Budget

61 Miss Quill asked the Minister for Health if he will provide a separate budget for the national liver transplant programme at St. Vincent's Hospital, Elm Park, Dublin 4 which would protect the hospital's overall budget from being reduced for this programme.

Question· oralPQ 8asked

61 Miss Quill asked the Minister for Health if he will provide a separate budget for the national liver transplant programme at St. Vincent's Hospital, Elm Park, Dublin 4 which would protect the hospital's overall budget from being reduced for this programme.

Ireland · Dáil Éireann · 16 December 1993

61 Miss Quill asked the Minister for Health if he will provide a separate budget for the national liver transplant programme at St. Vincent's Hospital, Elm Park, Dublin 4 which would protect the hospital's overall budget from being reduced for this programme.

Question· oralPQ 7asked

6 Miss Quill asked the Minister for Health if he will give details of the unit cost of an individual liver transplant.

Ireland · Dáil Éireann · 16 December 1993

6 Miss Quill asked the Minister for Health if he will give details of the unit cost of an individual liver transplant.

Question· oralPQ 1asked

1 Mr. R. Bruton asked the Taoiseach if his attention has been drawn to the provisional findings of the Task Force on the Service Sector; and if its recommendations will be published in advance of the 1994 budget so that the necessary tax reforms can be made in 1994.

Ireland · Dáil Éireann · 15 December 1993

1 Mr. R. Bruton asked the Taoiseach if his attention has been drawn to the provisional findings of the Task Force on the Service Sector; and if its recommendations will be published in advance of the 1994 budget so that the necessary tax reforms can be made in 1994.

Question· oralPQ 18asked

16 Proinsias De Rossa asked the Minister for Equality and Law Reform his response to the recent pre-budget submission made to his Department by the Coolock Law Centre and, particularly, its call for a development plan for legal services by 1997; and if he will make a statement on the matter.

Ireland · Dáil Éireann · 14 December 1993

16 Proinsias De Rossa asked the Minister for Equality and Law Reform his response to the recent pre-budget submission made to his Department by the Coolock Law Centre and, particularly, its call for a development plan for legal services by 1997; and if he will make a statement on the matter.

Question· Fragestunde12/6346open

Ansätze im Bundeshaushalt 1993 für die Bahnreform; Entlastung des Bundeshaushalts von Ausgaben für die Bahnreform bis 2003 (G-SIG: 12045334)

Germany · German Bundestag · 3 December 1993

Question· oralPQ 2asked

2 Mr. Yates asked the Minister for Finance if he has received the budget submission from the clothing industry in relation to their difficulties in maintaining competitiveness and, consequently, employment; and if so, the proposals, if any, the Government has to protect employment in this sector.

Ireland · Dáil Éireann · 23 November 1993

2 Mr. Yates asked the Minister for Finance if he has received the budget submission from the clothing industry in relation to their difficulties in maintaining competitiveness and, consequently, employment; and if so, the proposals, if any, the Government has to protect employment in this sector.

