Budget

To amend the Balanced Budget and Emergency Deficit Control Act of 1985 to exclude changes in tariffs from the paygo scorecard and to amend the Congressional Budget and Impoundment Control Act of 1974 to exempt changes in tariffs from certain points of order.

United States · United States Congress · 17 August 1994

Amends the Balanced Budget and Emergency Deficit Control Act of 1985 (Gramm-Rudman-Hollings Act) to exclude tariff changes from the pay-as-you-go enforcement provisions. Amends the Congressional Budget Act of 1974 to exempt tariff changes from certain points of order with respect to budget authority.

Expressing the sense of the Congress with respect to funding for the Uruguay Round of GATT negotiations.

United States · United States Congress · 17 August 1994

Expresses the sense of the Congress that: (1) trade agreements which promote free trade by reducing trade barriers are free in that they do not exact a cost on U.S. taxpayers by reducing net Federal revenues; and (2) budget rules which inaccurately calculate the revenue impact of trade agreements by ignoring the U.S. growth caused by tariff changes in other countries should not be applied to the General Agreement on Tariffs and Trade implementing legislation in a way that requires increased taxes or program reductions to "offset" expected tariff revenue reductions.

Affordable Health Care Now Act of 1994

United States · United States Congress · 16 August 1994

TABLE OF CONTENTS: Title I: Improved Access to Affordable Health Care Subtitle A: Increased Availability and Continuity of Health Coverage for Individuals and Their Families Subtitle B: Reform of Health Insurance 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: Assistance in Enrolling Uninsured Children in Health Insurance Subtitle H: Medicaid Reform Subtitle I: Remedies and Enforcement with Respect to Group Health Plans Subtitle J: Delivery of Health Care Services to Illegal Immigrants Title II: Health Care Cost Containment and Quality Enhancement Subtitle A: Medical Malpractice Liability Reform Subtitle B: Administrative Cost Savings and Fair Health Information Practices Subtitle C: Deduction for Cost of Catastrophic Health Plan; Medical Savings Accounts Subtitle D: Anti-Fraud Subtitle E: Increased Medicare Beneficiary Choice; Additional Medicare Reforms Subtitle F: Health Care Antitrust Improvements Subtitle G: Encouraging Enforcement Activities of Medical Self-Regulatory Entities Subtitle H: Reform of Clinical Laboratory Requirements for Simple Tests Subtitle I: Miscellaneous Provisions Title III: Long-Term Care Subtitle A: Tax Treatment of Long-Term Care Insurance Subtitle B: Establishment of Federal Standards for Long-Term Care Insurance Subtitle C: Protection of Assets Under Medicaid Through Use of Qualified Long-term Care Insurance Subtitle D: Studies Subtitle E: Volunteer Service Credit Demonstration Projects Affordable Health Care Now Act of 1994 - Title I: Improved Access to Affordable Health Care - Subtitle A: Increased Availability and Continuity of Health Coverage for Individuals 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. Requires standard coverage to include at least one option, either a fee-for-service option and if available, a point-of-service option and a managed care option. Provides for a five-year transition for existing group health plans. Part 2: Portability and Nondiscrimination - 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; (2) the limitation or exclusion extends over more than six months 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; or (3) an eligible individual has such coverage at the time the individual first became eligible. 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. Provides a one-time amnesty period for pre-existing condition exclusions. (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 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: Standards for Managed Care Arrangements and Essential Community Providers - Sets forth requirements for group health plans and insurers that provide health care coverage through managed care arrangements. Requires such arrangements to assure that covered individuals have reasonably prompt access through the entity's provider network to the benefits package and to centers of excellence. (Sec. 1022) Requires the Secretary of Health and Human Services (Secretary) to establish standards for utilization review programs and periodically review and update such standards to reflect changes in the delivery of health care services. Part 4: 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 determines that the State has in effect a regulatory enforcement mechanism that provides adequate sanctions. Subtitle B: Reform of Health Insurance - Part I: 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 provisions 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 coverage" 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 coverage," "MedAccess catastrophic coverage," and "MedAccess medisave coverage" 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 is sufficient for determining the actuarial value of coverage offered by a 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 premium rate variations, including discounts for employer wellness programs; 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. 1105) Requires the Secretary of Labor to monitor the prevalence and impact of adverse risk selection in the full insured plans made available to small employers resulting from the decision of small employers to self-insure. (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. Part 2: Marketplace for Individuals - Makes the provisions of Part 1 applicable to insurers offering health insurance coverage to individuals and their dependents. Part 3: Voluntary Health Purchasing Arrangements - Provides for the establishment of voluntary health purchasing arrangements. (Sec. 1124) Requires such arrangements to offer enrollment in health insurance coverage only to: (1) all eligible employees employed by small employers in a service area; and (2) all eligible individuals residing in such area. Part 4: Definitions and Miscellaneous Provisions - Provides definitions for purposes of this subtitle. (Sec. 1134) Requires the Secretary to make annual reports to the Congress on the implementation of this subtitle and the need for additional reforms to assure and expand coverage. (Sec. 1135) 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 - Makes inapplicable to a group health plan any State or local law requiring coverage of specific benefits, services, or categories of health care, or services of any class or type of provider of health care. (Sec. 1202) Makes inapplicable any State or local law prohibiting two or more employers from obtaining coverage under a multiple employer welfare arrangement under which all coverage: (1) consists of medical care described under specified provisions of the Employee Retirement Income Security Act of 1974 (ERISA); and (2) is fully insured. (Sec. 1203) Preempts, for a five-year period, State law provisions which restrict: (1) reimbursement rates or selective contracting; (2) differential financing incentives; and (3) utilization review methods. Directs the Comptroller General to study benefits and cost effectiveness of use of managed care in health services delivery and to report to the Congress, including recommendations as to whether such preemption should be extended. Part 2: Multiple Employer Health Benefits Protections - Amends the Employee Retirement Income Security Act of 1974 (ERISA) to provide a limited exemption from certain restrictions on ERISA preemption of State law for health plans maintained by multiple employers subject to certain Federal standards. Relieves such exempted multiple employer health plans of certain restrictions on preemption of State law, and treats them as employee welfare benefit plans. Sets forth exemption procedures, application and eligibility requirements, and additional notice, reporting, and actuarial requirements applicable to exempted multiple employer health plans. Requires multiple employer welfare arrangements providing certain medical care benefits to issue specified disclosures to participating employers. Requires each multiple employer welfare arrangement which is or has been an exempted multiple employer health plan, and under which coverage is not fully insured, to establish certain minimum reserves. Authorizes the Secretary of Labor to permit alternative means of compliance. Sets forth corrective actions, including actions to avoid depletion of reserves and actions in connection with termination of arrangements. Provides for expirations, renewals, suspensions, and revocations of exemptions. Provides for review of actions of the Secretary, including denials of applications and suspensions or revocations of exemptions. Provides for alternative means of distribution of summary plan descriptions. (Sec. 1212) Revises provisions relating to scope of preemption rules, treatment of single employer arrangements, and treatment of certain collectively bargained arrangements. (Sec. 1215) Sets forth special rules for employee leasing healthcare arrangements, providing that they be treated as multiple employer welfare arrangements. (Sec. 1216) Sets forth enforcement provisions relating to multiple employer welfare arrangements and employee leasing healthcare arrangements, including enforcement of filing requirements, actions by States in Federal court, criminal penalties for certain willful misrepresentations, cease activities orders, and responsibility for claims procedures. (Sec. 1217) Sets forth solvency requirements for certain self- insured group health plans. (Sec. 1218) Sets forth filing requirements for multiple employer welfare arrangements providing health benefits. (Sec. 1219) Provides for cooperation between Federal and State authorities, including: (1) agreements for State enforcement of ERISA provisions applicable to multiple employer welfare arrangements which are or have been exempted multiple employer health plans; and (2) enforcement and technical assistance to States with respect to issues involving multiple employer welfare arrangements. (Sec. 1220) Sets forth transitional rules. 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 in the case of determining whether any multiple employer health plan or insured multiple employer health plan is a voluntary employees' beneficiary association meeting certain requirements, if: (1) such plan provides at least standard coverage consistent with specified provisions of this Act (the Affordable Health Care Now Act of 1994); and (2) in the case of such an insured plan, it meets specified ERISA requirements not preempted by this Act. (Sec. 1222) Amends ERISA to direct the Secretary of Labor to prescribe an alternative method for the filing of a single annual report with respect to all employers participating under a multiple employer welfare arrangement under which all coverage consists of medical care and is fully insured. (Sec. 1223) Sets forth provisions for determining compliance with coverage requirements through multiple employer health arrangements. Subtitle D: Health Deduction Fairness - Amends the Internal Revenue Code to provide for: (1) a permanent extension and an increase in the health insurance tax deduction for self-employed individuals; and (2) a deduction of health insurance premiums for certain previously uninsured individuals. 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 services under Federal, State, local, and private programs; and (2) for developing plans to carry out such projects. Authorizes appropriations. Part 3: Community Health Networks - Sets forth qualifications for community health network arrangements. 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. Part 4: Additional Rural Health Care Provisions - Authorizes the Secretary to make grants to public and nonprofit private entities to develop health plans to provide services exclusively in rural and frontier areas. Authorizes appropriations. (Sec. 1532) Authorizes the Secretary to make grants to public and nonprofit private hospitals in medically underserved rural communities, and to public and nonprofit outpatient facilities in such communities, to develop or increase capacity to provide primary health services. (Sec. 1533) Authorizes the Secretary to make grants to such entities to conduct research and carry out demonstration projects to develop innovative approaches to the delivery of health care in rural areas, such as the use of telemedicine and mobile delivery units. (Sec. 1534) Authorizes appropriations for the training of rural health professionals other than physicians. Subtitle G: Assistance in Enrolling Uninsured Children in Health Insurance - Amends title XIX (Medicaid) of the Social Security Act (SSA) to provide for the establishment of State premium subsidy programs to assist eligible needy children with premiums for standard health coverage. Subtitle H: Medicaid Reform - Amends SSA title XIX to: (1) provide for the establishment of State health allowance programs under which the State makes payments to an approved group health plan which provides coverage to eligible individuals as an allowance towards the costs of providing the individual with benefits under the plan; (2) modify Federal requirements to allow States more flexibility in contracting for coordinated care services under Medicaid; (3) make changes regarding the period of certain waivers under Medicaid; and (4) reduce the amount of Federal payment adjustments under Medicaid for disproportionate share hospitals. (Sec. 1713) Eliminates the duplicative pediatric immunization program under Medicare. Subtitle I: Remedies and Enforcement with Respect to Group Health Plans - Amends the Employee Retirement Income Security Act of 1974 (ERISA) to set forth claims procedure special rules for group health plans. Directs the Secretary of Labor to establish a mediation program for disputes involving group health plan claims. Requires the Secretary to maintain a list of individuals with expertise to serve as facilitators under such program, and to propose a facilitator for each mediation subject to one objection by each party. Sets forth provisions for participation of attorneys, initiation of mediation, mediation procedures, time limits, costs, legal effect of participation, and confidentiality and admissibility. Sets forth court remedies for participants and beneficiaries with respect to group health plans. Subtitle J: Delivery of Health Care Services to Illegal Immigrants - Directs the Secretary of Health and Human Services to conduct a study of health care to illegal immigrants, including the effect of illegal immigration on health costs and the shifting of health costs. Requires a report to the Congress, with recommendations on appropriate means of: (1) alleviating health problems peculiar to illegal immigrants; (2) financing health care provided to illegal immigrants; and(3) increasing intergovernmental cooperation and coordination of efforts of the United States and other countries to alleviate such health problems and finance such efforts. 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. Reduces damages by any other payments made to compensate an individual for injuries. (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 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 and Fair Health Information Practices - Part 1: Administrative Cost Savings - Subpart A: Standards for Data Elements and Transactions - Directs the Secretary to adopt standards and modifications to standards that are: (1) consistent with the objective of reducing the costs of providing and paying for health care; and (2) in use and generally accepted, developed, or modified by the standard-setting organizations accredited by the American National Standard Institute. (Sec. 2104) Directs the Secretary to adopt standards: (1) for data elements of health information; and (2) for transmitting information electronically. Subpart B: Requirements With Respect to Certain Transactions and Information - Specifies standard transactions. Subpart C: Miscellaneous Provisions - Requires the Secretary to establish standards with respect to the operation of health information network services. (Sec. 2124) Authorizes the Secretary to make grants for demonstration projects to promote the development and use of electronically integrated community-based clinical information systems and computerized patient medical records. Subpart D: Assistance to the Secretary - Establishes the Health Care Information Advisory Committee to: (1) assist the Secretary in complying with requirements under this Act; (2) be generally responsible for advising the Secretary and the Congress on the status of the health information network; and (3) make recommendations to correct problems in the network and to refine and improve the network. Part 2: Fair Health Information Practices - Subpart A: Duties of Health Information Trustees - Specifies the duties of health information trustees with respect to inspection of protected health information. (Sec. 2142) Provides a procedure to amend protected health information. Subpart B: Use and Disclosure of Protected Health Information - Sets forth general limitations on the use and disclosure of protected health information by health information trustees. (Sec. 2152) Authorizes a health information trustee to disclose protected health information pursuant to a written authorization by the protected individual. (Sec. 2153) Describes the circumstances under which health information trustees may disclose protected health information to: (1) health plans, health care providers, and oversight agencies; (2) next of kin; (3) public health authorities; (4) health research entities; (5) authorities under emergencies; (6) courts or administrative agencies; (6) law enforcement agencies; (7) entities under subpoenas, warrants, and search warrants; and (8) health information service organizations. Subpart C: Access Procedures and Challenge Rights - Prohibits a government authority from obtaining protected health information about a protected individual from a health information trustee through subpoenas, warrants, and search warrants unless there is probable cause that the information is relevant to the law enforcement inquiry. (Sec. 2172) Establishes challenge procedures to such subpoenas. Subpart D: Miscellaneous Provisions - Restricts the information a health information trustee may disclose when a protected individual pays for health care through a payment card or electronic means. (Sec. 2183) Directs the Secretary to develop standards for electronic documents and communications. (Sec. 2184) Provides for the disclosure of protected health information to affiliated persons and agents and attorneys. (Sec. 2187) Requires States to establish a process for the maintenance of certain protected health information. Subpart E: Enforcement - Provides for civil actions against health information trustees. (Sec. 2192) Authorizes the Secretary to impose a civil money penalty against such trustees for a demonstrated pattern of failure to comply with this subpart. (Sec. 2193) Requires the Secretary to develop an alternative dispute resolution method for resolving claims for civil actions. (Sec. 2194) Amends the Federal criminal code to impose penalties for violations in disclosing and obtaining protected health information. Subpart F: Amendments to Title 5, United States Code - Requires certain Federal agency heads to promulgate rules protecting health information. Subpart G: Regulations, Research, and Education; Effective Dates; Applicability; and Relationship to Other Laws - Requires the Secretary to prescribe regulations to carry out this part not later than July 1, 1996. (Sec. 2197) Makes this part effective on January 1, 1997, except for certain provisions that take effect upon enactment. Subtitle C: Deduction for Cost of Catastrophic Health Plan; Medical Savings Accounts - 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 a 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 - Directs the Attorney General to establish an all-payer health care fraud and abuse control program. (Sec. 2302) Authorizes additional appropriations for such program and AG investigations of possible health care fraud. (Sec. 2303) Establishes in the Treasury the Anti-Fraud and Abuse Trust Fund for use in preventing anti-fraud and abuse law violations and repaying Medicaid and other beneficiaries for cost-sharing. (Sec. 2311) Amends SSA title XI and the Federal criminal code to: (1) revise current sanctions to provide for, among other things, mandatory exclusion from Medicare and State health care program participation of individuals or entities convicted of a fraud-related felony in connection with the delivery of a health care item or service, and criminal penalties of fines and imprisonment for health care fraud; and (2) authorize the Secretary of Health and Human Services (Secretary) to issue advisory opinions with regard to specified matters, including matters concerning prohibited remuneration and service inducements. (Sec. 2315) Modifies: (1) current limitations under Medicare (SSA title XVIII) on physician self-referral; and (2) effective date exceptions under the Omnibus Budget Reconciliation Act of 1993 for such referrals made for clinical laboratory services. (Sec. 2316) Directs the Comptroller General to study and report to the Congress on the costs of peer review contracts for Medicare HMOs. (Sec. 2332) Amends SSA title XVIII to require the Secretary to issue advisory opinions relating to prohibited referrals under Medicare. Directs the Secretary to issue regulations establishing systems under SSA titles XI and XVIII for the issuance of advisory opinions. Subtitle E: Increased Medicare Beneficiary Choice; Additional Medicare Reforms - Amends SSA title XVIII and the Omnibus Budget Reconciliation Act of 1990 to make specified changes in HMO and Medicare supplemental policy provisions. Imposes mandates on the Secretary in order to afford Medicare beneficiaries additional avenues for choosing health care coverage, including enrollment in private health insurance plans. (Sec. 2411) Extends current rules for computing Medicare part B (Supplementary Medical Insurance) premiums. (Sec. 2412) Amends the Internal Revenue Code to provide for the imposition of a Medicare part B premium tax for high-income Medicare part B beneficiaries. (Sec. 2413) Directs the Secretary to take such steps as necessary to consolidate administration of Medicare parts A (Hospital Insurance) and B. (Sec. 2414) Makes specified extensions with regard to Medicare as secondary payer, including those concerning data matches. Subtitle F: Health Care Antitrust Improvements - Exempts from all antitrust claims an activity relating to the provision of health care services that is: (1) within a "safe harbor" designated by the Attorney General, except for claims for injunctive relief asserted by the Attorney General or the Chair of the Federal Trade Commission in extraordinary circumstances; and (2) specified in and in compliance with the terms of a certificate of review issued by the Attorney General, where the activity occurs while the certificate is in effect, except for claims for injunctive relief. Sets forth provisions regarding the award of attorney fees and costs of suit to the prevailing party in an action based on a claim involving activity found to be exempt. (Sec. 2502) Directs the Attorney General to develop and designate specified safe harbors relating to the following, as well as to such other categories of activities as the Attorney General may designate (subject to specified requirements): (1) joint purchasing of health care services; (2) small hospital mergers; (3) startup and operation of collaborations between State-licensed providers through partial or full integration; (4) standard setting and enforcement activities by medical self-regulatory entities; (5) health care providers collectively supplying non-price medical information to buyers and consumers; (6) health care provider participation in surveys; (7) health care joint ventures' purchase or use of equipment or provision of advanced tertiary care services; (8) provision of market power screens at appropriate levels below which combinations of providers are too small to pose a realistic antitrust threat; (9) joint purchasing arrangements; and (10) good faith negotiations relating to legitimate collaborative activities. Directs the Attorney General to publish notice in the Federal Register soliciting proposals for additional safe harbors. Authorizes the Attorney General to modify or remove a safe harbor following notice and comment upon a determination that the safe harbor does not meet specified criteria. 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. 2503) 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 procedures regarding applications for, renovation of, and review of determinations regarding, such certificates. Limits the disclosure of information. (Sec. 2504) Sets forth provisions regarding notifications providing for a reduction in certain penalties under the antitrust laws for health care cooperative ventures. (Sec. 2505) Directs the Attorney General to periodically review the safe harbors, certificates of review, and notifications. (Sec. 2507) Establishes within the Department of Health and Human Services an Office of Health Care Competition Policy. 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 professional 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: Reform of Clinical Laboratory Requirements for Simple Tests - Amends the Public Health Service Act to exempt clinical laboratories performing only simple examinations and procedures from certificate requirements. (Sec. 2703) Directs the Secretary to use existing appropriations to conduct the study relating to the reliability and quality control procedures of clinical laboratory testing programs and the effect of errors in the testing procedures and results on the diagnosis and treatment of patients. (Sec. 2704) Directs the Secretary to revise the membership of the Clinical Laboratory Improvement Advisory Committee to contain a number of practicing physicians proportionate to the number of physician regulated clinical laboratories. Subtitle I: Miscellaneous Provisions - Requires certain Government agencies to refund health benefit contributions for their annuitants. (Sec. 2802) Makes aliens ineligible for social security and Medicaid benefits. (Sec. 2803) Limits the eligibility for social security benefits of certain drug and alcohol addicts. 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. Subtitle B: Establishment of Federal Standards for Long-Term Care Insurance - Amends the Public Health Service Act to mandate the establishment of model Federal standards for long-term care insurance. Prohibits the offering of a long-term care insurance policy in a State unless the State has a regulatory program meeting the requirements of this Act or the policy has been certified by the Secretary of Health and Human Services. Authorizes grants to States for demonstration programs to improve enforcement of the standards. Authorizes appropriations. Imposes on agents selling long-term policies a duty of good faith and fair dealing. Prohibits twisting, high pressure tactics, and cold lead advertising. Mandates minimum financial standards, including income and asset criteria, for advising individuals considering the purchase of a long-term policy. Prohibits sales: (1) to an individual eligible for assistance under title XIX (Medicaid) of the Social Security Act; (2) of duplicate service policies; and (3) of policies that reduce, limit, or coordinate benefits on the basis of eligibility for other coverage or benefits. Provides for: (1) criminal and civil penalties; and (2) agent training and certification. Sets forth additional carrier responsibilities relating to refunding of premiums, mailing of policies, providing information on denials of claims, reporting of information, and limiting compensation to agents for the sale or renewal of policies. Prohibits cancellation or nonrenewal of a long-term care policy except for nonpayment of premium or material misrepresentation. Sets forth continuation and conversion rights for group policies, regulating premiums for converted policies. Requires guaranteed issuance to an individual if the individual meets the minimum medical requirements of the policy. Mandates standards regarding upgraded benefits. Limits cancellation for nonpayment by an incapacitated individual. Requires: (1) subject to exceptions, uniform language and definitions, a uniform format, and at least one standard benefit package; and (2) disclosure of certain matters, including an outline of coverage. Mandates recommendations by the National Association of Insurance Commissioners (NAIC) regarding informing consumers on the long-term economic viability of long-term care insurance carriers. Limits certain conditions on benefits. Requires, if benefits are provided for home health care or community-based services, that certain minimum benefits be provided. Prohibits treating cognitive or mental impairments (including Alzheimer's disease and mental illness) differently from other medical conditions. Limits preexisting condition requirements. Requires: (1) each claimant to have a functional assessment by an individual or entity meeting NAIC qualifications and unconnected to the policy issuer; (2) inflation protection, unless rejected in writing by a policyholder; (3) disclosure of certain premium increases; and (4) nonforfeiture benefits. Prohibits a carrier from contesting a policy or claim based on fraud or misrepresentation unless notice is provided within a time period set by NAIC. Establishes the right of a purchaser to return a policy within a specified period. Defines "long-term care insurance policy," excluding: (1) any basic Medicare supplemental policies; (2) other insurance offered primarily to provide specified types of coverage; and (3) certain life insurance policies. Authorizes grants for programs to provide information, counseling, and assistance regarding the procurement of long-term insurance. Authorizes appropriations. Subtitle C: Protection of Assets Under Medicaid Through Use of Qualified Long-term Care Insurance - Amends the title XIX of the Social Security Act 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 D: 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. 3303) 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 designated 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 E: Volunteer Service Credit Demonstration Projects - 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.

Social Security Protection Act of 1994

United States · United States Congress · 12 August 1994

Social Security Protection Act of 1994 - Amends the Omnibus Budget Reconciliation Act of 1990 and the Balanced Budget and Emergency Deficit Control Act of 1985 (Gramm-Rudman-Hollings Act) to declare that no expenses of administering the old-age, survivors, and disability insurance (OASDI) programs shall be subject to sequestration, or reduction under sequestration, under the latter Act. Declares that no amendment made by this Act shall cause any adjustment to any discretionary spending limit.

Administrative Procedure Reform Act of 1994

United States · United States Congress · 12 August 1994

Administrative Procedure Reform Act of 1994 - Amends Federal law to require a Federal agency head to publish in the Federal Register a notice of intent to engage in major rulemaking which contains a Regulatory Impact Analysis. Requires a final Regulatory Impact Analysis for any final proposal for a major rule. Specifies the contents of such an Analysis, as well as hearing and comment period requirements. Defines major rule as any proposed regulatory action: (1) which affects more than 100 persons; or (2) compliance with which will require the expenditure of over $1 million by any person which is not a Federal agency. Prohibits an agency from adopting a major rule unless its final Regulatory Impact Analysis is approved by the Director of the Office of Management and Budget. Sets forth a standard of clarity for major rules. Directs the Administrator of the Office of Information and Regulatory Affairs to report to the Congress an analysis of the rulemaking procedures of Federal agencies and their impact on the regulated public and regulatory process.

To require the specific identification of intelligence construction projects in annual budget submissions and the authorization by law of such projects.

United States · United States Congress · 11 August 1994

Prohibits any intelligence community construction project in excess of $250,000 from being undertaken in a fiscal year unless such project is specifically: (1) identified as a separate item in the President's annual budget submission to the Congress; and (2) authorized by the Congress.

