2) uniform claims forms; and (3) uniform electronic transmission of the data elements, including protections to assure the confidentiality of patient-specific information and to protect against the unauthorized use and disclosure of information. Directs the Secretary, to achieve the subsequent reduction, to modify by regulation the standards adopted with respect to the initial reduction. Specifies that such modification may include such recommendations as reported by the Standardized Form Commission or any other provisions necessary to meet the goals for reduction in the paperwork burden of Federal health care programs. (Sec. 1002) Requires each State, to be eligible for Federal funds in connection with any State-administered health care program, to standardize the processing of paper and electronic claims to reduce the administrative and paperwork burdens on such programs by 75 percent during the five-year period following enactment of this Act. Sets forth provisions regarding enforcement of this provision and waivers of payment reductions for noncompliance. (Sec. 1003) Directs the Secretary to: (1) establish a Standardized Forms Commission to make recommendations on the standardization of paper and electronic claims processing to reduce the paperwork burden and enhance the efficiency and productivity of claims processing; and (2) submit recommendations to the Congress in the form of an implementing bill. Sets forth procedures for congressional consideration of such bill. Makes a health care provider or insurer that fails to comply with any enacted recommendations of the Commission ineligible for payments of claims submitted under any provision of the Social Security Act or the Public Health Service Act. Title XI: Meaningful Medical Liability Reform - Makes this title applicable with respect to any medical malpractice liability claim or action (such action) brought in State or Federal court, except with respect to certain claims or actions for damages arising from a vaccine-related injury or death. Sets forth provisions regarding: (1) preemption; (2) negotiated liability; (3) effect on sovereign immunity and choice of law or venue; and (4) jurisdiction. (Sec. 1102) Prohibits such action from being initiated after the expiration of: (1) the two-year period that begins on the latter of the date the alleged injury that is the subject of the claim was discovered or the date the injury should reasonably have been discovered; and (2) the four-year period that begins on the date on which the alleged injury occurred. Makes an exception for a minor who has not attained age six. (Sec. 1103) Provides that: (1) the liability of each defendant in such action, with respect to economic and noneconomic damages, shall be several only and not joint; (2) such a defendant shall be liable only for the amount of damages allocated to the defendant in direct proportion to such defendant's percentage of fault or responsibility for the injury; and (3) the trier of fact shall determine and assign a percentage of responsibility for each such defendant. (Sec. 1104) Requires: (1) all requests for discovery pursuant to such action to identify the relevant portion of the complaint, answer, or other pleading to which responses to the discovery requests are expected to relate; and (2) the court, with respect to any motion for an order compelling discovery, to award the prevailing party reasonable fees and expenses incurred in bringing or defending against the motion, including reasonable attorney fees, unless the court finds that the position of the unsuccessful party with substantially justified or that special circumstances make such an award unjust. (Sec. 1105) Limits the total amount of noneconomic damages that may be awarded to a claimant and family members to $250,000, regardless of the number of parties against whom the action is brought or the number of actions brought with respect to the injury. (Sec. 1106) Specifies that a defendant may not be required to pay damages awarded for any economic losses to be incurred after the date on which the judgment is entered exceeding $100,000, in a single, lump-sum payment, but shall be permitted to make such payments periodically based on projections of the amount of damages expected to be incurred by the claimant at appropriate intervals, as determined by the court. Permits the court to require that a defendant purchase an annuity or fund a reversionary trust to make periodic payments if the court determines that a reasonable basis exists for concluding that the defendant may be unable or otherwise fail to make the required periodic payments. Specifies that a court judgment awarding such payments may not be reopened at any time to contest, amend, or modify the schedule or amount of the payments in the absence of fraud or any other basis under which a party may obtain relief from a final judgment. (Sec. 1107) Sets forth provisions regarding costs and fees, including limitations on attorneys charging or collecting contingency fees. Establishes recordkeeping requirements as a prerequisite to the receipt of an award of attorney fees. (Sec. 1108) Sets forth provisions regarding: (1) contribution and indemnification; and (2) collateral sources. (Sec. 1110) Prohibits the award of noneconomic damages with respect to any medical product liability claim alleged against a medical product producer if: (1) the drug or device that is the subject of such claim was subject to specified approval or premarket approval under the Federal Food, Drug, and Cosmetic Act by the Food and Drug Administration (FDA); or (2) the drug or device is generally recognized as safe and effective pursuant to conditions established by the FDA and applicable regulations, including packaging and labeling regulations. Makes exceptions in cases of withheld information, misrepresentation, or illegal payment of FDA officials to secure approval. (Sec. 1111) Provides that, in any medical malpractice liability