Bill· SS. 1779 (103rd)open

Health Security Act

United States · United States Congress · 22 November 1993

TABLE OF CONTENTS: Title I: Health Care Security Subtitle A: Universal Coverage and Individual Responsibility Subtitle B: Benefits Subtitle C: State Responsibilities Subtitle D: Health Alliances Subtitle E: Health Plans Subtitle F: Federal Responsibilities Subtitle G: Employer Responsibilities Subtitle J (sic): General Definitions; Miscellaneous Provisions Title II: New Benefits Subtitle B (sic): Long-Term Care Title III: Public Health Initiatives Subtitle A: Workforce Priorities Under Federal Payments Subtitle B: Academic Health Centers Subtitle C: Health Research Initiatives Subtitle D: Core Functions of Public Health Programs; National Initiatives Regarding Preventive Health Subtitle E: Health Services for Medically Underserved Populations Subtitle F: Mental Health; Substance Abuse Subtitle G: Comprehensive School Health Education; School-Related Health Services Subtitle H: Public Health Service Initiative Subtitle I: Coordination With COBRA Continuation Coverage Title 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 Title VI: Premium Caps; Premium-Based Financing; and Plan Payments Subtitle A: Premium Caps Subtitle B: Premium-Related Financing Subtitle C: Payments to Regional Alliance Health Plans Title 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 Alliance Payments Subtitle C: Borrowing Authority to Cover Cash-Flow Shortfalls Title X: Coordination of Medical Portion of Workers Compensation and Automobile Insurance Subtitle A: Workers Compensation Insurance Subtitle C (sic): Commission on Integration of Health Benefits Subtitle E (sic): Davis-Bacon Act and Service Contract Act Subtitle F: Effective Dates Title XI: Transitional Insurance Reform Health Security Act - Title I: Health Care Security - Subtitle A: Universal 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. Defines an eligible individual as an individual who resides in the United States and is: (1) a citizen or national of the United States; (2) an alien permanently residing in the U.S. under color of law; or (3) a long-term nonimmigrant. Entitles a Medicare-eligible individual to benefits under Medicare instead of the above provisions of this Act. (Sec. 1002) Requires each eligible individual to enroll in an applicable health plan and pay any required premium. Prohibits disenrollment of an eligible individual until the individual is either enrolled in another plan or in Medicare. (Sec. 1003) States that nothing in this Act shall be construed as prohibiting: (1) an individual from purchasing any health services; (2) an individual from purchasing supplemental insurance; (3) an individual who is not an eligible individual from purchasing health insurance; or (4) employers from providing additional coverage. (Sec. 1004) States that a regional alliance health plan is the applicable plan for a family, unless a family member is eligible for a corporate alliance health plan. Allows military personnel, veterans, and Indians to enroll either with an alliance or with a military, veteran, or Indian plan, respectively. (Sec. 1005) Prohibits an undocumented alien from enrolling in a health plan under this Act. (Sec. 1011) Defines a family as an eligible individual's eligible spouse and children. Defines couple as meaning an individual and the individual's spouse. Defines a child as being under age 18, or under age 24 in the case of a full-time student. Subtitle B: Benefits - Includes the following terms and services in the comprehensive benefit package: (1) hospital services; (2) services of health professionals; (3) emergency and ambulatory medical and surgical services; (4) clinical preventive services; (5) mental illness and substance abuse services; (6) family planning services and services for pregnant women; (7) hospice care; (8) home health care; (9) extended care services; (10) ambulance services; (11) outpatient laboratory, radiology, and diagnostic services; (12) outpatient prescription drugs and biologicals; (13) outpatient rehabilitation services; (14) durable medical equipment and prosthetic and orthotic devices; (15) vision care; (16) dental care; (17) health education classes; and (18) investigational treatments. Describes such items and services. (Sec. 1131) Requires each health plan to offer to its enrollees only one of the following cost sharing schedules: (1) lower cost sharing; (2) higher cost sharing; or (3) combination cost sharing. Provides that the annual maximum out-of-pocket expenses for an individual in any of the plans shall be $1500 and for a family the annual maximum shall be $3000. (Sec. 1135) Sets forth a table of copayments and coinsurance. (Sec. 1141) Excludes the following items and services: (1) an item or service that is not medically necessary or appropriate; (2) an item or service that the National Health Board may determine is not medically necessary or appropriate; (3) custodial care, except hospice care; (4) surgery performed solely for cosmetic purposes, unless required to correct a congenital anomaly or performed to correct a part of the body injured by either disease or accident; (5) hearing aids; (6) eyeglasses and contact lenses for individuals at least 18 years of age; (7) in vitro fertilization; (8) sex change surgery and related services; (9) private duty nursing; (10) personal comfort items, except in the case of hospice care; and (11) any dental procedures involving orthodontic care, inlays, gold or platinum fillings, bridges, crowns, pin/post retention, dental implants, surgical periodontal procedures, or the preparation of the mouth for the fitting or continued use of dentures, except as specified. (Sec. 1151) Gives the National Health Board the authority to promulgate such regulations or establish such guidelines as necessary to assure uniformity in the application of the comprehensive benefit package across all health plans. Permits the Board to expand the benefit package. (Sec. 1162) Permits a health professional or facility to refuse to provide a benefit if the professional or facility objects on the basis of a religious belief or moral conviction. Subtitle C: State Responsibilities - Requires a State, in order to be approved as a participating State, to submit a document describing the State's health care system. (Sec. 1201) Requires a participating State to: (1) establish one or more regional alliances; (2) establish and publish the criteria used in the certification of its health plan; (3) meet minimum financial solvency requirements for health plans established by the National Health Board; (4) designate an agency or official to coordinate State responsibilities under this Act; (5) conform State laws to meet the requirements of title X of this Act with respect to workers' compensation and automobile insurance; and (6) carry out all the responsibilities of a participating State specified in this Act. (Sec. 1221) Permits a State, with the Board's approval, to operate a single-payer system if specified requirements are met. Subtitle D: Health Alliances - Provides for regional alliances and corporate alliances. (Sec. 1302) Requires a regional alliance to be governed by a Board of Directors consisting of: (1) employers, including self-employed individuals; and (2) members who represent individuals purchasing coverage. Requires each regional alliance to establish a provider advisory board consisting of health care providers and professionals. (Sec. 1311) Includes in a corporate alliance an eligible sponsor who is either a large employer (more than 5000 full-time employees) or a multiemployer plan (a plan with more than 5000 active participants). Excludes: (1) an employer whose primary business is employee leasing; (2) the Federal Government (other than the U.S. Postal Service); and (3) a State or local government. Excludes from corporate alliance eligibility the following classes of individuals: (1) AFDC recipients; (2) SSI recipients; (3) military personnel and families, veterans, and Indians who elect to enroll in specified plans specifically designed for them; and (4) seasonal or temporary employees. (Sec. 1321) Directs each regional alliance to negotiate with any State-certified health plan for a contract with the alliance for the enrollment under the plan of eligible individuals. (Sec. 1322) Requires each regional alliance to offer a choice of health plans, including at least one fee-for-service plan. (Sec. 1326) Requires each regional alliance to establish and maintain an office of an ombudsman to assist consumers in dealing with problems that arise with health plans and the alliance. (Sec. 1329) Permits a regional alliance to adjust payments to plans or use other financial incentives to encourage health plans to expand into areas that have inadequate health services. (Sec. 1341) Set forth provisions concerning the collection of funds by regional alliances from individuals, employers, and others. (Sec. 1351) Requires each regional alliance to compute a blended plan per capita payment amount for each regional alliance health plan for enrollment in the alliance. (Sec. 1361) Requires each regional alliance to comply with specified standards relating to the management of finances, maintenance of records, accounting practices, auditing procedures, financial reporting, and employer payments. (Sec. 1371) Provides for a reduction in cost sharing for low-income families. (Sec. 1373) Provides for premium discounts and reduction in liabilities for low-income families. (Sec. 1381) Permits each corporate alliance to: (1) offer coverage under either an appropriate self-insured health plan; or (2) negotiate with a State-certified plan to enter into a contract with the plan. (Sec. 1382) Requires each corporate alliance to provide a choice of health plans, including at least one fee-for-service plan and two health plans that are not fee-for-service plans. (Sec. 1385) Requires each corporate alliance to make an additional contribution towards the enrollment in health plans of the alliance by certain low-wage families. (Sec. 1386) Sets forth provisions relating to a corporate alliance concerning: (1) consumer information and marketing; (2) plan and information requirements; (3) management of funds; (4) cost control; (5) payments by corporate alliance employers to corporate alliances; (6) ERISA; and (7) disclosure and reserve requirements. Subtitle E: Health Plans - Requires a health plan to: (1) be either a self-insured plan (meaning a group health plan as defined by a the Employee Retirement Income Security Act of 1974) or a State-certified plan (meaning a plan certified by a State or the National Health Board); and (2) meet the applicable regulatory requirements. (Sec. 1402) Requires each health plan offered by either a regional or corporate alliance to accept for enrollment every alliance eligible individual, unless the plan has reached its enrollment limit. Prohibits the limit from being imposed on the basis of any personal characteristics of enrollees such as health status, need for health care, age, occupation, or affiliation with any person or entity. Prohibits a plan from: (1) restricting or terminating coverage for any reason, including nonpayment of premiums; (2) cancelling coverage for any eligible individual until that individual is enrolled in another plan; (3) excluding an eligible individual because of an existing medical condition; (4) imposing a waiting period before coverage begins; or (5) imposing a rider that excludes the coverage of particular eligible individuals. Prohibits discrimination by a health plan on the basis of race, national origin, sex, language, socioeconomic status, age, disability, health status, or anticipated need for health services. (Sec. 1405) Requires each plan to have a grievance procedure. (Sec. 1421) Permits an entity to offer a supplemental insurance policy if the policy and the entity meet specified requirements. (Sec. 1431) Requires each health plan, with respect to each electing essential community provider located within the plan's service area, to enter into either a written provider participation agreement or a written agreement under which the plan will make payment to the provider as specified. Provides a special rule for providers of school health services. Makes the provisions of the preceding sentence applicable only to health plans offered by a health alliance during the five-year period beginning with the first year in which any health plan is offered by the alliance. Directs the Secretary of Health and Human Services to study essential community providers and to make recommendations concerning such providers to the Congress. Provides that such recommendations shall apply unless a joint resolution of disapproval is enacted by the Congress. (Sec. 1441) Requires each health plan to meet specified requirements of title X of this Act with respect to workers' compensation and automobile medical liability services. Subtitle F: Federal Responsibilities - Establishes the National Health Board in the Executive Branch. Directs the President to appoint the Board's seven members. (Sec. 1503) Directs the Board to: (1) interpret the comprehensive benefit package; (2) adjust the delivery of preventive services; (3) take steps to assure that the comprehensive benefit package is available on a uniform national basis; (4) recommend to the President and the Congress appropriate revisions to the package; (5) oversee cost containment requirements; (6) develop and implement eligibility standards; (7) establish a performance based system of quality management; (8) develop and implement standards for a national health information system; (9) establish State requirements and monitor State compliance; (10) establish premium class factors; (11) develop a methodology for the risk-adjustment of premium payments; (12) establish financial requirements for guaranty funds; (13) establish standards for health plan grievance procedures; and (14) report annually to the President and the Congress. (Sec. 1506) Authorizes appropriations for the Board. (Sec. 1511) Requires the Board to approve a State health care system if the system meets the applicable requirements of this Act. Prohibits approval of a State health care system prior to 1996. (Sec. 1512) Imposes sanctions upon States failing to meet conditions for compliance. (Sec. 1515) Provides for planning grants to States for implementation assistance. (Sec. 1521) Provides for the Federal assumption of responsibilities in the absence of a State system. Provides for increased premiums of 15 percent during Federal operation of a State system to provide reimbursement for the Federal cost of operating the system. (Sec. 1541) Directs the Board to develop a risk adjustment and reinsurance methodology. Sets forth guideline for developing such methodology. (Sec. 1543) Directs the Board to establish an advisory committee to provide technical advice and recommendations regarding the risk adjustment and reinsurance methodology. (Sec. 1551) Directs the Board to establish minimum capital requirements for regional alliance health plans under which at least $500,000 of capital must be maintained for each plan in the area. Permits the Board to require additional capital. (Sec. 1552) Requires the Board to establish standards for guaranty funds established by the States. (Sec. 1571) Sets forth the responsibilities of the Secretary of Health and Human Services. Directs the Secretary to administer and implement all provisions of this Act, except those duties delegated to the Board, any other executive agency, or to any State. (Sec. 1572) Directs the Secretary to appoint an Advisory Council on Breakthrough Drugs that will examine the reasonableness of launch prices of new breakthrough drugs. (Sec. 1581) Provides for the certification of essential community providers. Sets forth the following categories of providers automatically certified (under provisions of the Public Health Service Act): (1) migrant health centers; (2) community health centers; (3) homeless program providers; (4) public housing providers; (5) family planning clinics; and (6) AIDS providers under the Ryan White Act. Includes as automatically certified (under other Acts) the following: (1) Indian health programs under the Indian Health Act; and (2) maternal and child health providers and a Federal qualified health center or rural health clinic under the Social Security Act. Includes as automatically certified (under provisions of this Act) the following: (1) providers of school health services; and (2) a qualified community practice network. Provides for the setting of standards for additional health providers. (Sec. 1591) Sets forth the responsibilities of the Secretary of Labor. Includes among those responsibilities the following: (1) enforcement requirements applicable to employers; (2) elections to become corporate alliances; (3) temporary assumption of insolvent self-insured corporate alliance health plans; (4) establishment and administration of the Corporate Alliance Health Plan Insolvency Fund; and (5) administering title I of ERISA as it relates to group health plans maintained by corporate alliances. Subtitle G: Employer Responsibilities - Requires employers to provide for the payments required under title VI of this Act. Sets forth other employer responsibilities including: (1) information reporting requirements; (2) requirements relating to new employees; (3) recordkeeping requirements; and (4) antidiscrimination requirements. (Sec. 1606) Prohibits self-funding of cost sharing benefits by regional alliance employers. (Sec. 1607) Requires an employer to make equal employer premium payments to all qualifying employees, if a voluntary premium payment is made. Places a limit on such voluntary employer premium payments. (Sec. 1608) Sets forth an employer's obligation to a qualifying retired beneficiary where the employer, as of October 1, 1993, was providing a threshold payment. (Sec. 1609) Authorizes the Secretary of Labor to impose a civil penalty of up to $10,000 for each violation of this subtitle with respect to each individual. Subtitle J (sic): General Definition; 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. Title II: New Benefits - Subtitle B (sic): Long-Term Care - Establishes requirements for State plans for home and community-based services to individuals with disabilities. Includes among those requirements the following: (1) a prohibition of limiting eligibility of individuals with disabilities based on income, age, geography, severity of disability, residential setting, or other grounds specified by the Secretary; (2) a requirement to serve low-income individuals; (3) a requirement to specify how Federal and State funds will be managed; (4) quality assurance requirements; and (5) reporting requirements. Requires a State to consult with individuals and groups of individuals with disabilities when developing the plan in order to have the plan approved. (Sec. 2103) Defines individuals with disabilities to mean any individual within one or more of the following four categories: (1) individuals requiring help with the activities of daily living; (2) individuals with severe cognitive or mental impairment; (3) individuals with severe or profound mental retardation; and (4) severely disabled children. (Sec. 2104) Requires a State plan to specify the services available. Requires each individualized plan to be developed in close consultation with the individual and the individual's family. Prohibits a State plan from covering: (1) room and board; (2) services furnished in a hospital, nursing facility, intermediate care facility for the mentally retarded, or other specified institutional setting; or (3) items or services to the extent coverage is provided for an individual under a health plan or Medicare. (Sec. 2105) Sets forth provisions relating to: (1) cost sharing; (2) quality assurance and safeguards; (3) advisory groups; (4) payments to States; and (5) the total Federal budget for State plans and allotments to States. (Sec. 2301) Directs the Secretary, with the advice and assistance of the National Long-Term Care Insurance Advisory Council to promulgate regulations as necessary to implement provisions concerning private long-term care insurance. Directs the Secretary to make appointments to such Council. Authorizes appropriations for such Council. (Sec. 2321) Directs the Secretary, after considering the Council's recommendations to promulgate regulations designed to: (1) standardize formats and terminology used in long-term care policies; (2) require insurers to provide customers on the range of public and private long-term care coverage available; and (3) establish other requirements promoting consumer understanding of benefits. (Sec. 2322) Directs the Secretary to promulgate regulations establishing requirements with respect to the terms of the benefits under long-term care policies, which shall include the following requirements that the policy may not: (1) limit coverage based on a preexisting condition, subject to an exception for a six-month period; (2) condition eligibility for benefits based on the need or receipt of any other service; (3) condition eligibility for any benefit on any particular diagnosis; (4) condition eligibility for benefits by providers on compliance with requirements not required by State or Federal law; and (5) condition coverage of any service by a provider on the provision of such service at a higher level of care than required by the insured individual. Prohibits discrimination by diagnosis in the treatment of: (1) Alzheimer's disease; (2) any organic or inorganic mental illness; (3) mental retardation or any other cognitive or mental impairment; or (4) HIV infection or AIDS. (Sec. 2323) Sets forth other requirements for such policies, including requirements related to: (1) premium; (2) sales practices; (3) continuation, renewal, replacement, conversion, and cancellation of policies; and (4) payment of benefits. (Sec. 2342) Provides for grants to States to enforce the Federal standards concerning long-term care policies. Sets forth requirements for receiving such grants. Authorizes appropriations. Prohibits the sale of a long-term care policy in a State without a regulatory program. (Sec. 2361) Authorizes the Secretary to make grants for the development and implementation of long-term care information, counseling, and other programs to: (1) States; (2) regional alliances (at the option of States within which such alliances are located; and (3) national organizations representing insurance consumers, long-term care providers, and insurers. Authorizes appropriations for such grants. 