Veterans Health Care Administrative Flexibility Act of 1994

United States · United States Congress · 9 August 1994

TABLE OF CONTENTS: Title I: Affordable Health Insurance Coverage Subtitle A: Tax Incentives Subtitle B: Premium Assistance Title II: Health Insurance and Delivery Systems Reform Subtitle A: Federal Standards for State Certification Programs Subtitle B: Consolidation of Federal Research Subtitle C: Self-Employed Individual and Small Employer Participation in Federal Employees Health Benefits Plans Subtitle D: Report on Health Care System Title III: Special Assistance for Rural, Frontier and Underserved Urban Areas Subtitle A: Planning, Demonstrations, and Grants Subtitle B: Technical Assistance Grants Subtitle C: Capital Assistance Loans and Loan Guarantees Subtitle D: Increasing Primary Care Providers Subtitle E: Payment Flexibility Subtitle F: Emergency Medical Systems Subtitle G: Studies and Reports Title IV: Long-Term Care Provisions Subtitle A: Long-Term Care Services and Contracts Subtitle B: Tax Treatment of Accelerated Death Benefits Subtitle C: Credit for Personal Assistance Title V: Health Care Providers Subtitle A: Education and Research Subtitle B: Health Care Liability Reform Subtitle C: Health Care Antitrust Improvements Title VI: Administrative Simplification and Privacy Title VII: Enhanced Penalties for Health Care Fraud Subtitle A: All-Payer Fraud and Abuse Control Program Subtitle B: Revisions to Current Sanctions for Fraud and Abuse Subtitle C: Administrative and Miscellaneous Provisions Subtitle D: Amendments to Criminal Law Subtitle E: Amendments to Civil False Claims Act Title VIII: Medicare and Medicaid Subtitle A: Medicare Subtitle B: Medicaid Program Title IX: Department of Veterans Affairs Title I: Affordable Health Insurance Coverage - Subtitle A: Tax Incentives - Amends the Internal Revenue Code to allow a deduction for the qualified health insurance costs of individuals (including self-employed individuals) that provide their own health insurance. (Sec. 111) Allows individuals a tax deduction for contributions made to a medical care savings account established for the benefit of one or more eligible individuals. Limits the amount of such deduction to specified amounts (dependent upon the tax filing category) or the high deductible health plan differential. Allows such deduction whether or not an individual itemizes deductions. (Sec. 112) Excludes employer contributions to medical savings accounts from the gross income of the employee, with a dollar limitation or the high deductible health plan differential. Excludes employer contributions to such accounts from employment taxes. (Sec. 113) Provides for the establishment of medical savings accounts. Sets contribution limitations, including that the individual on whose behalf such contributions are made is covered under a high deductible health plan. Subjects the account beneficiary to taxation as owner of the account. Imposes a penalty for distributions that are not used for qualified medical expenses. Subtitle B: Premium Assistance - Amends title XIX (Medicaid) of the Social Security Act (SSA) to require States with approved Medicaid plans to provide for State programs for furnishing certain low-income families with assistance in regard to certified health plan premiums. Establishes annual limitations on premium assistance spending. Requires the President's budget to include estimates of premium assistance expenditures under Medicare and Medicaid. Title II: Health Insurance and Delivery Systems Reform - Subtitle A: Federal Standards for State Certification Programs - Amends SSA title XIX to require State Medicaid plans to provide for State programs under a new SSA title XXI for certifying insured health plans in the State that meet certain Federal standards and delivery system guidelines developed by the Secretary of Health and Human Services (HHS) incorporating specified requirements pertaining, among other things, to guarantee issue and renewal, preexisting condition exclusions, minimum benefit packages, quality assurance, and access to health care services, as certified health plans. Requires State programs also to provide consumers in the State with comparative value information on the performance of all health plans in each community rating area established in the State. Requires risk adjustment programs. Authorizes appropriations. Requires the Secretary of Labor to develop similar standards and guidelines for Federal certification of self-insured health plans. Provides for: (1) the treatment of certain State laws with regard to health plans; and (2) expanded access to health plans through purchasing cooperatives, the Federal Employee Health Benefits Program in the case of small businesses, and certain multiple employer welfare arrangements maintained by qualified associations; (3) special rules for church, multiemployer, and certain rural cooperative plans; and (4) general employer responsibilities with regard to payroll deductions for certified health plan premiums. Subtitle B: Consolidation of Federal Research - Establishes the Agency for Quality Assurance and Consumer Information within the Department of Health and Human Services. Creates an Administrator for Quality Assurance and Consumer Information to head the Agency. (Sec. 211) Directs the Secretary of Health and Human Services, acting through the Administrator, to consolidate Federal research activities relating to quality and consumer information in health care to enable States to gain access to the results of such research from a central source. Lists current Federal responsibilities to be assumed by the Administrator. Authorizes appropriations. Subtitle C: Self-Employed Individual and Small Employer Participation in Federal Employees Health Benefits Plans - Amends Federal civil service law to require the Office of Personnel Management (OPM) to promulgate regulations applying the Federal Employees Health Benefits Program (FEHBP) to self-employed individuals and businesses employing 50 or fewer employees, allowing required enrollee and Government contributions to be made by the State or small business involved or else be made in full by the self-employed or small business enrollee. (Sec. 221) Extends continued coverage under FEHBP. Requires carriers under FEHBP and the small business health insurance program to submit periodic reports to OPM comparing costs between the programs. (Sec. 222) Prohibits the FEHBP and the program described by this subtitle from being offered exclusively to Members of the Congress and congressional employees. (Sec. 223) Directs the Secretary to study and report to the Congress on nonworker and noncovered employee buy-ins for FEHBP coverage. Subtitle D: Report on Health Care System - Directs the President to report to the Congress on specified aspects of the health care system. Title III: Special Assistance for Rural, Frontier and Underserved Urban Areas - Authorizes States to designate certain rural, frontier, or urban areas as underserved areas based on the lack of access to health plans, quality health providers, and health care facilities. (Sec. 302) Requires the Secretary, upon a State's request, to establish a procedure to certify such areas as underserved areas. Directs the Secretary to give priority in awarding assistance to applicants that serve such areas except with respect to assistance provisions that explicitly direct assistance to areas currently designated as underserved. Subtitle A: Planning, Demonstrations, and Grants - Authorizes the Secretary to conduct a demonstration project and grant program to encourage the development and operation of health networks. Authorizes appropriations. (Sec. 312) Amends title XX (Block Grants to States for Social Services) of the Social Security Act to provide for grants to private entities for developing health networks or health plans to serve underserved areas certified under section 302 of this Act. Authorizes appropriations. (Sec. 313) Amends the Public Health Service Act to establish a program of allotments to States for grants for community-based primary health services to low-income or medically underserved populations. Earmarks funding for such grants. Subtitle B: Technical Assistance Grants - Directs the Secretary to award technical assistance grants to public and private entities for establishing infrastructure for health networks and plans in underserved areas certified under section 302 of this Act. Authorizes appropriations. Subtitle C: Capital Assistance Loans and Loan Guarantees - Directs the Secretary to make loans to health networks, health plans that cover individuals residing in rural, frontier, or urban underserved areas, or health care providers that serve such areas for the capital costs of developing health delivery systems and expanding existing health delivery sites to make health care services available in underserved areas certified under section 302. Subtitle D: Increasing Primary Care Providers - Amends the Internal Revenue Code to: (1) allow a nonrefundable credit for certain primary health services providers for mandatory service periods in health professional shortage areas; and (2) increase the dollar limitation allowed for expensing medical equipment used in such areas. (Sec. 343) Mandates grants to federally qualified health centers (FQHCs) and other entities for providing access to services for medically underserved populations or in high impact areas not currently being served by a FQHC. Authorizes appropriations. (Sec. 345) Authorizes the Secretary to award grants to States for primary health care and social service programs targeted to pregnant women and infants. Authorizes appropriations. (Sec. 346) Amends the Elementary and Secondary Education Act of 1965 to revise provisions regarding the improvement of school health education. Requires the Secretary of Education to award grants to States for local programs of health education and prevention, early health intervention, and health education in pre-schools and elementary schools and to carry out other related activities. Authorizes appropriations. (Sec. 347) Authorizes frontier States (including Alaska, Wyoming, and Montana) to implement proposals to: (1) offer preventive services, including mobile preventive health centers; and (2) participate in demonstration projects to improve recruitment, retention, and training of rural providers. (Sec. 348) Authorizes specified amounts of appropriations for the National Health Service Corps Scholarship Program through FY 2000. (Currently, such sums as necessary are authorized to be appropriated.) Extends the authorization of appropriations for area health education centers through FY 2000. (Sec. 349) Directs the Secretary of Health and Human Services to establish the Interagency Task Force on Rural Telemedicine. (Sec. 350) Requires the Secretary, acting through the Office of Rural Health, to award grants to eligible entities to promote the use of telemedicine to strengthen health care in rural areas. Authorizes appropriations. Subtitle E: Payment Flexibility - Amends SSA title XVIII (Medicare) to: (1) make various specified changes in essential access community hospital (EACH) program provisions, including changes allowing an unlimited number of States to participate in the program, and eliminating grant tie-in requirements for EACH or rural primary care hospital designation. Extends the deadline for development of a prospective payment system (PPS) for inpatient rural primary care hospital services. Provides for the implementation of a PPS for outpatient rural primary care hospital services. Revises the physician staffing requirements for rural primary care hospitals. Authorizes increased appropriations for the EACH program. (Sec. 352) Amends Medicare part A to provide for medical assistance facility and emergency access care hospital demonstration projects for improving access to health care in rural areas. Authorizes appropriations. (Sec. 353) Makes various specified changes with regard to Medicare-dependent, small rural hospitals. (Sec. 354) Provides for expanded coverage for physician assistants and nurse practitioners. Subtitle F: Emergency Medical Systems - Amends the Public Health Service Act to prove for grants to States for systems to transport rural victims of medical emergencies by air. Authorizes appropriations. Subtitle G: Studies and Reports - Amends SSA title VII (Administration) to: (1) provide for the appointment of an Assistant Secretary for Rural Health in the Office of Rural Health Policy; and (2) make administrative changes respecting the Office and duties of the new assistant secretary. (Sec. 372) Requires: (1) the Prospective Parent Assessment Commission to study and report to the Congress on the need for legislation or regulations to ensure that vulnerable populations have adequate access to health plans and health care providers and services; and (2) the Secretary of HHS to study and report to the Congress on expanding the benefits under health plans for individuals residing in rural areas. Title IV: Long-Term Care Provisions - Subtitle A: Long-Term Care Services and Contracts - Amends the Internal Revenue Code to treat qualified long-term care services as medical care for purposes of the medical expense deduction. (Sec. 402) Provides for the treatment long-term care insurance as accident or health insurance. Excludes qualified long-term care insurance contracts from cafeteria plans. (Sec. 406) Sets forth consumer protection provisions to be satisfied by qualified long-term care insurance contracts, including the model regulation and model Act promulgated by the National Association of Insurance Commissioners (NAIC). (Sec. 407) Imposes an excise tax on insurers who fail to meet requirements for long-term care insurance policies. (Sec. 409) Requires NAIC to promulgate standards for the use of uniform language and definitions in such policies, with certain variations permitted. Subtitle B: Tax Treatment of Accelerated Death Benefits - Provides for the exclusion as a death benefit of any amount received under a life insurance contract because such individual is terminally ill. Allows insurance companies to issue accelerated death benefit riders on life insurance contracts. Subtitle C: Credit for Personal Assistance - Allows a tax credit for the cost of personal assistance services required by certain individuals. Describes such individuals as those who, by reason of a medically determinable physical impairment which can be expected to last for a continuous period of not less than 12 months, are unable to engage in any substantial gainful employment activity without personal assistance services appropriate to carry out activities of daily living. Limits the amount of such credit and provides a cost-of- living adjustment. Title V: Health Care Providers - Subtitle A: Education and Research - Amends SSA title XVIII to: (1) require the Director of the Office of Technology Assessment to provide for the appointment of an Advisory Commission on Workforce to develop recommendations and assessments with regard to national health care workforce policy and payment for a report to the Congress. Authorizes appropriations. (Sec. 502) Requires the Secretary of HHS to provide for a consortium demonstration program for testing and evaluating mechanisms for increasing the number of medical students entering primary care practice through the use of funds available for direct graduate medical education (GME) costs. Authorizes appropriations. (Sec. 503) Requires that residency training time spent in nonhospital-owned facilities be counted in determining full-time- equivalent residents for direct and indirect GME payments. (Sec. 504) Amends the Internal Revenue Code to create in the Treasury the National Fund for Medical Research consisting of designated overpayments and cash contributions for use by the National Institutes for Health (NIH) for medical research and construction and acquisition of equipment and facilities for NIH, and for health information communications under the Public Health Service Act. Subtitle B: Health Care Liability Reform - Amends SSA title XI part A to provide for various specified changes with regard to civil actions in State or Federal court for damages arising out of alleged injuries caused by health care providers or payors, including among such changes: (1) limitations on noneconomic damages, attorney contingency fees, and action time frames; (2) requirements for pleading of punitive damages, periodic damage payments, and risk management programs for health care providers; and (3) providing for State health care quality assurance programs funded out of a portion of all punitive damages awarded in the State. Subtitle C: Health Care Antitrust Improvements - Exempts from all antitrust claims an activity relating to the provision of health care services that is: (1) within a "safe harbor" designated by the Attorney General, except for claims for injunctive relief asserted by the Attorney General or the Chair of the Federal Trade Commission in extraordinary circumstances; and (2) specified in and in compliance with the terms of a certificate of review issued by the Attorney General, where the activity occurs while the certificate is in effect, except for claims for injunctive relief. Sets forth provisions regarding the award of attorney fees and costs of suit to the prevailing party in an action based on a claim involving an activity found to be exempt. (Sec. 522) Directs the Attorney General to develop and designate specified safe harbors relating to the following, as well as to such other categories of activities as the Attorney General may designate (subject to specified requirements): (1) joint purchasing of health care services; (2) small hospital mergers; (3) startup and operation of collaborations between State-licensed providers through partial or full integration; (4) standard-setting and enforcement activities by medical self-regulatory entities; (5) health care providers collectively supplying non-price medical information to buyers and consumers; (6) health care provider participation in surveys; (7) health care joint venture's purchase or use of new or existing high technology or costly equipment or the provision of advanced tertiary care services; (8) provision of market power screens at appropriate levels below which combinations of providers are too small to pose a realistic antitrust threat; (9) joint purchasing arrangements; and (10) good faith negotiations relating to legitimate collaborative activities. Directs the Attorney General to publish a notice in the Federal Register soliciting proposals for additional safe harbors. Authorizes the Attorney General to modify or remove a safe harbor following notice and comment upon a determination that the safe harbor does not meet specified required criteria. Sets forth criteria to be considered 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. 523) 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 procedures regarding applications for, revocation of, and review of determinations regarding such certificates. Limits the disclosure of information. (Sec. 524) Sets forth provisions regarding notifications providing for a reduction in certain penalties under the antitrust laws for health care cooperative ventures. (Sec. 525) Directs the Attorney General to: (1) periodically review the safe harbors, certificates of review, and notifications; and (2) publish, and periodically update, specified guidelines intended to promote greater certainty regarding the application of the antitrust laws to activities in the health care market. Title VI: Administrative Simplification and Privacy - Amends SSA title XI to provide for administrative simplification in the health care system including Medicare and Medicaid, by directing the Secretary of HHS to adopt specified standards for: (1) data elements and information transactions to electronic transmission of certain health information; (2) locating and accessing for authorized purposes health information available through the health information network developed through requirements under this title for electronic transmission of such information; and (3) certifying such information networks. Provides penalties for failure to comply with such standards and requirements. Authorizes appropriations. Establishes a Health Care Information Advisory Committee to advise the Secretary of HHS and the Congress on the status of the network. Authorizes appropriations. Directs the Secretary to make grants for electronically integrated demonstration projects for community-based clinical information systems and computerized patient medical records. (Sec. 601) Makes amendments with regard to the Medicare and Medicaid Coverage Data Bank and related identification processes. (Sec. 602) Provides for the establishment of a mechanism for protecting the privacy of individuals with respect to individually identifiable health care information that is created or maintained as part of health treatment, enrollment, payment, testing, or research processes. Establishes civil and criminal penalties for violations of such privacy protections. Authorizes appropriations. Title VII: Enhanced Penalties for Health Care Fraud - Subtitle A: All-Payer Fraud and Abuse Control Program - Directs the Secretary of HHS to establish a program to: (1) coordinate Federal, State, and local law enforcement programs to control fraud and abuse with respect to the delivery of and payment for health care; and (2) perform other specified tasks applicable to controlling health care fraud and abuse. (Sec. 701) Creates in the Treasury the Anti-Fraud and Abuse Trust Fund for use in conjunction with such program. (Sec. 702) Amends SSA title XI to provide for the application of Federal health anti-fraud and abuse sanctions to all fraud and abuse against any health care plan. (Sec. 703) Directs the Secretary of HHS to publish notice in the Federal Register soliciting proposals for certain: (1) safe harbor activities related to payment for health care services; and (2) interpretive rulings and special alerts concerning health care fraud and abuse. (Sec. 704) Directs the Secretary to establish a program through which individuals entitled to Medicare benefits may report to the Secretary on a confidential basis instances of suspected Medicare fraud by program providers. Subtitle B: Revisions to Current Sanctions for Fraud and Abuse - Amends SSA title XI to revise current sanctions for fraud and abuse involving Medicare and State health care programs, providing for: (1) program exclusion for individuals convicted of a felony relating to fraud or the unlawful manufacture or dispensing or a controlled substance; (2) new offenses under civil monetary penalty provisions, such as the offering of inducements to program-eligible individuals and the misuse of health security cards or unique health identifiers; (3) establishment of a minimum period of exclusion for practitioners and persons who fail to meet statutory obligations; (4) intermediate sanctions on eligible HMOs for program violations; and (5) procedures for imposing such sanctions. Subtitle C: Administrative and Miscellaneous Provisions - Directs the Secretary to establish a national health care fraud and abuse data collection program for the reporting by government health care providers, suppliers, and practitioners. Requires program information to be made available to Federal and State governments, subject to a possible fee. Subtitle D: Amendments to Criminal Law - Amends the Federal criminal code to set penalties for knowingly executing a scheme or artifice to: (1) defraud any health care plan in connection with the delivery of, or payment for, health care benefits, items, or services; or (2) obtain, by means of false or fraudulent pretenses, representations, or promises, money or property owned by, or under the custody or control of, any health care plan or person in connection with delivery of or payment for health care benefits. (Sec. 731) Requires the Secretary of the Treasury to deposit into the Anti-Fraud and Abuse Trust Fund an amount equal to criminal fines imposed. (Sec. 732) Makes other specified criminal law changes with regard to forfeitures and injunctive relief with respect to Federal health care offenses and provides for similar deposits into the Anti-Fraud and Abuse Trust Fund. Subtitle E: Amendments to Civil False Claims Act - Makes provisions of the Civil False Claims Act applicable to the use of false records or statements made to a health care plan. Includes within the definition of "claim" for purposes of such Act, a request or demand for money or property which is made or presented to a health care plan. Provides for deposits into the Anti-Fraud and Abuse Trust Fund of amounts equal to penalties and damages imposed under the Civil False Claims Act. Title VIII: Medicare and Medicaid - Subtitle A: Medicare - Directs the Secretary to study and report to the Congress on allowing payment under Medicare for certain Medicare beneficiaries enrolled in either private or other Federal health care plans. (Sec. 802) Revises Medicare provisions on payments to HMOs and competitive medical plans. Directs the Secretary of HHS to establish certain demonstration projects in designated areas for paying such organizations on the basis of a special payment methodology. Amends the Omnibus Budget Reconciliation Act of 1987 to provide for an extension of social health maintenance organizations. (Sec. 803) Amends: (1) the Omnibus Budget Reconciliation Act of 1990 (OMBRA '90) to permit Medicare supplemental policies to be offered in all States; and (2) SSA title XVIII to make technical corrections to provisions on Medicare supplemental policies. (Sec. 811) Makes specified changes with regard to Medicare part A (Hospital Insurance) provisions with regard to: (1) inpatient hospital services updates for PPS hospitals; (2) payment reductions for capital-related costs for inpatient hospital services; (3) payment adjustments for disproportionate share hospitals in participating States; (4) moratoriums on new long-term hospitals; (5) adjustment reductions for indirect medical education; and (6) routine service cost limit reductions for skilled nursing facilities. (Sec. 821) Makes specified changes with regard to Medicare part B (Supplementary Medical Insurance) provisions with regard to: (1) physicians' services updates and payments; (2) establishment of hospital outpatient PPS for hospital outpatient departments; and (3) general Medicare part B premiums. (Sec. 831) Makes specified changes with regard to Medicare parts A and B provisions with regard to: (1) Medicare as secondary payer; and (2) routine cost limit reductions for home health services. Subtitle B: Medicaid Program - Provides for coordination of the Medicaid program with the new health care system established under this Act through such changes as: (1) establishing a cap on payments for certain acute medical services furnished under Medicaid; (2) providing for the integration of certain Medicaid eligibles into the new system; (3) providing for State programs for supplemental benefits; and (4) providing for optional coverage under certified health plans of SSI-eligible individuals. (Sec. 861) Amends SSA title XIX to modify Federal requirements to allow State flexibility in contracting for coordinated care services under Medicaid. (Sec. 871) Amends: (1) Medicaid long-term care provisions, permitting certain demonstration projects and relief from third party liability requirements when cost-effective, among other changes; and (2) the Omnibus Budget Reconciliation Act of 1986 with regard to frail elderly demonstration projects. (Sec. 878) Modifies Medicaid provisions on case management services and home and community-based waivers. (Sec. 881) Makes specified changes in provisions concerning: (1) disproportionate share hospital (DSH) payment adjustments; (2) the Federal medical assistance percentage for certain States; and (3) criteria for determining the amount of disallowances. (Sec. 882) Directs the Secretary to submit recommendations to the Congress on a phased-in elimination of Medicaid DSH payment adjustments. (Sec. 885) Makes technical corrections relating to OMBRA '90 provisions on physicians' services. Title IX: Department of Veterans Affairs - Veterans Health Care Administrative Flexibility Act of 1994 - Expresses as the intent of the Congress that Department of Veterans Affairs health care facilities participate as health care providers recognized under health care reform legislation enacted by the States. Directs the Secretary of Veterans Affairs to provide health care services in a State enacting such reform legislation. Prohibits any State from denying Department participation as a health care provider under such legislation unless the State's chief executive officer certifies that: (1) the benefits to be provided by the Department do not meet the State quality benefits standard; or (2) the location of Department facilities does not meet State proximity requirements. Authorizes the Secretary, in order to facilitate the provision of Department health care services in a manner that is responsive to local market and regulatory conditions, to designate Department health care facilities which shall be exempt from specified Federal regulatory provisions. Allows exempted Department facilities to enter into contracts and agreements for the provision of health care and related services under a State health care reform plan. Exempts such contracts and agreements for less than $250,000 from prior review by the Department's Central Office. Provides for review of contracts or agreements of such amount or greater. Authorizes the Secretary to utilize Department personnel to provide necessary health care services under this title. Provides funding by establishing in the Treasury a Department of Veterans Affairs Health Care Reform Fund, into which shall be deposited certain funds collected by the Secretary from third party payers to defray the costs of providing health care services to veterans. Requires a separate account to be maintained in the Fund for each exempted Department health care facility. Allows exempted Department facilities to expend funds to cover marketing, advertising, legal, acquisition, construction, repair, and renovation costs.

Providing for consideration of the bill (H.R. 4906) to amend the Congressional Budget and Impoundment Control Act of 1974 to limit consideration of nonemergency matters in emergency legislation.

United States · United States Congress · 9 August 1994

Sets forth the rule for the consideration of H.R. 4906 (consideration of nonemergency matters in emergency spending legislation).

Providing for consideration of the bill (H.R. 4907) to reform the concept of baseline budgeting.

United States · United States Congress · 9 August 1994

Sets forth the rule for the consideration of H.R. 4907 (Federal budget process).

To reduce the discretionary spending limits to reflect spending cuts approved by the House of Representatives.

United States · United States Congress · 8 August 1994

Reduces discretionary spending limits for new budget authority for FY 1995. Reduces adjusted discretionary spending limits for outlays for FY 1995 through 1998. Sets forth programmatic assumptions for such reductions.

Taxpayers' Right to Know Resolution

United States · United States Congress · 8 August 1994

Taxpayer's Right to Know Resolution - Amends rule XV of the Rules of the House of Representatives to make it out of order in the House or in the Committee of the Whole to pass or adopt except by a rollcall vote, a quorum being present, and the yeas and nays being considered as ordered any bill, joint resolution, or conference report: (1) making or continuing an appropriation; (2) increasing the statutory limit on the public debt; (3) amending the Congressional Budget and Impoundment Control Act of 1974 or the Balanced Budget and Emergency Deficit Control Act of 1985 or changing the congressional budget process; (4) providing revenue; (5) establishing, extending, or raising any user fee; or (6) authorizing the enactment of new budget authority. Makes it out of order in any committee to report such legislation except by a rollcall vote, approved by a majority of the members voting, a quorum being present.

Emergency Spending Control Act of 1994

United States · United States Congress · 5 August 1994

Emergency Spending Control Act of 1994 - Amends the Congressional Budget Act of 1974 to restrict the inclusion of nonemergency spending proposals in emergency spending legislation.

Baseline Reform Act of 1994

United States · United States Congress · 5 August 1994

Baseline Reform Act of 1994 - Amends the Balanced Budget and Emergency Deficit Control Act of 1985 (Gramm-Rudman-Hollings Act) to declare that the estimated budget outlays submitted to the Congress by the President each year shall not include an inflation adjustment for programs and activities subject to discretionary appropriations. Requires the President's budget to include: (1) estimated expenditures and appropriations for the current year; and (2) a certain comparison of levels of estimated expenditures and proposed appropriations that includes the proposed increase or decrease in spending in percentage terms. Amends the Congressional Budget Act of 1974 to make conforming changes to the development of the concurrent resolution on the budget. Declares that: (1) the starting point for any deliberations in the Committee on the Budget of each House on the budget resolution for the next fiscal year shall be the estimated level of outlays for the current year in each function and subfunction; and (2) any increases or decreases in the congressional budget for the next fiscal year shall be from such estimated levels. Requires the Congressional Budget Office (CBO) to include in reports to budget committees certain current year comparisons and a table on sources of spending growth under current law in total mandatory spending for the budget year and the ensuing four fiscal years. Requires the CBO to include in cost estimates of pending legislation a comparison of prior year spending levels to current year levels. Requires the Comptroller General to report annually to the Congress all programs and activities with permanent appropriations or that fall within a specified definition of spending authority.

Emergency Spending Control Act of 1994

United States · United States Congress · 5 August 1994

Emergency Spending Control Act of 1994 - Amends the Balanced Budget and Emergency Deficit Control Act of 1985 (Gramm-Rudman-Hollings Act) to limit emergency appropriations and legislation to the matter of emergency. Allows such a statute to contain other offsetting provisions that reduce spending or non-emergency appropriations for the designated emergency. Makes it out of order in the House of Representatives or the Senate to consider any bill or joint resolution containing an emergency designation, if the legislation provides an appropriation for any other item or matter.