action that is certified as a class action: (1) the share of damages under any final judgment or settlement that is awarded to any party serving as a representative claimant shall be calculated in the same manner as the shares awarded to all other members of the claimant class (but permits the award of reasonable compensation, costs, and expenses relating to the representation of the class); (2) if a party is represented by an attorney who has a beneficial interest in the subject of the litigation, the court shall make a determination of whether such interest constitutes a conflict of interest sufficient to disqualify the attorney; and (3) an attorney may not represent the class if the attorney has paid, or is obligated to pay, a fee to a third party who assisted the attorney in obtaining the representation of any party to the action (and bars an attorney who knowingly violates this provision from representing the party in such action or any action to which this title applies). Title XII: Antitrust Reforms - 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: (1) the identities of the parties to the venture; (2) the nature, objectives, and planned activities of the venture; and (3) 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. (Sec. 1203) 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. Title XIII: Expenditure Targets for the Medicaid and Medicare Programs - Requires the Director of the Office of Management and Budget, not later than 30 days after the end of each fiscal year beginning with FY 1995, to determine the amount of "medicaid excess expenditures" and "medicare excess expenditures" for such fiscal year. Defines such terms for a fiscal year as the amount by which the Federal expenditures under each such program for such fiscal year exceed the target expenditures for each such program. Sets formulas for determining the target expenditures. (Sec. 1302) Provides that if the Director determines that there are Medicaid or Medicare excess expenditures for a fiscal year, specified categories of health insurance benefits (including certain tax credits and exclusions and assistance to individuals with preexisting conditions in purchasing health insurance) that are effective in the applicable taxable or calendar year beginning after such fiscal year may be delayed until the following year. Makes such provision applicable only to so many of such categories in the order in which such categories are listed such that the savings resulting from such delay at least equal the costs of the Medicaid and Medicare excess expenditures.
United States · United States Congress · 26 January 1994
Peace Powers Act of 1994 - Amends the United Nations Participation Act to prohibit the President from subordinating any element of the armed forces participating in a United Nations peacekeeping activity to the command or operational control of any foreign nationals unless he submits specified documents to the appropriate congressional committees or the Congress enacts an Act or joint resolution authorizing such subordination. Lists as the specified documents determinations by the President that: (1) the proposed subordination is in the national security interest (along with a justification for such determination); (2) the unit commanders of the armed forces proposed for subordination will retain the ability to report independently to higher U.S. military authorities; (3) the United States will retain authority to withdraw the armed forces from the operation at any time and to take any action to protect such forces if endangered; (4) the armed forces will remain under U.S. administrative command for purposes of discipline and evaluation; and (5) the proposed foreign command arrangement does not violate the Constitution. (Sec. 5) Provides for notification to the Congress of proposed participation in, or expenditure of funds for, United Nations peacekeeping activities and other related matters. (Sec. 9) Requires the President to report annually to the Congress on the anticipated budget for, and U.S. contributions to, United Nations peacekeeping activities. (Sec. 11) Revises provisions that authorize the President to waive reimbursement from the United Nations for U.S. participation in peacekeeping activities. Permits the Secretary of Defense to authorize such a waiver if an emergency exists, subject to congressional notification requirements. Bars U.S. contributions to United Nations peacekeeping activities, beginning in FY 1995, until the Secretary certifies to the Congress that the United Nations has reimbursed the Department of Defense (DOD) directly for all goods and services provided on a reimbursable basis for such activities. (Sec. 12) Limits the availability of funds made available to DOD for United Nations peacekeeping activities, beginning in FY 1996, unless the Congress has by law specifically made funds available for such purposes. (Sec. 13) Declares that, effective FY 1996, the Congress does not intend to make funds available for payment of U.S. contributions to such activities that exceed 25 percent of the total of such contributions of all countries unless the Congress enacts a statute specifically authorizing a greater percentage contribution. (Sec. 14) Prohibits the obligation or expenditure of funds to pay U.S. contributions for such activities unless the Secretary of State certifies to the appropriate congressional committees that U.S. manufacturers and suppliers are being given equal opportunities to provide equipment, services, and material for such activities. (Sec. 16) Permits intelligence to be provided to the United Nations only pursuant to specified agreements and advance notification to the Congress. (Sec. 17) Withholds, beginning in FY 1995, 50 percent of the funds for U.S. contributions for United Nations peacekeeping activities unless the President makes a specified certification regarding the establishment of an Office of Inspector General within the United Nations.