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. 3061) Directs the Secretary to carry out a program with respect to graduate nurse training programs that is equivalent to the program for approved physician training programs. Establishes a National Council on Graduate Nurse Education. (Sec. 3071) Authorizes appropriations for the following programs: (1) primary care physician and physician assistant training; (2) training of underrepresented minorities and disadvantaged persons; and (3) nurse training. (Sec. 3072) Authorizes appropriations for the following programs: (1) a program of skill upgrading and occupational retraining for health care workers; (2) a demonstration program to assist workers in health care institutions in obtaining advanced career positions; (3) a program to develop and operate health-worker job banks in local employment services agencies, subject to certain conditions; (4) a program to provide joint labor-management decision-making in the health care sector on workplace matters related to the restructuring of the health care delivery system of this Act; and (5) a program to facilitate the comprehensive workforce adjustment initiative. (Sec. 3073) Directs the Secretary of Health and Human Services and the Secretary of Labor to jointly establish the National Institute for Health Care Workforce Development. States that the Director of the Institute shall make recommendations to the Secretaries regarding: (1) the supply of health care workers; (2) the impact of this Act; and (3) the development and implementation of high-performance, high-quality health care delivery systems. Directs the Secretaries to establish an advisory board to assist in the development of such recommendations. Subtitle B: Academic Health Centers - Provides for the access of regional and corporate alliance patients to qualified academic health centers. Subtitle C: Health Research Initiatives - Amends the Public Health Service Act to ensure that the National Institutes of Health conducts and supports biomedical and behavioral research on promoting health and preventing diseases, disorders, and other health conditions. Provides for health services research. Authorizes appropriations for such research. Subtitle D: Core Functions of Public Health Programs; National Initiatives Regarding Preventive Health - Authorizes appropriations for the core functions of public health programs and national initiatives regarding health promotion and disease prevention. (Sec. 3312) Authorizes the Secretary to make grants to States to carry out one or more of the following core functions: (1) data collection; (2) activities to protect the environment and to assure the safety of housing, workplaces, and food and water; (3) investigation and control of adverse health conditions; (4) public information and education programs to reduce risks to health such as use of tobacco, alcohol, and drugs, sexual activities that increase the risk of HIV transmission and other sexually transmitted diseases, poor diet, physical inactivity, and low childhood immunization levels; (5) accountability and quality assurance activities; (6) provision of public health laboratory services to complement private clinical laboratory services that screen for diseases and conditions; (7) training and education to assure provision of care by all health professionals; and (8) leadership policy development and administrative activities. (Sec. 3331) Authorizes the Secretary to make grants to agencies of State or local government, private nonprofit organizations, and coalitions that link two or more of these groups for the purpose of carrying out projects to develop and implement innovative community-based strategies to provide for health promotion and disease prevention activities for which there is a significant need. Subtitle E: Health Services for Medically Underserved Populations - Directs the Secretary to make grants to migrant health centers and community health centers, which shall be in addition to other funds available to such centers. Authorizes appropriations. (Sec. 3412) Authorizes appropriations for: (1) grants and contracts for the development of qualified community health plans and practice networks; and (2) loans and guaranteeing the principal and interest to Federal and non-Federal lenders on behalf of public and private entities for the capital costs of developing qualified community health plans and practice networks. (Sec. 3461) Authorizes the Secretary to make grants and enter into contracts with qualified community health groups to provide enabling services such as transportation, community and patient outreach, patient education, and translation services in order to increase the capacity of individuals to utilize the items and services under title I of this Act. Authorizes appropriations. (Sec. 3471) Authorizes appropriations for: (1) the National Health Service Corps; and (2) such amounts as are necessary to ensure that at least 20 percent of participants in the Scholarship Program or the Loan Repayment Program of the Corps are nurses. (Sec. 3481) Entitles a hospital with a low-income utilization rate in a base year of at least 25 percent to a payment as specified. Requires 75 percent of the total available to be allocated to hospitals for low-income assistance. Requires 25 percent of the total available to be allocated to hospitals for assistance in furnishing inpatient hospital services that are not covered services under title I of this Act. Subtitle F: Mental Health; Substance Abuse - Authorizes appropriations to carry out this part. Provides for grants to: (1) increase access to mental health and substance abuse services; (2) improve State and local capacity to coordinate and monitor such services; (3) provide incentives to integrate public and private service systems; and (4) supplement any activity under part B (Alcohol and Drug Abuse and Mental Services Block Grant) of title XIX of the Public Health Service Act. (Sec. 3503) Authorizes the Secretary to make loans for the capital costs incurred in the development of non-acute, residential treatment centers and community-based ambulatory clinics. (Sec. 3521) Requires the establishment of a pilot program demonstrating the integration of the mental illness and substance abuse services of the States with the services included under title I of this Act. Subtitle G: Comprehensive School Health Education; School-Related Health Services - Authorizes appropriations for the programs of this subtitle. States that the purposes of the programs shall be to: (1) support the provision in kindergarten through grade 12 of comprehensive health education programs; (2) establish a national framework within which States can create comprehensive school health education programs that target the health risk behaviors of youth, including tobacco use, alcohol and drug abuse, sexual behaviors resulting in infections, injury prevention, dietary patterns, and sedentary lifestyles; (3) pay the initial costs of planning and establishing such programs; (4) support related Federal demonstrations and training; (5) motivate youth to stay in school, avoid teen pregnancy, and strive for success; (6) improve the knowledge of health education among youth; and (7) further the National Education Goals set forth in title I of the Goals 2000: Educate America Act. Defines comprehensive school health education program. Requires such programs to be sensitive to cultural and ethnic issues, promote involvement by families, and promote personal responsibility. Sets forth requirements for applying for grants and selection of grantees. Subtitle H: Public Health Service Initiative - Establishes a Public Health Service Initiative consisting of specified amounts authorized to be appropriated for the Initiative. States that: (1) the Initiative includes the programs of subtitles C through G of this title and the programs of subtitle D of title VIII; and (2) amounts appropriated to carry out the Initiative, including subtitles A through F of this title, are available to carry out specific programs for which the amounts are appropriated. Subtitle I: Coordination with COBRA Continuation Coverage - Amends title XXII (Requirements for Certain Group Health Plans for Certain State and Local Employees) of the Public Health Service Act to provide for coordination with COBRA continuation coverage. Repeals such title XXII upon implementation of this Act. Title 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 Management Program. (Sec. 5002) Establishes the National Quality Management Council which shall: (1) administer the National Quality Management Program; (2) perform any other duty specified in this subtitle; and (3) advise the National Health Board with respect to its duties under this subtitle. Requires the Council to develop a set of national measures of quality performance to be used in the assessment of and the provision of access to health care services. Requires the Council, in addition, to: (1) recommend to the Board establishing goals for performance by health plans and health care providers on a subset of national measures of quality performance; (2) direct the Administrator for Health Care Policy and Research to develop, review, and disseminate practice guidelines to determine how diseases can most effectively be prevented, diagnosed, treated, and managed; and (3) direct the Administrator for Health Care Policy and Research to support research related to a five-year priority list of performance measures. (Sec. 5008) Directs the National Health Board to: (1) establish and oversee regional professional foundations to perform such duties as develop lifetime learning programs for health professionals and conduct research on health care quality; and (2) establish the National Quality Consortium to perform such duties as establishing continuing education for health professionals and provide advice on research priorities. (Sec. 5012) Requires each regional alliance and each corporate alliance to: (1) disseminate specified information to consumers; and (2) ensure that performance and quality standards are continually approved. Subtitle B: Information System, Privacy, and Administrative Simplification - Directs the National Health Board to develop and implement a health information system, in consultation with Federal agencies, States, employers, health plans, and others, by which the Board shall collect, report, and regulate the collection and dissemination of health care information which shall be used for: (1) health care planning by Federal, State, and local government; (2) establishing and monitoring payments for health services; (3) assessing and improving the quality of health care; (4) managing and containing costs at the alliance and plan levels; and (5) other specified purposes. Requires the establishment of an electronic data network to collect, compile, and transmit information. (Sec. 5120) Sets forth provisions providing for health information privacy standards. (Sec. 5130) Directs the National Health Board to develop the following standard health care benefit forms: (1) an enrollment and disenrollment form; (2) a clinical encounter record; and (3) a claim form. (Sec. 5140) Establishes the National Privacy and Health Data Advisory Council in order to advise the National Health Board with respect to its duties under this subtitle. (Sec. 5141) Sets forth monetary penalties for violating health information system standards. Subtitle C: Remedies and Enforcement - Sets forth provisions with respect to the review of benefit determinations for enrolled individuals, including provisions: (1) regulating the time limits for notice of disposition of a claim; (2) governing a plan's duty to review claim denials; (3) concerning urgent requests for preauthorization; and (4) concerning other time limits with respect to time limits and notice. (Sec. 5202) Requires each State to establish a complaint review office for each regional alliance established by a State. Permits aggrieved individuals to file complaints with the appropriate review office. (Sec. 5205) Provides for a Federal Health Plan Review Board to review the decisions of complaint review office hearing officers. (Sec. 5207) Sets monetary penalties for a plan which unreasonably denies or delays payment or provision of benefits. (Sec. 5211) Directs each State to establish and maintain an Early Resolution Program in each complaint review office. Requires a program to include: (1) forums for mediation of disputes; and (2) other forums of alternative dispute resolution as may be prescribed. Establishes guidelines for the eligibility of cases for submission to the Early Resolution Program. States that conclusions of the mediation proceedings shall be treated as nonbinding and shall not affect any rights to review. (Sec. 5231) Sets forth additional remedies and enforcement provisions. Title VI: Premium Caps; Premium-Based Financing; and Plan Payments - Subtitle A: Premium Caps - Sets forth provisions which provide for the computation of factors that limit the growth of premiums for the comprehensive benefit package in regional alliance health plans, including the computation of a: (1) regional alliance inflation factor; and (2) general health care inflation factor. (Sec. 6002) Directs the Board to determine: (1) a national per capita baseline premium target; (2) the national average per capita current coverage health expenditures; and (3) current health care expenditures. (Sec. 6003) Directs the Board to determine a regional alliance per capita premium. (Sec. 6004) Requires a regional alliance to annually obtain premium bids from each plan seeking to participate as a regional alliance health plan with respect to the alliance. (Sec. 6005) Permits any participating State to assume responsibility for containment of health care expenditures in the State consistent with this Act. (Sec. 6006) Directs the chair of the Board to establish an advisory commission on regional variations in health expenditures. Requires the commission to examine methods of eliminating variation in regional alliance per capital premium targets due to variation in practice patterns, not due to other factors. Requires the Board to submit its recommendations to the Congress. Requires such recommendations to apply unless a joint resolution of disapproval is passed. (Sec. 6011) Subjects each noncomplying regional alliance health plan for a year to a reduction in plan payment as specified, in order to assure that payments to regional alliance health plans by a regional alliance are consistent. Defines a noncomplying plan to include a plan in which the final accepted bid exceeds the maximum complying bid for the per capita target premium. Defines maximum complying bid. (Sec. 6021) Directs the Board to develop a methodology for calculating an annual per capita expenditure equivalent for amounts paid for coverage for the comprehensive benefit package within a corporate alliance. (Sec. 6022) Terminates a corporate alliance with two excess years in a three year period. Provides that employers that were corporate alliance employers with respect to a terminated alliance shall become regional alliance employers. Defines an excess year as one in which the rate of increase for the corporate alliance exceeds the national corporate inflation factor. Defines rate of increase and national corporate inflation factor. (Sec. 6031) Sets forth special rules for a single-payer State. (Sec. 6041) Directs the Secretary to establish a program to monitor prices and expenditures in the U.S. health care system. Subtitle B: Premium-Related Financings - Makes each family enrolled in a regional health alliance plan or in a corporate alliance health plan in a class of family enrollment responsible for payment of the family share of premium payable for enrollment. Provides for income-related discounts and specified credits. (Sec. 6102) Establishes the formula for determining the premiums. (Sec. 6111) Provides for the repayment of alliance credits by certain families. (Sec. 6114) Provides for the special treatment of certain retirees and qualified spouses and children. (Sec. 6121) Requires each regional alliance employer to pay a monthly premium to the regional alliance for a qualifying employee. Sets forth provisions for determining such premium. Varies the premium depending upon such factors as the employer's size and average wages paid. (Sec. 6126) Sets forth provisions applicable to self-employed individuals. (Sec. 6131) Sets forth provisions for determining the corporate employer premium. Subtitle C: Payments to Regional Alliance Health Plans - Sets forth provisions to determine the computation of: (1) the blended plan per capita payment amount; and (2) the plan bid, AFDC, and SSI proportions. Title 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 revise and limit the coverage of group health plans ERISA. Makes certain ERISA provisions inapplicable with respect to State-certified health plans. Provides for an exception from ERISA civil action provisions where review is otherwise available under the Health Security Act (this Act, HSA). (Sec. 8402) Establishes ERISA requirements for expeditious reporting and disclosure applicable to group health plans, through special rules consistent with ERISA and HSA purposes. Excludes plans maintained by regional alliances from treatment as multiple employer welfare arrangements. (Sec. 8403) Revises certain ERISA provisions relating to continuation coverage under group health plans. Repeals such provisions upon implementation of HSA. (Sec. 8404) Makes ERISA standards for group health plans regarding: (1) cases of adoption applicable except to the extent otherwise provided in regulations of the National Health Board under HSA; and (2) coverage of pediatric vaccines inapplicable to a group health plan upon its becoming a corporate alliance health plan under HSA. (Sec. 8405) Requires group health plans under ERISA to comply with HSA requirements relating to health plan claims procedure. Title IX: Aggregate Government Payments - Subtitle B (sic): Aggregate Federal Alliance Payments - States that this section constitutes budget authority in advance of appropriation Acts and obligates the Federal Government to provide for the payment to regional alliances of a capped Federal alliance payment amount. Defines capped Federal alliance payment amount. Subtitle C: Borrowing Authority to Cover Cash-flow Shortfalls - Authorizes the Secretary to make available loans to regional alliances to cover any period of temporary cash-flow shortfall attributable to: (1) any estimation discrepancy; (2) a period of temporary cash-flow shortfall attributable to an administrative error; or (3) a period of temporary cash-flow shortfall relating to the relative timing during the year in which amounts are received and payments are required. Sets forth loan terms and conditions. Title X: Coordination of Medical Portion of Workers Compensation and Automobile Insurance - Subtitle A: Workers Compensation Insurance - Requires each health plan that provides services to enrollees through participating providers to make arrangements to provide workers' compensation to such enrollees. (Sec. 10002) Requires each workers compensation carrier that is liable for payment for workers compensation services furnished by or through a health plan, regardless of whether or not the services are included in the comprehensive benefit package, to make payment for such services. (Sec. 10011) Sets forth requirements for participating States. (Sec. 10031) Authorizes demonstration projects in one or more States with respect to the treatment of work-related injuries and illnesses. Subtitle C (sic): Commission on Integration of Health Benefits - Establishes the Commission on Integration of Health Benefits, which shall study and report on the feasibility and appropriateness of transferring financial responsibility for all medical benefits, including those currently covered by workers' compensation and automobile insurance, to health plans. Authorizes appropriations. Subtitle E (sic): Davis-Bacon Act and Service Contract Act - Amends the Davis-Bacon Act and the Service Contract Act of 1965 to require Health Security Act benefits. Subtitle F: Effective Dates - Sets forth effective date provisions. Title XI: Transitional Insurance Reform - Sets forth transitional provisions concerning: (1) enforcement; (2) preservation of current coverage; (3) restrictions on premium increases during transition; (4) portability requirements; (5) restrictions limiting benefit reductions; and (6) the establishment of the National Transitional Health Insurance Risk Pool.