Baseline Reform Act of 1994

United States · United States Congress · 5 August 1994

Full Budget Disclosure Act of 1994 - Amends the Balanced Budget and Emergency Deficit Control Act of 1985 (Gramm-Rudman-Hollings Act) to create: (1) a current policy baseline for projecting current-year spending; and (2) a current funding baseline for projecting spending without any inflation adjustment except for expiring housing contracts. Requires the President's budget to include: (1) estimated expenditures and appropriations for the current year; (2) a certain comparison of levels of estimated expenditures and proposed appropriations that includes the proposed increase or decrease in spending in percentage terms. Amends the Congressional Budget Act of 1974 to make conforming changes to the development of the concurrent resolution on the budget. Requires the Congressional Budget Office (CBO) to include in reports to budget committees certain current year comparisons and a table on sources of spending growth under current law in total mandatory spending for the budget year and the ensuing four fiscal years. Requires the CBO to include in the annual report to the Congress all direct spending programs. Requires the CBO to include in cost estimates of pending legislation a comparison of prior year spending levels to current year levels.

Health Security Act

United States · United States Congress · 3 August 1994

TABLE OF CONTENTS: Title I: Improved Access to Standardized and Affordable Health Plans Subtitle A: Rules and Definitions of General Applicability Subtitle B: Health Plan Standards Subtitle C: Benefits and Cost-Sharing Subtitle D: Access to Health Plans Subtitle E: Federal Responsibilities Subtitle F: Participating State Responsibilities Subtitle G: Miscellaneous Provisions Title II: New Benefits Subtitle A: Coverage of Outpatient Prescription Drugs in Medicare Subtitle B: Home and Community-Based Services Subtitle C: Long-Term Care Insurance Improvement and Accountability Subtitle D: Life Care Subtitle E: Study and Report Title III: Health Professions Workforce Subtitle A: Workforce Priorities Under Federal Payments Subtitle B: Academic Health Centers Subtitle C: Health Research Initiatives Subtitle D: Core Functions of Public Health Programs; National Initiatives Regarding Preventive Health Subtitle E: Health Services for Medically Underserved Populations Subtitle F: Mental Health; Substance Abuse Subtitle G: Comprehensive School Health Education; School-Related Health Services Subtitle H: Public Health Service Initiative Subtitle I: Additional Provisions Regarding Public Health Subtitle J: Occupational Safety and Health Subtitle K: Full Funding for WIC Subtitle L: Border Health Improvement Title IV: Medicare and Medicaid Subtitle A: Medicare Subtitle B: Medicaid Program Title V: Quality and Consumer Protection Subtitle A: Quality Management and Improvement Subtitle B: Administrative Simplification Subtitle C: Privacy of Health Information Subtitle D: Expanded Efforts to Combat Health Care Fraud and Abuse Affecting Federal Outlay Programs Subtitle E: Medical Liability Reform Subtitle F: Remedies and Enforcement Subtitle G: Repeal of Exemption Title VI: Individual and Employer Subsidies Subtitle A: Individual Premium and Cost-Sharing Assistance Subtitle B: Employer Subsidies Title VII: Revenue Provisions Subtitle A: Financing Provisions Subtitle B: Tax Treatment of Employer-Provided Health Care Subtitle C: Exempt Health Care Organizations Subtitle D: Tax Treatment of Long-Term Care Insurance and Services Subtitle E: Other Revenue Provisions Subtitle F: Graduate Medical Education and Academic Health Centers Trust Fund Title VIII: Other Federal Programs Subtitle A: Indian Health Services Title IX: Workers Compensation Medical Services Title X: Premium Financing Subtitle A: National Health Care Cost and Coverage Commission Subtitle B: Employer and Individual Premium Requirements and Assistance Title XI: Ensuring Health Care Reform Financing Health Security Act - Title I: Improved Access to Standardized and Affordable Health Plans: Subtitle A: Rules and Definitions of General Applicability - Directs each participating State to require that each health plan or long-term care policy issued, sold, offered for sale, or operated in the State shall be certified by the appropriate certifying authority as one of the following: (1) a certified standard health plan; (2) a certified supplemental health benefits plan; or (3) a certified long-term care policy. Applies the following principles to all standard health plans: (1) no standard health plan may discriminate on the basis of medical history, health status, preexisting medical conditions, or genetic predisposition to medical conditions; (2) a standard plan shall offer an annual open enrollment period and accept all eligible individuals for coverage, shall not impose a rider that serves to exclude coverage to an individual, and shall not impose waiting periods before coverage begins; (3) a standard health plan shall ensure that all medically necessary or appropriate services, as defined in the benefits package, are provided; and (4) health benefits coverage shall be portable from one standard health plan to another. (Sec. 1003) States that nothing in this Act shall be construed as prohibiting the following: (1) an individual from purchasing any health care services; (2) an individual from purchasing supplemental insurance to cover health care services not included within the standard benefits package; (3) an individual who is not an eligible individual from purchasing health insurance; (4) employers from providing coverage for benefits in addition to such standard benefits package; or (5) an individual from obtaining health care from any health care provider of such individual's choice. Subtitle B: Health Plan Standards - Sets forth the following standards which a standard health plan must meet: (1) insurance market reform standards; (2) delivery system reform standards; (3) standards for participation in a guaranty fund; (4) standards for the collection and reporting of data; and (5) standards for effective grievance procedures for enrollees. (Sec. 1111) Requires a standard health plan sponsor to: (1) when offering a community-rated standard health plan, offer such plan to any community-rated individual applying for coverage; and (2) when offering an experience-rated standard health plan, offer such plan to any experience-rated indivudal eligible for coverage under the plan through such individuals' experience-rated employer. Defines: (1) a standard health plan as one providing the standard benefits package under subtitle C; (2) a community-rated plan as a plan provided to community-rated individuals; (3) a community-rated individual as one who not an experience-rated individual; (4) an experience-rated plan as a health plan which is a self-insured plan of an experience-rated employer or is an insured health plan which is experience-rated, but which covers only experience-rated individuals; (5) an experience-rated employer as an employer employing more than 500 employees or a multiemployer plan that covers 500 or more employees; and (6) an experience-rated individual as one who is an employee of an experience-rated employer. Requires a community-rated standard health plan to be made available to community-rated individuals throughout the entire community-rating area. Requires a State to be divided into one or more community rating areas in which there must be a minimum of 250,000 individuals residing. Prohibits a metropolitan statistical area in a State from being incorporated into more than one community rating area. Permits a standard health plan sponsor to refuse to renew an individual's plan only for: (1) fraud or materials misrepresentation on the individuals' part; or (2) nonpayment of premiums. (Sec. 1112) Sets forth enrollment process requirements, including the requirement of an annual open enrollment period. (Sec. 1113) Includes in the definition of children, for purposes of coverage, a child who is under 25 years of age or disabled and who is unmarried. (Sec. 1114) Prohibits discrimination based on health status including medical condition, lack of evidence of insurability, or anticipated need for health care services. Prohibits imposing a waiting period before coverage begins. Permits a standard health plan to impose a limitation or exclusion of benefits relating to treatment of a condition based on a preexisting condition if: (1) the condition was diagnosed or treated during the three-month period ending on the day before the date of enrollment; (2) the limitation or exclusion extends for not more than six months; (3) the limitation or exclusion does not apply to an individual who, as of the date of birth, was covered under the plan; or (4) the limitation or exclusion does not relate to pregnancy. (Sec. 1116) Requires a plan to have uniform premiums within a community rating area. (Sec. 1117) Requires each standard health plan to participate in a standard health plan risk adjustment program and a reinsurance program. (Sec. 1118) Sets forth financial solvency requirements. (Sec. 1121) Sets forth provisions concerning: (1) antidiscrimination requirements; (2) quality assurance standards; (3) the consumer grievance process; (4) the issuance of a health security card to each individual enrolled in each standard health plan; (5) information and marketing standards; (6) patient's rights to self-determination in health care; and (7) contracts with purchasing cooperatives. (Sec. 1128) Requires each standard health plan to ensure that all health care providers reimbursed by the plan are authorized under State law to provide applicable services. Requires a plan to ensure that all nonnetwork items and services covered are reasonably available and accessible. Requires covered services to be available to all enrollees throughout the service plan area with reasonable promptness. Requires each plan to establish a program under which participating physicians shall agree to accept the plan's payment schedule as payment in full. States that nothing in this Act shall be construed to: (1) force an individual to receive health care solely through the individual's standard plan; or (2) prohibit any individual from privately contracting with any health care provider and paying for such treatment as agreed to between the individual and the provider. (Sec. 1141) States that nothing in this Act shall be construed as to prevent a standard health plan sponsor from offering and pricing supplemental health benefits plans pursuant to a State certification plan. Applies the same standards to supplemental plans as are applicable to the standard plan concerning issue, availability, enrollment, nondiscrimination, and rating limitation. Sets forth provisions concerning marketing abuses and requirements for cost-sharing plans. Subtitle C: Benefits and Cost-Sharing - Defines a standard benefits package as a benefit package that: (1) provides all the items and services under the categories of health care items and services described in section 1202; (2) provides for at least one of the three cost-sharing schedules established under section 1213 by the National Health Benefits Board; and (3) has an actuarial value that is equivalent to the actuarial value of the benefits package provided by the Blue Cross/Blue Shield Standard Option under the Federal Employees Health Benefits Program as in effect during 1994. Defines an alternative standard benefits package as a benefits package that: (1) provides all the items and services under the categories of health care items and services described in section 1202; (2) provides for the very high deductible cost-sharing schedule established under 1213 by the Board; and (3) has an actuarial value that is less than the actuarial value of the benefits package provided by the Blue Cross/Blue Shield Standard Option as in effect during 1994. (Sec. 1202) Lists the following items and services as categories of medical care to be furnished to health plan enrollees when medically necessary or appropriate: (1) hospital services, including inpatient hospital services, outpatient hospital services, and 24-hour a day hospital emergency services; (2) health professional services, including consultations that are provided in a home, office, or other ambulatory care setting, or an institutional setting and services and supplies furnished as incident to such health professional services; (3) 24-hour a day emergency services and ambulatory medical or surgical services; (4) clinical preventive services, including services for high risk populations, age-appropriate immunizations, tests, and clinician visits furnished consistent with any periodicity schedule specified by the Board; (5) mental illness and substance abuse services, including inpatient, outpatient, residential non-hospital, and intensive non-residential services, for the treatment of mental illness and substance abuse disorders; (6) voluntary comprehensive family planning services, including counseling and education, contraceptive drugs and devices, and services for pregnant women; (7) items and services provided for end of life care (hospice care); (8) home health care and home infusion drug therapy services provided as an alternative to inpatient hospital treatment, treatment in a skilled nursing facility, or treatment in a rehabilitation facility; (9) extended care services described in title XVIII (Medicare) of the Social Security Act, when provided to an inpatient of a skilled nursing facility or a rehabilitation facility and when provided as an alternative to receiving inpatient hospital services; (10) ambulance services; (11) laboratory, radiology, and diagnostic services provided upon prescription to individuals who are not inpatients of a hospital, hospice, skilled nursing facility, or rehabilitation facility; (12) outpatient prescription drugs, blood clotting factors, drugs used for home infusion therapy, biologicals, and accessories and supplies used directly with the above items; (13) outpatient occupational therapy, physical therapy, respiratory therapy, speech-language pathology services, and outpatient audiology services when used to restore or maintain functional capacity or prevent or minimize limitations on physical and cognitive functions as a result of an illness or other health condition, including attaining new functional abilities at an age-appropriate rate; (14) durable medical equipment, prosthetic devices, orthotics and prosthetics, and accessories and supplies used directly with the above equipment or devices; (15) routine eye examinations, diagnosis, and treatment for defects in vision furnished to individuals who are under 22 years of age, including eyeglasses and contact lenses furnished according to a periodicity schedule established by the Board; (16) to individuals under 22 years of age, emergency dental treatment, prevention and diagnosis of dental disease, treatment of dental disease, space maintenance procedures to prevent orthodontic complications, and interceptive orthodontic treatment to prevent severe malocclusion; (17) for individuals who are over 22 years of age, emergency dental treatment, as specified by the Board; (18) routine ear examinations and diagnosis for defects in hearing as part of a physician visit and hearing aids when recommended by a physician or audiologist; and (19) items and services required to provide patient care pursuant to the design of a qualified investigation treatment. (Sec. 1211) Establishes a National Health Benefits Board to: (1) promulgate regulations or establish guidelines as may be necessary to clarify and refine items and services under the categories of health care items and services described in section 1202; (2) establish and update periodicity schedules for the items and services in the categories of health care items and services described in section 1202; and (3) design mental illness substance and abuse services so as to achieve parity with services for other medical conditions. Authorizes the Board to establish: (1) criteria for determinations of medical necessity or appropriateness; (2) procedures for determinations of medical necessity or appropriateness; and (3) regulations or guidelines to be used in determining whether an item or service is medically necessary. Requires the Board to establish cost-sharing schedules to be provided by health plans providing a standard benefits package or an alternative standard benefits package. Authorizes the Board to develop legislative proposals for modifications to the actuarial equivalence provisions of section 1201 and the categories of items and services under section 1202. Authorizes appropriations to the Bord. (Sec. 1217) Sets forth procedures for the congressional consideration of Board proposals. Subtitle D: Access to Health Plans - Requires each employer to make available to each employee the opportunity: (1) in the case of an experience-rated employer, to enroll through the employer in one of at least three certified experience-rated standard health plans; or (2) in the case of a community-rated employer, to enroll in any community-rated plan offered through a purchasing cooperative operating in the community rating area of the employer and, at the employer's option, to enroll in one of at least three community-rated standard health plans. (Sec. 1321) Directs a State, in accordance with specified provisions, to certify health insurance purchasing cooperatives. Requires that each cooperative be chartered under State law and operated as a not-for-profit corporation. Permits a State to establish or sponsor a purchasing cooperative to serve a community rating area. Requires each purchasing cooperative to: (1) negotiate (regarding premiums and marketing fees) with and enter into agreements with standard health plans; (2) enter into agreements with community-rated employers; (3) enroll community-rated employees and community-rated individuals in standard health plans; (4) collect premiums and make payments to standard health plans on behalf of community-rated employers and community-rated individuals; (5) provide for coordination with other purchasing cooperatives; (6) provide comparative information to the public and the participating State on standard health plans offered through the purchasing opperative; (7) have the capability of accepting data from standard health plans; (8) comply with such fiduciary responsibility, financial management, and administrative requirements as the Secretary may establish; and (9) carry out other functions provided for under this title. Prohibits a cooperative from: (1) performing any activity (including review, approval, or enforcement) relating to payment rates for providers; (2) performing any activity (including certification or enforcement) relating to compliance of standard health plans with the requirements of this Act; (3) assuming insurance risk; or (4) performing other activities identified by the State as being inconsistent with the performance of its duties under this Act. (Sec. 1322) Requires a purchasing cooperative to offer all community-rated individuals and community-rated employees residing within the community rating area served by the cooperative the opportunity to enroll in any standard health plan that has entered into an agreement with the cooperative. (Sec. 1324) Directs a purchasing cooperative to charge members a uniform membership fee to cover costs. (Sec. 1331) Requires a purchasing cooperative for a community rating area to offer to enter into an agreement with each community-rated employer that employs individuals in the community rating area and that desires to join the cooperative. (Sec. 1341) Sets forth requirements applicable to the Federal Employees Health Benefits Program. (Sec. 1351) Sets forth rules relating to multiple employer welfare arrangements. Subtitle E: Federal Responsibilities - Directs the Secretary of Health and Human Services to implement all provisions of this Act, subject to stated exceptions, and report annually to the President and the Congress concerning the health care system of this Act. Authorizes appropriations. (Sec. 1411) Requires the Secretary to approve a State health care system for which a plan has been submitted, unless it does not meet applicable requirements. (Sec. 1412) Provides sanctions for participating States not in compliance, including Federal assumption of responsibilities. (Sec. 1422) Provides for Federal assumption of responsibilities in non-participating States. (Sec. 1431) Directs the Secretary to establish premium class and age class factors. (Sec. 1435) Directs the Secretary to develop a risk adjustment and reinsurance methodology. (Sec. 1441) Directs the Secretary to establish minimum capital requirements for workers, as well as additional capital requirements to reflect factors likely to affect the financial stability of a carriers. (Sec. 1461) Directs the Secretary to certify as an essential community provider any health care provider meeting the standards for certification or that is within any of the following categories of providers: (1) covered entities as defined under the Public Health Service Act, school health centers, public or nonprofit hospitals, public and private nonprofit mental health and substance abuse providers, runaway homeless youth centers or transitional living programs for homeless youth, public or nonprofit maternal and child health providers, rural health clinics, and programs of the Indian Health Service shall all be considered category one entities; and (2) Medicare dependent small rural hospitals and children's hospitals shall both be considered category two entities. (Sec. 1463) Directs the Secretary to publish standards for the certification of additional categories of health care providers and organizations as essential community providers. (Sec. 1466) Provides that for essential community providers electing to apply to a health plan, the plan shall either: (1) enter into a provider participation agreement; or (2) enter into an agreement under which the plan makes payments to the provider. (Sec. 1467) Requires the Secretary, within five years of enactment, to submit to the Congress specific recommendations, based on studies, concerning whether, and to what extent, sec. 1466 provisions should continue to apply to some or all essential community providers. Requires the recommendations to be implemented unless a congressional joint resolution disapproving such recommendations is enacted. (Sec. 1481) Sets forth the responsibilities of the Secretary of Labor. (Sec. 1491) Provides that the Office of Rural Health Policy shall be headed by an Assistant Secretary, instead of a Director. Subtitle F: Participating State Responsibilities - Sets forth provisions concerning approval of State plans and certification of standard health plans and supplemental health benefits plans. Requires the Secretary to establish a program for the accreditation, certification, and enforcement (the ACE program) of health plan standards by States. (Sec. 1502) Requires each participating State to be divided into one or more community rating areas. (Sec. 1503) Provides for: (1) open enrollment periods; (2) a risk adjustment program; (3) guaranty funds; and (4) public access sites. (Sec. 1511) Prohibits, as a general rule, any State law from applying to any services provided under a health plan that is not a fee-for-service plan. (Sec. 1512) Provides for the override of restrictive State practice laws. (Sec. 1521) Provides for the continuance of existing Federal law waivers under Medicare, Medicaid, or the Employee Retirement Income Security Act. (Sec. 1522) Sets forth provisions concerning: (1) the Hawaii Prepaid Health Care Act; (2) alternative State provider payment systems; and (3) alternative State hospital services payment systems. (Sec. 1531) Sets forth requirements for State single-payer systems. (Sec. 1541) Provides for the early implementation of comprehensive State programs. Subtitle G: Miscallenous Provisions - Permits a health professional or health facility to deny the provision of an item or service if the professional or facility objects on the basis of religious belief or moral conviction. Prohibits discrimination on the basis of race, national origin, sex, religion, language, income, age, sexual orientation, disability, health status, or anticipated need for health services. Title II: New Benefits - Subtitle A: Coverage of Outpatient Prescription Drugs in Medicare - Amends title XVIII (Medicare) of the Social Security Act to provide for: (1) Medicare coverage of certain outpatient prescription drugs and biologicals as well as home infusion drug therapy services; (2) payment rules and related requirements, such as those pertaining to deductibles, for covered outpatient prescription drugs; (3) manufacturer rebates to the Secretary under Medicare part B (Supplementary Medical Insurance) for covered outpatient prescription drugs; (4) a Prescription Drug Payment Review Commission appointed by the Director of the Congressional Office of Technology Assessment for reporting annually to the Congress on Medicare coverage of outpatient prescription drugs; and (5) the provision of covered outpatient drugs through Medicare drug benefit plans under contract with the Secretary to individuals entitled to benefits under Medicare part A (Hospital Insurance) and enrolled under Medicare part B. Authorizes appropriations. (Sec. 2007) Allows the Secretary, in providing for payments for covered outpatient drugs under Medicare contracts with HMOs and competitive medical plans, to base such payments on classes of enrollees or geographic factors that are different from those otherwise utilized for determining payment. Subtitle B: Home and Community Based Services - Entitles each State with an approved plan for home and community-based services for individuals with disabilities to specified payments. Authorizes appropriations. (Sec. 2111) Amends the Public Health Service Act to direct the Secretary to compile, evaluate, and disseminate information to assist in the replication of successful long-term health care services programs that are aimed at offering care management to hospitalized individuals in need of long-term care so that services to meet individual needs and preferences can be arranged in home and community-based settings as an alternative to long-term nursing home placement. Establishes a related grant program. Authorizes appropriations. Subtitle C: Long-Term Care Insurance Improvement and Accountability - Long-Term Care Insurance Improvement and Accountability Act - Provides for the promulgation of standards and model benefits with respect to long-term care insurance. (Sec. 2211) Prohibits the sale of a long-term care policy unless it meets specified standards. (Sec. 2212) Regulates sales practices and renewal practices for long-term care policies. (Sec. 2215) Establishes benefit standards for long-term care policies. Subtitle D: Life Care - Life Care Act - Amends the Public Health Service Act to add a new title, Title XXVII - Life Care: Public Insurance Program for Nursing Home Care. Directs the Secretary to: (1) establish a voluntary insurance program for individuals 35 yers of age and over to cover the nursing home stays of such individuals; and the nursing home stays of such individuals; and (2) establish a process for enrollment in the Life Care Program. Prohibits the coverage amount from exceeding $90,000. Provides coverage under the title for: (1) nursing care; (2) specified therapy services; (3) medical social work; (4) drugs and appliances; (5) other nursing home facility services; and (6) with respect to the first six months of covered residence in a nursing facility, such room and board costs as are not