United States · United States Congress · 25 January 1994
TABLE OF CONTENTS: Title I: Portable and Permanent Private Health Insurance Subtitle A: Portability Subtitle B: Permanence Title II: Small Business Health Insurance Pools Title III: Enhanced Efficiency Through Paperwork Reduction Title IV: Antitrust Reforms Consensus Interim Health Act - Title I: Portable and Permanent Health Insurance - Subtitle A: Portability - Amends COBRA provisions of the Internal Revenue Code with respect to continuation coverage requirements to permit the options of: (1) identical coverage; (2) coverage with an annual $1,000 deductible; and (3) coverage with an annual $3,000 deductible. Permits penalty-free withdrawals from qualified retirement plans for such coverage. Subtitle B: Permanence - Prohibits either an insurer or an employer from cancelling a health plan other than for: (1) nonpayment of premiums; (2) fraud; (3) noncompliance; or (4) the plan will no longer be provided in a geographic area. (Sec. 112) Requires an insurer, with respect to any individual health plan as of enactment, to offer the insured the option to purchase a new individual health insurance plan. (Sec. 113) Requires an insurer, with respect to any group health plan in effect as of enactment, to offer the option to purchase upon leaving the group a new individual health insurance plan. Title II: Small Business Health Insurance Pools - Prohibits any State or local law from applying that: (1) prohibits two or more employers or groups from obtaining coverage under a multiple employer health plan; and (2) requires the coverage of one or more specific benefits, services, or categories of health care or provider. (Sec. 203) Preempts, for five years, the following provisions of State law: (1) restrictions on reimbursement rates or selective contracting; (2) restrictions on differential financial incentives; and (3) restrictions on utilization review methods. Title III: Enhanced Efficiency Through Paperwork Reduction - Directs the Secretary of Health and Human Services to adopt standards to reduce the administrative and paperwork burdens of all Federal health care programs by a total of 75 percent over a five-year period. (Sec. 302) Requires any State-administered health care program, in order to be eligible for funds in connection with such program, to standardize the processing of paper and electronic claims by 75 percent over a five-year period. (Sec. 303) Provides for the establishment of a Standardized Forms Commission to make recommendations on the standardization of paper and electronic claims processing. Title IV: Antitrust Reforms - Provides for the promulgation of guidelines under which a health care joint venture may request that the entities participating in the joint venture receive specified exemptions under the antitrust laws. (Sec. 402) Permits the Attorney General to issue a certificate of public advantage to an eligible health care joint venture, exempting such venture under the antitrust laws, if: (1) the benefits that are likely to result outweigh any likely reduction in competition; and (2) any such reduction is reasonably necessary to obtain such benefits. (Sec. 403) Establishes the Interagency Advisory Committee on Competition, Antitrust Policy, and Health Care in order to: (1) evaluate competition and antitrust policy; (2) analyze the effectiveness of health care joint ventures receiving exemptions; and (3) make recommendations.
United States · United States Congress · 20 November 1993
TABLE OF CONTENTS: Title I: Tax and Insurance Provisions Subtitle A: Tax Treatment of Health Care Expenses Subtitle B: Insurance Provisions Subtitle C: Employer Provisions Subtitle D: Federal Preemption Subtitle E: Report Title II: Medicare and Medicaid Reforms Subtitle A: Medicare Subtitle B: Medicaid Title III: Health Care Liability Reform Title IV: Administrative Cost Savings Subtitle A: Standardization of Claims Processing Subtitle B: Electronic Medical Data Standards Subtitle C: Development and Distribution of Comparative Value Information Subtitle D: Preemption of State Quill Pen Laws Title V: Anti-Fraud Subtitle A: Criminal Prosecution of Health Care Fraud Subtitle B: Coordination of Health Care Anti-Fraud and Abuse Activities Title VI: Antitrust Provisions Title VII: Long-Term Care Consumer Choice Health Security Act of 1994 - Title I: Tax and Insurance Provisions - Subtitle A: Tax Treatment of Health Care Expenses - Amends the Internal Revenue Code to allow a tax credit for health care expenses based upon percentages of qualified health insurance premiums and adjusted gross income. Provides advance payments of such credit by employers. (Sec. 102) Allows individuals a tax credit for a percentage of contributions made to a medical care savings account established for the benefit of an eligible individual. Exempts such accounts from taxation. Establishes an excise tax for excess contributions to medical care savings accounts and makes such accounts subject to the tax on prohibited transactions. (Sec. 103) Terminates the medical expense deduction and the exclusion for employer-provided health insurance. Subtitle B: Insurance Provisions - Part I: Federally Qualified Health Insurance Plans - Sets forth requirements for federally qualified health insurance plans, including coverage for acute medical care, cost-sharing, premium rating practices, and guaranteed issuance and renewability. Part II: Certification of Federally Qualified Health Insurance Plans - Requires States to meet standards for regulatory programs for the certification of federally qualified health insurance plans. Subtitle C: Employer Provisions - Requires employers to: (1) withhold health insurance premiums from employee wages and remit such premiums to the employee's chosen insurer; and (2) notify employees of their right to claim an advance refundable tax credit for such premiums. (Sec. 122) Provides for the conversion and continuation of existing insurance plans to required coverage under this Act. (Sec. 125) Establishes the Benefits Cash Out Commission to propose a procedure under which individuals may cash out Federal health benefits. Provides for congressional consideration