Bill· SS. 1770 (103rd)open

Health Equity and Access Reform Today Act of 1993

United States · United States Congress · 22 November 1993

TABLE OF CONTENTS Title I: Basic Reforms to Expand Access to Health Insurance coverage and to Ensure Universal Coverage Subtitle A: Universal Access Subtitle B: Qualified General Access Plans in the Small Employer and Individual Marketplace Subtitle C: Qualified Health Plans in the Large Employer Marketplace Subtitle D: Benefits; Benefits Commission Subtitle E: State and Federal Responsibilities in Relation to Qualified Health Plans Subtitle F: Universal Coverage Subtitle G: Definitions Title II: Tax Enforcement Provisions Subtitle A: General Tax Provisions Subtitle B: Provisions Relating to Acceleration of Death Benefits Subtitle C: Long-Term Care Tax Provisions Subtitle D: Enforcement Provisions Title III: Quality Assurance and Simplification Subtitle A: Quality Assurance Subtitle B: Administrative Simplification Title IV: Judicial Reforms Subtitle A: Medical Liability Reform Subtitle B: Anti-Fraud and Abuse Control Program Subtitle C: Treatment of Certain Activities Under the Antitrust Laws Title V: Special Assistance for Frontier, Rural, and Urban Underserved Areas Subtitle A: Frontier, Rural, and Urban Underserved Areas Subtitle B: Primary Care Provider Education Subtitle C: Programs Relating to Primary and Preventive Care Services Title VI: Treatment of Existing Federal Programs Subtitle A: Medicaid Program Subtitle B: Medicare Title VII: Patient's Right to Self-Determination Regarding Health Care Health Equity and Access Reform Today Act of 1993 - Title I: Basic Reforms to Expand Access to Health Insurance Coverage and to Ensure Universal Coverage - Subtitle A: Universal Access - Provides access to health insurance coverage under a qualified health plan for every citizen and lawful permanent resident of the United States. (Sec. 1003) Establishes a program under which persons with low incomes (and who are not eligible for Medicaid) will receive vouchers to buy insurance through purchasing groups. (Sec. 1004) Requires each employer to make available, either directly, through a purchasing group, or otherwise, enrollment in a qualified health plan to each eligible employee. Subtitle B: Qualified General Access Plan in the Small Employer and Individual Marketplace - Requires the National Association of Insurance Commissioners to develop specific standards to implement requirements concerning: (1) guaranteed eligibility, availability, and renewability of health insurance coverage; (2) nondiscrimination based on health status; (3) benefits offered; (4) insurer financial solvency; (5) enrollment process; (6) premium rating limitations; (7) risk adjustment; and (8) consumer protection. (Sec. 1119) Requires each qualified general access plan to: (1) establish and maintain a quality assurance program and a mediation procedures program; and (2) contain assurances of service to designated underserved areas. (Sec. 1141) Provides for the formation of purchasing groups by individuals and small employers. (Sec. 1161) Requires brokers or insurers to provide specified information to prospective enrollees. (Sec. 1162) Prohibits insurers from creating improper financial incentives and from selling duplicate coverage. Subtitle C: Qualified Health Plans in the Large Employer Marketplace - Requires the Secretary of Health and Human Services, in consultation with the Secretary of Labor, to establish standards for large employer plans similar to requirements applicable to small employer plans. (Sec. 1203) Requires large employers to offer to employees at least a standard package and a catastrophic package. (Sec. 1205) Allows two or more large employers to form purchasing groups, but not through an individual or small employer purchasing group. (Sec. 1206) Requires a semi-annual review of each large employer plan to determine whether requirements are being met and what corrective actions need to be taken. (Sec. 1221) Amends the Employee Retirement Income Security Act of 1974 and the Public Health Service Act to revise provisions to conform to this Act. Subtitle D: Benefits; Benefits Commission - Requires each qualified health plan to provide a standard package and a catastrophic package. Specifies items and services to be covered. (Sec. 1311) Establishes the Benefits Commission to develop and propose legislation that provides a clarification of covered items and services and includes specifications for cost sharing. (Sec. 1314) Provides for congressional consideration and implementation of such legislation. Subtitle E: State and Federal Responsibilities in Relation to Qualified Health Plans - Requires each State to establish a program to: (1) certify insured health plans; (2) disseminate information on health care coverage areas; (3) establish procedures for purchasing groups; (4) prepare information concerning plans and purchasing groups; (5) provide for a risk adjustment program, including an adjustment for differences in nonpayments among qualified insured health plans; (6) develop a binding arbitration process; and (7) specify an annual general enrollment period. (Sec. 1421) Allows the waiver of specified requirements. (Sec. 1431) Provides preemptions of certain State laws. (Sec. 1441) Specifies the Federal responsibilities with respect to multi-State employer plans and in case of State defaults. Subtitle F: Universal Coverage - Requires each citizen or lawful permanent resident to be covered under a qualified health plan or equivalent health care program by January 1, 2005. Provides an exception for any individual who is opposed for religious reasons to health plan coverage, including those who rely on healing using spiritual means through prayer alone. Subtitle G: Definitions - Defines terms used in this Act. Title II: Tax and Enforcement Provisions - Subtitle A: General Tax Provisions - Amends the Internal Revenue Code to exclude from an employee's gross income employer-provided coverage under a qualified health plan or employer-provided contributions to the employee's medical savings account. Includes excess employer contributions in such gross income. (Sec. 2002) Allows a business expense deduction for employer costs of qualified health plans or contributions to an employee's medical savings account. Increases the allowable deduction (from 25 percent to 100 percent) for the qualified health insurance costs of self-employed individuals. Makes such deduction permanent. (Sec. 2003) Allows individuals a tax deduction for contributions made to a medical care savings account established for the benefit of an eligible individual. Allows such deduction whether or not an individual itemizes deductions. Disallows distributions from such accounts as medical expense deductions. Excludes employer contributions to such accounts from employment taxes. Establishes an excise tax for excess contributions to medical care savings accounts. (Sec. 2004) Eliminates the commonality of interest and geographic location requirements with respect to group purchasing by large tax-exempt organizations. (Sec. 2005) Revises and repeals provisions concerning continuation coverage requirements of group health plans upon implementation of this Act. Subtitle B: Provisions Relating to Acceleration of Death Benefits - Requires payment under a life insurance contract on the life of an insured who is terminally ill to be treated as a death benefit, making such payment eligible for tax exclusion from gross income. (Sec. 2102) Provides that any reference to life insurance shall be treated as referring to a qualified terminal illness rider. Subtitle C: Long-Term Care Tax Provisions - Treats qualified long-term care services as medical care for purposes of the medical expense deduction. (Sec. 2202) Provides for the treatment of long-term care insurance as accident and health insurance. (Sec. 2301) Sets forth consumer protection provisions to be satisfied by qualified long-term care insurance contracts, including the model regulation and Act promulgated by National Association of Insurance Commissioners (NAIC). Requires NAIC to promulgate standards for the use of uniform language and definitions in such policies, with certain variations permitted. Subtitle D: Enforcement Provisions - Amends part A (General Provisions) of Social Security Act title XI to establish the Health Insurance Coverage Data Bank to: (1) further the purposes of coverage requirements under this Act; and (2) collect certain information reported by employers about individual employee group health plan coverage for purposes of identifying and collecting from responsible third parties any amounts owed to reimburse Medicare or Medicaid for health care items and services furnished to their beneficiaries. (Replaces the Medicare and Medicaid Coverage Data Bank.) (Sec. 2402) Amends the Internal Revenue Code to impose excise taxes on failures by employers and insurers to comply with provisions of this Act. (Sec. 2411) Amends the Employee Retirement Income Security Act of 1974 to make conforming changes regarding enforcement of employer failures. Title III: Quality Assurance and Simplification - Subtitle A: Quality Assurance - Directs the Secretary of Health and Human Services, in consultation with relevant agencies, to develop and publish standards for quality assurance programs and ensure that appropriate performance measures are established. Requires the standards to contain provider risk programs to prevent or provide early warning of practices that may result in injury. (Sec. 3002) Provides for the standardization of information through a national health data system. (Sec. 3003) Requires the Secretary to establish measures to determine quality of care in specialized centers of care. (Sec. 3004) Authorizes appropriations to examine the feasibility of creating an Agency for Clinical Evaluations by consolidating the responsibilities of specified other offices. (Sec. 3005) Requires the Secretary to report annually to the Congress on factors affecting universal coverage and make recommendations for increasing such coverage. (Sec. 3006) Requires the Secretary to monitor the reinsurance market for qualified health plans and periodically report to the Congress on the financial implications. (Sec. 3101) Amends the Public Health Service Act to establish within the Agency for Health Care Policy and Research a clearinghouse for information and research data concerning clinical trials. Requires the appointment of a fund investigator for the Agency. (Sec. 3201) Amends the Internal Revenue Code to establish the National Fund for Medical Research and provide for the designation of tax overpayments to such fund. Subtitle B: Administrative Simplification - Establishes a health care data interchange system to make data available on a uniform basis to all participants in the health care system. (Sec. 3302) Requires the Health Care Data Panel to develop regulations for the operation of an integrated electronic health care data interchange system. (Sec. 3304) Sets forth requirements for such system including: data and transaction standards, uniform working files, code sets, unique identifiers, standards for confidentiality, rules for the transfer of information, and periodic reviews. (Sec. 3313) Establishes the Health Care Data Panel and a National Health Informatics Commission to advise the Panel on its activities. Title IV: Judicial Reforms - Subtitle A: Medical Liability Reform - Requires a qualified health plan to provide effective mediation procedures for hearing and resolving health care malpractice claims. (Sec. 4013) Requires each State to adopt an alternative dispute resolution method for the resolution of health care malpractice claims and consumer grievances. (Sec. 4021) Establishes provisions with respect to liability under health care malpractice actions brought in State or Federal courts. (Sec. 4022) Limits attorney contingency fees and award amounts for noneconomic damages. (Sec. 4024) Establishes a two-year statute of limitations for health care malpractice claims, except in the case of minors. (Sec. 4025) Requires each State to establish a set of specialty clinical guidelines. Allows the use of such guidelines as a rebuttable presumption in a claim or action, if the service provided was the appropriate standard of medical care. (Sec. 4026) Prohibits the award of punitive damages against the producer of a drug or device that is approved by the Food and Drug Administration. (Sec. 4027) Requires a report to the appropriate congressional committees on the operation of this subtitle. Subtitle B: Anti-Fraud and Abuse Control Program - Requires the Secretary to establish in the Office of the Inspector General of the Department of Health and Human Services a program to control fraud and abuse under the universal health care plan. Establishes the Anti-Fraud and Abuse Trust Fund. (Sec. 4102) Amends title XI of the Social Security Act (SSA) to provide for the application of the penalties for Medicare and Medicaid fraud to all health care programs. (Sec. 4103) Requires the Secretary to establish a program through which Medicare-eligible individuals may report instances of suspected fraud under Medicare. (Sec. 4111) Revises current SSA title XI sanctions for fraud and abuse involving Medicare and State health care programs, with changes providing for: (1) program exclusion for individuals convicted of a felony relating to fraud or the unlawful manufacture or dispensing of a controlled substance; (2) new offenses under civil monetary penalty provisions, such as the offering of inducements to program-eligible individuals; (3) establishment of a minimum period of exclusion for practitioners and persons who fail to meet statutory obligations; (4) intermediate sanctions on eligible health maintenance organizations for program violations; and (5) procedures for imposing such sanctions. (Sec. 4121) Directs the Secretary to establish a national health care fraud and abuse data collection program for the reporting by each government agency and health care plan of final adverse actions against health care providers, suppliers, and practitioners. Requires program information to be made available to the public for a reasonable fee. (Sec. 4122) Amends SSA title XI to require the Secretary to publish in the Federal Register a listing of all final adverse actions taken during the quarter. (Sec. 4131) Amends the Federal criminal code to 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 (benefits); and (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 the delivery of, or payment for, health care benefits. (Sec. 4132) Directs the court, upon a finding that a Federal health care offense is of a type that poses a serious threat to the health of any individual or has a significant detrimental impact on the health care system, to order a person convicted of that offense to forfeit property that was used in the commission of the offense or that constitutes or was derived from proceeds traceable to the offense that is of a value proportionate to the seriousness of the offense. (Sec. 4133) Authorizes the Attorney General to commence a civil action in Federal court to enjoin a violation constituting a Federal health care offense. (Sec. 4134) Makes commission of a Federal health care offense a predicate to a violation of the Racketeer Influenced and Corrupt Organizations Act. (Sec. 4141) 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 any request or demand for money or property which is made or presented to a health care plan. Subtitle C: Treatment of Certain Activities Under the Antitrust Laws - Exempts from the antitrust laws specified "safe harbor" activities related to the provision of health care services. Sets forth provisions regarding the award of attorney fees and costs of suit to the prevailing party in an action based on a claim involving activity found to be exempt. (Sec. 4202) Lists as safe harbors specified: (1) activities relating to health care services of combinations of health care providers with market share below a specified threshold; (2) activities of medical self-regulatory entities relating to standard setting or enforcement activities not conducted for purposes of financial gain; (3) participation of a health care provider in a written survey of the prices of services, reimbursement levels, or the compensation and benefits of employees and personnel; (4) activities relating to health care joint ventures for high technology and costly equipment and services; (5) activities relating to hospital mergers; (6) joint purchasing arrangements; and (7) negotiations. (Sec. 4203) Directs the Attorney General to publish a notice in the Federal Register soliciting proposals for additional safe harbors and to review and report to the Congress on proposed safe harbors. Sets forth criteria in establishing safe harbors, including: (1) the extent to which a competitive or collaborative activity will accomplish an increase in health care access and quality, the establishment of cost efficiencies, and increased ability of health care facilities to provide services in medically underserved areas or to underserved populations; and (2) whether designation as a safe harbor will result in specified desirable outcomes. (Sec. 4204) Directs the Attorney General to issue certificates of review for providers of health care services and assist persons in applying for such certificates. Sets forth provisions regarding applications for, revocation of, and review of determinations regarding such certificates. Limits the disclosure of information. (Sec. 4205) Sets forth provisions regarding notifications providing for a reduction in certain penalties under the antitrust laws for health care cooperative ventures. (Sec. 4206) Directs the Attorney General to: (1) review the safe harbors and certificates of review periodically; and (2) promulgate such rules, regulations, and guidelines as necessary to carry out provisions of this subtitle. (Sec. 4208) Establishes within the Department of Health and Human Services an Office of Health Care Competition Policy. Title V: Special Assistance for Frontier, Rural, and Urban Underserved Areas - Subtitle A: Frontier, Rural, and Urban Underserved Areas - Amends the Public Health Service Act to establish a program of allotments to States for grants for community-based primary health services to low-income or medically underserved populations regarding infant mortality and referrals for the health management of infants and pregnant women. Earmarks for the allotments specified percentages of appropriations under certain provisions added by this Act. (Sec. 5002) Mandates grants to federally qualified health centers (FQHCs) and other entities for providing access to services for medically underserved populations or in high impact areas not currently being served by a FQHC. Authorizes appropriations. Directs the Secretary to report to the appropriate congressional committees on the relationship and interaction between community health centers and hospitals in providing services to such populations. (Sec. 5003) Amends the Internal Revenue Code to: (1) allow a nonrefundable credit for certain primary health services providers for mandatory service periods in health professional shortage areas; (2) exclude from gross income qualified loan repayments to the National Health Service Corps; (3) increase the dollar limitation allowed for expensing medical equipment used in rural health shortage areas; and (4) allow a deduction for student loan payments by medical professionals practicing in rural areas. (Sec. 5004) Amends title XVIII (Medicare) of the Social Security Act (SSA) to provide for: (1) establishment of rural emergency access care hospitals under Medicare; and (2) coverage of and payment for rural emergency access care hospital services under Medicare part B (Supplementary Medical Insurance). (Sec. 5005) Amends the Public Health Service Act to direct the Secretary to make grants to States to assist in the creation or enhancement of air medical transport systems that provide victims 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. (Sec. 5006) Authorizes the Secretary to conduct a demonstration project and grant program to encourage the development and operation of rural health networks. Authorizes appropriations. (Sec. 5007) Requires the Secretary to report to the Congress on improving access to benefits under qualified health plans for individuals residing in rural areas. Subtitle B: Primary Care Provider Education - Requires the Secretary to provide for the establishment of demonstration projects to evaluate mechanisms to increase the number and percentage of medical students entering primary care practice through funds otherwise available for direct graduate medical education costs under the Medicare program. (Sec. 5102) Allows funding under Medicare for training in nonhospital-owned facilities. (Sec. 5103) Increases authorized funding for the National Health Service Corps Scholarship and Loan Repayment Programs. Authorizes funding through FY 1998. (Sec. 5104) Increases and extends through FY 1997 authorized funding for training for certain health service providers. Subtitle C: Programs Relating to Primary and Preventive Care Services - Authorizes appropriations for a grant program to improve coordination of maternal and infant care. (Sec. 5202) Amends the Elementary and Secondary Education Act of 1965 to authorize appropriations to carry out a comprehensive school health education and prevention program for elementary and secondary school students. (Sec. 5203) Allows frontier States (including Alaska, Wyoming, and Montana) to implement proposals and participate in demonstration projects which give special consideration to their diverse needs. Title VI: Treatment of Existing Federal Programs - Subtitle A: Medicaid Program - Gives States the option of allowing the enrollment of Medicaid-eligible individuals (including a limited number of AFDC- and SSI-eligible individuals) in the standard benefit package under a qualified health plan, instead of enrollment in the State's Medicaid program. (Sec. 6001) Sets forth requirements for States exercising such option. Places a cap on Federal payments for acute medical services furnished under a State's Medicaid programs. (Sec. 6011) Discontinues reimbursement standards for inpatient hospital services. Revises the Federal medical assistance percentage for certain States. Modifies Federal requirements to allow States more flexibility in contracting for coordinated care services under Medicaid. (Sec. 6021) Provides for waivers from requirements on coordinated care programs. Gives States the option to guarantee the continued Medicaid eligibility of individuals enrolled with risk contracting and other managed care entities. (Sec. 6031) Provides for phased-in elimination of Medicaid hospital disproportionate share adjustment payments. Subtitle B: Medicare - Requires the Secretary to: (1) submit to the Congress a proposal for legislation which provides for the enrollment of Medicare beneficiaries in qualified health plans; and (2) provide for a monthly payment to a qualified health plan on behalf of enrolled Medicare beneficiaries. (Sec. 6111) Amends the Omnibus Budget Reconciliation Act of 1990 (OMBRA '90) to revise provisions for a modified payment methodology for risk contractors. (Sec. 6112) Requires the Secretary to provide for adjustment in Medicare capitation payments to take into account secondary payer status. Authorizes the Secretary to make additional payments to eligible organizations with risk-sharing contracts. (Sec. 6121) Amends OMBRA '90 to: (1) make permanent the Medicare select policy program; and (2) allow access to Medicare select policies in all States. Amends Medicare to revise the Medicare select policy program and provide for a civil penalty for misrepresentations made in connection with such a policy. (Sec. 6131) Makes specified changes with regard to monthly Medicare part B premium determinations for part B enrollees. (Sec. 6132) Amends the Internal Revenue Code to provide for an increase in the Medicare part B premium for individuals with high income. (Sec. 6133) Makes permanent certain payment reductions relating to outpatient hospital services furnished under Medicare. (Sec. 6135) Imposes copayments for laboratory services and certain home health visits provided under Medicare. (Sec. 6137) Provides for phased-in elimination of Medicare disproportionate share hospital payments. (Sec. 6138) Directs the Secretary to discontinue hospital reimbursements for costs relating to the recovery of bad debts. (Sec. 6139) Makes specified changes with regard to Medicare as a secondary payer. Title VII: Patient's Right to Self-Determination Regarding Health Care - Provides for the treatment of advance directives and other measures, including a study by the Secretary on issues relating to health care decisions by the patient, in addressing the patient's right to self-determination regarding health care.