covered by beneficiary copayment. Subtitle E: Study and Report - Provides for a study on issues relating to appropriate care at the end of life. Title III: Health Professions Workforce - Subtitle A: Workforce Priorities Under Federal Payments - Establishes within the Department of Health and Human Services the National Council on Graduate Medical Education. Directs the Council to ensure that the aggregate number of individuals entering graduate medical education programs does not exceed specified limits. Directs the Council to designate the number of individuals authorized to be enrolled in each specialty. (Sec. 3031) Sets forth provisions concerning Federal formula payments to: (1) qualified entities for the costs of operating approved physician training programs; and (2) academic health centers and other eligible institutions. (Sec. 3061) Sets forth provisions concerning Federal payments to: (1) medical schools; (2) graduate nurse training programs; (3) dental schools; and (4) schools of public health. (Sec. 3081) Authorizes appropriations through FY 2000 for workforce development. Subtitle B: Academic Health Centers - Authorizes grants to: (1) eligible centers for the establishment and operation of information and referral systems to provide the services of such centers to rural health plans; and (2) community-and provider-based health plans for the purpose of providing the services of eligible centers to residents of rural or urban communities who otherwise would not have adequate access to such services. Subtitle C: Health Research Initiatives - Requires 0.25 percent of all premium-related payments made by employers, individuals, and families for coverage under this Act to be used for biomedical and behavioral research and health services research as specified. (Sec. 3221) Authorizes appropriations for a medical technology impact study. Subtitle D: Core Functions of Public Health Programs; National Initiatives Regarding Preventive Health - Authorizes appropriatons for: (1) core functions of public health programs; and (2) national initiatives regarding health promotion and disease prevention. Provides for grants to states for core functions of public health programs. Provides grants for agencies of State or local government and nonprofit organizations for national prevention initiatives. Provides for grants and authorizes appropriations for the development of rural telemedicine. Subtitle E: Health Services for Medically Underserved Populations - Authorizes appropriations for: (1) the development of community health groups and health care sites and services; and (2) the capital costs of the development of community health groups. (Sec. 3402) Authorizes approprations for grants and contracts for enabling and supplemental services. (Sec. 3471) Authorizes appropriations for the National Health Service Corps Program. (Sec. 3481) Provides for payments to hospitals with a low-income utilization rate of not less than 25 percent. Subtitle F: Mental Health; Substance Abuse - Requires each State, as a condition of participation under title I, to integrate the mental illness and substance abuse services of the State and its political subdivisions with the mental illness and substance abuse services offered by health plans pursuant to title I. Authorizes appropriations to States for grants for the development and operation of comprehensive managed mental health and substance abuse programs that are integrated with the health delivery system established under this Act. Subtitle G: Comprehensive School Health Education; School-Related Health Services - Provides for grants to State educational agencies in eligible States to integrate comprehensive school health education in schools within the State, with priority given to those communities in greatest need. Authorizes appropriations. (Sec. 3603) Establishes a Healthy Students-Healthy Schools Interagency Task Force. (Sec. 3681) Authorizes appropriations for grants to State health agencies or local community partnerships for the development and operation of school-related health services. Subtitle H: Public Health Service Initiative - Authorizes appropriations through FY 2004 for specified programs under title III, as well as programs of the Indian Health Service under title VIII. Subtitle I: Additional Provisions Regarding Public Health - Authorizes grants for the purpose of implementing and developing for trainees a curriculum that includes training in identification, treatment, and referral of victims of domestic violence and women's health needs. Subtitle J: Occupational Safety and Health - Directs the Secretary of Health and Human Services and the Secretary of Labor to work together to develop and implement a comprehensive program to expand and coordinate initiatives to prevent occupational injuries and illnesses. Establishes a National Advisory Board for Occupational Injury and Illness Prevention to provide oversight. Authorizes appropriations. Subtitle K: Full Funding for WIC - Amends provisions of the Child Nutrition Act of 1966 concerning the special supplemental food program to authorize to be: (1) appropriated such amounts as are necessary through FY 2000; and (2) made available other specified amounts through FY 2000. Subtitle L: Border Health Improvement - Authorizes the President to conclude an agreement with Mexico to establish a binational commission to be known as the United States - Mexico Border Health Commission to: (1) conduct a needs assessment; (2) develop and implement a plan to carry out actions recommended by the needs assessment; and (3) formulate recommendations to United States and Mexico concerning reimbursement for health care costs. Title IV: Medicare and Medicaid - Subtitle A: Medicare - Amends SSA title XVIII (Medicare) to allow individuals to elect to remain in certain plans. (Sec. 4002) Makes specified changes with regard to eligible organization and Medicare supplemental policy enrollment. (Sec. 4101) Revises provisions relating to Medicare part A and concerned with: (1) various specified hospital and skilled nursing facility payment adjustments for, among other things, capital-related costs for inpatient hospital services and services for low-income patients; (2) the Medicare-dependent, small rural hospital program and the rural health transition grant program; (3) payments for certain multi-campus, rehabilitation, and long-term care hospitals; (4) long-term hospital designation; and (5) indirect medical education payment termination. (Sec. 4111) Replaces the essential access community hospital (EACH) program with a limited service hospital program, prohibiting EACH designations after July 1, 1994, while permitting payment to prior designated EACHs. Authorizes appropriations. Makes part A and B amendments relating to rural primary care hospitals and medical assistance facilities. Repeals provisions for prospective payment systems (PPSs) for rural primary care services. (Sec. 4112) Requires the Secretary to study and report to the Congress with regard to subacute care. (Sec. 4201) Makes specified changes with regard to Medicare part B provisions on: (1) payment for physicians' services, adding limitations on payments relating to inpatient stays in certain hospitals and making various other changes concerning, among other things, service updates, adjustments for volume and intensity, and the performance standard factor; (2) underserved area bonus payments; (3) payments for certain outpatient hospital services and durable medical equipment; (4) eye or eye and ear hospitals; and (5) the general Medicare part B premium. (Sec. 4206) Requires the Secretary to establish: (1) demonstration projects for Medicare State-based performance standard rates of increase; and (2) bidding areas for the competitive acquisition of specified items and services. Provides for a reduction in payment amounts if such competitive acquisition fails to achieve certain savings. (Sec. 4209) Imposes across-the-board co-payments for clinical diagnostic laboratory tests. (Sec. 4212) Provides for expanded coverage for physician assistants and nurse practitioners. Bases payments for physician assistants and certain nurse practitioners on the physician fee schedule. (Sec. 4213) Prohibits nonparticipating physicians and suppliers from receiving payment for items or services provided under Medicare. (Sec. 4214) Requires the Secretary to develop a methodology for implementing a resource-based system for determining practice expense relative value units for each physician's service. (Sec. 4301) Modifies provisions relating to Medicare parts A and B and concerned with: (1) medicare as secondary payer; (2) payments for home health services; and (3) Medicare supplemental policies. (Sec. 4303) Directs the Secretary to use a competitive process to contract with centers of excellence for certain appropriate services (including cataract surgery). (Sec. 4305) Imposes co-payments for home health services. (Sec. 4306) Terminates payments for direct graduate medical education costs attributable to an approved medical residency training program. (Sec. 4307) Amends the Omnibus Budget Reconciliation Act of 1990 to permit Medicare supplemental policies in all States. Subtitle B: Medicaid Program - Amends SSA title XIX (Medicaid) to prohibit a State Medicaid plan from paying for items and services in the standard benefit package described above in title I of this Act, with certain exceptions. (Sec. 4605) Limits State Medicaid expenditures to HMOs to HMOs that are certified as a standard health plan. Revises the 75/25 rule under Medicaid HMO provisions. (Sec. 4611) Modifies national DSH payment limit provisions. Creates a Medicaid part B (Payments to Hospitals Serving Vulnerable Populations). (Sec. 4615) Makes various specified changes with regard to Medicaid long-term care provisions (including provisions on frail elderly demonstration project waivers) as well as with regard to other provisions concerning: (1) Medicaid coverage of certified nurse practitioners and clinical nurse specialist services; and (2) relief from third party liability requirements. Title V: Quality and Consumer Protection - Subtitle A: Quality Management and Improvement - Directs the Secretary of Health and Human Services to establish the National Quality Council to oversee a program of quality management and improvement designed to enhance the quality, appropriateness, and effectiveness of health care services and access to such services. Authorizes appropriations. Subtitle B: Administrative Simplification - States that the purpose of this subtitle is to improve the efficiency and effectiveness of the health care system, including Medicare and Medicaid, by encouraging the development of a health information network through the establishment of standards and requirements for the electronic transmission of certain health information. Provides for standards for data elements and information transactions. Imposes penalties for violators of the standards. Requires standards relating to the form of health security cards issued by health plans and the information needed to be encoded electronically on such cards. Establishes the Health Care Information Advisory Committee. Provides for grants for demonstration projects to promote the development and use of electronically integrated community-based clinical information systems and computerized patient medical records. Repeals provisions of the Social Security Act that established the Medicare and Medicaid Coverage Data Bank. Subtitle C: Privacy of Health Information - States that the purpose of this subtitle is to establish effective mechanisms to protect the privacy of individuals with respect to individually identifiable health care information. Permits the disclosure of health information only in accordance with provisions of this subtitle. Specifies authorized disclosures. Subtitle D: Expanded Efforts to Combat Health Care Fraud and Abuse Affecting Federal Outlay Programs - Directs the Secretary and the Attorney General to establish a joint program to: (1) coordinate Federal, State, and local law enforcement programs to control fraud and abuse affecting Federal outlay programs; (2) conduct investigations and audits relating to the delivery of and payment of health care; and (3) facilitate the enforcement of this subtitle and other statutes applicable to health care fraud and abuse. (Sec. 5302) Establishes the Federal Outlay Program Fraud and Abuse Control Account to be available for carrying out such program. (Sec. 5303) Establishes the HHS Office of Inspector General Asset Forfeiture Proceeds Fund. (Sec. 5304) Authorizes monetary rewards for information relating to a possible prosecution of a Federal health care offfense. (Sec. 5311) Imposes civil penalties for certain violations, including fraud, with respect to certified standard health or long-term care plans or long-term care services. (Sec. 5313) Excludes an individual or entity from participating in any applicable health plan if the individual or entity: (1) is excluded from participation in a public program due to conviction for health care-related crimes or patient abuse; (2) has been convicted under Federal or State law of specified felonies in connection with the delivery of a health care item or service; or (3) has been convicted of a felony relating to the unlawful manufacture, distribution, prescription, or dispensing of a controlled substance. Waives mandatory exclusion if it would significantly harm or pose a risk to public health. Bars payments under a certified standard health plan for the delivery of or payment for any item or service furnished by an excluded individual. (Sec. 5321) Amends the Federal criminal code to provide criminal penalties for fraud, theft, embezzlement, false statements, bribery, and graft in connection with health care. (Sec. 5331) Imposes civil penalties for false claims regarding certified standard health plans or long-term care insurance policies. Subtitle E: Medical Liability Reform - Requires parties to any malpractice action, before the commencement of such action, to participate in a State-based alternative dispute resolution system. Limits attorney's contingency fees. Provides for demonstration projects concerning medical malpractice liability. Authorizes appropriations for such projects. Subtitle F: Remedies and Enforcement - Establishes procedures for the review of health claims, including the review of claims, proceedings in complaint review offices, civil money penalties, the establishment of early resolution programs, mediation proceedings, enforcement of settlement agreements, due process for health care providers, judicial review, civil enforcement, private enforcement rights, consumer protections, discrimination claims, and facial constitutional challenges to invalidate this Act or any provision of this Act. Subtitle G: Repeal of Exemption - Establishes the applicability of the following Acts to the health insurance business: (1) the Sherman Act; (2) the Clayton Act; (3) the Federal Trade Commission Act; and (4) the Robinson-Patman Antidiscrimination Act. Title VI: Individual and Employer Subsidies - Subtitle A: Individual Premium and Cost-Sharing Assistance - Requires a participating State to have in effect a program for furnishing premium assistance and cost-sharing assistance in accordance with the provisions of this subtitle. Sets forth eligibility standards for such assistance. Provides for payments to States furnishing premium assistance. Subtitle B: Employer Subsidies - States that it is the purpose of this subtitle to provide subsidies to eligible employers in providing, or expanding the provision of, health care coverage for the employer's employees. Sets forth provisions concerning the eligibility for and amount of such subsidy. Declares ineligible for such a subsidy: (1) the self-employed; (2) employee leasing firms; and (3) State or local governments. Title VII: Revenue Provisions - Subtitle A: Financing Provisions - Amends the Internal Revenue Code to increase the excise taxes on cigarettes and other tobacco products. Applies such increases to tobacco products manufactured and sold in Puerto Rico. (Sec. 7103) Imposes an excise tax on the manufacture or importation of roll-your-own tobacco. (Sec. 7111) Imposes a tax: (1) on a percentage of premiums received under taxable health insurance policies; and (2) on a percentage of amounts received for health-related administrative services. Imposes on self-insured plans a monthly tax on a percentage of the accident or health coverage expenditures and direct administrative expenditures. (Sec. 7112) Imposes a 25 percent tax on community-rated high cost health plans to be paid by the issuer. Requires the Secretary of Health and Human Services to establish a reference premium for each class of enrollment for community-rated plans within a community rating area. Imposes a 25 percent tax on the excess premium equivalents of an experience-related standard health plan. (Sec. 7121) Provides for the recapture of certain health care subsidies received by high-income individuals. Transfers such amounts to the Supplemental Medical Insurance Trust Fund. (Sec. 7131) Increases the excise tax on certain hollow point and large caliber handgun ammunition. (Sec. 7132) Requires certain shareholders of S corporations and limited partners who materially participate in corporate activities to include their share of income or loss from such corporation when determining net earnings from self-employment. (Sec. 7133) Provides for extending Medicare coverage and applying the hospital insurance tax to all State and local government employees. Subtitle B: Tax Treatment of Employer-Provided Health Care - Declares that on and after January 1, 2004, gross income of an employee includes employer-provided coverage under an accident or health plan which is not permitted coverage. (Sec. 7202) Prohibits health benefits from being provided under cafeteria plans. (Sec. 7203) Increases and makes permanent the deduction for health insurance costs of self-employed individuals. (Sec. 7211) Imposes a tax on employer-provided health benefits that do not meet the requirements for permitted coverage. Subtitle C: Exempt Health Care Organizations - Sets forth qualification and disclosure requirements for tax-exempt health care organizations. (Sec. 7302) Imposes an excise tax on the beneficiary of a taxable inurement and on the management of the participating tax-exempt health care organization. (Sec. 7303) Provides for the treatment of health maintenance organizations, parent organizations, and health insurance purchasing cooperatives as tax-exempt entities. (Sec. 7304) Provides for the taxation as an insurance company other than a life insurance company of certain organizations that provide health insurance and other prepaid health care services. (Sec. 7305) Repeals the special rules for Blue Cross and Blue Shield and similar organizations. (Sec. 7306) Provides a tax exemption for certain qualified high risk insurance pools. (Sec. 7308) Provides for the tax treatment of bonds of certain nonprofit tax-exempt organizations in a manner similar to governmental bonds. Subtitle D: Tax Treatment of Long-Term Care Insurance and Services - Treats qualified long-term care services as medical care for purposes of the medical expense deduction. (Sec. 7402) Provides for the treatment of long-term care insurance as accident and health insurance. (Sec. 7403) Allows accelerated death benefits under life insurance contracts to be paid to terminally ill individuals. Subtitle E: Other Revenue Provisions - Requires the Secretary of the Treasury to submit to specified congressional committees a legislative proposal providing statutory standards for the classification of workers as employees or independent contractors. (Sec. 7502) Increases the penalty for failure to file correct information for returns involving payments for services. (Sec. 7505) Allows a tax credit for certain primary health services providers that practice in health professional shortage areas. (Sec. 7506) Increases the amount allowed to be expensed as a depreciable business asset if such asset is medical equipment. (Sec. 7521) Requires additional reserves for post-retirement medical and life insurance benefits to cover not less than ten years of the working lives of covered employees and to be maintained as separate accounts. (Sec. 7522) Allows a tax credit for the cost of personal assistance services required by certain employed individuals. Limits the amount of such credit and provides a cost-of-living adjustment. Subtitle F: Graduate Medical Education and Academic Health Centers Trust Fund - Establishes the Graduate Medical Education and Academic Health Centers Trust Fund, consisting of the Graduate Medical Education Accountand the Academic Health Centers Account. Provides funding for such trust fund through tax and assessments on insured and self-insured plans and transfers from certain social security trust funds. Title VIII: Other Federal Programs - Subtitle A: Indian Health Service - Makes qualifying Indians eligible for health and supplemental benefits under the Indian Health Service (IHS). (Sec. 8105) Authorizes an IHS program to contract with a health plan to provide health care services to non-Indians. (Sec. 8107) Makes IHS programs eligible for Medicare payments. (Sec. 8109) Directs the Secretary of Health and Human Services to: (1) establish an advisory group to access budget aspects of IHS programs; (2) conduct health service transitional studies and establish a related advisory group; (3) develop a long-term care demonstration program; (4) survey health services available to Indian veterans; and (5) develop new funding methodologies. (Sec. 8118) Authorizes appropriations. Subtitle B: Department of Veterans Affairs - Veterans Health Care Reform Act of 1994 - Allows veterans, individuals currently enrolled in a health plan under the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), and their family members to be enrolled in a Department of Veterans Affairs health plan (VA plan). Requires the Secretary of Veterans Affairs to ensure that each VA plan provides to enrolled individuals the items and services in the standard benefit package under this Act. Allows such plans to offer supplemental health benefits and cost-sharing plans consistent with this Act. Provides a limitation with regard to veterans enrolled with health plans outside the VA. Prohibits the imposition of any plan enrollment charges upon service-connected disabled veterans, veterans receiving disability compensation from the VA, former prisoners of war, veterans of the Mexican border period or World War I, and veterans unable to defray the costs of such care. Allows the Secretary to establish plan charges for other veterans. Deems a VA facility to be a Medicare provider, and a VA health plan to be a Medicare HMO, for purposes of any program administered by the Secretary of Health and Human Services under Medicare (title XXVIII of the Social Security Act). Allows for the recovery of certain care and services provided under a VA plan in the case of an individual who has coverage under another plan. Establishes in the Treasury the Department of Veterans Affairs Health Plan Fund to be used for VA health plan payments and services. Preserves existing benefits for VA facilities not operating within a health plan certified under this Act. Directs the Secretary to organize health plans and operate VA facilities as, or within, health plans under this Act. Preempts conflicting State health plan standards or requirements. Directs the Secretary to designate a health plan director for each VA health plan organized and operated under this subtitle. Authorizes such directors to enter into contracts and agreements for the provision of care and services under the VA plan as well as related services (equipment, maintenance, and repair). Authorizes the Secretary to enter into resource-sharing agreements with other health care plans and providers, health industry organizations, individuals, and other Government departments and agencies. Provides certain administrative and personnel flexibility, as well as expenditure authority, for care and services under a VA plan. Establishes in the Treasury the Veterans Health Care Investment Fund. Authorizes appropriations. Provides specified credits to the Fund for FY 1995 through 1997 for operation of VA health plans. Requires a report from the Secretary to the Congress on the operation of such plans. Authorizes the Secretary to accept and use grants for health care services provided to special populations if used by the VA while operating under a VA health plan. Title IX: Workers Compensation Medical Services - Applies the provisions of subtitle B of title V of this Act to the provision of workers compensation medical services in the same manner as such provisions apply with respect to the provision of services included in the standard benefit package. Requires that, in cases where a workers compensation claim is challenged, a health plan must provide or pay for all medical care in the standard benefit package according to the applicable workers compensation for schedule, until the challenge is adjudicated. Provides for demonstration projects with respect to treatment of work-related injuries and illness. Establishes a Commission on Workers Compensation Medical Services. Title X: Premium Financing - Subtitle A: National Health Care Cost and Coverage Commission - Establishes the National health Care Cost and Coverage Commission to monitor and respond to: (1) trends in health care coverage; and (2) changes in per-capita premiums and other indicators of health care inflation. Provides for congressional consideration of Commission recommendations. Subtitle B: Employer and Indiandual Premium Requirements and Assistance - Requires, with respect to a participating State, each resident U.S. citizen or lawful alien to: (1) enroll in or be covered under a health plan; (2) pay any premium required, consistent with this Act. Excludes individuals covered under an equivalent health care program such as Medicare, Medicaid, a military or veterans health care program, CHAMPUS, the Indian Health Care Improvement Act, or an approved State single-payer system. Provides for a religious exemption. Excludes inmates. Requires employers of 25 or more and employers of less than 25 than make an election, to make health care coverage premium payments on behalf of the employer's qualifying employees. Permits other employers to elect to be treated as community-rated employers. Sets forth provisions for providing for the determination premium payments. Title XI: Ensuring Health Care Reform Financing - States that it is the purpose of this title to ensure that this Act does not result in unanticipated increases in the Federal deficit. States that any entitlement provided by this Act, including premium assistance, shall be subject to the operation of this Act. Requires the President, annually through FY 2004, to issue a health care baseline. Requires the President's budget to include a current health care baseline. Provides that if a baseline exceeds the initial (1995) baseline by more than a specified amount there is to be a proposed order that offsets the excess through a combination of: (1) reductions in premium assistance; (2) reductions in the Medicare deductible for drugs; and (3) reductions in each direct spending program of this Act by a uniform percentage. Requires the eligibility percentage for children and pregnant women to be reduced last. Sets forth provisions in the event of war or low growth. Provides for a Government Accounting Office audit and for additonal reporting requirements by the Office of Management and Budget and the National Health Care Commission.