of such proposal prior to its implementation. (Sec. 126) Imposes excise taxes on employers and health insurance carriers for noncompliance with this Act. Subtitle D: Federal Preemption - Preempts specified State laws concerning health insurance. Subtitle E: Report - Requires the Secretary of Health and Human Services to report to the Congress five years after the enactment of this Act on certain aspects of health insurance coverage. Title II: Medicare and Medicaid Reforms - Subtitle A: Medicare - Directs the Secretary to report to the Congress on the feasibility of allowing future Medicare beneficiaries to elect to receive certificates with which to purchase private health insurance coverage instead of receiving Medicare benefits. (Sec. 202) Eliminates disproportionate share hospital payments under Medicare. (Sec. 203) Provides for a reduction in the adjustment for indirect medical education costs under Medicare. (Sec. 204) Imposes copayments for laboratory services, certain home health visits, and skilled nursing facility services provided under Medicare. (Sec. 207) Moves payment updates to January for all payment rates under Medicare's hospital insurance program. (Sec. 208) Accelerates the transition to prospective rates for facility costs in hospital outpatient departments. Subtitle B: Medicaid - Places a cap on Federal payments for acute medical services furnished under a State's Medicaid program. (Sec. 212) Provides for waivers from Medicaid requirements in order to establish acute medical services programs. (Sec. 213) Terminates disproportionate share hospital payments under Medicaid. (Sec. 214) Directs the Secretary to provide grants to States for programs to provide health insurance coverage, acute medical services, preventive care, and disease prevention services to low-income individuals. Title III: Health Care Liability Reform - Health Care Liability Reform Act of 1994 - Limits payments, damages, and attorney's fees in health care malpractice actions and claims. (Sec. 304) Declares that a manufacturer or seller of a health care product shall not be strictly liable for injury from: (1) a defect in the design of the product; or (2) a failure to warn or instruct regarding a risk posed by the product that was not known or reasonably knowable. (Sec. 305) Limits the amount of noneconomic damages that may be awarded in a health care malpractice claim or a health care product liability claim. Allows several liability for noneconomic loss and for punitive damages. (Sec. 306) Allows punitive damages to be awarded only if the claimant establishes that the harm suffered was the result of conduct manifesting conscious, flagrant indifference to the health of those harmed by the product. Disallows punitive damages against a product approved by the Food and Drug Administration. Title IV: Administrative Cost Savings - Subtitle A: 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. 402) 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. 403) 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. Subtitle B: 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. 412) 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. 413) 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 standards. (Sec. 414) Sets forth limitations on data requirements where standards with respect to data elements are in effect. (Sec. 415) 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. Subtitle C: 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. 422) 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. 423) 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. Subtitle D: Preemption of State Quill Pen Laws - Specifies that, effective January 1, 1996, 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. Title V: Anti-Fraud - Subtitle A: Criminal Prosecution of Health Care Fraud - Amends the Federal criminal code to impose penalties upon 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. 502) 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. Subtitle B: Coordination of Health Care Anti-Fraud and Abuse Activities - Amends the Social Security Act to provide for: (1) the application of Federal health anti-fraud and abuse sanctions to all fraud and abuse against any health insurance plan; and (2) treble damages for making or causing to be made false statements or representatives involving Medicare or State health care programs, for illegal remuneration, and for false statements or representatives with respect to the condition or operation of health care institutions. Directs the Secretary of Health and Human Services, in consultation with State and local health care officials, to: (1) identify opportunities for the satisfaction of community service obligations that a court may impose upon the conviction of a criminal offense involving Medicare or State health care programs; and (2) make information concerning such opportunities available to Federal and State law enforcement officers and State and local health care officials. Title VI: Antitrust Provisions - 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's fees and costs of suit to the prevailing party in an action based on a claim involving activity found to be exempt. (Sec. 602) 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. 603) 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. 604) 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. 605) Sets forth provisions regarding notifications providing for a reduction in certain penalties under the antitrust laws for health care cooperative ventures. (Sec. 606) 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 carry out provisions of this title. Title VII: Long-Term Care - Amends the Internal Revenue Code to exclude from gross income certain amounts withdrawn from individual retirement accounts and certain employer cash or deferred arrangements to pay long-term care premiums. (Sec. 702) 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. 703) Provides for the exclusion as a death benefit of any amount paid or advanced to an individual under a life insurance contract because such individual is terminally ill or chronically and has been permanently confined to ill and qualified facility.