Bill· SS. 1775 (103rd)open

Health Security Act

United States · United States Congress · 22 November 1993

TABLE OF CONTENTS: Title I: Health Care Security Subtitle A: Universal Coverage and Individual Responsibility Subtitle B: Benefits Subtitle C: State Responsibilities Subtitle D: Health Alliances Subtitle E: Health Plans Subtitle F: Federal Responsibilities Subtitle G: Employer Responsibilities Subtitle J (sic): General Definitions; Miscellaneous Provisions Title II: New Benefits Subtitle A: Medicare Outpatient Prescription Drug Benefit Subtitle B: Long-Term Care Title III: Public Health Initiatives Subtitle A: Workforce Priorities Under Federal Payments Subtitle B: Academic Health Centers Subtitle C: Health Research Initiatives Subtitle D: Core Functions of Public Health Programs; National Initiatives Regarding Preventive Health Subtitle E: Health Services for Medically Underserved Populations Subtitle F: Mental Health; Substance Abuse Subtitle G: Comprehensive School Health Education; School-Related Health Services Subtitle H: Public Health Service Initiative Subtitle I: Coordination With COBRA Continuation Coverage Title IV: Medicare and Medicaid Subtitle A: Medicare and the Alliance System Subtitle B: Savings in Medicare Program Subtitle C: Medicaid Subtitle D: Increase in SSI Personal Needs Allowance Title V: Quality and Consumer Protection Subtitle A: Quality Management and Improvement Subtitle B: Information Systems, Privacy, and Administrative Simplification Subtitle C: Remedies and Enforcement Subtitle D: Medical Malpractice Subtitle E: Fraud and Abuse Subtitle F: McCarran-Ferguson Reform Title VI: Premium Caps; Premium-Based Financing; and Plan Payments Subtitle A: Premium Caps Subtitle B: Premium-Related Financing Subtitle C: Payments to Regional Alliance Health Plans Title VII: Revenue Provisions Subtitle A: Financing Provisions Subtitle B: Tax Treatment of Employer-Provided Health Care Subtitle C: Employment Status Provisions Subtitle D: Tax Treatment of Funding of Retiree Health Benefits Subtitle E: Coordination with COBRA Continuing Care Provisions Subtitle F: Tax Treatment of Organizations Providing Health Care Services and Related Organizations Subtitle G: Tax Treatment of Long-term Care Insurance and Services Subtitle H: Tax Incentives for Health Services Providers Subtitle I: Miscellaneous Provisions Title VIII: Health and Health-Related Programs of the Federal Government Subtitle A: Military Health Care Reform Subtitle B: Department of Veterans Affairs Subtitle C: Federal Employees Health Benefits Program Subtitle D: Indian Health Service Subtitle E: Amendments to the Employee Retirement Income Security Act of 1974 Subtitle F: Special Fund for WIC Program Title IX: Aggregate Government Payments to Regional Alliances Subtitle A: Aggregate State Payments Subtitle B: Aggregate Federal Alliance Payments Subtitle C: Borrowing Authority to Cover Cash-Flow Shortfalls Title X: Coordination of Medical Portion of Workers Compensation and Automobile Insurance Subtitle A: Workers Compensation Insurance Subtitle B: Automobile Insurance Subtitle C: Commission on Integration of Health Benefits Subtitle D: Federal Employees' Compensation Act Subtitle E: Davis-Bacon Act and Service Contract Act Subtitle F: Effective Dates Title XI: Transitional Insurance Reform Health Security Act - Title I: Health Care Security - Subtitle A: Universal Courage and Individual Responsibility - Entitles each eligible individual to: (1) the benefit provided under subtitle B through the applicable health plan in which the individual is enrolled; and (2) a health security card to be issued by the alliance or other entity that offers the applicable health plan in which the individual is enrolled. Defines an eligible individual as an individual who resides in the United States and is: (1) a citizen or national of the United States; (2) an alien permanently residing in the U.S. under color of law; or (3) a long-term nonimmigrant. Entitles a Medicare-eligible individual to benefits under Medicare instead of the above provisions of this Act. (Sec. 1002) Requires each eligible individual to enroll in an applicable health plan and pay any required premium. Prohibits disenrollment of an eligible individual until the individual is either enrolled in another plan or in Medicare. (Sec. 1003) States that nothing in this Act shall be construed as prohibiting: (1) an individual from purchasing any health services; (2) an individual from purchasing supplemental insurance; (3) an individual who is not an eligible individual from purchasing health insurance; or (4) employers from providing additional coverage. (Sec. 1004) States that a regional alliance health plan is the applicable plan for a family, unless a family member is eligible for a corporate alliance health plan. Allows military personnel, veterans, and Indians to enroll either with an alliance or with a military, veteran, or Indian plan respectively. (Sec. 1005) Prohibits an undocumented alien from enrolling in a health plan under this Act. (Sec. 1011) Defines a family as an eligible individual's eligible spouse and children. Defines couple as meaning an individual and the individual's spouse. Defines a child as being under age 18, or under age 24 in the case of a full-time student. Subtitle B: Benefits - Includes the following terms and services in the comprehensive benefit package: (1) hospital services; (2) services of health professionals; (3) emergency and ambulatory medical and surgical services; (4) clinical preventive services; (5) mental illness and substance abuse services; (6) family planning services and services for pregnant women; (7) hospice care; (8) home health care; (9) extended care services; (10) ambulance services; (11) outpatient laboratory, radiology, and diagnostic services; (12) outpatient prescription drugs and biologicals; (13) outpatient rehabilitation services; (14) durable medical equipment and prosthetic and orthotic devices; (15) vision care; (16) dental care; (17) health education classes; and (18) investigational treatments. Describes such items and services. (Sec. 1131) Requires each health plan to offer to its enrollees only one of the following cost sharing schedules: (1) lower cost sharing; (2) higher cost sharing; or (3) combination cost sharing. Provides that the annual maximum out-of-pocket expenses for an individual in any of the plans shall be $1500 and for a family the annual maximum shall be $3000. (Sec. 1135) Sets forth a table of copayments and coinsurance. (Sec. 1141) Excludes the following items and services: (1) an item or service that is not medically necessary or appropriate; (2) an item or service that the National Health Board may determine is not medically necessary or appropriate; (3) custodial care, except hospice care; (4) surgery performed solely for cosmetic purposes, unless required to correct a congenital anomaly or performed to correct a part of the body injured by either disease or accident; (5) hearing aids; (6) eyeglasses and contact lenses for individuals at least 18 years of age; (7) in vitro fertilization; (8) sex change surgery and related services; (9) private duty nursing; (10) personal comfort items, except in the case of hospice care; and (11) any dental procedures involving orthodontic care, inlays, gold or platinum fillings, bridges, crowns, pin/post retention, dental implants, surgical periodontal procedures, or the preparation of the mouth for the fitting or continued use of dentures, except as specified. (Sec. 1151) Gives the National Health Board the authority to promulgate such regulations or establish such guidelines as necessary to assure uniformity in the application of the comprehensive benefit package across all health plans. Permits the Board to expand the benefit package. (Sec. 1162) Permits a health professional or facility to refuse to provide a benefit if the professional or facility objects on the basis of a religious belief or moral conviction. Subtitle C: State Responsibilities - Requires a State, in order to be approved as a participating State, to submit a document describing the State's health care system. (Sec. 1201) Requires a participating State to: (1) establish one or more regional alliances; (2) establish and publish the criteria used in the certification of its health plan; (3) meet minimum financial solvency requirements for health plans established by the National Health Board; (4) designate an agency or official to coordinate State responsibilities under this Act; (5) conform State laws to meet the requirements of title X of this Act with respect to workers' compensation and automobile insurance; and (6) carry out all the responsibilities of a participating State specified in this Act. (Sec. 1221) Permits a State, with the Board's approval, to operate a single-payer system if specified requirements are met. Subtitle D: Health Alliances - Provides for regional alliances and corporate alliances. (Sec. 1302) Requires a regional alliance to be governed by a Board of Directors consisting of: (1) employers, including self-employed individuals; and (2) members who represent individuals purchasing coverage. Requires each regional alliance to establish a provider advisory board consisting of health care providers and professionals. (Sec. 1311) Includes in a corporate alliance an eligible sponsor who is either a large employer (more than 5,000 full-time employees) or a multiemployer plan (a plan with more than 5000 active participants). Excludes: (1) an employer whose primary business is employee leasing; (2) the Federal Government (other than the U.S. Postal Service); and (3) a State or local government. Excludes from corporate alliance eligibility the following classes of individuals: (1) AFDC recipients; (2) SSI recipients; (3) military personnel and families, veterans, and Indians who elect to enroll in specified plans specifically designed for them; and (4) seasonal or temporary employees. (Sec. 1321) Directs each regional alliance to enter into a contract with any State-certified health plan to contract with the alliance for the enrollment under the plan of eligible individuals. (Sec. 1322) Requires each regional alliance to offer a choice of health plans, including at least one fee-for-service plan. (Sec. 1326) Requires each regional alliance to establish and maintain an office of an ombudsman to assist consumers in dealing with problems that arise with health plans and the alliance. (Sec. 1329) Permits a regional alliance to adjust payments to plans or use other financial incentives to encourage health plans to expand into areas that have inadequate health services. (Sec. 1341) Set forth provisions concerning the collection of funds by regional alliances from individuals, employers, and others. (Sec. 1351) Requires each regional alliance to compute a blended plan per capita payment amount for each regional alliance health plan for enrollment in the alliance. (Sec. 1353) Requires each regional alliance to make payments to the Federal Government for academic health centers and graduate medical education. (Sec. 1361) Requires each regional alliance to comply with specified standards relating to the management of finances, maintenance of records, accounting practices, auditing procedures, financial reporting, and employer payments. (Sec. 1371) Provides for a reduction in cost sharing for low-income families. (Sec. 1373) Provides for premium discounts and reduction in liabilities for low-income families. (Sec. 1381) Permits each corporate alliance to: (1) offer coverage under either an appropriate self-insured health plan; or (2) negotiate with a State-certified plan to enter into a contract with the plan. (Sec. 1382) Requires each corporate alliance to provide a choice of health plans, including at least one fee-for-service plan and two health plans that are not fee-for-service plans. (Sec. 1385) Requires each corporate alliance to make an additional contribution towards the enrollment in health plans of the alliance by certain low-wage families. (Sec. 1386) Sets forth provisions relating to corporate alliances concerning: (1) consumer information and marketing; (2) plan and information requirements; (3) management of funds; (4) cost control; (5) payments by corporate alliance employers to corporate alliances; (6) ERISA; (7) disclosure and reserve requirements; (8) trusteeship of insolvent corporate alliance health plans; (9) imposition and collection of periodic assessments on self-insured corporate alliance plans; and (10) payments to the Federal Government by multiemployer corporate alliances for academic health centers and gradual medical education. Subtitle E: Health Plans - Requires a health plan to: (1) be either a self-insured plan (meaning a group health plan as defined by a the Employee Retirement Income Security Act of 1974) or a State-certified plan (meaning a plan certified by a State or the National Health Board); and (2) meet the applicable regulatory requirements. (Sec. 1402) Requires each health plan offered by either a regional or corporate alliance to accept for enrollment every alliance eligible individual, unless the plan has reached its enrollment limit. Prohibits the limit from being imposed on the basis of any personal characteristics of enrollees such as health status, need for health care, age, occupation, or affiliation with any person or entity. Prohibits a plan from: (1) restricting or terminating coverage for any reason, including nonpayment of premiums; (2) cancelling coverage for any eligible individual until that individual is enrolled in another plan; (3) excluding an eligible individual because of an existing medical condition; (4) imposing a waiting period before coverage begins; or (5) imposing a rider that excludes the coverage of particular eligible individuals. Prohibits discrimination by a health plan on the basis of race, national origin, sex, language, socio-economic status, age, disability, health status, or anticipated need for health services. (Sec. 1405) Requires each plan to have a grievance procedure. (Sec. 1421) Permits an entity to offer a supplemental insurance policy if the policy and the entity meet specified requirements. (Sec. 1431) Requires each health plan, with respect to each electing essential community provider located within the plan's service area, to either: (1) enter into a written provider participation agreement; or (2) enter into a written agreement under which the plan will make payment to the provider as specified. Provides a special rule for providers of school health services. Makes the provisions of the proceeding sentence applicable only to health plans offered by a health alliance during the five year period beginning with the first year in which any health plan is offered by the alliance. Directs the Secretary of Health and Human Services to study essential community providers and to make recommendations concerning such providers to the Congress. Provides that such recommendations shall apply unless a joint resolution of disapproval is enacted by the Congress. (Sec. 1441) Requires each health plan to meet specified requirements of title X of this Act with respect to workers' compensation and automobile medical liability services. Subtitle F: Federal Responsibilities - Establishes the National Health Board in the Executive Branch. Directs the President to appoint the Board's seven members. (Sec. 1503) Directs the Board to: (1) interpret the comprehensive benefit package; (2) adjust the delivery of preventive services; (3) take steps to assure that the comprehensive benefit package is available on a uniform national basis; (4) recommend to the President and the Congress appropriate revisions to the package; (5) oversee cost containment requirements; (6) develop and implement eligibility standards; (7) establish a performance based system of quality management; (8) develop and implement standards for a national health information system; (9) establish State requirements and monitor State compliance; (10) establish premium class factors; (11) develop a methodology for the risk-adjustment of premium payments; (12) establish financial requirements for guaranty funds; (13) establish standards for health plan grievance procedures; and (14) report annually to the President and the Congress. (Sec. 1506) Authorizes appropriations for the Board. (Sec. 1511) Requires the Board to approve a State health care system if the system meets the applicable requirements of this Act. Prohibits approval of a State health care system prior to 1996. (Sec. 1512) Provides for sanctions for States failing to meet conditions for compliance. (Sec. 1515) Provides for planning grants to States for implementation assistance. (Sec. 1521) Provides for the Federal assumption of responsibilities in the absence of a State system. Provides for increased premiums of 15 percent during Federal operation of a State system to provide reimbursement for the Federal cost of operating the system. (Sec. 1541) Directs the Board to develop a risk adjustment and reinsurance methodology. Sets forth guidelines for developing such methodology. (Sec. 1543) Directs the Board to establish an advisory committee to provide technical advice and recommendations regarding the risk adjustment and reinsurance methodology. (Sec. 1551) Directs the Board to establish minimum capital requirements for regional alliance health plans under which at least $500,000 of capital must be maintained for each plan in the area. Permits the Board to require additional capital. (Sec. 1552) Requires the Board to establish standards for guaranty funds established by the States. (Sec. 1571) Sets forth the responsibilities of the Secretary of Health and Human Services. Directs the Secretary to administer and implement all provisions of this Act, except those duties delegated to the Board, any other executive agency, or to any State. (Sec. 1572) Directs the Secretary to appoint an Advisory Council on Breakthrough Drugs that will examine the reasonableness of launch prices of new breakthrough drugs. (Sec. 1581) Provides for the certification of essential community providers. Sets forth the following categories of providers automatically certified (under provisions of the Public Health Service Act): (1) migrant health centers; (2) community health centers; (3) homeless program providers; (4) public housing providers; (5) family planning clinics; and (6) AIDS providers under the Ryan White Act. Includes as automatically certified (under other Acts) following: (1) Indian health programs under the Indian Health Act; and (2) maternal and child health providers and a federally qualified health center or rural health clinic under the Social Security Act. Includes as automatically certified (under provisions of this Act) the following: (1) providers of school health services; and (2) a qualified community practice network. Provides for the setting of standards for additional health providers. (Sec. 1591) Sets forth the responsibilities of the Secretary of Labor. Includes among those responsibilities the following: (1) enforcement requirements applicable to employers; (2) elections to become corporate alliances; (3) temporary assumption of insolvent self-insured corporate alliance health plans; (4) establishment and administration of the Corporate Alliance Health Plan Insolvency Fund; and (5) administering title I of ERISA as it relates to group health plans maintained by corporate alliances. Subtitle G: Employer Responsibilities - Requires employers to provide for the payments required under title VI of this Act. Sets forth other employer responsibilities including: (1) information reporting requirements; (2) requirements relating to new employees; (3) recordkeeping requirements; and (4) antidiscrimination requirements. (Sec. 1606) Prohibits self-funding of cost sharing benefits by regional alliance employers. (Sec. 1607) Requires an employer to make equal employer premium payments to all qualifying employees, if a voluntary premium payment is made. Places a limit on such voluntary employer premium payments. (Sec. 1608) Sets forth an employer's obligation to a qualifying retired beneficiary where the employer, as of October 1, 1993, was providing a threshold payment. (Sec. 1609) Authorizes the Secretary of Labor to impose a civil penalty of up to $10,000 for each violation of this subtitle with respect to each individual. Subtitle J (sic): General Definitions; Miscellaneous Provisions - Sets forth the definitions and rules used in this Act. Subtitle B: Miscellaneous Provisions (sic) - (Sec. 1911) Grants the National Health Board, the Secretary of Health and Human Services, and the Secretary of Labor authority to issue regulations as necessary to permit the timely implementation of this Act. Title II: New Benefits - Subtitle A: Medicare Outpatient Prescription Drug Benefit - (Secs. 2001 through 2005) Amends title XVIII of the Social Security Act to provide for: (1) Medicare coverage of covered outpatient prescription drugs and biologicals as well as home infusion drug therapy services; (2) payment rules and related requirements, such as those pertaining to deductibles, for covered outpatient prescription drugs; (3) manufacturer rebates to the Secretary under Medicare part B for covered outpatient prescription drugs; and (4) determination of the Medicare part B premium attributable to covered outpatient prescription drugs. Subtitle B: Long-Term Care - Establishes requirements for State plans for home and community-based services to individuals with disabilities. Includes among those requirements the following: (1) a prohibition of limiting eligibility of individuals with disabilities based on income, age, geography, severity of disability, residential setting, or other grounds specified by the Secretary; (2) a requirement to serve low-income individuals; (3) a requirement to specify how Federal and State funds will be managed; (4) quality assurance requirements; and (5) reporting requirements. Requires a State to consult with individuals and groups of individuals with disabilities when developing the plan in order to have the plan approved. (Sec. 2103) Defines "individuals with disabilities" to mean any individual within one or more of the following four categories: (1) individuals requiring help with the activities of daily living; (2) individuals with severe cognitive or mental impairment; (3) individuals with severe or profound mental retardation; and (4) severely disabled children. (Sec. 2104) Requires a State plan to specify the services available. Requires each individualized plan to be developed in close consultation with the individual and the individual's family. Prohibits a State plan from covering: (1) room and board; (2) services furnished in a hospital, nursing facility, intermediate care facility for the mentally retarded, or other specified institutional setting; or (3) items or services to the extent coverage is provided for an individual under a health plan or Medicare. (Sec. 2105) Sets forth provisions relating to: (1) cost sharing; (2) quality assurance and safeguards; (3) advisory groups; (4) payments to States; and (5) the total Federal budget for State plans and allotments to States. (Sec. 2301) directs the Secretary, with the advice and assistance of the National Long-Term Care Insurance Advisory Council to promulgate regulations as necessary to implement provisions concerning private long-term care insurance. Directs the Secretary to make appointments to such Council. Authorizes appropriations for such Council. (Sec. 2321) Directs the Secretary, after considering the Council's recommendations to promulgate regulations designed to: (1) standardize formats and terminology used in long-term care policies; (2) require insurers to provide information to customers on the range of public and private long-term care coverage available; and (3) establish other requirements promoting consumer understanding of benefits. (Sec. 2322) Directs the Secretary to promulgate regulations establishing requirements with respect to the terms of and benefits under long-term care policies, which shall include the following requirements that the policy may not: (1) limit coverage based on a preexisting condition, subject to an exception for a six month period; (2) condition eligibility for benefits based on the need or receipt of any other service; (3) condition eligibility for any benefit on any particular