Health Security Act

United States · United States Congress · 2 August 1994

TABLE OF CONTENTS: Title I: Health Insurance and Delivery Systems Reform Subtitle A: Federal Standards for State Regulatory Programs Subtitle B: Coordination With Other Provisions of Law Title II: Coverage Title III: Premium and Cost-Sharing Assistance Title IV: Administrative Simplification and Privacy Title V: Malpractice and Fraud Subtitle A: Federal Tort Reform Subtitle B: Expanded Efforts to Combat Health Care Fraud and Abuse Affecting Federal Outlay Programs Title VI: Medicare, Medical Education, and Medicaid Subtitle A: Medicare Subtitle B: Medical Education Subtitle C: Home and Community-Based Services Subtitle D: Medicaid Program Title VII: Revenue Provisions Subtitle A: Financing Provisions Subtitle B: Tax Treatment of Employer-Provided Health Care Subtitle C: Deduction for Individuals Purchasing Own Health Insurance Subtitle D: Exempt Organizations Subtitle E: Tax Treatment of Long-Term Care Insurance and Services Subtitle F: Health Care Trust Funds Subtitle G: Other Revenue Provisions Subtitle H: Ensuring Health Care Financing Health Security Act - States that it is the purpose of this Act to achieve universal health insurance coverage through: (1) subsidies for the purchase of health insurance; (2) affordable standardized health insurance; (3) elimination of exclusionary practices by health insurance companies; (4) a permanent National Health Commission for recommending periodically to the Congress how to increase the number of people covered by health insurance; (5) reduction of health costs through more open competitive markets and continued advances in medical education and research; and (6) health care provided under Medicare and Medicaid and health programs of the Departments of Defense and of Veterans Affairs, and the Indian Health Service. Title I: Health Insurance and Delivery Systems Reform - Subtitle A: Federal Standards for State Regulatory Programs - Amends the Social Security Act (SSA) to add a new title XXI under which States are required to establish accreditation, certification, enforcement, and information programs for certifying all health plans and long-term care policies (except multistate self-insured health plans which will be certified by the Secretary of Labor) issued, sold, offered for sale, or operated in the State that meet certain standards incorporating specified requirements, such as those pertaining to community rating, preexisting conditions, and a patient's right to self-determination in health care services, as certified standard, nonstandard, or supplemental health plans or certified long-term care policies in order to participate in Medicaid. (Sec. 101) Requires establishment of such programs also for: (1) enforcing applicable standards for such plans and policies; (2) providing consumers in the State with comparative value information on the performance of all health plans in each community rating area established in the State; (3) designating State health plan service areas for purposes of access to essential community providers, delivery of benefits, and improved access to underserved areas; (4) providing for reinsurance, risk adjustment, and cost-sharing adjustment programs; (5) specifying an annual general enrollment period; (6) providing for a premium approval process for long-term care policies; (7) providing for the certification of workplace wellness programs; (8) enforcing employer responsibilities with regard to employee access to standard plans; (9) oversight of purchasing cooperatives; (10) supporting quality assurances for measuring access to and appropriateness of health care services provided to consumers; (11) supporting development of community health networks and plans; (12) supporting development of community health networks and plans; (13) providing coordination between health plans and automobile medical liability policies; (14) developing remedy and enforcement mechanisms (including early resolution programs) as described for dealing with complaints involving health plans, collecting any civil monetary penalties assessed by the Secretary of Health and Human Services (HHS) under such program, and for handling civil actions brought to invalidate any provision of this Act; and (15) conforming State laws and procedures to the rules regarding fraud and medical malpractice under SSA title XI. Directs the Secretary to initially determine and approve the compliance of such State programs with the Federal guidelines under this new title and periodically review such State programs to determine if they continue to comply with such guidelines. Provides funding for such programs. Sets forth requirements relating to: (1) possessions of the United States; (2) State single-payer systems; and (3) treatment of certain State laws. Directs the Secretary to: (1) develop certification criteria for workplace wellness programs; and (2) certify certain private accreditation entities. Describes the various benefit packages and the categories of items and services included in them (such as mental illness and substance abuse services as well as family planning services and services for pregnant women). Prescribes general cost-sharing under the standard benefits package. Creates in HHS a National Health Benefits Board to: (1) establish cost-sharing schedules to be provided by standard packages; and (2) define the standards to be used by a health plan in determining whether an item or service under certain categories of health care items and services is medically necessary or appropriate for an enrollee in the plan. Outlines the process for congressional consideration of any Board recommendations to modify standard benefit packages and cost-sharing assistance. Authorizes appropriations. Sets forth special provisions relating to abortion and religious beliefs, providing that nothing under this new title shall be construed to require the creation or maintenance of abortion clinics or other abortion providers within a State or any region of a State. Details general employer responsibilities pertaining to payroll deductions and other specified matters in enrolling their employees in certified standard health plans. Lists specific duties of purchasing cooperatives, which include making enrollment information available, enrolling community-rated individuals in certified standard health plans, and collecting and forwarding plan premiums to the plan, as well as specific requirements governing the organization and operation of purchasing cooperatives. Provides for access to standard health benefit plan coverage through qualified association plans. Sets forth special rules for church and multiemployer plans. Requires the Secretary to direct the Agency for Health Care Policy and Research and the Health Care Financing Administration to support and conduct research on the effects of health care reform on health care delivery systems and methods for risk adjustment. Authorizes appropriations. Requires the Secretary to award grants to States or community-based, independent, not-for-profit organizations that have submitted applications to establish demonstration projects that provide certified standard health plans with the technical assistance to implement the results of quality improvement research into medical practice. Directs the Secretary to submit an annual report to the Congress which: (1) reviews the results of the quality improvement research grants; (2) evaluates consumer information programs established by participating States; (3) tracks the evolution of national performance measures and other research; and (4) evaluates State, regional, and national trends on quality of health care. Allows the Secretary to make grants to and enter into contracts with: (1) eligible public or private non-profit consortia for the development of community health groups (i.e. certified community health plans or community health networks); and (2) community health groups for their operation. Authorizes the Secretary to make certain types of financial assistance available to a community health group or isolated rural facility applying for capital assistance. Directs the Secretary to: (1) award grants to eligible entities to establish demonstration projects to promote telemedicine and other uses of the telecommunications network in rural areas; and (2) establish the Interagency Task Force on Rural Telemedicine to, among other things, identify specific uses for telemedicine that have proven to be effective and review the policy of the Health Care Financing Administration relating to reimbursement for telemedicine services. Subtitle B: Coordination With Other Provisions of Law - Eliminates immunity from antitrust suits under provisions commonly known as the McCarran-Ferguson Act with respect to health insurance. (Sec. 112) Elevates the position of the Director of the Office of Rural Health to the position of the Assistant Secretary for Rural Health and expands that official's duties. (Sec. 113) Permits the Secretary of Labor to issue special reporting and disclosure rules for employer group health plans and make other conforming amendments to the Employee Retirement Income Security Act of 1974 (ERISA). Repeals ERISA provisions on multiple employer welfare arrangements. Title II: Coverage - Amends SSA to add a new title XXII under which is established the National Health Care Commission to monitor and respond to: (1) trends in health insurance coverage; and (2) changes in per-capita premiums and other indicators of health care inflation. Requires the Commission to report to the Congress biennially on the status of health insurance coverage in the nation and the national goal of universal coverage. Authorizes appropriations. Provides that if 95 percent of the resident population is not covered by 2002, the Commission shall submit to the Congress an implementing bill which such statutory provisions as the Commission determines are necessary or appropriate to implement recommendations developed by it to achieve that target. Title III: Premium and Cost-Sharing Assistance - Amends SSA title XIX (Medicaid) to require State Medicaid plans to provide for a State program furnishing premium and cost-sharing assistance in accordance with a new Medicaid part B (State Programs for Premium and Cost-Sharing Assistance), which includes a grant program for providing cost-sharing assistance for certain individuals with incomes above 100 percent of the poverty line. Title IV: Administrative Simplification and Privacy - Amends SSA title XI to: (1) delay employer reporting requirements under Medicare and Medicaid Coverage Data Bank provisions; (2) terminate the Bank, effective January 1, 1996; (3) provide for administration simplification in the health care system, including Medicaid and Medicare, through an information network developed according to certain specified data element standards and requirements for electronic transmission and accessing of certain health information; (4) direct the Secretary to establish standards for certifying health information network services as qualified services and for establishing the form of health security cards issued by health plans and the information to be encoded electronically on such cards; (5) provide penalties for failure to comply with data element standards and requirements and for misuse of health security cards and personal health identifiers; (6) provide billing rules for clinical laboratory services; (7) establish the Health Care Information Advisory Committee for advising the Secretary and the Congress with respect to the health information network and network operations; (8) provide for demonstration projects to promote development and use of electronically integrated community-based clinical information systems and computerized patient medical records; (9) provide for privacy of health information; and (10) authorize appropriations. Amends SSA title XVIII (Medicare) to repeal provisions requiring the identification of secondary payer situations. Title V: Malpractice and Fraud - Subtitle A: Federal Tort Reform - Amends SSA title XI to provide for Federal medical malpractice provisions preempting inconsistent State laws (with specified exceptions) for governing malpractice actions brought in State or Federal courts (except with regard to actions arising from a vaccine-related injury or death covered under the Public Health Service Act) without establishing any new basis for bringing malpractice in Federal courts. Requires: (1) States participating under new SSA title XXI to establish alternative dispute resolution procedures for settling medical malpractice claims; and (2) any such claims to have gone through and reached final resolution under such procedures in order for any medical malpractice liability action to be brought with respect to such claim in a participating State. Authorizes the Secretary to provide funds to one or more eligible participating States to establish no-fault medical liability system demonstration projects to replace the common law tort liability system for medical injuries. Authorizes appropriations. Subtitle B: Expanded Efforts to Control Health Care Fraud and Abuse Affecting Federal Outlay Programs - Amends SSA title XI to provide for additional measures for controlling health care fraud and abuse affecting Federal outlay programs, among other means by: (1) mandating a joint program by the Secretary and the Attorney General to coordinate Federal, State, and local law enforcement programs to control fraud and abuse affecting Federal outlay programs; (2) providing qualified immunity to individuals providing information to such officials on health care fraud or abuse; (3) establishing the HHS Office of Inspector General Asset Forfeiture Proceeds Fund, consisting of all proceeds from forfeitures that have been transferred to the HHS Inspector General (IG) from the Department of Justice Asset Forfeiture Fund and available to the IG for investigation expenses; (4) allowing rewards for information leading to possible prosecution for a Federal health care offense; and (5) making revisions with regard to civil monetary penalties for health care fraud and abuse, including increasing such penalties, and with regard to private rights of action and mandatory exclusion from health care program participation. (Sec. 531) Amends Federal criminal code and (Civil False Claims Act) provisions, covering health care fraud as well as theft and embezzlement, false statements, and bribery and graft in connection with health care, and false claims for payments by health plans in order to conform to the changes made above under SSA. Title VI: Medicare, Medical Education, and Medicaid - Subtitle A: Medicare - Amends SSA title XVIII to replace provisions on payments to health maintenance organizations and competitive medical plans with provisions on payments to certain certified standard health plans, modifying provisions with regard to risk-contracting. (Sec. 611) Makes various specified changes in provisions related to Medicare part A (Hospital Insurance) and concerned with: (1) inpatient hospital services updates for prospective payment system hospitals; (2) payment reductions for capital-related costs for inpatient hospital services; (3) disproportionate share payment reductions; (4) payment methodology for rehabilitation and long-term care hospitals; (5) new designations of new long-term hospitals; (6) extension of the freeze on updates to routine service cost limits for skilled nursing facilities; (7) payments for sole community hospitals with teaching programs and multihospital campuses; (8) Medicare-dependent, small rural hospitals; (9) the rural health transition grant program; (10) a new limited service hospital program replacing the essential access community hospital program; (11) rural primary care hospitals and medical assistance facilities; and (12) termination of indirect medical education payments. (Sec. 622) Directs the Secretary to study and report to the Congress on subacute care. (Sec. 631) Makes various specified changes in provisions related to Medicare part B (Supplementary Medical Insurance) and concerned with: (1) updates for physicians' services; (2) volume performance standard rates of increase; (3) limitations on payment for physicians' services relating to inpatient stays in certain hospitals; (4) underserved area bonus payments; (5) development and implementation of resource-based methodology for practice expenses; (6) demonstration projects for Medicare State-based performance standard rate of increase; (7) elimination of formula-driven overpayments for certain outpatient hospital services; (8) eye or eye and ear hospitals; (9) imposition of coinsurance on laboratory services; (10) competition acquisition for items and services and laboratory services; (11) expanded coverage for physician assistants and nurse practitioners; and (12) general part B premiums. (Sec. 651) Makes various specified changes in provisions related to Medicare parts A and B and concerned with: (1) Medicare as secondary payer; (2) physician referral exceptions; (3) Medicare supplemental policies; (4) reductions in routine cost limits for home health services; (5) termination of graduate medical education payments; and (6) extension of social health maintenance organization demonstrations. (Sec. 653) Requires the Secretary to use a competitive process to contract with centers of excellence for cataract surgery and coronary artery by-pass surgery with payment under Medicare to be made for services subject to such contracts on the basis of specified negotiated or all-inclusive rates. (Sec. 659) Requires the Prospective Payment Assessment Commission and the Physician Payment Review Commission to each study and report to the Congress on Medicare spending. (Sec. 660) Directs the Secretary to develop a process to ensure that Medicare claims are submitted first by Medicare, Medicare supplemental policies, and other policies that provide supplemental benefits under Medicare before providers can submit claims to Medicare beneficiaries. Subtitle B: Medical Education - Amends SSA title XVIII to add a new part D (Medical Education) providing Federal payments to: (1) qualified applicants of approved physician and dental training programs and graduate nurse training programs; (2) medical schools for certain costs; and (3) academic health centers and other eligible institutions. Establishes the Graduate Medical Education and Academic Health Centers and Biomedical and Behavioral Research Trust Fund Advisory Committee to study and report to the Congress on operations of the Graduate Medical Education and Academic Health Centers Trust Fund, and the Biomedical and Behavioral Research Trust Fund. Authorizes appropriations. Subtitle C: Home and Community-Based Services - Amends SSA title XIX to add new parts: (1) C (State Programs for Home and Community-Based Services for Individuals with Disabilities) under which each State with an approved plan for home and community-based services for individuals with disabilities can receive Federal payments to provide such services to such individuals; and (2) D (Payments to Hospitals Serving Vulnerable Populations). Subtitle D: Medicaid Program - (Sec. 671) Limits: (1) coverage under Medicaid of items and services covered under the standard benefits package; and (2) State expenditures to certified health plans. Provides that no certified health plan with a Medicaid contract could have more than 50 percent of its enrollment composed of SSI-Medicaid recipients. (Sec. 673) Replaces disproportionate share hospital payment provisions with provisions relating to payments to hospitals serving vulnerable populations. (Sec. 674) Sets forth Medicaid long-term care provisions, including provisions for payments for personal care services and frail elderly services. (Sec. 675) Provides for an increased resource disregard for individuals receiving certain services. (Sec. 676) Increases the number of frail elderly demonstration project waivers. Amends the Omnibus Budget Reconciliation Act of 1986 to provide for the development of waiver protocols and model certification guidelines for an organization operating a demonstration project under such a waiver. (Sec. 677) Eliminates the: (1) requirement of prior institutionalization with respect to habilitation services furnished under a waiver for home or community-based services; and (2) rule regarding availability of beds in certain institutions. (Sec. 679) Provides for Medicaid coverage of all certified nurse practitioner and clinical nurse specialist services. Title VII: Revenue Provisions - Subtitle A: Financing Provisions - Amends the Internal Revenue Code to increase the excise taxes on cigarettes and other tobacco products. Applies such increase to tobacco products manufactured and sold in Puerto Rico. Increases such taxes for a temporary period for the funding of subsidies for children and pregnant women. (Sec. 703) Imposes an excise tax on the manufacture or importation of roll-your-own tobacco. (Sec. 705) Imposes a tax: (1) on a percentage of premiums received under taxable health insurance policies; and (2) on a percentage of amounts received for health-related administrative services. Imposes on self-insured plans a monthly tax on a percentage of the accident or health coverage expenditures and direct administrative expenditures. (Sec. 706) Imposes a 25 percent tax on high cost health plans to be paid by the issuer or the plan sponsor. Makes such tax non-deductible. (Sec. 711) Provides for the recapture of certain health care subsidies received by high-income individuals. Transfers such amounts to the Supplementary Medical Insurance Trust Fund. (Sec. 715) Increases the excise tax on certain hollow point and large caliber handgun ammunition. (Sec. 716) Requires certain shareholders of S corporations and limited partners who materially participate in corporate activities to include their share of income or loss from such corporation when determining net earnings from self-employment. (Sec. 717) Provides for extending Medicare coverage and applying the hospital insurance tax to all State and local government employees. Subtitle B: Tax Treatment of Employer-Provided Health Care - Imposes a tax on employer-provided health benefits that do not meet the requirements for permitted coverage. (Sec. 722) Includes in gross income health insurance coverage provided through flexible spending arrangements. (Sec. 723) Extends the deduction for health insurance costs of self-employed individuals until December 31, 1995. Subtitle C: Deduction for Individuals Purchasing Own Health Insurance - Allows a full deduction for the costs to individuals who purchase their own health insurance. Allows such deduction against the gross income of the individual. Subtitle D: Exempt Organizations - Sets forth qualification and disclosure requirements for tax-exempt health care organizations. (Sec. 742) Imposes an excise tax on the beneficiary of a taxable insurement and on the management of the participating tax-exempt health care organization. (Sec. 743) Provides for the treatment of health maintenance organizations, parent organizations, and health insurance purchasing cooperatives as tax-exempt entities. (Sec. 744) Provides for the taxation as an insurance company other than a life insurance company of certain organizations that provide health insurance and other prepaid health care services. (Sec. 746) Provides a tax exemption for certain qualified high risk insurance pools. (Sec. 748) Provides for the tax treatment of bonds of certain nonprofit tax-exempt organizations in a manner similar to governmental bonds. Subtitle E: Tax Treatment of Long-Term Care Insurance and Services - Treats qualified long-term care services as medical care for purposes of the medical expense deduction. (Sec. 752) Provides for the treatment of long-term care insurance as accident and health insurance. (Sec. 753) Allows accelerated death benefits under life insurance contracts to be paid to terminally ill individuals. Subtitle F: Health Care Trust Funds - Establishes the following trust funds to finance health-related programs: (1) the Health Security Trust Fund; (2) the Graduate Medical Education and Academic Health Centers Trust fund; and (3) the Biomedical and Behavioral Research Trust fund. Provides funding for such Trust Funds through tax and assessments made under this Act. Subtitle G: Other Revenue Provisions - Requires the Secretary of the Treasury to submit to specified congressional committees a legislative proposal providing statutory standards for the classification of workers as employees or independent contractors. (Sec. 772) Increases the penalty for failure to file correct information for returns involving payments for services. (Sec. 775) Allows a tax credit for certain primary health services providers that practice in health professional shortage areas. (Sec. 776) Increases the amount allowed to be expensed as a depreciable business asset if such asset is medical equipment. (Sec. 781) Requires additional reserves for post-retirement medical and life insurance benefits to cover not less than ten years of the working lives of covered employees and to be maintained as separate accounts. (Sec. 783) Allows a tax credit for the cost of personal assistance services required by certain employed individuals. Limits the amount of such credit and provides a cost-of-living adjustment. (Sec. 785) Makes the limit on annual deferrals inapplicable in the case of an individual covered under an excess benefit arrangement maintained by a tax-exempt group medical practice. Subtitle H: Ensuring Health Care Financing - Sets forth provision to ensure that programs under this Act and unanticipated increases in other Federal health spending do not increase the Federal deficit.

Employment Enhancement Reform Act

United States · United States Congress · 29 July 1994

TABLE OF CONTENTS: Title I: Consolidation of Federal Employment Assistance Programs Subtitle A: Block Grants to States Subtitle B: Consolidation and Repeal of Certain Federal Employment Assistance Programs Title II: Notice of Availability of Earned Income Credit Title III: Repeal of Temporary Futa Surtax Employment Enhancement Reform Act - Title I: Consolidation of Federal Employment Assistance Programs - Subtitle A: Block Grants to States - Establishes a block grant program to prepare individuals for employment by increasing their occupational and educational skills. Authorizes the Secretary of Labor to make such grants, for up to five-year periods subject to annual approval and availability of appropriations, to States to provide employment assistance to eligible individuals. Reserves funds for grants to Indian tribes and migrant and seasonal farm worker organizations. (Sec. 103) Allocates such grants to States on the basis of relative numbers of: (1) unemployed in areas of substantial unemployment; (2) excess unemployed; and (3) economically disadvantaged adults. (Sec. 104) Sets forth requirements for applications, use of grants, and conduct of State programs. Requires State programs to provide employment assistance to the following types of eligible individuals: (1) economically disadvantaged and 14 years or older; (2) certain types of dislocated workers; (3) individuals with disabilities; (4) Armed Forces members being separated under other than adverse conditions; (5) unemployed veterans; and (6) displaced homemakers. Requires States to: (1) profile and evaluate individuals to determine the employment assistance services to be provided; (2) notify individuals of other sources of supportive services; (3) provide appropriate employment assistance, within specified limits; (4) monitor rates of individuals successfully obtaining employment after separation from the program, according to specified criteria; and (5) establish one-stop-shop centers throughout the State for program information and profiling and evaluation. Authorizes certain discretionary activities under State programs. (Sec. 107) Directs the Secretary to make biennial determinations of State success in placing individuals in employment. Authorizes reduction or termination of payments when a State has not been successful, and reinstatement or increase of payments when a State implements appropriate modifications of its program. (Sec. 110) Authorizes appropriations. Subtitle B: Consolidation and Repeal of Certain Federal Employment Assistance Programs - Chapter 1: Consolidation of Programs - Amends the Stewart B. McKinney Homeless Assistance Act to eliminate community mental health services demonstration projects for homeless individuals who are chronically mentally ill. (Sec. 112) Amends the Rehabilitation Act of 1973 to add requirements for State collaborative programs of supported employment services for individuals with the most severe disabilities, special recreation activities and services, and projects with industry. Repeals other provisions for special project grants for supported employment programs, special recreational programs, projects with industry, and supported employment services for individuals with severe disabilities. Chapter 2: Repeal of Programs - Repeals Higher Education Act of 1965 provisions for special programs for students whose families are engaged in migrant and seasonal farmwork. (Sec. 122) Repeals: (1) the disabled veterans outreach program and the local veterans employment representative program under Federal law relating to veterans; and (2) the homeless veterans reintegration project under the Stewart B. McKinney Homeless Assistance Act. (Sec. 123) Repeals: (1) the Foster Grandparent and Senior Companion programs under the Domestic Volunteer Service Act; (2) employment and training program provisions under the Food Stamp Act of 1977 (but allowing college students who are parents responsible for care of a dependent child under age 6 to be eligible for the food stamp program); and (3) the older American community service employment program under the Older Americans Act of 1965. (Sec. 124) Repeals the Job Training Partnership Act, except those provisions relating to the Job Corps. Authorizes appropriations for the Job Corps. (Sec. 125) Repeals the Appalachian vocational and other educational facilities and operations program under the Appalachian Regional Development Act of 1965. (Sec. 126) Repeals certain provisions relating to rules for computing the targeted job credit under the Internal Revenue Code. (Sec. 127) Repeals the JOBS (job opportunities and basic skills training) program provisions for recipients of AFDC (aid to families with dependent children) under the Social Security Act. (Sec. 128) Repeals: (1) the Service Members Occupational Conversion and Training Act of 1992; (2) the Adult Education Act; (3) the Carl D. Perkins Vocational and Applied Technology Education Act; (4) the National Literacy Act of 1991; and (5) and the Indian Employment, Training and Related Services Demonstration Act of 1992. (Sec. 133) Repeals special programs relating to adult education for Indians, under the Indian Education Act of 1988. (Sec. 134) Repeals special Social Security Act provisions relating to Indian tribes and JOBS training programs. (Sec. 135) Repeals provisions for for the VISTA Literacy Corps under the Domestic Volunteer Service Act of 1973. (Sec. 136) Repeals: (1) the Wagner-Peyser Act (employment agencies); (2) the adult education for the homeless grants program and the job training for the homeless demonstration grants program under the Stewart B. McKinney Homeless Assistance Act; (3) the trade adjustment assistance for workers program under the Trade Act of 1974; (4) FY 1993 and 1994 authorizations of appropriations for certain grants, as well as certain technical assistance conditions, under the Homeownership and Opportunity through HOPE Act; and (5) the State legalization impact-assistance grants program under the Immigration Reform and Control Act of 1986. Subtitle C: Effective Dates - Sets forth effective dates. Title II: Notice of Availability of Earned Income Credit - Amends the Social Security Act and the Food Stamp Act of 1977 to require that notice of availability of the earned income tax credit be provided to applicants for and former recipients of AFDC, Medicaid, or food stamps. (Sec. 202) Amends the Omnibus Budget Reconciliation Act of 1990 to require printing of a notice of the availability of the earned income tax credit and the dependent care tax credit on W-4 forms for employee withholding exemptions. Title III: Repeal of Temporary FUTA Surtax - Repeals the temporary FUTA (Federal Unemployment Tax Act) surtax under the Internal Revenue Code.

A bill to amend the Balanced Budget and Emergency Deficit Control Act of 1985 to require that OMB and CBO estimates for paygo purposes to recognize the increased revenues generated by economic growth resulting from legislation implementing any trade agreement.

United States · United States Congress · 28 July 1994

Amends the Balanced Budget and Emergency Deficit Control Act of 1985 (Gramm-Rudman-Hollings Act) to require pay-as-you-go estimates with respect to legislation implementing a trade agreement to take into account increased revenues generated by growth in the gross domestic product resulting from such legislation to offset any loss in tariff revenues due to that legislation, subject to the condition that such increased revenues shall not be used as offsets beyond the total of lost revenues due to that legislation.