United States · United States Congress · 19 November 1993
Equitable Escheatment Act of 1993 - Amends specified Federal law to prescribe guidelines under which unclaimed distributions of security interests shall be subject to the custodial taking (escheatment) by the State which contains the principal executive offices of either the issuer or the holder of those securities.
United States · United States Congress · 18 November 1993
Spending Reduction Enforcement Act of 1993 - Establishes the Spending Reduction Commission to propose cost savings and changes in law to achieve at least $65 billion of budget outlay reductions for the budget year and each outyear until a balanced budget is reached. Sets forth the procedure for implementation of the Commission's recommendations by the Office of Management and Budget, the President, and the Congress. Makes budget outlay reductions permanent. Establishes sequester provisions if the full amount of savings required by this Act is not achieved in a session of the Congress.
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 · 2 November 1993
Grants the consent of the Congress to the amendment to articles I, II, and III of the Historic Chattahoochee Compact between Alabama and Georgia which: (1) provide that the purpose of the Compact is to promote the cooperative development of the Chattahoochee valley's full potential for historic preservation and tourism; (2) make such Compact effective immediately as to the States ratifying it whenever Alabama and Georgia have ratified it and the Congress has given its consent; and (3) permit the two States to establish a joint agency to be known as the Historic Chattahoochee Commission.
United States · United States Congress · 28 October 1993
Expresses the sense of the Senate that the Department of Labor should provide adequate: (1) resources to the States to cover costs of developing and implementing the worker profiling system; and (2) flexibility for Governors to ensure that the appropriated funds will be made available to provide reemployment services for profiled claimants.
United States · United States Congress · 27 October 1993
Amends the Standing Rules of the Senate to make it out of order in the Senate to consider any bill, joint resolution, conference report, amendment, or motion that contains one or more unfunded Federal mandates, unless the provisions containing such mandates are considered individually or en bloc, at the discretion of the Majority Leader or his designee. Requires a two-thirds vote of approval by the Senators for the provisions to remain part of the bill and to waive a point of order made against the measure.
United States · United States Congress · 27 October 1993
Amends the Standing Rules of the Senate to add rule XLIII to require: (1) an affirmative two-thirds vote of the members of the committee to report any bill or resolution that contains one or more unfunded Federal mandates; and (2) a reported measure containing such a mandate to be accompanied by an explanation of why the unfunded mandate is important enough to be imposed upon State and local budgets without attendant Federal funding. Makes it out of order for the Senate to consider any bill that has not satisfied the requirements of this Act. Requires a two-thirds vote of the Senate to waive this point of order.
United States · United States Congress · 18 October 1993
Amends the Standing Rules of the Senate to add a rule that makes it out of order to consider any material in any bill, joint resolution, amendment, motion, conference report, or amendment between the Houses that increases a tax retroactively. Requires an affirmative three-fifths' roll call vote of all Senators to waive this rule.
United States · United States Congress · 13 October 1993
Prohibits the U.S. Postal Service or the Attorney General from fining or otherwise penalizing any person who transmits by private express or other unlawful means, delivers to any agent thereof, or deposits at any appointed place any letter or packet. Amends the Federal criminal code to conform with this Act.
United States · United States Congress · 7 October 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 Subtitle H: Medicaid Program Flexibility 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 · 7 October 1993
Amends the Internal Revenue Code to repeal the retroactive application of income, estate, and gift tax rate increases. Requires a reduction in administrative expenses of Federal departments and agencies for FY 1994 through 1996.