diagnosis; (4) condition eligibility for benefits by providers on compliance with requirements not required by State or Federal law; and (5) condition coverage of any service by a provider on the provision of such service at a higher level of care than required by the insured individual. Prohibits discrimination by diagnosis in the treatment of: (1) Alzheimer's disease; (2) any organic or inorganic mental illness; (3) mental retardation or any other cognitive or mental impairment; or (4) HIV infection or AIDS. Sets forth other requirements for such policies, including requirements related to: (1) premiums; (2) sales practices; (3) continuation, renewal, replacement, conversion, and cancellation of policies; and (4) payment of benefits. (Sec. 2342) Provides for grants to States to enforce the Federal standards concerning long-term care policies. Sets forth requirements for receiving such grants. Authorizes appropriations. Prohibits the sale of a long-term care policy in a State without a regulatory program. (Sec. 2361) Authorizes the Secretary to make grants for the development and implementation of long-term care information, counseling, and other programs to: (1) States; (2) regional alliances (at the option of States within which such alliances are located; and (3) national organizations representing insurance consumers, long-term care providers, and insurers. Authorizes appropriations for such grants. (Sec. 2601) Authorizes the Secretary to conduct a demonstration program to test the effectiveness of various approaches to financing and providing integrated acute and long-term care services for the chronically ill and disabled. Sets forth the services and benefits to be provided, including: (1) all benefits of the comprehensive benefit package provided under title I of this Act; (2) transitional benefits, including assessment and home care; (3) long-term care benefits, including adult day care, home-delivered meals, and nursing facility services in specialized care units; and (4) habilitation services. Permits any of the following to be eligible for such services under criteria to be established by the Secretary: (1) individuals with disabilities under a State program; (2) individuals entitled to benefits under the Medicare program; and (3) individuals entitled to Medicaid and who are also either entitled to Medicare or Supplemental Security Income benefits. Requires reports to the Congress on the demonstration program. Title III: Public Health Initiatives - Subtitle A: Workforce Priorities Under Federal Payments - Establishes within the Department of Health and Human Services the National Council on Graduate Medical Education. Directs the National Council to designate for each academic year the number of individuals nationwide who are authorized to be enrolled in each specified approval physician training program for each medical specialty. Sets forth provisions specifying: (1) Federal formula payments to approved physician training programs; (2) application for payments; and (3) amount of payments. (Sec. 3061) Directs the Secretary to carry out a program with respect to graduate nurse training programs that is equivalent to the program for approved physician training programs. Establishes a National Council on Graduate Nurse Education. (Sec. 3071) Authorizes appropriations for the following programs: (1) primary care physician and physician assistant training; (2) training of underrepresented minorities and disadvantaged persons; and (3) nurse training. (Sec. 3072) Authorizes appropriations for the following programs: (1) a program of skill upgrading and occupational retraining for health care workers; (2) a demonstration program to assist workers in health care institutions in obtaining advanced career positions; (3) a program to develop and operate health-worker job banks in local employment services agencies, subject to certain conditions; (4) a program to provide joint labor-management decision-making in the health care sector on workplace matters related to the restructuring of the health care delivery system of this Act; and (5) a program to facilitate the comprehensive workforce adjustment initiative. (Sec. 3073) Directs the Secretary of Health and Human Services and the Secretary of Labor to jointly establish the National Institute for Health Care Workforce Development. States that the Director of the Institute shall make recommendations to the Secretaries regarding: (1) the supply of health care workers; (2) the impact of this Act; and (3) the development and implementation of high-performance, high-quality health care delivery systems. Directs the Secretaries to establish an advisory board to assist in the development of such recommendations. Subtitle B: Academic Health Centers - Directs the Secretary to make payments to a qualified academic health center or qualified teaching hospital in order to assist such eligible institutions with costs that are not routinely incurred by other entities in providing health services, but are incurred by such institutions by virtue of the academic nature of such institutions. States that such costs include: (1) costs resulting from reduced staff productivity due to teaching responsibilities; (2) the uncompensated costs of clinical research; and (3) exceptional costs associated with an institutions specialized expertise. Provides that the funding for such payments will come from transfers from the Federal Hospital Insurance Trust Fund, payments made by regional alliances to the Federal government for academic health centers and graduate medical education, and payments from corporate alliances. (Sec. 3131) Provides for the access of regional and corporate alliance patients to academic health centers. Subtitle C: Health Research Initiatives - Amends the Public Health Service Act to ensure that the National Institutes of Health conducts and supports biomedical and behavioral research on promoting health and preventing diseases, disorders, and other health conditions. Provides for health services research. Authorizes appropriations for such research. Subtitle D: Core Functions of Public Health Programs; National Initiatives Regarding Preventive Health - Authorizes appropriations for the core functions of public health programs and national initiatives regarding health promotion and disease prevention. (Sec. 3312) Authorizes the Secretary to make grants to States to carry out one or more of the following core functions: (1) data collection; (2) activities to protect the environment and to assure the safety of housing, workplaces, and food and water; (3) investigation and control of adverse health conditions; (4) public information and education programs to reduce risks to health such as use of tobacco, alcohol, and drugs, sexual activities that increase the risk of HIV transmission and other sexually transmitted diseases, poor diet, physical inactivity, and low childhood immunization levels; (5) accountability and quality assurance activities; (6) provision of public health laboratory services to complement private clinical laboratory services that screen for diseases and conditions; (7) training and education to assure provision of care by all health professionals; and (8) leadership policy development and administrative activities. (Sec. 3331) Authorizes the Secretary to make grants to agencies of State or local government, private nonprofit organizations, and coalitions that link two or more of these groups for the purpose of carrying out projects to develop and implement innovative community-based strategies to provide for health promotion and disease prevention activities for which there is a significant need. Subtitle E: Health Services for Medically Underserved Populations - Directs the Secretary to make grants to migrant health centers and community health centers, which shall be in addition to other funds available to such centers. Authorizes appropriations. (Sec. 3412) Authorizes appropriations for: (1) grants and contracts for the development of qualified community health plans and practice networks; and (2) loans and guaranteeing the principal and interest to Federal and non-Federal lenders on behalf of public and private entities for the capital costs of developing qualified community health plans and practice networks. (Sec. 3461) Authorizes the Secretary to make grants and enter into contracts with qualified community health groups to provide enabling services such as transportation, community and patient outreach, patient education, and translation services in order to increase the capacity of individuals to utilize the items and services under title I of this Act. Authorizes appropriations. (Sec. 3471) Authorizes appropriations for: (1) the National Health Service Corps; and (2) such amounts as are necessary to ensure that at least 20 percent of participants in the Scholarship Program or the Loan Repayment Program of the Corps are nurses. (Sec. 3481) Entitles a hospital with a low-income utilization rate in a base year of at least 25 percent to a payment as specified. Requires 75 percent of the total available to be allocated to hospitals for low-income assistance. Requires 25 percent of the total available to be allocated to hospitals for assistance in furnishing inpatient hospital services that are not covered services under title I of this Act. Subtitle F: Mental Health; Substance Abuse - Authorizes appropriations to carry out this part. Provides for grants to: (1) increase access to mental health and substance abuse services; (2) improve State and local capacity to coordinate and monitor such services; (3) provide incentives to integrate public and private service systems; and (4) supplement any activity under part B (Alcohol and Drug Abuse and Mental Services Block Grant) of title XIX of the Public Health Service Act. (Sec. 3503) Authorizes the Secretary to make loans for the capital costs incurred in the development of non-acute, residential treatment centers and community-based ambulatory clinics. (Sec. 3521) Requires the establishment of a pilot program demonstrating the integration of the mental illness and substance abuse services of the States with the services included under title I of this Act. Subtitle G: Comprehensive School Health Education; School-Related Health Services - Authorizes appropriations for the programs of this subtitle. States that the purposes of the programs shall be to: (1) support, in kindergarten through grade 12, the provision of comprehensive health educator programs; (2) establish a national framework within which States can create comprehensive school health education programs that target the health risk behaviors of youth, including tobacco use, alcohol and drug abuse, sexual behaviors resulting in infections, injury prevention, dietary patterns, and sedentary lifestyles; (3) pay the initial costs of planning and establishing such programs; (4) support related Federal demonstrations and training; (5) motivate youth to stay in school, avoid teen pregnancy, and strive for success; (6) improve the knowledge of health education among youth; and (7) further the National Education Goals set forth in title I of the Goals 2000: Educate America Act. Defines "comprehensive school health education program." Requires such programs to be sensitive to cultural and ethnic issues, promote involvement by families, and promote personal responsibility. Sets forth requirements for applying for grants and selection of grantees. Subtitle H: Public Health Service Initiative - Establishes a Public Health Service Initiative consisting of specified amounts authorized to be appropriated for the Initiative. States that: (1) the Initiative includes the programs of subtitles C through G of this title and the programs of subtitle D of title VIII; and (2) amounts appropriated to carry out the Initiative, including subtitles A through F of this title, are available to carry out specific programs for which the amounts are appropriated. Subtitle I: Coordination with COBRA Continuation Coverage - Amends title XXII (Requirements for Certain Group Health Plans for Certain State and Local Employees) of the Public Health Service Act to provide for coordination with COBRA continuation coverage. Repeals such title XXII upon implementation of this Act. Title IV: Medicare and Medicaid - Subtitle A: Medicare and the Alliance System - Amends title XVIII of the Social Security Act to provide for optional State integration of Medicare beneficiaries into regional alliance plans. (Sec. 4002) Allows individuals to elect to remain in certain plans. (Sec. 4003) Provides for payments to regional alliances on behalf of certain Medicare-eligible individuals. (Sec. 4004) Extends protections for working aged and disabled individuals to group health plans of all employers. Repeals the limitation on the period of protection for individuals with end stage renal disease. Prohibits Medicare payment for items and services provided under any health plan under this Act. Simplifies Medicare benefit coordination in cases where the individual is also eligible for benefits under this Act's health plans. (Sec. 4011) Makes various changes concerning eligible organization and Medicare supplemental policy enrollment and comparative informational materials, eligible organization outlier payments, and participating provider point-of-service networks. (Sec. 4022) Provides for expanded Medicare coverage for physician assistant, nurse practitioner, and clinical nurse specialist services. (Sec. 4031) Amends title XI of the Social Security Act to: (1) provide for termination of the separate Medicare peer review program upon adoption of the National Quality Management Program above under subtitle A of title V of this Act; and (2) repeal provisions on surgical procedure review and second opinions. (Sec. 4032) Amends title XVIII of the Social Security Act to provide for mandatory assignment for all Medicare part B services. (Sec. 4033) Directs the Secretary of Health and Human Services to take such steps as may be necessary to consolidate administration of Medicare parts A and B and supersedes certain conflicting requirements to the extent required to achieve such purpose. (Sec. 4035) Prohibits the Secretary from implementing any change in procedures for billing and processing Medicare claims within six months of implementing any previous change. Adds advanced notification to providers as a requirement for carriers and fiscal intermediaries under Medicare. (Sec. 4041) Amends title XI of the Social Security Act to: (1) provide for civil monetary penalties for kickback violations under Medicare and State health care programs (the programs); (2) make other penalty-related changes, including increases in criminal and civil monetary penalties, a new criminal penalty exception for certain providers, additional civil monetary penalty offenses related to alliance systems, and requirements for the deposit of penalties collected into the All-Payer Account established above under title V of this Act; (3) revise exclusion provisions, with changes establishing a minimum period of exclusion for certain individuals and entities subject to permissive exclusion from the programs, and providing for program exclusions based on actions under alliance systems; and (4) modify sanction provisions, with changes removing certain conditions for imposing sanctions and setting specified civil money penalties for use in lieu of authorized sanctions. (Sec. 4042) Amends title XVIII of the Social Security Act to revise the limitations on physician self-referrals. (Sec. 4051) Provides for the termination of payments under Medicare for medical education costs and directs the Secretary to make specified transfers from certain Medicare trust funds to the new accounts established above for funding physician training programs and academic health centers. (Sec. 4061) Amends title XVIII of the Social Security Act to provide for the treatment of: (1) uniformed services and VA health plans as eligible organizations under Medicare; and (2) health care facilities of the Department of Veterans Affairs as providers under Medicare. Subtitle B: Savings in Medicare Program - Amends title XVIII of the Social Security Act to provide for: (1) reductions in the update for inpatient hospital services and the adjustment for indirect medical education costs, in payments for capital-related costs for inpatient hospital services; (2) revisions to payment adjustments for disproportionate share hospitals in States participating under this Act; and (3) an extension of the freeze on updates to routine service costs of skilled nursing facilities. (Sec. 4111) Amends title XVIII of the Social Security Act to provide for: (1) establishment of cumulative expenditure goals for physician services; (2) use of real gross domestic product for volume adjustments; (3) repeal of restrictions on the maximum reduction permitted in default update; (4) reduction in the conversion factor for the physician fee schedule for 1995; (5) place limitations on payment for physicians' services furnished by high-cost hospital medical staffs; (6) requirements for physicians to identify the hospital at which the service was furnished; (7) an increase in practice expense relative value units for certain services while assuring budget neutrality; (8) a study and report to the Congress by the Secretary on a resource-based system for determining practice expense relative value units for each physician's service; (9) an increase in work relative value units for office visits while assuring budget neutrality; (10) a reduction in relative values for office consultations; (11) adjustment of outlier intensity of relative values; (12) changes in underserved area bonus payments; (13) elimination of formula-driven payments for certain outpatient hospital services; (14) copayments for laboratory services; and (15) competitive acquisition procedures for Medicare part B items and services (including clinical diagnostic laboratory tests). (Sec. 4131) Makes changes with respect to: (1) Medicare as secondary payer; (2) payments for health maintenance organizations and competitive medical plans with risk-sharing contracts; and (3) routine cost limits and copayments for, respectively, home health services and visits. (Sec 4135) Directs the Secretary to use a competitive process to contract with centers of excellence for cataract surgery, coronary artery by-pass surgery, and such other services as the Secretary determines to be appropriate. (Sec. 4141) Amends title XVIII of the Social Security Act to revise Medicare part B premium provisions. (Sec. 4151) Requires the Secretary to submit a report to the Congress on the growth in spending under Medicare for FY 2000 through 2003. Subtitle C: Medicaid - Amends title XIX (Medicaid) of the Social Security Act to provide that if a State Medicaid plan provides for payment to regional alliances of the amounts required above it is not required to provide payment for items and services covered under the comprehensive benefit package for alliance eligible individuals and will receive no Federal financial assistance with respect to such items and services. (Sec. 4211) Provides for: (1) spenddown eligibility and increased income and resource disregard for nursing facility residents; and (2) informing such residents about the availability of assistance for home and community-based services. (Sec. 4221) Provides for: (1) treatment of items and services not covered under the comprehensive benefit package; and (2) establishment of a program under Medicare of noncovered items and services for poor children. (Sec. 4231) Discontinues certain payment policies under Medicaid. (Sec. 4241) Limits the frequency of changes in a State's billing and claims processing system, and provides for advance notification to providers of any major billing change. (Sec. 4251) Establishes the Medicaid Commission to study, report, and make recommendations with respect to options involving block grant use, integration of long-term care services, and consolidation of institutional and home- and community-based long-term care in relation to the Medicaid program. Authorizes appropriations. Subtitle D: Increase in SSI Personal Needs Allowance - Amends title XVI (Supplemental Security Income) (SSI) to provide for an increase in the SSI personal needs allowance. Title V: Quality and Consumer Protection - Subtitle A: Quality Management and Improvement - Requires the National Health Board to establish and oversee a performance-based program of quality management and improvement designed to enhance the quality, appropriateness, and effectiveness of heath care services and access to such services which will be called the National Quality Management Program. (Sec. 5002) Establishes the National Quality Management Council which shall: (1) administer the National Quality Management Program; (2) perform any other duty specified in this subtitle; and (3) advise the National Health Board with respect to its duties under this subtitle. Requires the Council to develop a set of national measures of quality performance to be used in the assessment of and the provision of access to health care services. Requires the Council, in addition, to: (1) recommend to the Board establishing goals for performance by health plans and health care providers on a subset of national measures of quality performance; (2) direct the Administrator for Health Care Policy and Research to develop, review, and disseminate practice guidelines to determine how diseases can most effectively be prevented, diagnosed, treated, and managed; and (3) direct the Administrator for Health Care Policy and Research to support research related to a five year priority list of performance measures. (Sec. 5008) Directs the National Health Board to: (1) establish and oversee regional professional foundations to perform such duties as develop lifetime learning programs for health professionals and conduct research on health care quality; and (2) establish the National Quality Consortium to perform such duties as establishing continuing education for health professionals and provide advice on research priorities. (Sec. 5012) Requires each regional alliance and each corporate alliance to: (1) disseminate specified information to consumers; and (2) ensure that performance and quality standards are continually improved. Subtitle B: Information Systems, Privacy, and Administrative Simplification - Directs the National Health Board to develop and implement a health information system, in consultation with Federal agencies, States, employers, health plans, and others, by which the Board shall collect, report, and regulate the collection and dissemination of health care information which shall be used for: (1) health care planning by Federal, State, and local government; (2) establishing and monitoring payments for health services; (3) assessing and improving the quality of health care; (4) managing and containing costs at the alliance and plan levels; and (5) other specified purposes. Requires the establishment of an electronic data network to collect, compile, and transmit information. (Sec. 5120) Sets forth provisions providing for health information privacy standards. (Sec. 5130) Directs the National Health Board to develop the following standard health care benefit forms: (1) an enrollment and disenrollment form; (2) a clinical encounter record; and (3) a claim form. (Sec. 5140) Establishes the National Privacy and Health Data Advisory Council in order to advise the National Health Board with respect to its duties under this subtitle. (Sec. 5141) Sets forth monetary penalties for violating health information system standards. Subtitle C: Remedies and Enforcement - Sets forth provisions with respect to the review of benefit determinations for enrolled individuals, including provisions: (1) regulating the time limits for notice of disposition of a claim; (2) governing a plan's duty to review claim denials; (3) concerning urgent requests for preauthorization; and (4) concerning other time limits with respect to time limits and notice. (Sec. 5202) Requires each State to establish a complaint review office for each regional alliance established by a State. Permits aggrieved individuals to file complaints with the appropriate review office. (Sec. 5205) Provides for a Federal Health Plan Review Board to review the decisions of complaint review office hearing officers. (Sec. 