People's Protection Crime Control Act of 1994

United States · United States Congress · 28 July 1994

TABLE OF CONTENTS: Title I: Public Safety and Policing Subtitle A: Cops on the Beat Subtitle B: Safe Schools Subtitle C: Criminal Street Gangs; Crimes Against Children; Parental Accountability Subtitle D: Punishment of Serious Juvenile Offenders Title II: State Prison Construction Grants Title III: Elimination of Delays in Carrying Out Sentences Subtitle A: Post Conviction Petitions: General Habeas Corpus Reform Subtitle B: Special Procedures for Collateral Proceeding in Capital Cases Subtitle C: Funding for Litigation of Federal Habeas Corpus Petitions in Capital Cases Title IV: Two Strikes, You're Out Title V: Taking Prisoners Off the Streets Subtitle A: Expanding Prison Capacity Subtitle B: Restriction on Court Jurisdiction Subtitle C: Limitation of Prisoners' Rights Subtitle D: Prison Governance Title VI: Victims Rights Subtitle A: Generally Subtitle B: Admissibility of Evidence Subtitle C: Good Faith Exemption to the Exclusionary Rule Title VII: Protection of Women Subtitle A: Spouse Abuse and Stalking Subtitle B: Victims of Sexual Violence Subtitle C: Punishment of Sex Offenders Subtitle D: Rural Domestic Violence and Child Abuse Enforcement Title VIII: Criminal Aliens and Alien Smuggling Subtitle A: Deportation of Criminal Aliens Subtitle B: Prevention and Punishment of Alien Smuggling Title IX: Instant Check, Rural Drug Task Forces, and Enhanced Drug Penalties Subtitle A: Instant Check System for Handgun Purchases Subtitle B: Drug Trafficking in Rural Areas Subtitle C: Miscellaneous Title X: Miscellaneous Title XI: Penalties for Harassment or Obstruction of Lawful Hunting Title XII: Violent Crime Reduction Trust Fund People's Protection Crime Control Act of 1994 - Title I: Public Safety and Policing - Subtitle A: Cops on the Beat - Public Safety Partnership and Community Policing Act of 1994 - Amends the Omnibus Crime Control and Safe Streets Act of 1968 (Omnibus Act) to authorize the Attorney General to make grants to units of State and local government, and to other public and private entities, to increase police presence, expand and improve cooperative efforts between law enforcement agencies (LEAs) and members of the community to address crime and disorder problems, and otherwise enhance public safety. Permits such grants to be used for programs, projects, and other activities to rehire law enforcement officers who have been laid off as a result of State and local budget reductions and to hire new, additional career law enforcement officers and former members of the armed forces as career law enforcement officers, for deployment in community-oriented policing. Sets forth provisions regarding: (1) additional authorized grant projects involving police and community interaction; (2) preferential consideration for certain grants; (3) technical assistance; (4) matching funds; (5) fund allocation; (6) the termination of grants for hiring officers; (7) application requirements; (8) review of applications by a designated State office; (9) grant renewal; (10) limits on use of funds; (11) performance evaluation; (12) revocation or suspension of funding; and (13) access by the Attorney General and Comptroller General to documents. Authorizes appropriations. Subtitle B: Safe Schools - Amends the Controlled Substances Act (CSA) to increase penalties for drug trafficking in or near schools. (Sec. 112) Authorizes: (1) a school district to elect to qualify as a Federal safe school district by decision of a local educational agency or by referendum of the voters in a school district served by such an agency; and (2) the Attorney General to make grants to local educational agencies or LEAs of Federal safe school districts to pay for enhanced school security measures. (Sec. 113) Increases penalties for violation of the Gun-Free School Zones Act. Subtitle C: Criminal Street Gangs; Crime Against Children; Parental Accountability - Amends the Federal criminal code to prohibit: (1) committing specified "predicate gang crimes" (including murder, assault, kidnapping, arson, and retaliating against a witness, victim, or informant) with intent to promote or further the activities of a criminal street gang or for the purpose of gaining entrance to, or maintaining or increasing position in, a gang; (2) participating in, or inducing any individual to participate in, a gang; (3) employing or inducing any individual to commit a predicate gang crime with such intent; or (4) using any communication facility in causing or facilitating the commission of such a crime with such intent. Sets penalties for violations. Authorizes the Attorney General and the Secretary of the Treasury to investigate such offenses. Directs the U.S. Sentencing Commission to amend the sentencing guidelines to increase the base offense level for any felony committed for the purpose of gaining entrance into, or maintaining or increasing position in, a gang. (Sec. 122) Amends: (1) the Federal criminal code to set penalties for drive-by shootings; (2) the Omnibus Act to include among drug control and system improvement grant funding objectives law enforcement and prevention programs relating to gangs or to youth who are involved or at risk of being involved in gangs; and (3) the CSA to increase penalties for drug trafficking in or near public housing. (Sec. 125) Amends the Federal criminal code to require the parent or legal guardians of a juvenile charged with any violation of Federal law to attend all court proceedings involving the juvenile (attendance provision), with exceptions. Makes the parents or legal guardians of a juvenile who has been convicted of a criminal offense under any Federal law liable to the United States for a civil penalty of not more than $10,000, with exceptions. Authorizes the court to decline to enforce the attendance provision if it would cause undue hardship or to impose such penalty if the court determines that the parents or legal guardians exercised reasonable care, supervision, and control of the juvenile and counseled the juvenile that criminal activity is unacceptable. Sets forth provisions regarding the amount of civil penalties. Permits a parent or legal guardian ordered to pay the penalty to petition the court to perform community service or attend and successfully complete parenting classes in lieu of such penalty. (Sec. 126) Provides for imposition of the death penalty for murder during the sexual exploitation of children. (Sec. 127) Increases penalties for sex offenses against victims below age 16. (Sec. 128) Sets penalties for international trafficking in child pornography. (Sec. 129) Requires: (1) the Attorney General to establish guidelines for State legislation that prohibits the production, distribution, receipt, or possession of materials depicting a person under age 18 engaging in sexually explicit conduct and that provides for a maximum imprisonment of at least one year and for the forfeiture of assets used in, or gained from, such offenses; and (2) each State to enact and maintain legislation complying with such guidelines in order to receive assistance under provisions of the Victims of Crime Act and the Child Abuse Prevention and Treatment Act. (Sec. 130) Provides for national registration of convicted child abusers. Requires the Attorney General to establish guidelines for State registration programs. Authorizes a State to permit qualified entities to obtain from an authorized State agency a nationwide background check on a provider. (Sec. 131) Increases penalties for: (1) assaults against children; (2) using minors in drug trafficking; (3) drug distribution to minors; and (4) using a minor in the commission of a Federal offense. (Sec. 132) Amends the CSA to set penalties for physical trainers or advisers who attempt to persuade or induce a person to possess or use anabolic steroids. (Sec. 133) Directs the Sentencing Commission to: (1) amend the sentencing guidelines to increase by at least four levels the base offense level for sexual abuse offenses; and (2) review the appropriateness and adequacy of existing offense characteristics and adjustments applicable to such offenses. (Sec. 134) Provides for interstate enforcement of child support orders. (Sec. 135) Amends the Social Security Act to require that procedures by which information regarding the amount of overdue child support owed by an absent parent residing in the State be made available to any consumer reporting agency (currently, at the request of such agency). Repeals a provision authorizing the State to impose a fee for furnishing the information. (Sec. 136) Makes certain crimes involving the use of persons below age 18 predicates to an offense under the Racketeer Influenced and Corrupt Organizations Act (RICO). (Sec. 139) Makes it a Federal offense to remove a child from, or to retain a child outside, the United States to obstruct the lawful exercise of parental rights. (Sec. 140) Authorizes appropriations to carry out State court programs regarding international parental child abduction. Subtitle D: Punishment of Serious Juvenile Offenders - Makes serious juvenile drug offenses Armed Career Criminal Act predicates. (Sec. 152) Provides for the prosecution as adults of violent juvenile offenders. (Sec. 153) Requires that juveniles found guilty of certain offenses be fingerprinted and photographed, with such fingerprints and photographs sent to the Federal Bureau of Investigation (FBI), Identification Division. Directs the court to transmit to such division information concerning the adjudication. Title II: State Prison Construction Grants - Authorizes the Attorney General to provide grants to States to build, expand, or operate space in correctional facilities in order to increase prison bed capacity. (Sec. 202) Sets forth formulas for the distribution of Federal funds in FY 1995 through 1999 based on the number of violent crimes reported by the States to the FBI. Allocates 25 percent of the total amount of funds appropriated under this title in each of FY 1996 through 1999 to States which make specified changes to State laws and regulations, such as inclusion of: (1) truth in sentencing laws which require persons convicted of violent crimes to serve not less than 85 percent of the sentence imposed; (2) mandatory prison sentences for persons convicted of the most serious violent crimes; (3) pretrial detention for those whose release can be shown to pose a danger to any other person or the community; and (4) the requirement that a juvenile who was age 13 or older on the date of the commission of a violent felony be prosecuted as an adult. (Sec. 203) Authorizes appropriations, subject to specified limitations. Title III: Elimination of Delays in Carrying Out Sentences - Subtitle A: Post Conviction Petitions: General Habeas Corpus Reform - Amends the Federal judicial code to establish a one-year statute of limitations for habeas corpus actions brought by State prisoners. (Sec. 302) Vests authority to issue certificates of probable cause for appeal of habeas corpus orders exclusively in the courts of appeals. (Sec. 304) Permits the denial of a habeas corpus petition on the merits notwithstanding the failure of the applicant to exhaust State court remedies. (Sec. 305) Imposes a one-year period of limitation for filing for collateral relief by Federal prisoners. Subtitle B: Special Procedures for Collateral Proceedings in Capital Cases - Amends the Federal judicial code to set forth special habeas corpus procedures in capital cases, including provisions governing: (1) appointment of counsel; (2) stays of execution; (3) filing of a habeas corpus petition; (4) State unitary review procedures applicability; and (5) time limits for determining such a petition or a motion to correct a sentence. Subtitle C: Funding for Litigation of Federal Habeas Corpus Petitions in Capital Cases - Amends the Omnibus Act to require the Director of the Bureau of Justice Assistance to provide grants to the States to support litigation pertaining to Federal habeas corpus petitions in capital cases. Title IV: Two Strikes, You're Out - Directs the court, in the case of a conviction for a Federal violent felony, to sentence the defendant to prison for life if the defendant has previously been convicted of one or more other violent felonies (and if a death results, subjects the defendant to the death penalty). Title V: Taking Prisoners Off the Streets - Subtitle A: Expanding Prison Capacity - Amends the Davis-Bacon Act to make provisions concerning the rate of wages for laborers and mechanics inapplicable to prison construction. Subtitle B: Restriction on Court Jurisdiction - Amends the Federal judicial code to deny the district court, in any action challenging the constitutionality of conditions of confinement in any correctional institution housing persons accused or convicted of a crime or juveniles adjudicated delinquent, jurisdiction to: (1) impose a ceiling on the population of any correctional institution or to require any adjustment of the release dates of inmates; or (2) prohibit the use of tents or prefabricated structures for housing inmates. Prohibits any consent decree in any such action from providing relief greater than the minimum required to bring the conditions of confinement into substantial compliance with the Constitution. Provides for modification of orders or decrees. Subtitle C: Limitation of Prisoners' Rights - Amends the Civil Rights of Institutionalized Persons Act to prohibit an adult who is convicted of a crime and confined in any correctional facility from bringing a civil action for deprivation of rights until available plain, speedy, and effective administrative remedies are exhausted. Specifies that such exhaustion of remedies may not be required unless the Attorney General has certified, or the court has determined, that such remedies are in substantial compliance with specified minimum acceptable standards (as under current law) or are otherwise fair and effective. Applies such standard to review and certification procedures under the Act. Directs the court, on its own motion or on motion of a party, to dismiss specified actions brought by an adult convicted of a crime and confined in any correctional facility if the court is satisfied that the action: (1) fails to state a claim upon which relief can be granted; or (2) is frivolous or malicious. Repeals a provision of such Act requiring that the minimum standards provide for an advisory role for employees and inmates of a correctional facility in the formulation, implementation, and operation of the system for resolution of inmate grievances. (Sec. 515) Amends the Federal judicial code to require the court to dismiss a case in a forma pauperis proceeding if the allegation of poverty is untrue or if the action fails to state a claim upon which relief may be granted or is frivolous or malicious, even if partial filing fees have been imposed by the court. Requires a prisoner in a correctional institution to include in a filed affidavit a statement of all assets such prisoner possesses. Directs the court to ask the correctional institution for information relating to the extent of the prisoner's assets and to require full or partial payment of filing fees according to the prisoner's ability to pay. Subtitle D: Prison Governance - Amends the Federal criminal code to authorize corporal punishment for the discipline of Federal prisoners convicted of crime who commit serious infractions of prison policy or rules regarding inmate behavior. (Sec. 522) Requires the Director of the Bureau of Prisons to develop and implement a Federal prison housing plan that provides three levels of prisoner housing quality, amenities, and privileges, as incentive awards directly related to the degree of prison-related work in which each inmate voluntarily participates. Title VI: Victims Rights - Subtitle A: Generally - Amends the Federal criminal code to require the Bureau of Prisons to provide 30 days' notice before the release of a prisoner to: (1) the judge, jury, attorneys, victims, and victims' family members in the case in which the prisoner was convicted; and (2) the local authorities in the place of conviction. (Sec. 602) Directs (current law authorizes) the court, when sentencing a defendant convicted of an offense under the Federal criminal code or under specified provisions of the Federal Aviation Act of 1958, to order that the defendant make restitution to any victim of the offense. Authorizes the court to further order restitution of any person who was harmed physically, emotionally, or pecuniarily by unlawful conduct of the defendant related to the offense. Directs the court to order restitution of the full amount of the victim's losses without consideration of: (1) the economic circumstances of the offender; or (2) the victim's compensation with respect to a loss from insurance or any other source. Sets forth provisions regarding: (1) the manner of and schedule for restitution; (2) circumstances in which there is more than one offender or more than one victim; (3) the effect of compensation from insurance or other sources; (4) setoffs; (5) compliance with a restitution order as a condition of probation, parole, or other form of release; (6) enforcement of a restitution order; and (7) procedures for issuing an order of restitution. (Sec. 603) Revises Federal Rule of Criminal Procedure: (1) 24(b) to entitle each side to six peremptory challenges (currently, six for the Government and ten for the defendant or defendants jointly); and (2) 32 to provide for a victim's right of allocution in sentencing for a crime of violence or sexual abuse. (Sec. 605) Sets penalties for retaliatory killings of witnesses, victims, and informants. Subtitle B: Admissibility of Evidence - Amends the Federal Rules of Evidence (FRE) to allow evidence of similar offenses in criminal or civil sexual assault and child molestation cases. (Sec. 612) Revises FRE 412 (sex offense cases; relevance of victim's past behavior) to: (1) expand the scope of the rape shield law and to require that an order admitting evidence of a victim's past sexual behavior explain the finding of relevance and the basis of a finding that the probative value of the evidence outweighs the danger of unfair prejudice; and (2) make inadmissible evidence to show invitation or provocation by a victim in sexual abuse cases. Subtitle C: Good Faith Exemption to the Exclusionary Rule - Specifies that evidence shall not be excluded on the ground that a search or seizure was in violation of the Fourth Amendment to the Constitution if carried out in circumstances justifying an objectively reasonable belief that it was in conformity with the Fourth Amendment. Makes the fact that evidence was obtained pursuant to and within the scope of a warrant prima facie evidence of the existence of such circumstances. Specifies that evidence shall not be excluded in a proceeding in a court of the United States on the ground that it was obtained in violation of a statute, administrative rule or regulation, or rule of procedure unless exclusion is expressly authorized by statute or by rule prescribed by the Supreme Court pursuant to statutory authority. Title VII: Protection of Women - Subtitle A: Spouse Abuse and Stalking - Amends the Federal criminal code to: (1) set penalties for interstate travel to commit spouse abuse or to violate a protective order; and (2) provide for full faith and credit of protective orders among the States. Subtitle B: Victims of Sexual Violence - Establishes a civil remedy for victims of sexual violence. (Sec. 712) Authorizes the restitution of victims of sex offenses. (Sec. 713) Provides for pretrial detention in sex offense cases. Subtitle C: Punishment of Sex Offenders - Provides for imposition of the death penalty for persons engaging in sexual abuse resulting in death. (Sec. 722) Increases penalties for recidivist sex offenses. (Sec. 723) Directs the Sentencing Commission to amend the sentencing guidelines to increase the base offense level for sex offenses. (Sec. 724) Provides for testing for human immunodeficiency virus for persons charged in sex offense cases and the disclosure of the test results to the victim. Directs the Sentencing Commission to amend existing guidelines for sentences for sex offenses where the offender knew or had reason to know that he was infected with such virus, except where the offender did not engage or attempt to engage in conduct creating a risk of transmission of the virus to the victim. Subtitle D: Rural Domestic Violence and Child Abuse Enforcement - Authorizes the Attorney General to make grants to State and local governments and other public or private entities of rural States to: (1) implement, expand, and establish cooperative efforts and projects between law enforcement officers, prosecutors, victim advocacy groups, and other related parties to investigate and prosecute incidents of domestic violence and child abuse; (2) provide treatment and counseling to victims of domestic violence and child abuse; and (3) work in cooperation with the community to develop education and prevention strategies directed toward such issues. Authorizes appropriations. Title VIII: Criminal Aliens and Alien Smuggling - Subtitle A: Deportation of Criminal Aliens - Amends the Immigration and Nationality Act (INA) to permit an alien sentenced to imprisonment to be deported prior to the termination of such imprisonment if the Immigration and Naturalization Service (INS) petitions the appropriate court or other authority to release the alien into INS custody for execution of a deportation order. Prohibits the deportation until all direct appeals of the conviction have been exhausted. (Sec. 802) Authorizes the registration of aliens on criminal probation or criminal parole within the United States. (Sec. 803) Expands the definition of "aggravated felony" to include illicit trafficking in explosive materials and a crime of violence for which the term of imprisonment is at least five years. (Sec. 804) Amends the INA to authorize the Attorney General to issue a final order of deportation without an administrative hearing or administrative review for any alien who was not lawfully admitted for permanent residence, or who had permanent resident status on a conditional basis, and whom the Attorney General determines is deportable and has been convicted of an aggravated felony. Limits judicial review of such determinations. Provides that an alien convicted of an aggravated felony shall be conclusively presumed to be deportable. (Sec. 805) Grants a U.S. district court jurisdiction to enter a judicial order of deportation at the time of sentencing against an alien convicted of an aggravated felony, if such order has been requested prior to sentencing by the U.S. Attorney. (Sec. 806) Restricts defenses to exclusion and deportation for certain aliens convicted of aggravated felonies. (Sec. 807) Enhances penalties for failing to depart or for reentering after a final order of deportation. Limits collateral attacks on deportation orders. (Sec. 809) Authorizes appropriations for a criminal alien information system. Subtitle B: Prevention and Punishment of Alien Smuggling - Authorizes appropriations for Border Patrol agents and investigators. (Sec. 813) Includes alien smuggling as a predicate to an offense under RICO. (Sec. 814) Increases penalties for: (1) employers who knowingly employ smuggled aliens; and (2) bringing in and harboring certain aliens. (Sec. 816) Subjects any property which facilitates or which has been used for smuggling or harboring illegal aliens to forfeiture. (Sec. 817) Directs the Attorney General to enter into a contract which provides for compensation to a State or political subdivision with respect to the incarceration of an undocumented criminal alien who has been convicted of a felony. Specifies the method for determining compensation. Title IX: Instant Check, Rural Drug Task Forces, and Enhanced Drug Penalties - Subtitle A: Instant Check System for Handgun Purchases - Requires each State to establish and maintain an instant criminal check system for handgun purchases. Sets forth: (1) prohibitions on uses of such information; and (2) identification procedure requirements for licensed importers, manufacturers, and dealers once a State system becomes operational and specified notice requirements are met. Sets penalties for noncompliance. (Sec. 904) Requires each State to establish a system accessible by telephone that any licensee, law enforcement officer, or court may contact for criminal history information. (Sec. 905) Provides for the correction of erroneous system information as well as a private course of action after all administrative remedies are exhausted and records are not corrected. (Sec. 906) Directs the Attorney General to expedite: (1) the incorporation of the remaining State criminal history records into the Federal criminal records systems maintained by the FBI; and (2) the development of hardware and software systems to link State criminal history check systems into the National Crime Information Center. (Sec. 907) Sets forth provisions regarding: (1) access to State criminal records; and (2) funding for improvements in State records systems. (Sec. 910) Authorizes appropriations. Subtitle B: Drug Trafficking in Rural Areas - Amends the Omnibus Act to authorize appropriations and increase the base allocation for rural drug enforcement assistance. (Sec. 912) Directs the Attorney General to establish a Rural Crime and Drug Enforcement Task Force in each of the Federal judicial districts which encompass significant rural lands. Specifies that assets seized as a result of investigations initiated by such a task force shall be used primarily to enhance the operations of the task force and its participating State and local LEAs. (Sec. 913) Authorizes the Attorney General to cross-designate up to 100 law enforcement officers with jurisdiction to enforce CSA provisions on non-Federal lands and the Federal criminal code to the extent necessary to effect the purposes of this Act. Directs the Attorney General to ensure that each of the task forces are adequately staffed with investigators. (Sec. 914) Requires the Director of the Federal Law Enforcement Training Center to develop a specialized course for training law enforcement officers from rural agencies in the investigation of drug trafficking and related crimes. Authorizes appropriations and the hiring of additional Drug Enforcement Administration agents. Subtitle C: Miscellaneous - Enhances penalties for drug trafficking in prisons. (Sec. 922) Amends the CSA and the Controlled Substances Import and Export Act to reduce the amount of cocaine involved in an offense which is necessary to trigger specified penalties. Subjects a person convicted for the possession of a mixture or substance which contains cocaine (currently, cocaine base) to specified penalties. Directs the Sentencing Commission to promulgate necessary amendments to conform the sentencing guidelines to the amendments made by this section. Title X: Miscellaneous - Amends the Higher Education Act of 1965 to prohibit the award of Pell grants to any individual incarcerated in a Federal or State penal institution. (Sec. 1002) Makes a person who is incarcerated in a Federal or State penal institution ineligible for any professional or commercial license provided by any agency or authority of the United States. (Sec. 1003) Amends the Social Security Act to make certain limitations on, and requirements regarding, the payment of Old Age, Survivors, and Disability Insurance Benefits to prisoners applicable to individuals convicted of any criminal offense (currently, a felony). (Sec. 1004) Sets limitations on the use of veterans' educational assistance by prisoners. Makes such limits inapplicable with respect to any period during which a person is participating in a work-release program or is residing in a halfway house. Title XI: Penalties for Harassment or Obstruction of Lawful Hunting - Recreational Hunting Safety and Preservation Act of 1994 - Makes it unlawful to intentionally obstruct a lawful hunt on Federal lands. (Sec. 1105) Establishes: (1) civil penalties for such violations; (2) procedures for individual and Government agent complaints; and (3) permitted uses of collected penalty money. (Sec. 1106) Authorizes injunctive relief. Permits an affected individual or sportsman's organization to bring a civil action to recover actual and punitive damages and attorney's fees. (Sec. 1107) Specifies that: (1) this title is not intended to preempt a State law or local ordinance that provides for civil or criminal penalties for a person who obstructs or otherwise interferes with a lawful hunt; and (2) the bringing of an action pursuant to this title shall not prevent an independent action against a person under a State law or local ordinance. Title XII: Violent Crime Reduction Trust Fund - Directs the President, through the Office of Management and Budget (OMB), to ensure that the number of full-time equivalent positions in all Federal agencies does not exceed specified limits during FY 1994 through 1998. (Sec. 1203) Establishes within the Treasury a Violent Crime Reduction Trust Fund. Requires specified amounts saved from the reduction in Federal positions to be deposited in the Fund. (Sec. 1204) Requires the Director of OMB to reduce certain discretionary spending limits set forth in the Congressional Budget Act for FY 1994 through 1998 as specified.

DRAFT ECSC OPERATING BUDGET FOR 1995

European Union · European Commission · 27 July 1994

Council Regulation (ECSC, EC, Euratom) No 1923/94 of 25 July 1994 amending the Financial Regulation of 21 December 1977 applicable to the general budget of the European Communities

European Union · EUR-Lex · 25 July 1994

Proposal for a Council Regulation (EC, ECSC, Euratom) amending the Financial Regulation of 21 December 1977 applicable to the general budget of the European Communities

European Union · European Commission · 22 July 1994

Environmental Technologies Act of 1994

United States · United States Congress · 20 July 1994

TABLE OF CONTENTS: Title I: General Provisions Title II: Policy Coordination and Technology Programs Subtitle A: Policy Coordination and Program Planning Subtitle B: Environmental Technology Innovation Initiative Subtitle C: Other Research Activities Title III: Performance Measurements Title IV: Department of Energy Environmental Technology Development Title V: Authorization of Appropriations Title I: General Provisions - Environmental Technologies Act of 1994 - Sets forth congressional findings and purposes. Title II: Policy Coordination and Technology Programs - Subtitle A: Policy Coordination and Program Planning - Requires the President, acting through the Director of the Office of Science and Technology Policy, to develop an interagency strategy that: (1) ensures the coordinated, interagency promotion of the research, development, and demonstration of environmental technologies; and (2) develops priorities for Federal environmental technology efforts. (Sec. 202) Requires the Director to coordinate Federal activities and resources that are applied to life-cycle assessment and other design-for-environment resources in order to maximize the contribution of such assessments and resources to the efficient design, development, and use of such technologies and to sustainable economic development. (Sec. 203) Amends the Stevenson-Wydler Technology Innovation Act of 1980 to include goals for sustainable economic development within technology innovation programs. Includes such goals in other existing programs under specified Acts. Subtitle B: Environmental Technology Innovation Initiative - Establishes an Environmental Innovation Initiative, to be administered by the Administrator of the Environmental Protection Agency (EPA), to promote the research, development, and demonstration of technologies that will contribute to sustainable economic development. Includes programs established under this Act in the Initiative. Provides assistance to eligible entities. (Sec. 211) Requires the Administrator to encourage the participation of socially and economically disadvantaged individuals and entities located in economically depressed areas in carrying out the Initiative. (Sec. 212) Directs the Administrator to conduct an interagency innovative environmental technology program to develop or demonstrate advanced precommercial environmental technologies. Makes U.S. companies and partnerships eligible for financial assistance for projects, subject to certain conditions. Provides for recoupment of assistance in connection with projects which have led to the development of a marketed product or process. (Sec. 213) Establishes the President's Total Environmental Quality Award to be awarded periodically to companies and other organizations which have benefited the United States through environmental technologies. Establishes a National Environmentally Sound Technology Award for individuals who have pioneered the development and use of a highly innovative environmental technology. (Sec. 214) Directs the Administrator to use existing information network capabilities to provide access to data on environmental technologies developed, tested, verified, or certified by programs under this Act and by other appropriate sources. (Sec. 215) Requires the Administrator to establish a program to demonstrate the performance of environmental technologies at Federal laboratories and facilities. (Sec. 216) Directs the Administrator to enter into an agreement with the National Research Council to study the influences on technological innovation in environmental technologies of economic, governmental, and other incentives and barriers. Subtitle C: Other Research Activities - Requires the Director of the National Science Foundation (NSF) to support research activities that will advance the integration of engineering practices and environmental protection in the development of advanced technologies. Title III: Performance Measurements - Requires the Secretary of Commerce, through the Director of the National Institute of Standards and Technology, to establish a program that provides for performance measurements for environmental technology products (excluding those primarily intended to improve the environment through pollution control, remediation, and monitoring). (Sec. 302) Authorizes the Administrator to designate entities to perform environmental technology verification. (Sec. 303) Requires the President to consider performance measurements for environmental technologies developed pursuant to this title in any program for evaluating and approving Federal purchases of environmental technologies. Title IV: Department of Energy Environmental Technology Development - Directs the Secretary of Energy to conduct programs of research, development, and demonstration on: (1) new and improved technologies for environmental restoration and waste management; (2) training for environmental technicians, engineers, and scientists; and (3) technologies for reducing worker exposure to radioactivity in association with site remediation. (Sec. 402) Requires the Secretary to establish a program to demonstrate the technological and economic feasibility of recycling and reusing radioactively uncontaminated and decontaminated metals and equipment and of other waste minimization techniques. Provides for the recycling and reuse of the metals and equipment at a minimum of three national laboratories or former nuclear weapons production facilities. (Sec. 403) Directs the Secretary to incrementally increase the proportion of the annual budget request for the Environmental Restoration and Waste Management program that is attributable to research and development until such proportion is at least ten percent. Requires the Secretary to ensure that such increase does not affect other Department of Energy programs. Authorizes appropriations for nondefense research and development activities of the Office of Technology Development. Title V: Authorization of Appropriations - Authorizes appropriations.