United States · United States Congress · 5 October 1993
Calls for: (1) the President to encourage the United Nations (UN) to permit representatives of Taiwan to participate fully in UN activities; and (2) cabinet-level exchanges between Taiwan and the United States.
United States · United States Congress · 4 October 1993
Amends the Congressional Budget Act of 1974 to provide for downward adjustment in Appropriations Committees' allocations and suballocations when bills are passed that reduce appropriations and require rescissions. Requires the Congressional Budget Office to provide scorecards for such measures.
United States · United States Congress · 4 October 1993
Prohibits funds from being expended for deployment of U.S. armed forces outside the United States under United Nations command unless the use of funds for such deployment is expressly authorized in a law enacted after enactment of this Act.
United States · United States Congress · 24 September 1993
South African Democratic Transition Support Act of 1993 - Expresses the sense of the Congress with respect to U.S. policy towards South Africa. Repeals specified provisions of the Comprehensive Anti-Apartheid Act of 1986, providing for a total repeal of such Act when the President certifies to the Congress that an interim government that was elected on a nonracial basis through free and fair elections has taken office in South Africa. Urges all State or local governments and private entities in the United States to rescind any restrictions on economic interactions with South Africa. Authorizes the President to provide development and economic support fund assistance to support the transition to nonracial democracy in South Africa. Prohibits such assistance to the Government of South Africa unless the President certifies to the Congress that an interim government elected on a nonracial basis through free and fair elections has taken office. Exempts from such prohibition assistance to the Transitional Executive Council, South African higher education institutions, and any other entity that would promote the transition to nonracial democracy. Declares that the President should: (1) negotiate a tax treaty with South Africa; (2) initiate negotiations with the South African Government to provide for Overseas Private Investment Corporation programs in such country; (3) conclude cooperative agreements with South Africa on various issues; and (4) encourage other donors to expand their activities in support of the transition to nonracial democracy. States that: (1) the Director of the Trade and Development Agency should provide additional funds for projects in South Africa; (2) the Export-Import Bank should expand its activities in connection with exports to South Africa; and (3) the Director of the U.S. Information Agency should use his authorities to promote the transition to nonracial democracy. Requires the heads of Federal Government agencies, in procuring goods or services, to make affirmative efforts to assist business enterprises having more than 50 percent ownership by nonwhite South Africans. Directs the Secretary of the Treasury to instruct the U.S. executive directors of international financial institutions to urge financial assistance to South Africa to support the transition to democracy.
United States · United States Congress · 14 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 · 6 August 1993
Expresses the sense of the Congress that: (1) the accounting standards proposed by the Financial Accounting Standards Board will have grave economic consequences, particularly for businesses in new-growth sectors, which rely heavily on entrepreneurship; and (2) the Board should not change the current accounting rules by requiring that businesses deduct the value of stock options from profits.
United States · United States Congress · 1 July 1993
Spending Reduction Act of 1993 - Establishes the Spending Reduction Commission to propose cost savings and changes in law to achieve at least $65 billion of budget outlay reductions for the budget year and each outyear until a balanced budget is reached. Sets forth the procedure for implementation of the Commission's recommendations by the Office of Management and Budget, the President, and the Congress. Makes budget outlay reductions permanent. Requires the Comptroller General to make a compliance report on this Act at the end of each congressional session.
United States · United States Congress · 30 June 1993
Federal Mandate Relief Act of 1993 - Prohibits the enforcement of an intergovernmental regulation against a State or local government with respect to a fiscal year: (1) unless sufficient Federal funds have been appropriated to reimburse all State or local governments for the total additional costs that will be incurred by those governments in complying with the regulation during the fiscal year; or (2) the Congress approves by a two-thirds vote of the Members of each House a joint resolution that waives such prohibition with respect to that intergovernmental regulation and that fiscal year. Specifies that the total additional costs that will be incurred by State and local governments in complying with an intergovernmental regulation during a fiscal year shall be the total compliance costs estimated by the Director of the Office of Management and Budget under this Act. Requires the Director, for each fiscal year in which an intergovernmental regulation will be in effect, to submit to the President and the Congress a report that contains an estimate for that fiscal year and the following fiscal year of the total additional costs that have been or will be incurred by each State and local government in complying with the regulation. Sets forth provisions with respect to reimbursements of State and local governments by Federal agencies.
![Official portrait of Sen. Coverdell, Paul [R-GA]](https://www.congress.gov/img/member/c000813_200.jpg)