5207) Sets monetary penalties for a plan which unreasonably denies or delays payment or provision of benefits. (Sec. 5211) Directs each State to establish and maintain an Early Resolution Program in each complaint review office. Requires a program to include: (1) forums for mediation disputes; and (2) other forums of alternative dispute resolution as may be prescribed. Establishes guidelines for the eligibility of cases for submission to the Early Resolution Program. States that conclusions of the mediation proceedings shall be treated as nonbinding and shall not affect any rights to review. (Sec. 5231) Sets forth additional remedies and enforcement provisions. Subtitle D: Medical Malpractice - Prohibits any medical malpractice liability action until the final resolution of the claim under alternative dispute resolution. Requires each regional alliance health plan and corporate alliance health plan to adopt at least one specified method of alternative dispute resolution. Prohibits an individual from bringing a medical malpractice liability action unless the individual submits an affidavit that includes a report by a qualified specialist that states that there is a meritorious cause for filing the action. (Sec. 5311) Directs the Secretary to establish: (1) a project to demonstrate whether substituting liability for medical malpractice on the part of the health plan in which a physician participates for the personal liability of the physician will result in improvements in the quality of care, reductions in defense medical practices, and better risk management; (2) a pilot program under which the Secretary provides funds to one or more eligible States to determine the effect of applying practice guidelines in the resolution of medical malpractice liability actions. Subtitle E: Fraud and Abuse - Directs the Secretary and the Attorney General to establish a program: (1) to coordinate the functions of the Attorney General, the Secretary, and other organizations with respect to the prevention, detection, and control of health care fraud and abuse; (2) to conduct investigations, audits, evaluations, and inspections relating to the delivery of and payment for health care; and (3) to facilitate the enforcement of this and other statutes applicable to health care fraud. (Sec. 5402) Creates, in the Treasury, the All-Payer Health Care Fraud and Abuse Control Account which shall consist of: (1) gifts and bequests; (2) administrative penalties and assessments and portions of civil monetary penalties imposed under provisions of the Social Security Act; (3) all criminal fines imposed in cases involving a Federal health care offense; (4) penalties imposed under the False Claims Act involving claims related to the provision of health care items and services; and (5) amounts resulting from the forfeiture of property by reason of Federal health care offense. States that amounts in the fund may be used to cover costs incurred in operating the Program. (Sec. 5411) Excludes from participation in any health plan any individual or entity excluded from participation in a public program under provisions of the Social Security Act. (Sec. 5413) Sets forth physician self-referral limitations. (Sec. 5431) Amends the Federal criminal code to set penalties for knowingly executing a scheme or artifice to: (1) defraud any health alliance, health plan, or other person (alliance) in connection with the delivery of, or payment for, health care benefits, items, or services (benefits); and (2) obtain, by false or fraudulent means, money or property owned by, or under the custody of control of, any such alliance in connection with the delivery of, or payment for, health care benefits. (Sec. 5432) Amends: (1) the Federal criminal code to require the court, in imposing sentence on a person convicted of a Federal health care offense that poses a serious threat to the health of any person or has a significant detrimental impact on the health care system, to order such person to forfeit property used in the commission of the offense or that constitutes, or is derived from, proceeds traceable to the commission of the offense which is of a value proportionate to the seriousness of the offense; and (2) the Federal judicial code to require that all proceeds of forfeiture relating to Federal health care offenses be deposited into the Department of Justice Assets Forfeiture Fund. (Sec. 5433) Amends the Federal criminal code to set penalties for: (1) knowingly and willfully falsifying, concealing, or covering up a material fact, making any false, fictitious, or fraudulent statements or representations, or making or using any false writing or document knowing it to contain any false, fictitious, or fraudulent statement or entry, in any matter involving a health alliance or health plan; and (2) bribery of, and graft by, a health care official. (Sec. 5435) Authorizes: (1) the Attorney General to commence a civil action in Federal court to enjoin a Federal health care offense; and (2) a person privy to certain grand jury information concerning a health law violation to disclose that information to an attorney for the Government to use in any civil proceeding related to a Federal health care offense. (Sec. 5437) Sets penalties for: (1) theft or embezzlement in connection with a health alliance, health plan, or fund connected with such alliance or plan; and (2) misuse of a health security card issued, or unique identifier provided, pursuant to this Act. (Sec. 5441) Makes provisions of the Civil False Claims Act applicable to the use of false records or statements made to a health plan. Includes within the definition of "claim" for purposes of such Act any request or demand for money or property which is made or presented to a health plan. Subtitle F: McCarran-Ferguson Reform - Amends the McCarran-Ferguson Act to repeal the exemption under specified antitrust laws for the business of insurance to the extent that such business relates to the provision of health benefits. Title VI: Premium Caps; Premium-Based Financing; and Plan Payments - Subtitle A: Premium Caps - Sets forth provisions which provide for the computation of factors that limit the growth of premiums for the comprehensive benefit package in regional alliance health plans, including the computation of a: (1) regional alliance inflation factor; and (2) general health care inflation factor. (Sec. 6002) Directs the Board to determine: (1) a national per capita baseline premium target; (2) the national average per capita current coverage health expenditures; and (3) current health care expenditures. (Sec. 6003) Directs the Board to determine a regional alliance per capita premium. (Sec. 6004) Requires a regional alliance to annually obtain premium bids from each plan seeking to participate as a regional alliance health plan with respect to the alliance. (Sec. 6005) Permits any participating State to assume responsibility for containment of health care expenditures in the State consistent with this Act. (Sec. 6006) Directs the chair of the Board to establish an advisory commission on regional variations in health expenditures. Requires the commission to examine methods of eliminating variation in regional alliance per capita premium targets due to variation in practice patterns, not due to other factors. Requires the Board to submit its recommendations to the Congress. Requires such recommendations to apply unless a joint resolution of disapproval is passed. (Sec. 6011) Subjects each noncomplying regional alliance health plan for a year to a reduction in plan payment as specified, in order to assure that payments to regional alliance health plans by a regional alliance are consistent. Defines a noncomplying plan to include a plan in which the final accepted bid exceeds the maximum complying bid for the per capita target premium. Defines "maximum complying bid." (Sec. 6021) Directs the Board to develop a methodology for calculating an annual per capita expenditure equivalent for amounts paid for coverage for the comprehensive benefit package within a corporate alliance. (Sec. 6022) Terminates a corporate alliance with two excess years in a three year period. Provides that employers that were corporate alliance employers with respect to a terminated alliance shall become regional alliance employers. Defines an excess year as one in which the rate of increase for the corporate alliance exceeds the national corporate inflation factor. Defines rate of increase and national corporate inflation factor. (Sec. 6031) Sets forth special rules for a single-payer State. (Sec. 6041) Directs the Secretary to establish a program to monitor prices and expenditures in the U.S. health care system. Subtitle B: Premium-Related Financings - Makes each family enrolled in a regional health alliance plan or in a corporate alliance health plan in a class of family enrollment responsible for payment of the family share of premium payable for enrollment. Provides for income related discounts and specified credits. (Sec. 6102) Establishes the formula for determining the premiums. (Sec. 6111) Provides for the repayment of credit by certain families. (Sec. 6114) Provides for the special treatment of certain retirees and qualified spouses and children. (Sec. 6121) Requires each regional alliance employer to pay a monthly premium to the regional alliance for a qualifying employee. Sets forth provisions for determining such premium. Varies the premium depending upon such factors as the employer's size and average wages paid. (Sec. 6126) Sets forth provisions applicable to self-employed individuals. (Sec. 6131) Sets forth provisions for determining the corporate employer premium. Subtitle C: Payments to Regional Alliance Health Plans - Sets forth provisions to determine the computation of: (1) the blended plan per capita payment amount; and (2) the plan bid, AFDC, and SSI proportions. Title VII: Revenue Provisions - Subtitle A: Financing Provisions - Amends the Internal Revenue Code to increase the excise taxes on cigarettes and other tobacco products. (Sec. 7113) Imposes an excise tax on the manufacture or importation of roll-your-own tobacco. (Sec. 7121) Imposes an assessment on each corporate alliance employer and a temporary assessment on employers with retiree health benefit costs. Requires such assessments to be paid in the same manner as employment taxes. (Sec. 7131) Provides for the recapture of certain health care subsidies received by high-income individuals. Transfers such amounts to the Supplemental Medical Insurance Trust Fund. (Sec. 7141) Requires certain shareholders of S corporations and limited partners who materially participate in corporate activities to include their share of income or loss from such corporation when determining net earnings from self-employment. (Sec. 7142) Provides for extending Medicare coverage and applying the hospital insurance tax to all State and local government employees. Subtitle B: Tax Treatment of Employer-Provided Health Care - Provides exceptions to the exclusion of employer-provided contributions to an accident or health plan from the gross income of an employee. (Sec. 7202) Prohibits the provision of health benefit under cafeteria plans. (Sec. 7203) Makes permanent the deduction for health insurance costs of self-employed individuals. Increases such deduction to 100 percent of the basic coverage purchased from a health alliance with limitations. Subtitle C: Employment Status Provisions - Requires the Secretary of the Treasury to prescribe regulations defining an employee for employment tax purposes. (Sec. 7302) Increases the penalty for failure to file correct returns involving payments for services. (Sec. 7303) Sets forth rules to limit retroactive employment tax reclassifications. Subtitle D: Tax Treatment of Funding of Retiree Health Benefits - Requires additional reserves for post-retirement medical and life insurance benefits to cover not less than ten years of the working lives of covered employees and to be maintained as separate accounts. (Sec. 7402) Terminates the authority of pension plans to maintain health benefits accounts. Subtitle E: Coordination with COBRA Continuing Care Provisions - Repeals provisions concerning continuation coverage requirements of group health plans upon implementation of this Act. Subtitle F: Tax Treatment of Organizations Providing Health Care Services and Related Organizations - Provides for the tax treatment of charitable organizations providing health care services, insurance provided by health maintenance organizations, and certain private foundations. (Sec. 7602) Sets forth transitional rules for taxing certain organizations providing health insurance and other prepaid health care services as insurance companies other than life insurance companies. (Sec. 7603) Exempts regional alliances from income tax. Subtitle G: Tax Treatment of Long-term Care Insurance and Services - Treats qualified long-term care services as medical care for purposes of the medical expense deduction. (Sec. 7702) Provides for the treatment of long-term care insurance as accident and health insurance. (Sec. 7703) Allows accelerated death benefits under life insurance contracts to be paid to terminally ill individuals. Subtitle H: Tax Incentives for Health Service Providers - Allows a tax credit for certain qualified individuals who provide primary health services full time in a health professional shortage area. (Sec. 7802) Increases the allowable depreciation deduction for expensing certain medical equipment. Subtitle I: Miscellaneous Provisions - Allows a tax credit for the cost of personal assistance services required by an employed individual who for medical reasons is unable to engage in substantial gainful activity. (Sec. 7902) Denies tax-exempt status for private activity bonds of regional alliances, corporate alliances, or guaranty funds established under this Act. Title VIII: Health and Health-Related Programs of the Federal Government - Subtitle A: Military Health Care Reform - Directs the Secretary of Defense to establish one or more uniformed services health plans in order to provide health care services to members of the armed forces on active duty for 30 or more days as well as their covered beneficiaries. Requires conformity of such plans with health plan requirements set forth in this Act. (Sec. 8001b) Allows any such plan to rely upon the use of military health care facilities, supplemented by civilian health care providers or health plans under agreements entered into by the Secretary. Requires at least the items and services in the comprehensive benefit package under this Act to be included in each such plan. Preempts any conflicting State health plan requirements. Provides for plan enrollment, effect of failure to enroll, and choosing between a uniformed services health plan and other available plans. Prohibits the imposition of plan charges to an active-duty member other than subsistence charges, but allows the Secretary to impose limited charges for covered beneficiaries. Establishes in the Department of Defense a financial account for payments received in connection with a uniformed services health plan, allowing such funds to be used only for purposes directly related to the delivery and financing of health care services under this Subtitle. Subtitle B: Department of Veterans Affairs - Allows each veteran who is an eligible individual under this Act and individuals currently enrolled in a health plan under the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) to be enrolled with a Department of Veterans Affairs (VA) health plan. Requires conformity of such plans with health plan requirements set forth in this Act, with all the items and services of the comprehensive benefit package under this Act included. Allows such plans to offer supplemental health benefits and cost-sharing policies as consistent with this Act. Provides a limitation with regard to veterans enrolled with health plans outside the VA. Prohibits the imposition of any plan enrollment charges upon service-connected disabled veterans, veterans receiving disability compensation from the VA, former prisoners of war, and veterans unable to defray the costs of such care. Allows the Secretary of Veterans Affairs to establish plan charges for other veterans. Deems a VA facility to be a Medicare provider for purposes of any program administered by the Secretary of Health and Human Services. Allows for the recovery of certain care and services provided under a VA plan in the case of an individual who has coverage under another plan. Establishes in the Treasury the Department of Veterans Affairs Health Plan Fund to be used for VA health plan payments and services. Preserves existing benefits for VA facilities not operating within a health plan certified under this Act. (Sec. 8102) Directs the Secretary of Veterans Affairs to organize health plans and operate VA facilities as, or within, health plans under this Act. Preempts existing State health plan standards or requirements. Authorizes the Secretary to contract for the provision of services by a VA health plan when cost-effective, or to share resources with other health care plans, providers, or organizations. Authorizes appropriations to the VA for FY 1995 through 1997 for VA health plans under this Subtitle, subject to availability of appropriations. Requires a report from the Secretary to the Congress concerning the operation of the VA health care system within the requirements of this Act. Authorizes the Secretary to accept and use grants for health care services provided to special populations if used by the VA while operating under a VA health plan. Subtitle C: Federal Employees Health Benefits Programs - (Secs. 8202 through 8204) Provides for termination of the Federal Employees Health Benefits Program (FEHB) and treatment of Federal employees, annuitants, and other individuals (including those residing abroad) who would otherwise have been eligible for FEHBP under this Act's health plans. Subtitle D: Indian Health Service - Makes qualifying Indians eligible to enroll in a comprehensive benefits health program of the Indian Health Service. (Sec. 8303) Authorizes appropriations for supplemental Indian health care benefits. (Sec. 8305) Exempts tribal governments and organizations from making employer payments. (Sec. 8306) Sets forth provisions regarding health service to non-enrollees and non-Indians. (Sec. 8311) Requires each health program of the Indian Health Service to establish a comprehensive benefit package fund. (Sec. 8313) Authorizes appropriations for the Indian Health Service programs. Subtitle E: Amendments to the Employee Retirement Income Security Act of 1974 - Amends the Employee Retirement Income Security Act of 1974 (ERISA) to revise and limit the coverage of group health plans under ERISA. Makes certain ERISA provisions inapplicable with respect to State-certified health plans. Provides for an exception from ERISA civil action provisions where review is otherwise available under the Health Security Act (this Act, HSA). (Sec. 8402) Establishes ERISA requirements for expeditious reporting and disclosure applicable to group health plans, through special rules consistent with ERISA and HSA purposes. Excludes plans maintained by regional alliances from treatment as multiple employer welfare arrangements. (Sec. 8403) Revises certain ERISA provisions relating to continuation coverage under group health plans. Repeals such provisions upon implementation of HSA. (Sec. 8404) Makes ERISA standards for group health plans regarding: (1) cases of adoption applicable except to the extent otherwise provided in regulations of the National Health Board under HSA; and (2) coverage of pediatric vaccines inapplicable to a group health plan upon its becoming a corporate alliance health plan under HSA. (Sec. 8405) Requires group health plans under ERISA to comply with HSA requirements relating to health plan claims procedure. Subtitle F: Special Fund for WIC Program - Authorizes appropriations through FY 2000 for the special supplemental food program for women, infants, and children under the Child Nutrition Act of 1966. Title IX: Aggregate Government Payments - Subtitle A: Aggregate State Payments - Sets forth provisions which have formulas for determining each participating State's payment to regional alliances within the State. Provides two different formulas. Establishes one payment formula for non-cash assistance recipients. Establishes another formula relating to cash assistance recipients. Defines a non-cash assistance adult as an individual who is: (1) over 21 years; (2) a U.S. citizen or lawful alien; and (3) is not an AFDC or SSI recipient or a Medicare-eligible individual. (Sec. 9022) Directs the National Health Board to review appropriateness of such payments. Subtitle B: Aggregate Federal Alliance Payments - Sets forth the formula for determining Federal payments to regional alliances for cash assistance recipients. (Sec. 9102) States that this section constitutes budget authority in advance of appropriation Acts and obligates the Federal Government to provide for the payment to regional alliances of a capped Federal alliance payment amount. Defines "capped Federal alliance payment amount." Subtitle C: Borrowing Authority to Cover Cash-flow Shortfalls - Authorizes the Secretary to make available loans to regional alliances to cover any period of temporary cash-flow shortfall attributable to: (1) any estimation discrepancy; (2) a period of temporary cash-flow shortfall attributable to an administrative error; or (3) a period of temporary cash-flow shortfall relating to the relative timing during the year in which amounts are received and payments are required. Sets forth loan terms and conditions. Title X: Coordination of Medical Portion of Workers Compensation and Automobile Insurance - Subtitle A: Workers Compensation Insurance - Requires each health plan that provides services to enrollees through participating providers to make arrangements to provide workers compensation to such enrollees. (Sec. 10002) Requires each workers' compensation carrier that is liable for payment for workers' compensation services furnished by or through a health plan, regardless of whether or not the services are included in the comprehensive benefit package, to make payment for such services. (Sec. 10011) Sets forth requirements for participating States. (Sec. 10031) Authorizes demonstration projects in one or more States with respect to the treatment of work-related injuries and illnesses. Subtitle B: Automobile Insurance - Requires an individual entitled to automobile insurance medical benefits and enrolled in a health plan to receive automobile insurance medical services through the provision of such services by the health plan. (Sec. 10102) Requires each automobile insurance carrier that is liable for payment for automobile insurance medical services furnished by or through a health plan, regardless of whether or not the services are included in the comprehensive benefit package, to make payment for such services. (Sec. 10111) Requires each participating State to develop a fee schedule applicable to payment for automobile insurance medical services for which a fee is not included in the applicable fee schedule. Subtitle C: Commission on Integration of Health Benefits - Establishes the Commission on Integration of Health Benefits which shall study and report on the feasibility and appropriateness of transferring financial responsibility for all medical benefits, including those currently covered by workers compensation and automobile insurance, to health plans. Authorizes appropriations. Subtitle D: Federal Employees' Compensation Act - Requires the Federal Employees' Compensation Act to be interpreted and administered consistent with the provisions of subtitle A. Subtitle E: Davis-Bacon Act and Service Contract Act - Amends the Davis-Bacon Act and the Service Contract Act of 1965 to require Health Security Act benefits. Subtitle F: Effective Dates - Sets forth effective date provisions. Title XI: Transitional Insurance Reform - Sets forth transitional provisions concerning: (1) enforcement; (2) preservation of current coverage; (3) restrictions on premium increases during transition; (4) portability requirements; (5) restrictions limiting benefit reductions; and (6) the establishment of the National Transitional Health Insurance Risk Pool.