Health Security Act

United States · United States Congress · 19 July 1994

TABLE OF CONTENTS: Title I: Health Care Security Subtitle A: Universal Coverage and Individual Responsibility Subtitle B: Benefits Subtitle C: State Responsibilities Subtitle D: Consumer Purchasing Cooperatives Subtitle E: Employer Purchasers Subtitle F: Health Plans Subtitle G: Federal Responsibilities Subtitle H: Miscellaneous Employer Responsibilities Subtitle I: General Definitions; Miscellaneous Provisions Title II: Long-Term Care Title III: Public Health Initiatives Subtitle A: Workforce Priorities Under Federal Payments Subtitle B: Academic Health Centers Subtitle C: Health Research Initiatives Subtitle D: Core Functions of Public Health Programs; National Initiatives Regarding Preventive Health Subtitle E: Health Services for Medically Underserved Populations Subtitle F: Mental Health; Substance Abuse Subtitle G: Comprehensive School Health Education; School-Related Health Services Subtitle H: Public Health Service Initiative Subtitle I: Additional Provisions Regarding Public Health Subtitle J: Occupational Safety and Health Subtitle K: Full Funding for WIC Subtitle L: Border Health Improvement Title V (sic): Quality and Consumer Protection Subtitle A: Quality Management and Improvement Subtitle B: Information Systems, Privacy, and Administrative Simplification Subtitle C: Remedies and Enforcement Subtitle D: Medical Malpractice Subtitle E: Expanded Efforts to Combat Health Care Fraud and Abuse Subtitle F: Repeal of Exemption Title VI: Premium Caps; Premium-Based Financing; and Plan Payments Subtitle A: Premium Caps Subtitle B: Premium-Related Financings Subtitle C: Payments to Health Plans and Miscellaneous Provisions Title VIII (sic): Health and Health-Related Programs of the Federal Government Subtitle E (sic): Amendments to the Employee Retirement Income Security Act of 1974 Title IX: Aggregate Government Payments Subtitle B (sic): Aggregate Federal Payments to Participating State Subtitle C: Borrowing Authority to Cover Cash-Flow Shortfalls Title X: Workers Compensation Medical Services Title XI: Transitional Insurance Reform Health Security Act - Title I: Health Care Security - Subtitle A: Universal Coverage and Individual Responsibility - Entitles each eligible individual to: (1) the benefit provided under subtitle B through the applicable health plan in which the individual is enrolled; and (2) a health security card to be issued by the alliance or other entity that offers the applicable health plan in which the individual is enrolled. Entitles a Medicare-eligible individual to benefits under Medicare instead of the provisions of this Act. (Sec. 1002) Requires each eligible individual to enroll in an applicable health plan and pay any required premium. Prohibits disenrollment of an eligible individual until the individual is either enrolled in another plan or becomes Medicare-eligible. (Sec. 1003) States that nothing in this Act shall be construed as prohibiting: (1) an individual from purchasing any health services; (2) an individual from purchasing supplemental insurance; (3) an individual who is not an eligible individual from purchasing health insurance; or (4) employers from providing additional coverage. (Sec. 1004) Prescribes principles applicable to all health plans, including: (1) nondiscrimination based on medical history, pre- existing medical conditions, or genetic predisposition to medical conditions; (2) open enrollment periods; and (3) the provision of services as defined in the benefits package. (Sec. 1005) States that a community-rated health plan is the applicable plan for a family, unless a family member is eligible for an experienced-rated health plan. (Sec. 1006) Prohibits an ineligible alien from enrolling in a health plan under this Act. Subtitle B: Benefits - Includes the following terms and services in the comprehensive benefit package: (1) hospital services; (2) services of health professionals; (3) emergency and ambulatory medical and surgical services; (4) clinical preventive services; (5) mental illness and substance abuse services; (6) family planning services and services for pregnant women; (7) hospice care; (8) home health care; (9) extended care services; (10) ambulance services; (11) outpatient laboratory, radiology, and diagnostic services; (12) outpatient prescription drugs and biologicals; (13) outpatient rehabilitation services; (14) durable medical equipment and prosthetic and orthotic devices; (15) vision care; (16) hearing aids for children; (17) dental care; (18) investigational treatments; and (19) optional services. (Sec. 1131) Requires each health plan to offer to its enrollees only one of the following cost sharing schedules: (1) lower cost sharing; (2) higher cost sharing; or (3) combination cost sharing. Provides that the annual maximum out-of-pocket expenses for an individual in any of the plans shall be $2500 and for a family the annual maximum shall be $3000. (Sec. 1141) Excludes the following items and services: (1) an item or service that is not medically necessary or appropriate; (2) an item or service that the National Health Board may determine is not medically necessary or appropriate; (3) custodial care, except hospice care; (4) surgery performed solely for cosmetic purposes, unless required to correct a congenital anomaly or performed to correct a part of the body altered by either disease or accident; (5) hearing aids; (6) eyeglasses and contact lenses for individuals at least 18 years of age; (7) in vitro fertilization; (8) sex change surgery and related services; (9) private duty nursing; (10) personal comfort items, except in the case of hospice care; and (11) any dental procedures involving orthodontic care, inlays, gold or platinum fillings, bridges, crowns, pin-post retention, dental implants, surgical periodontal procedures, or the preparation of the mouth for the fitting or continued use of dentures, except as specified. (Sec. 1151) Gives the National Health Board the authority to promulgate such regulations or establish such guidelines as necessary to assure uniformity in the application of the comprehensive benefit package across all health plans. Permits the Board to expand the benefit package. (Sec. 1162) Permits a health professional or facility to refuse to provide a benefit if the professional or facility objects on the basis of a religious belief or moral conviction. (Sec. 1163) Requires facilities to promptly report incorrect test results to the provider who ordered the test. Subtitle C: State Responsibilities - Requires a State, in order to be approved as a participating State, to submit a document describing the State's health care system. (Sec. 1201) Sets forth general responsibilities for participating States. (Sec. 1207) Requires the establishment of a National Center of Consumer Advocacy to provide technical assistance, adequate training, and support to States and Offices of Consumer Advocacy in each State. (Sec. 1209) Requires a State to designate an agency to coordinate the delivery of medical and social services to children with special health care needs. (Sec. 1221) Permits a State, with the Board's approval, to operate a single-payer system if specified requirements are met. (Sec. 1281) Provides for reductions in cost sharing for certain low-income families enrolled in community-rated health plans. Subtitle D: Consumer Purchasing Cooperatives - Requires a State to certify consumer purchasing cooperatives to: (1) enter into agreements with health plans; (2) enter into agreements with community-rated employers; (3) enroll eligible individuals in health plans; (4) make payments to health plans on behalf of community-rated employers and eligible individuals; (5) provide for coordination with other cooperatives; (6) provide information on health plans; and (7) carry out other functions as provided in this title. (Sec. 1321) Provides for the Federal Employees Health Benefits Program (FEHBP) to serve as a consumer purchasing cooperative in each health care coverage area designated by a State. Subtitle E: Employer Purchasers - Sets forth the responsibilities of employer purchasers of health plans. (Sec. 1411) Directs the Secretary of Labor to develop and publish standards applicable to employer sponsored plans offered by large group purchasers. Subtitle F: Health Plans - Sets forth requirements for the certification of health plans by a State. (Sec. 1531) Sets forth requirements relating to essential community providers. Subtitle G: Federal Responsibilities - Establishes the National Health Board in the Executive Branch. (Sec. 1603) Sets forth the general duties and responsibilities of the Board, including an annual report to the President and the Congress. (Sec. 1611) Requires the Board to approve a State health care system if the system meets the applicable requirements of this Act. Prohibits approval of a State health care system prior to 1996. (Sec. 1621) Provides for the Federal assumption of responsibilities in the absence of a State system. (Sec. 1641) Directs the Board to develop a risk adjustment and reinsurance methodology. Sets forth guidelines for developing such methodology. (Sec. 1651) Directs the Board to establish minimum capital requirements for community-rated health plans. (Sec. 1660) Requires the Board to establish a national annual open enrollment period. (Sec. 1671) Sets forth the responsibilities of the Secretary of Health and Human Services. Directs the Secretary to administer and implement all provisions of this Act, except those duties delegated to the Board, any other executive agency, or to any State. (Sec. 1672) Directs the Secretary to undertake an interdisciplinary medical technology impact study to assess the overall effect on patient outcomes of medical technologies used in treating a list of target diseases and conditions. (Sec. 1681) Provides for the certification of essential community providers. Sets forth the categories of providers automatically certified. (Sec. 1687) Directs the Secretary to perform responsibilities with respect to the development of workplace wellness programs. (Sec. 1691) Sets forth the responsibilities of the Secretary of Labor in administering provisions of this Act and related Acts. (Sec. 1695) Provides for collective bargaining dispute resolution for the transition period to a restructured health care delivery system. Subtitle H: Miscellaneous Employer Responsibilities - Sets forth employer responsibilities including: (1) auditing of records; (2) prohibitions on discrimination based on family status; (3) evasion of obligations; (4) prohibitions on self-funding of cost sharing benefits; and (5) obligations to retirees. Subtitle I: General Definitions; Miscellaneous Provisions - Sets forth the definitions and rules used in this Act. (Sec. 1911) Grants the National Health Board, the Secretary of Health and Human Services, and the Secretary of Labor authority to issue regulations as necessary to permit the timely implementation of this Act. (Sec. 1917) Expresses the sense of the Senate Committee on Labor and Human Resources that when the Health Security Act is enacted it should include specified sources of financing not within the jurisdiction of the Committee. Expresses the sense of such Committee that when health reform legislation is enacted it should include the permanent extension of the research and development tax credit. (Sec. 1918) Expresses the sense of such Committee that provisions encouraging the establishment of medical savings accounts be included in any health reform bill passed by the Senate, in conjunction with a comprehensive benefit package described in subtitle B of this title. Title II: Long-Term Care - Establishes requirements for State programs for home and community-based services to individuals with disabilities. Requires a State to consult with individuals and groups of individuals with disabilities when developing the plan in order to have the plan approved. (Sec. 2103) Defines individuals with disabilities to mean any individual within one or more of the following four categories: (1) individuals requiring help with the activities of daily living; (2) individuals with severe cognitive or mental impairment; (3) individuals with severe or profound mental retardation; and (4) severely disabled children. (Sec. 2107) Directs the Secretary to establish an advisory group to advise on all aspects of such State programs. (Sec. 2111) Provides financial assistance to States to assist in developing and implementing, or expanding and enhancing, a family- centered, culturally competent, community-centered, comprehensive statewide system of extended services and benefits for children with special health care needs. (Sec. 2201) Long-Term Care Insurance Improvement and Accountability Act - Amends the Public Health Service Act to mandate the establishment of model Federal standards for long-term care insurance. (Sec. 2301) Life Care Act - Amends the Public Health Service Act to establish a voluntary long-term care insurance program for individuals 35 years of age and over to cover the nursing home stays of such individuals. (Sec. 2303) Expresses the sense of the Senate Committee on Labor and Human Services concerning the success of PACE (Program of All- inclusive Care for the Elderly) in providing integrated service delivery. Title III: Public Health Initiatives - Subtitle A: Workforce Priorities Under Federal Payments - Establishes within the Department of Health and Human Services the National Council on Graduate Medical Education. Directs the National Council to designate for each academic year the number of individuals nationwide who are authorized to be enrolled in each specified approved physician training program for each medical specialty. (Sec. 3031) Makes funds available for: (1) qualified entities for the operation of approved physician training programs; (2) eligible medical schools for the direct costs of academic programs; and (3) qualified academic health centers or teaching hospitals. (Sec. 3071) Directs the Secretary to carry out a program with respect to graduate nurse training programs that is equivalent to the program for approved physician training programs. Establishes a National Council on Graduate Nurse Education. (Sec. 3081) Authorizes appropriations to the Secretary of Health and Human Services for the following programs: (1) primary care physician and physician assistant training; (2) training of underrepresented minorities and disadvantaged persons; (3) expanding rural health career opportunities and retention efforts; and (4) nurse training. Directs the Secretary to establish a National Advisory Board on Health Care Workforce Development to make recommendations on health care worker matters. Amends the Public Health Service Act to authorize appropriations for grants to improve the training of health care workers in assisting the needs of mentally retarded individuals and others with developmental disabilities. (Sec. 3082) Authorizes appropriations to the Secretary of Labor for a retraining program, a demonstration program for advanced career positions, and a workforce adjustment program. Subtitle B: Academic Health Centers - Authorizes appropriations for grants for: (1) rural information and referral systems; and (2) community- and provider-based health plans to provide services of eligible centers to residents of rural or urban communities. Subtitle C: Health Research Initiatives - Amends the Public Health Service Act to ensure that the National Institutes of Health conducts and supports biomedical and behavioral research on promoting health and preventing diseases, disorders, and other health conditions. Provides for health services research. Authorizes appropriations for such research. Subtitle D: Core Functions of Public Health Programs; National Initiatives Regarding Preventive Health - Authorizes appropriations for the core functions of public health programs and national initiatives regarding health promotion and disease prevention. Subtitle E: Health Services for Medically Underserved Populations - Authorizes appropriations for: (1) grants and contracts for the development of qualified community health plans and networks; (2) loans and grants for the capital costs of developing qualified community health groups; and (3) grants and contracts for enabling and supplemental services. (Sec. 3471) Authorizes appropriations for: (1) the National Health Service Corps; and (2) such amounts as are necessary to ensure that a specified percentage of participants in the Scholarship Program or the Loan Repayment Program of the Corps are nurses. (Sec. 3481) Entitles a hospital with a low-income utilization rate to specified payments. (Sec. 3491) Expresses the sense of the Senate Committee on Labor and Human Resources on the appropriate recognition of the success of community and migrant health centers. Subtitle F: Mental Health; Substance Abuse - Authorizes appropriations for grants to States for the development and operation of comprehensive managed mental health and substance abuse programs that are integrated with the health delivery system established under this Act. Subtitle G: Comprehensive School Health Education; School- Related Health Services - Authorizes appropriations for: (1) the development and implementation of comprehensive age appropriate health education programs in public schools for children and youth kindergarten through grade 12; and (2) increase access to preventive and primary health care services for children and youth through school-based or school-linked health service sites. Subtitle H: Public Health Service Initiative - Specifies the initiatives under this Act to be funded through funds not otherwise appropriated. Subtitle I: Additional Provisions Regarding Public Health - Requires the Secretary to reserve allocated appropriations for curriculum development and implementation regarding domestic violence and women's health needs. Subtitle J: Occupational Safety and Health - Directs the Secretary of Health and Human Services and the Secretary of Labor to work together to develop and implement a comprehensive program to expand and coordinate initiatives to prevent occupational injuries and illnesses. Subtitle K: Full Funding for WIC - Amends the Child Nutrition Act of 1966 to authorize appropriations for the special supplemental food program. Subtitle L: Border Health Improvement - Authorizes the President to conclude an agreement with Mexico to establish a binational commission to be known as the United States-Mexico Border Health Commission. Title V (sic): Quality and Consumer Protection - Subtitle A: Quality Management and Improvement - Requires the National Health Board to establish and oversee a performance-based program of quality management and improvement designed to enhance the quality, appropriateness, and effectiveness of health care services and access to such services which will be called the National Quality Council. (Sec. 5002) Specifies the duties of such Council. Subtitle B: Information Systems, Privacy, and Administrative Simplification - Directs the National Health Board to develop standards under which health care providers and health plans collect information for a national health care data network. (Sec. 5135) Authorizes the Board to make grants for demonstration projects to promote the development and use of electronically integrated community-based clinical information systems and computerized patient medical records. (Sec. 5160) Health Care Privacy Protection Act - Amends Federal criminal law to prescribe penalties for the wrongful disclosure of protected health information and the misuse of health security cards. (Sec. 5163) Provides limitations on the disclosure of protected health information. (Sec. 5195) Requires the Board to publish standard benefit forms. Subtitle C: Remedies and Enforcement - Sets forth provisions with respect to the review of benefit determinations for enrolled individuals, including provisions: (1) regulating the time limits for notice of disposition of a claim; (2) governing a plan's duty to review claim denials; (3) concerning urgent requests for preauthorization; and (4) concerning other time limits with respect to time limits and notice. (Sec. 5202) Requires each State to establish a complaint review office to permit aggrieved individuals to file complaints. (Sec. 5205) Provides for a Federal Health Plan Review Board to review the decisions of complaint review office hearing officers. (Sec. 5206) Sets monetary penalties for a plan which unreasonably denies or delays payment or provision of benefits. (Sec. 5211) Directs each State to establish and maintain an Early Resolution Program in each complaint review office. Requires a program to include: (1) forums for mediation of disputes; and (2) other forums of alternative dispute resolution as may be prescribed. (Sec. 5231) Sets forth additional remedies and enforcement provisions. Subtitle D: Medical Malpractice - Requires States to adopt an alternative dispute resolution system mechanism under which the parties must participate prior to the commencement of a medical malpractice action. Subtitle E: Expanded Efforts to Combat Health Care Fraud and Abuse - Requires the Secretary of Health and Human Services and the Attorney General to establish a joint program for health care fraud and abuse control. (Sec. 5421) Amends Federal criminal law to impose penalties for health care fraud, theft or embezzlement in connection with health care, false statements relating to health care matters, and bribery and graft relating to health care. Subtitle F: Repeal of Exemption - Amends specified Acts to repeal the exemption for health insurance. Title VI: Premium Caps; Premium-Based Financing; and Plan Payments - Subtitle A: Premium Caps - Sets forth provisions which provide for the computation of factors that limit the growth of premiums for the comprehensive benefit package in community-rated health plans. (Sec. 6002) Directs the Board to determine: (1) a national per capita baseline premium target; and (2) the health care coverage area per capita premium target. (Sec. 6006) Directs the chair of the Board to establish an advisory commission on regional variations in health expenditures. Requires the commission to examine methods of eliminating variation in health care coverage area per capita premium targets due to variation in practice patterns. (Sec. 6011) Subjects each noncomplying community-rated health plan for a year to a reduction in plan payment as specified, in order to assure that payments to community-rated health plans are consistent. (Sec. 6021) Directs the Board to develop a methodology for calculating an annual per capita expenditure equivalent for amounts paid for coverage for the comprehensive benefit package within a large group purchaser. (Sec. 6031) Sets forth special rules for a single-payer State. (Sec. 6041) Directs the Secretary to establish a program to monitor prices and expenditures in the U.S. health care system. Subtitle B: Premium-Related Financings - Makes each family enrolled in a community-rated health plan or an experienced-rated health plan in a class of family enrollment responsible for payment of the family share of premium. Provides for income-related discounts and specified credits. (Sec. 6116) Exempts certain employers from coverage obligations. (Sec. 6121) Specifies premium payments for community-rated employers, including premium discounts. (Sec. 6131) Specifies premium payments for large group purchasers. Subtitle C: Payments to Health Plans and Miscellaneous Provisions - Makes States responsible for assisting health plans and cooperatives in the collection of premium payments. Sets forth other duties and responsibilities of States and health plans with respect to payments and other administrative matters. Title VIII (sic): Health and Health-Related Programs of the Federal Government - Subtitle E (sic): Amendments to the Employee Retirement Income Security Act of 1974 - Amends the Employee Retirement Income Security Act of 1974 (ERISA) to define group health plan. (Sec. 8402) Sets limitations on coverage of group health plans under title I (Protection of Employee Benefit Rights) of ERISA. Authorizes the Secretary of Labor to provide special rules for group health plan reporting and disclosure. Makes provisions relating to interference with protected rights and coercive interference applicable to enrollees in large group purchaser health plans. (Sec. 8403) Revises certain continuation coverage requirements (from COBRA - the Consolidated Omnibus Budget Reconciliation Act) under ERISA with respect to group health plans. Repeals ERISA provisions for continuation coverage under group health plans upon full implementation of universal coverage under this Act. Amends the Public Health Service Act with respect to period of coverage under a qualified health plan. Repeals such coverage provisions upon full implementation of universal coverage under this Act. (Sec. 8404) Ends certain ERISA provisions' applicability with respect to: (1) cases of adoption, to the extent otherwise provided in regulations of the National Health Board under this Act; and (2) coverage of pediatric vaccines under group health plans, upon the plan's becoming a large group purchaser health plan under this Act. (Sec. 8405) Requires group health plans covered by specified ERISA provisions to comply with the requirements of this Act for health plan claims procedures. (Sec. 8406) Exempts the Hawaii Prepaid Health care Act from certain ERISA preemption provisions, under specified conditions. Title IX: Aggregate Government Payments - Subtitle B (sic): Aggregate Federal Payments to Participating State - Directs the Secretary of Health and Human Services (HHS) to pay a capped Federal entitlement payment amount to each participating State in each calendar quarter. Sets forth formulas and rules for capped entitlement payments. Subtitle C: Borrowing Authority to Cover Cash-Flow Shortfalls - Directs the Secretary of HHS to make available loans to States to cover any period of temporary cash-flow shortfall attributable to an estimation discrepancy, an administrative error, or relative timing during the year in which amounts are received and payments are required to be made. (Sec. 9201) Requires each State to provide that any surplus of funds resulting from an estimation discrepancy, up to a reasonable amount specified by the Secretary of HHS, shall be held in a State contingency fund for any future shortfalls from such a discrepancy. Title X: Workers Compensation Medical Services - Makes specified provisions under this Act (HSA) relating to use of standard forms and health care information applicable to a health plan or health care provider's provision of workers compensation medical services. Requires plans and providers that render such services to: (1) provide relevant health care information necessary to assist the worker in the safe and timely return to work; and (2) comply with legal duties and reporting requirements under State workers compensation laws and other Federal and State laws, including those regarding reporting of occupational injuries and diseases. Directs the Secretary of Labor to promulgate rules to clarify such plan and provider information responsibilities. (Sec. 10001) Requires health plans to provide care in disputed workers compensation cases, until an adjudicated determination is made that the claim is compensable as workers compensation. Requires the workers compensation carrier (or the self-insured employer) to reimburse the health plan and the worker if such determination is made. (Sec. 10002) Directs the Secretaries of HHS and Labor to conduct demonstration projects in one or more States with respect to treatment of work-related injuries and illnesses. Requires project development of: (1) protocols for treatment of work-related conditions; and (2) model methods of workers compensation carriers capitated payment on a per case basis to health plans for treatment of specified work-related injuries and illnesses. (Sec. 10003) Establishes a Commission on Workers Compensation Medical Services. Directs the Commission to study the relationship of workers compensation medical services to the new health system under this Act in terms of impact on the cost of such services, access to appropriate care for injured workers, and quality of medical care and its impact on functional and vocational outcomes for injured workers, considering specified issues. Requires the Commission's final report to the President and specified congressional committees to include a recommendation as to whether a transfer of financial responsibility for some or all medical benefits to health plans should be effected, along with a detailed implementation plan if such transfer is recommended. Title XI: Transitional Insurance Reform - Sets forth transitional provisions concerning: (1) enforcement; (2) preservation of current coverage; (3) restrictions on premium increases during transition; (4)portability requirements; (5) restrictions limiting benefit reductions; and (6) the establishment of the National Transitional Health Insurance Risk Pool.

To amend the Congressional Budget Act of 1974 to make section 313 (relating to extraneous matter in reconciliation legislation and popularly known as the Byrd rule) applicable to the Senate only.

United States · United States Congress · 19 July 1994

Amends the Congressional Budget Act of 1974 to make provisions relating to extraneous matter in reconciliation legislation (popularly known as the Byrd rule) applicable to the Senate only.

proposition de résolution sur l'avant-projet de budget général des communautés européennes pour l'exercice 1995 (Volume 1 - A - Etat général des recettes - B - Financement du budget général), (n° E-260)

France · Senate · 16 July 1994

Federal Mandate Accountability and Reform Act of 1994

United States · United States Congress · 14 July 1994

TABLE OF CONTENTS: Title I: Legislative Accountability and Reform Title II: Regulatory Accountability and Reform Title III: Judicial Review Title IV: Baseline Study Federal Mandate Accountability and Reform Act of 1994 - Title I: Legislative Accountability and Reform - Requires each congressional committee of authorization to issue with every reported bill containing a Federal mandate an analysis of the fiscal impact of that mandate on State, local, and tribal governments, especially to the extent it: (1) imposes new enforceable duties; or (2) reduces or eliminates Federal financial assistance. (Sec. 102) Requires the Director of the Congressional Budget Office (CBO) to study and report on any proposed legislation establishing, amending, or reauthorizing any Federal program likely to have a significant budgetary impact on State, local, or tribal governments, especially any direct costs below or above $50 million threshold. Authorizes appropriations to CBO to conduct such studies. (Sec. 103) Provides for a point of order against any reported legislation unless it has a CBO Director report and either: (1) the direct costs of all Federal mandates in the legislation are estimated at less than $50 million in each of up to five fiscal years; or (2) the increase in authorization of appropriations under existing or for new Federal financial assistance programs provided by the legislation and usable by State, local, or tribal governments for mandate-subject activities is at least equal to the estimated direct costs of the mandates; and (3) the committee of jurisdiction has identified a reduction in authorization of existing appropriations, a reduction in direct spending, or an increase in receipts. Title II: Regulatory Accountability and Reform - Requires each agency to: (1) assess the effects of Federal regulations on State, local, and tribal governments, including the availability of resources to carry out any mandates in those regulations; and (2) seek to minimize those burdens that uniquely or significantly affect such governmental entities, consistent with achieving statutory and regulatory objectives. (Sec. 201) Directs each agency to develop an effective process to permit elected officials and other representatives of State, local, and tribal governments to provide meaningful and timely input in the development of regulatory proposals. Authorizes appropriations. (Sec. 202) Requires each agency to prepare a written statement of specified estimates before promulgating any notice of proposed rulemaking or final rule including Federal mandates that may result in aggregate State, local, or tribal expenditures of $100 million or more in any one year. (Sec. 203) Requires the Director of the Office of Management and Budget (OMB) to collect such statements and forward copies to the CBO Director. (Sec. 204) Requires the OMB Director to establish pilot programs in at least two agencies to test innovative and more flexible regulatory approaches that: (1) reduce reporting and compliance burdens on small governments; and (2) meet overall statutory goals and objectives. Title III: Judicial Review - Declares that any reports or statements prepared under this Act, any compliance or noncompliance with it, and any determination concerning its applicability shall not be subject to judicial review. Title IV: Baseline Study - Requires the Director of the Bureau of the Census to examine the measurement and definition issues involved in calculating the total costs and benefits to State, local, and tribal governments of compliance with Federal law. Requires such study to consider the feasibility of measuring indirect costs and benefits as well as the direct costs and benefits of the Federal, State, local, and tribal relationship. Authorizes appropriations.

Housing Choice and Community Investment Act of 1994

United States · United States Congress · 13 July 1994

TABLE OF CONTENTS: Title I: Assistance for the Homeless Title II: Public and Indian Housing Subtitle A: Enhanced Flexibility for Public Housing Agencies Subtitle B: Severely Distressed Public Housing Program Subtitle C: Anti-Crime Initiatives Subtitle D: Authorizations and Extensions Subtitle E: Applicability Subtitle F: Termination of Certain Assisted Housing Programs Subtitle G: Midnight Basketball League Training and Partnership Subtitle H: Miscellaneous Provisions Title III: Homeownership Subtitle A: Expanded Single Family Homeownership Opportunities Subtitle B: Miscellaneous Provisions Subtitle C: Authorizations Title IV: Section 8 Rental Assistance Title V: Home Investment Partnerships Title VI: Multifamily and Supportive Housing Subtitle A: Preservation Subtitle B: Renewal of Expiring Section 8 Contracts Subtitle C: Other Section 8 Program Amendments Subtitle D: Supportive Housing Subtitle E: Miscellaneous Provisions Title VII: Community and Economic Development Title VIII: Nonjudicial Foreclosure of Defaulted Single Family Mortgages Title IX: Rural Housing Title X: Regulatory and Miscellaneous Programs Housing Choice and Community Investment Act of 1994 - Title I: Assistance for the Homeless - Stewart B. McKinney Homeless Housing Assistance Reorganization Act of 1994 - Replaces specified homeless assistance programs with a program of grants for comprehensive assistance for homeless individuals and families. Authorizes appropriations. Title II: Public and Indian Housing - Subtitle A: Enhanced Flexibility for Public Housing Agencies - Amends the United States Housing Act of 1937 to authorize the Secretary of Housing and Urban Development to make public housing direct loans. Authorizes appropriations. (Sec. 202) Authorizes the use of modernization funds for replacement housing. (Sec. 205) Amends the Housing and Urban-Rural Recovery Act of 1983 to permit homeless families with children to use early childhood development program services. Authorizes appropriations. (Sec. 206) Authorizes an entrepreneurial public housing agency (PHA) and resident management corporation (RMC) demonstration program. (Sec. 209) Amends the United States Housing Act of 1937 to authorize the sale of public housing to nonprofit organizations to facilitate resident homeownership. Subtitle B: Severely Distressed Public Housing Program - Amends the United States Housing Act of 1937 to revise the severely distressed housing program, including grant level increases. Subtitle C: Anti-Crime Initiatives - Amends the Public and Assisted Housing Drug Elimination Act of 1990 to establish a community partnerships against crime program of grants to PHAs and owners of federally assisted low-income housing, entitled the Community Partnerships Against Crime Act of 1994. Authorizes appropriations. (Sec. 223) Directs law enforcement entities to make criminal records available to requesting PHAs for screening and eviction purposes. Subtitle D: Authorizations and Extensions - Amends the United States Housing Act of 1937 to increase budget authority for specified public and Indian housing programs. (Sec. 232) Authorizes appropriations for: (1) public housing operating subsidies; (2) the family self-sufficiency program; (3) family investment and economic opportunity centers; (4) the resident management and tenant opportunity program; and (5) the Indian housing loan guarantee program. Subtitle E: Applicability - Applies specified public housing provisions to Indian housing. Subtitle F: Termination of Certain Assisted Housing Programs - Terminates specified public and Indian housing programs. Subtitle G: Midnight Basketball League Training and Partnership - Midnight Basketball League Training and Partnership Act - Amends the Cranston-Gonzalez National Affordable Housing Act to provide grants for midnight basketball league training and partnership programs. Authorizes appropriations. Subtitle H: Miscellaneous Provisions - Provides for the deregulation of public housing agencies. Title III: Homeownership - Subtitle A: Expanded Single Family Homeownership Opportunities - Amends the National Housing Act to revise: (1) single family mortgage limits; and (2) refinancing procedures for qualifying Department of Housing and Urban Development (HUD)-held mortgages. (Sec. 303) Authorizes innovative affordable housing demonstration programs through the use of alternative financing instruments. Authorizes appropriations. (Sec. 304) Establishes a single family risk-sharing mortgage insurance program. Subtitle B: Miscellaneous Provisions - Amends the Cranston-Gonzalez National Affordable Housing Act to revise the national homeownership fund demonstration and to cite such provisions as the " National Homeownership Fund Demonstration Act". Authorizes appropriations. (Sec. 313) Amends the Housing and Community Development Act of 1992 to expand the energy efficient mortgages pilot program. Subtitle C: Authorizations - Amends the Federal National Mortgage Association Charter Act to authorize an aggregate amount of guaranteed loan principal under the mortgage-backed security program. (Sec. 322) Amends the National Housing Act to authorize an aggregate amount of Federal Housing Administration (FHA) mortgage insurance. (Sec. 323) Amends the Cranston-Gonzalez National Affordable Housing Act to authorize appropriations for the HOPE programs. (Sec. 324) Amends the National Housing Act to extend the home equity conversion mortgage program. Title IV: Section 8 Rental Assistance - Amends the United States Housing Act of 1937 to merge the section 8 public housing certificate and voucher programs into a single revised certificate program. (Sec. 403) Increases budget authority for family unification assistance. Title V: Home Investment Partnerships - Amends the Cranston-Gonzalez National Affordable Housing Act to authorize HOME program loan guarantees. Authorizes appropriations. Title VI: Multifamily and Supportive Housing - Subtitle A: Preservation - Amends the Housing and Community Development Act of 1987 to authorize appropriations for low-income housing preservation. Subtitle B: Renewal of Expiring Section 8 Contracts - Amends the United States Housing Act of 1937 to authorize the Secretary to enter into new section 8 construction and rehabilitation contracts. (Sec. 614) Directs the Secretary to provide assistance to tenants in units with expiring contracts. Authorizes appropriations for activities under this subtitle. Subtitle C: Other Section 8 Program Amendments - Amends the United States Housing Act of 1937 to provide incentives for multifamily mortgage refinancing. (Sec. 633) Authorizes civil penalties for violation of section 8 housing assistance payment contracts. Subtitle D: Supportive Housing - Authorizes appropriations for supportive housing service coordinators. (Sec. 643) Amends the Housing and Community Development Act of 1992 to authorize appropriations for: (1) supportive housing for the elderly; and (2) supportive housing for persons with disabilities. (Sec. 645) Amends the Cranston-Gonzalez National Affordable Housing Act to authorize appropriations for persons with AIDS. Subtitle E: Miscellaneous Provisions - Amends the Housing and Community Development Amendments of 1978 to authorize appropriations for the flexible subsidy program. (Sec. 653) Extends the multifamily mortgage credit demonstration program. (Sec. 655) Amends the National Housing Act to authorize civil penalties against general partners and certain managing agents of multifamily housing projects. (Sec. 658) Authorizes appropriations for the general insurance fund and the special risk insurance fund. (Sec. 659) Increases FHA mortgage insurance limits for multifamily housing in high cost areas. Title VII: Community and Economic Development - Amends the Housing and Community Development Act of 1974 to authorize the Secretary to make grants to stimulate economic development in specified investment areas (LIFT program). Authorizes appropriations. (Sec. 702) Authorizes, and authorizes appropriations for, a colonias assistance program. (Sec. 703) Amends the Cranston-Gonzalez National Affordable Housing Act to extend the colonias community development block grant (CDBG) set-aside. (Sec. 704) Amends the Housing and Community Development Act of 1974 to authorize CDBG appropriations. (Sec. 707) Amends the HUD Demonstration Act of 1993 to authorize appropriations for the community viability fund. (Sec. 708) Amends the Housing and Community Development Act of 1992 to authorize appropriations for: (1) the community investment corporation demonstration program; and (2) the national cities in schools program. (Sec. 710) Authorizes appropriations for water and wastewater projects for cities with special needs (defined to include minority communities with special needs). (Sec. 711) Amends the Housing and Community Development Act of 1974 to temporarily prohibit recapture or reduction of UDAG funds. Title VIII: Nonjudicial Foreclosure of Defaulted Single Family Mortgages - Single Family Mortgage Foreclosure Act of 1994 - Authorizes the Secretary to foreclose defaulted single family mortgages. Title IX: Rural Housing - Amends the Housing Act of 1949 to authorize appropriations for specified rural housing and related programs. (Sec. 902) States that Indian tribes and entities are eligible for rural housing assistance. (Sec. 903) Authorizes the Secretary of Agriculture to establish a Treasury escrow fund for rural housing loan payments. (Sec. 905) Extends set-aside authority for targeted rural areas and colonias (and increases colonia set-sides). (Sec. 906) Amends the rural housing for the elderly or handicapped program to: (1) reduce maximum loan periods; and (2) extend nonprofit entity set-asides. (Sec. 907) Permits migrant farmworker project rental assistance to be used for operating expenses. (Sec. 908) Makes manufactured home parks eligible for building site loans for cooperatives. (Sec. 911) Directs the Secretary of Agriculture to establish a rural housing capacity demonstration program for Native Americans and Alaskan Natives. Title X: Regulatory and Miscellaneous Programs - Amends the Residential Lead-Based Paint Hazard Reduction Act of 1992 to authorize appropriations, including specified set-asides, for lead-based paint reduction activities. (Sec. 1005) Amends the Housing and Urban Development Act of 1970 to authorize appropriations for HUD research and development. (Sec. 1007) Amends the Housing and Community Development Act of 1987 to authorize appropriations for the fair housing initiatives program. (Sec. 1008) Amends the Home Mortgage Disclosure Act of 1975 to authorize civil money penalties for reporting violations by nonsupervised lending institutions. (Sec. 1009) Amends the Cranston-Gonzalez National Affordable Housing Act to authorize appropriations for the Youthbuild program. (Sec. 1010) Amends the Neighborhood Reinvestment Corporation Act to authorize appropriations for the Neighborhood Reinvestment Corporation. (Sec. 1011) Amends the Department of Housing and Urban Development Act to authorize appropriations for HUD salaries and expenses. (Sec. 1013) Amends the National Housing Act to authorize civil money penalties for improper participation in the origination of title I (housing renovation and modernization) loans. (Sec. 1014) Cancels specified public facilities loan indebtedness of Lockport Township, Illinois. (Sec. 1015) Establishes the National Commission on the Future of the Federal Housing Administration. Sets aside Commission funding. Terminates the Commission 12 months after appointment of all its members.

Forest Fire and Pest Emergency Act

United States · United States Congress · 13 July 1994

Forest Fire and Pest Emergency Act - Declares that the reduction of natural fuels, on Federal lands within California that have been identified as extreme fire risk, constitutes an emergency action to prevent or to reduce risk to public health or safety or to serious resource loss for the duration of the drought there. Directs Federal agencies to work with State agencies to identify areas of extreme fire risk and take action to reduce natural fuels. Authorizes the use of emergency fire suppression funds to reduce natural fuels in such areas, provided reductions in the Sierra forests are consistent with the fuels management guidelines of the California Spotted Owl EA or subsequent EIS. Directs the Forest Service to prepare a budget request declaring an emergency in areas identified as requiring additional treatments due to drought or pest infestation on National forest lands. Directs Federal agencies to prepare, and submit to the Congress, a strategic fire plan and annual budget.

An original bill to authorize major medical facility construction projects for the Department of Veterans Affairs for fiscal year 1995, and for other purposes.

United States · United States Congress · 12 July 1994

Authorizes the Secretary of Veterans Affairs to carry out the major medical facility projects and leases for which funds are requested in the FY 1995 budget of the Department of Veterans Affairs. Authorizes additional major medical facility projects, in specified amounts, as well as projects for which funds were appropriated under the Emergency Supplemental Appropriations Act of 1994. Authorizes appropriations for FY 1995 for such projects and leases, with specified limitations. Authorizes the Secretary to undertake an administrative reorganization at the Department Medical Center in Sepulveda, California, as necessitated by the January 1994 earthquake there, without regard to a congressional waiting period requirement.

An original resolution expressing the sense of the Senate regarding conditions for continued United States participation under the Convention on Biological Diversity.

United States · United States Congress · 11 July 1994

Expresses the sense of the Senate that, in formulating U.S. participation under the Convention on Biological Diversity, the President should ensure that: (1) any proposal for funding includes specific budget offsets to ensure that the deficit is not increased; (2) a restructured Global Environmental Facility is the financing mechanism referred to in the Convention; (3) further decisions under the Convention provide adequate and effective protections for intellectual property and are not weaker than those provided under the General Agreement on Tariffs and Trade (GATT), U.S. laws, or the laws of other developed countries; (4) the United States has received a vote in all institutions, organizations, and mechanisms created under the Convention that is commensurate with the level of U.S. assessed contributions under the Convention; (5) the biological safety protocol is submitted to the Senate for its advice and consent to ratification; and (6) U.S. contributions under the Convention are solely dependent upon appropriations by the U.S. Congress and are not bound by assessments of organizations created under the Convention. Calls on the President to report to the Congress annually on the status of U.S. participation under the Convention.

Les conditions d'exercice par l'Etat de ses responsabilités d'actionnaire

France · Senate · 6 July 1994

Les conditions d'exercice par l'Etat de ses responsabilités d'actionnaire

proposition de résolution sur l'avant-projet de budget général des Communautés européennes pour l'exercice 1995 ( coopération avec les pays de l'Europe centrale et orientale)

France · Senate · 4 July 1994

proposition de résolution sur l'avant-projet de budget général des Communautés européennes pour l'exercice 1995 (pesc)

France · Senate · 1 July 1994

proposition de résolution sur l'avant-projet de budget général des Communautés européennes pour l'exercice 1995 (protection des consommateurs)

France · Senate · 1 July 1994

proposition de résolution sur l'avant-projet de budget général des Communautés européennes pour l'exercice 1995 (actioons structurelles)

France · Senate · 1 July 1994

proposition de résolution sur l'avant-projet de budget général des Communautés européennes pour l'exercice 1995 (jeunesse, formation)

France · Senate · 1 July 1994

proposition de résolution sur l'avant-projet de budget général des Communautés européennes pour l'exercice 1995

France · Senate · 1 July 1994

A bill to reduce Government spending by $100,000,000,000 each fiscal year until a balanced Federal budget is achieved.

United States · United States Congress · 1 July 1994

Requires the Congress, beginning with FY 1995, to reduce Government spending by $100 billion each fiscal year until a balanced budget is achieved. Makes such reductions permanent. Sets forth sequestration procedures if such savings are not achieved.

Proposal for a COUNCIL REGULATION (EC) amending the Financial Regulation of 21 December 1977 applicable to the general budget of the European Communities

European Union · European Commission · 1 July 1994

12 Ms Keogh asked the Minister for Equality and Law Reform the marriage counselling service agencies that have received funding as promised in the 1994 Budget; the amount each agency has received; and when all moneys available will be disbursed.

Ireland · Dáil Éireann · 30 June 1994

12 Ms Keogh asked the Minister for Equality and Law Reform the marriage counselling service agencies that have received funding as promised in the 1994 Budget; the amount each agency has received; and when all moneys available will be disbursed.

Social Security Trust Fund Protection Act of 1994

United States · United States Congress · 30 June 1994

Social Security Trust Fund Protection Act of 1994 - Amends the Budget Enforcement Act of 1990 to prohibit the House of Representatives or the Senate from considering any bill, joint resolution, amendment, motion, or conference report that would increase the aggregate tax liability: (1) on Social Security benefits and does not deposit the revenue resulting from such increase in the trust funds under increase title II (Old Age, Survivors and Disability Insurance) of the Social Security Act; or (2) of certain Railroad Retirement benefits and does not deposit the revenue resulting from such increase in the Social Security Equivalent Benefit Account.

Department of Energy High Energy and Nuclear Physics Authorization Act of 1994

United States · United States Congress · 30 June 1994

Department of Energy High Energy and Nuclear Physics Authorization Act of 1994 - Authorizes appropriations for FY 1996 through 1999 for high energy physics and nuclear physics activities of the Department of Energy (DOE). Instructs the Secretary of Energy to: (1) enter into negotiations with the European Organization for Nuclear Research (CERN) regarding U.S. participation in the planning and construction of the Large Hadron Collider project; (2) submit an operations plan to certain congressional committees subsequent to enactment of appropriations for DOE high energy or nuclear activities; (3) contract with an independent organization to review the governance of DOE high energy and nuclear physics programs; and (4) report to the Congress on a mandated long-range plan prepared jointly with the Director of the National Science Foundation regarding Federal high energy and nuclear physics programs based on current and projected funding levels. Mandates that each of the President's annual budget requests for DOE high energy and nuclear physics activities distinguish between the budget for capital expenditures and other activities.

Inspector General Reform Act of 1994

United States · United States Congress · 29 June 1994

Inspector General Reform Act of 1994 - Amends the Inspector General Act of 1978 to authorize each Federal agency Inspector General (IG) to appoint an Assistant Inspector General for Inspections and Evaluation to supervise the inspection and evaluation of the adequacy of management and other internal controls of agency programs and operations. Requires the IG to prepare prevention vulnerability assessments of programs, systems, and operations identified as susceptible to fraud, waste, or abuse. (Sec. 4) Requires each IG to develop multiyear strategic plans for assessing a Federal establishment's risks and problems, assign the resources required to implement these strategies, and provide performance measures to evaluate such progress. (Sec. 5) Specifies conflict of interest restrictions for officers and employees of a Federal establishment's IG Office. Sets an IG's term of office at five years. Prohibits the removal of an IG from office except for good cause. Specifies procedures for the recommendation and appointment of IG's. Requires the IG of an establishment to consult with the establishment head regularly about the performance of IG duties and responsibilities. (Sec. 6) Prohibits executive branch officials from preventing, prohibiting, or interfering with IG activities. Requires an IG to notify the President and specified congressional committees: (1) of any reasonable grounds for believing this prohibition has been violated; or (2) if an agency head continues to unreasonably refuse or fail to provide information or assistance to an IG. Sets forth requirements for issuance of IG subpoenas to Federal agencies. (Sec. 7) Authorizes any IG to obtain office space, equipment, office supplies, communications facilities, or other services in substantially the same manner as they may be obtained on behalf of the IG Office by the head of the establishment. Authorizes an IG to hire legal counsel. (Sec. 8) Revises annual reporting requirements, including those for the contents of such reports. (Sec. 10) Requires an IG to seek to coordinate with the Attorney General an investigation of any allegation of a possible violation of a Federal criminal law within 15 days of initiating such investigation. (Sec. 11) Grants IG personnel law enforcement authority to carry weapons and executive warrants under specified conditions. (Sec. 12) Grants the IG of the Department of Justice oversight responsibility for the internal investigations performed by the Department's Office of Professional Responsibility. (Sec. 13) Requires IGs to monitor any agency response to findings of misconduct. (Sec. 14) Requires separate appropriation accounts in the President's budget for the IG offices of designated Federal entities. (Sec. 15) Requires each IG to submit to the President, the Congress, and the establishment head each appropriation request for that Office. (Sec. 16) Prohibits any disclosure of a whistleblower's identity, except in accordance with an Attorney General request as part of a criminal investigation. Requires each IG to ensure, at the time of receiving any complaint or information from an employee, that the employee is fully aware of any rights or remedies afforded him or her. (Sec. 17) Declares that each IG shall be considered independent of the establishment or designated Federal entity in which it is established. (Sec. 18) Makes IGs ineligible for any Federal award or other form of recognition, exception for a presidential award.

Budget Resolution Accountability Act of 1994

United States · United States Congress · 29 June 1994

Budget Resolution Accountability Act of 1994 - Amends the Congressional Budget Act of 1974 to require the Budget Committee report accompanying the concurrent resolution on the budget to include each specific deviation from the President's budget by program and amount. Prohibits the offering of amendments in the House of Representatives or the Senate that increase or decrease spending in any functional category unless a statement has been inserted in the Congressional Record that identifies the specific program, project, or activity that is to be increased or decreased. Expresses the sense of the House that during consideration of a concurrent resolution on the budget in the Committee of the Whole, the Committee on Rules should allow specific amendments to increase or decrease particular functional categories and not only amendments in the nature of a substitute.

Providing for consideration of the bill (H.R. 4600) to amend the Congressional Budget and Impoundment Control Act of 1974 to provide for the expedited consideration of certain proposed rescissions of budget authority.

United States · United States Congress · 28 June 1994

Sets forth the rule for the consideration of H.R. 4600 (providing for the expedited consideration of certain proposed rescissions of budget authority).

Department of Defense Appropriations Act, 1995

United States · United States Congress · 27 June 1994

TABLE OF CONTENTS: Title I: Military Personnel Title II: Operation and Maintenance Title III: Procurement Title IV: Research, Development, Test and Evaluation Title V: Revolving and Management Funds Title VI: Other Department of Defense Programs Title VII: National Foreign Intelligence Program Title VIII: General Provisions Department of Defense Appropriations Act, 1995 - Title I: Military Personnel - Appropriates funds for FY 1995 for military and reserve personnel in the Army, Navy, Marine Corps, and Air Force and for National Guard personnel in the Army and Air Force. Title II: Operation and Maintenance - Appropriates funds for FY 1995 for the operation and maintenance of the Army, Navy, and Air Force (including a transfer of funds in each case), the Marine Corps, the defense agencies, the reserve components, and the Army and Air National Guards. Appropriates funds for the Army's National Board for the Promotion of Rifle Practice, the Court of Military Appeals, environmental restoration (including a transfer of funds), support for specified international sporting competitions, and transportation for humanitarian assistance for Afghanistan, the Kurdish population and other minorities of northern Iraq, and the people of sub-Saharan Africa. Title III: Procurement - Appropriates funds for FY 1995 for procurement by the armed forces and reserve components of aircraft, missiles, weapons, tracked combat vehicles, ammunition, shipbuilding and conversion (including a transfer of funds and including the carrier replacement program and the DDG-51 destroyer program), National Guard and reserve equipment and defense-wide procurement. Title IV: Research, Development, Test and Evaluation - Appropriates funds for FY 1995 for research, development, test and evaluation by the armed forces and defense agencies. Appropriates funds for the Directors of Test and Evaluation and Operational Test and Evaluation. Title V: Revolving and Management Funds - Appropriates funds for: (1) the Defense Business Operations Fund; and (2) programs under the National Defense Sealift Fund (including a transfer of funds). Title VI: Other Department of Defense Programs - Appropriates funds for: (1) the Department of Defense (DOD) medical and health care programs; (2) the destruction of lethal chemical agents and munitions; (3) drug interdiction and counter-drug activities, defense (including a transfer of funds); (4) expenses and activities of the Office of the Inspector General in carrying out the Inspector General Act of 1978; (5) defense conversion and reinvestment (including a transfer of funds); and (6) the Korean Enhanced Readiness Account (including a tranfer of funds). Title VII: National Foreign Intelligence Program - Appropriates funds for: (1) the Central Intelligence Agency Retirement and Disability System Fund; and (2) expenses of the Community Management Account. Title VIII: General Provisions - Specifies authorized, restricted, and prohibited uses of appropriated funds. (Sec. 8013) Prohibits during FY 1995 the management by end strengths of DOD civilian personnel. (Sec. 8030) Requires operational control of the Naval Reserve Personnel Center to be provided by the Commander, Naval Reserve Command. (Sec. 8033) Authorizes the Secretary of Defense to establish with host governments of NATO-member countries an account for the deposit of residual value amounts negotiated in the return of U.S. military installations to such countries. (Sec. 8040) Directs the Secretary to include a complete five-year review, containing specified force structure and budget information, in any base closure and realignment plan submitted to the Congress. (Sec. 8051) Repeals a provision of the Department of Defense Appropriations Act, 1994 which authorizes DOD to develop and procure the LANDSAT 7 vehicle. (Sec. 8055) Provides Buy American requirements with respect to the DOD procurement of carbon, alloy, or armor steel plating. (Sec. 8059) Earmarks funds appropriated in this Act for the cleanup of uncontrolled hazardous waste contamination affecting the sale of a parcel of land at Hamilton Air Force Base, California. (Sec. 8062) Authorizes the payment of voluntary separation incentive payments to military personnel. (Sec. 8067) Limits the total funding, as well as the amount of funds authorized to be obligated from this Act, for the Uniformed Services Treatment Facilities program. (Sec. 8068) Prohibits the use of funds: (1) for travel or other support costs of the Tailhook Association; (2) to procure aircraft fuel cells not produced or manufactured in the United States; (3) for compensation of National Foreign Intelligence personnel in excess of a specified amount; (4) to transport chemical munitions to the Johnston Atoll for storage or demilitarization purposes; (5) by a DOD entity without compliance with the Buy American Act; and (6) for the DDG-51 destroyer program or the LHD-1 amphibious assault ship program until FY 1995 options for acquisition of sealift ships have been exercised. (Sec. 8092) Directs the Secretary and the Director of Central Intelligence to deliver a report providing specified information concerning all R&D projects involving the implementation, monitoring, or verification of current and projected international arms control agreements. (Sec. 8100) Expresses the sense of the Congress that none of this Act's funds should be used: (1) to deploy U.S. military forces to participate in the implementation of a peace settlement in Bosnia-Herzegovina, unless previously authorized by the Congress; or (2) for costs incurred by U.S. military units serving in United Nations-sanctioned international peacekeeping or peace enforcement operations unless the President undertakes certain consultation with the Congress regarding such U.S. participation. Expresses the sense of the Congress that the President should seek supplemental appropriations for any significant deployment of U.S. forces performing international humanitarian or peacekeeping functions. (Sec. 8112) Earmarks funds from this Act for resettlement of the Rongelap Atoll and the repair of damages caused by the nuclear testing program. (Sec. 8114) Directs the Assistant Secretary of Defense for Command, Control, Communications, and Intelligence to establish and implement a master plan for all acquisition of automated document conversion systems, equipment, and technologies.

To amend title XVIII of the Social Security Act to provide for coverage under part B of the medicare program of drugs approved by the Food and Drug Administration for the treatment of individuals with multiple sclerosis.

United States · United States Congress · 27 June 1994

Amends title XVIII (Medicare) of the Social Security Act, as amended by the Omnibus Budget Reconciliation Act of 1993, to provide for coverage of drugs approved by the Food and Drug Administration for the treatment of individuals with multiple sclerosis.

Pharmaceutical Marketplace Reform Act of 1994

United States · United States Congress · 24 June 1994

TABLE OF CONTENTS: Title I: Medicare Program Subtitle A: Covered Outpatient Prescription Drugs and Rebates Subtitle B: Drug Use Review Subtitle C: Effective Date Title II: Medicaid Program Title III: Commissions Title IV: Additions to the Master Agreement Pharmaceutical Marketplace Reform Act of 1994 - Title I: Medicare Program - Subtitle A: Covered Outpatient Prescription Drugs and Rebates - Amends title XVIII (Medicare) of the Social Security Act (SSA) to cover as medical and other services certain outpatient drugs and biologicals, certain prescription drugs used in immunosuppressive therapy furnished to organ transplant patients, erythropoietin for dialysis patients, anticancer chemotherapeutic oral drugs, as well as other outpatient drugs or biologicals for which payment may be specially allowed. (Sec. 102) Conditions payment for a covered outpatient drug on the manufacturer's having entered into a rebate agreement containing certain terms with the Secretary of Health and Human Services (HHS). Requires a rebate or discount to Medicare of 17 percent off the average manufacturer's retail price (AMRP). Authorizes negotiation of higher rebates as well as standard or higher rebates for new drugs. Requires the HHS Secretary to establish a generic-only dispensing policy, subject to a Federal upper limit, for any multiple source (generic) covered outpatient drug for which there are three or more therapeutically and pharmaceutically equivalent brands of the drug sold and marketed in the United States. Requires exclusion from payment of any innovator version of a multiple source (brand name) drug unless the prescription, in the physician's handwriting, contains the phrase "brand medically necessary" and, at the Secretary's option, a medical justification is provided. Authorizes the Secretary to establish, as a condition of outpatient drug coverage or payment, a system requiring approval of a drug before its dispensing. Subtitle B: Drug Use Review - Directs the Secretary to: (1) provide for a drug use review program; (2) establish a methodology to provide payment to pharmacists for prospective drug review and certain pharmaceutical care activities; (3) establish standards for counseling by pharmacists of individuals receiving covered outpatient drugs; and (4) a Drug Use Review Board (DUR Board) of physicians and pharmacists. (Sec. 111) Requires the DUR program to provide for case management of drug therapy for individuals receiving covered drugs who are at high risk for potential medication-related problems. Subtitle C: Effective Date - Sets the effective date of this title. Title II: Medicaid Program - Amends SSA title XIX (Medicaid) to deny Federal payment to a State for any brand name drug unless the prescription, in the physicians' handwriting, contains the phrase "brand medically necessary" and, at the Secretary's option, a medical justification is provided. (Sec. 201) Denies Federal payments for any State expenditures for the dispensing of brand name drugs that exceed 15 percent, for 1995, or ten percent, for 1996 and after, of expenditures for the dispensing of all multiple source drugs, brand name and generic. (Sec. 202) Provides for an 11 percent rebate to Medicaid for a generic drug if its price is more than half the price of the corresponding brand name drug. Specifies decreasing rebates, from nine to seven to five percent, from 1995 through 1997 and after for generic drugs whose price does not exceed half the price of the corresponding brand name drug. (Sec. 203) Denies Medicaid payments for any calendar quarter to any State which fails to have in effect regulations requiring each health care plan offered in the State covering outpatient prescription drugs to establish a pharmacy and therapeutics committee or drug use board of physicians and pharmacists which shall make recommendations to the plan to assure that outpatient prescription drugs used by enrollees are medically appropriate and likely to result in positive medical outcomes. Requires each health care plan to establish a therapeutic formulary of committee- or board-approved outpatient prescription drugs. Requires each health care plan to establish a pharmaceutical care services program ensuring services by licensed pharmacists and including drug use review, drug therapy and case management, preapproved or protocol-approved interchange of pharmaceutical products, management of patient compliance incentive programs, and other pertinent services. Requires each health care plan to establish a system under which any pharmacists providing outpatient prescription drugs to enrollees is provided payment for services required to comply with any requirements imposed on the pharmacists by this Act. Title III: Commissions - Amends SSA title XI (General Provisions and Peer Review), as amended by the Omnibus Budget Reconciliation Act of 1993, to direct the Secretary to provide for the appointment of a Pharmaceutical Marketplace Information Commission, which shall: (1) provide general information about pharmaceutical prices in the U.S. market and in international, industrial-based markets; (2) provide information to buyers about whether the prices of new drugs are reasonable, based on specified factors; (3) monitor the use and prices of generic drugs; and (4) make recommendations to the Congress on the desirability of extending patents on certain pharmaceutical products. Authorizes appropriations. (Sec. 302) Requires the Director of the Congressional Office of Technology Assessment to provide for the appointment of a Prescription Drug Payment Review Commission to monitor Medicare drug program operations, conduct studies, and make recommendations to the Congress on the operation of the program in general. Title IV: Additions to the Master Agreement - Amends Federal law with respect to limitations on prices procured by the Department of Veterans Affairs and other Federal agencies. Requires the master agreement between the Secretary of Veterans Affairs and each manufacturer of covered drugs to require each manufacturer of single source and brand name drugs to offer them for sale to every buyer on equal terms and conditions including any rebates, free merchandise, discounts and other similar adjustments. Permits such manufacturers to offer rebates, free merchandise, discounts and other similar adjustments only if the manufacturer experiences savings as a result of specified efficiencies in purchasing. (Sec. 402) Requires the master agreement also to require each manufacturer of single source and brand name drugs to report certain information to the Pharmaceutical Marketplace Information Commission.