Bill· SS. 1772 (103rd)referred

A bill to reduce federal employment to the levels proposed in the Vice President's Report of the National Performance Review.

United States · United States Congress · 22 November 1993

Sets limits on the total number of full-time equivalent executive agency positions in FY 1994 through 1999. Directs the Office of Management and Budget to monitor agency compliance with such employment limit and notify the Congress and President of any noncompliance, in which case future hiring for the agency in question shall be suspended. Provides for waivers from the requirements of this Act under certain conditions.

Bill· HRH.R. 3704 (103rd)open

Health Equity and Access Reform Today Act of 1993

United States · United States Congress · 22 November 1993

TABLE OF CONTENTS: Title I: Basic Reforms to Expand Access to Health Insurance Coverage and to Ensure Universal Coverage Subtitle A: Universal Access Subtitle B: Qualified General Access Plans in the Small Employer and Individual Marketplace Subtitle C: Qualified Health Plans in the Large Employer Marketplace Subtitle D: Benefits; Benefits Commission Subtitle E: State and Federal Responsibilities in Relation to Qualified Health Plans Subtitle F: Universal Coverage Subtitle G: Definitions Title II: Tax and Enforcement Provisions Subtitle A: General Tax Provisions Subtitle B: Provisions Relating to Acceleration of Death Benefits Subtitle C: Long-Term Care Tax Provisions Subtitle D: Enforcement Provisions Title III: Quality Assurance and Simplification Subtitle A: Quality Assurance Subtitle B: Administrative Simplification Title IV: Judicial Reforms Subtitle A: Medical Liability Reform Subtitle B: Anti-Fraud and Abuse Control Program Subtitle C: Treatment of Certain Activities Under the Antitrust Laws Title V: Special Assistance for Frontier, Rural, and Urban Underserved Areas Subtitle A: Frontier, Rural, and Urban Underserved Areas Subtitle B: Primary Care Provider Education Subtitle C: Programs Relating to Primary and Preventive Care Services Title VI: Treatment of Existing Federal Programs Subtitle A: Medicaid Program Subtitle B: Medicare Title VII: Patient's Right to Self-Determination Regarding Health Care Health Equity and Access Reform Today Act of 1993 - Title I: Basic Reforms to Expand Access to Health Insurance Coverage and to Ensure Universal Coverage - Subtitle A: Universal Access - Provides access to health insurance coverage under a qualified health plan for every citizen and lawful permanent resident of the United States. (Sec. 1003) Establishes a program under which persons with low incomes (and who are not eligible for Medicaid) will receive vouchers to buy insurance through purchasing groups. (Sec. 1004) Requires each employer to make available, either directly, through a purchasing group, or otherwise, enrollment in a qualified health plan to each eligible employee. Subtitle B: Qualified General Access Plan in the Small Employer and Individual Marketplace - Requires the National Association of Insurance Commissioners to develop specific standards to implement requirements concerning: (1) guaranteed eligibility, availability, and renewability of health insurance coverage; (2) nondiscrimination based on health status; (3) benefits offered; (4) insurer financial solvency; (5) enrollment process; (6) premium rating limitations; (7) risk adjustment; and (8) consumer protection. (Sec. 1119) Requires each qualified general access plan to: (1) establish and maintain a quality assurance program and a mediation procedures program; and (2) contain assurances of service to designated underserved areas. (Sec. 1141) Provides for individuals and small employers to form purchasing groups. (Sec. 1161) Requires brokers or insurers to provide specified information to prospective enrollees. (Sec. 1162) Prohibits insurers from creating improper financial incentives and from selling duplicate coverage. Subtitle C: Qualified Health Plans in the Large Employer Marketplace - Requires the Secretary of Health and Human Services, in consultation with the Secretary of Labor, to establish standards for large employer plans similar to requirements applicable to small employer plans. (Sec. 1203) Requires large employers to offer to employees at least a standard package and a catastrophic package. (Sec. 1205) Allows two or more large employers to form purchasing groups, but not through an individual or small employer purchasing group. (Sec. 1206) Requires a semi-annual review of each large employer plan to determine whether requirements are being met and what corrective actions need to be taken. (Sec. 1221) Amends the Employee Retirement Income Security Act of 1974 and the Public Health Service Act to revise provisions to conform to this Act. Subtitle D: Benefits; Benefits Commission - Requires each qualified health plan to provide a standard package and a catastrophic package. Specifies items and services to be covered. (Sec. 1311) Establishes the Benefits Commission to develop and propose legislation that provides a clarification of covered items and services and includes specifications for cost sharing. (Sec. 1314) Provides for congressional consideration and implementation of such legislation. Subtitle E: State and Federal Responsibilities in Relation to Qualified Health Plans - Requires each State to establish a program to: (1) certify insured health plans; (2) disseminate information on health care coverage areas; (3) establish procedures for purchasing groups; (4) prepare information concerning plans and purchasing groups; (5) provide for a risk adjustment program, including an adjustment for differences in nonpayments among qualified insured health plans; (6) develop a binding arbitration process; and (7) specify an annual general enrollment period. (Sec. 1421) Allows the waiver of specified requirements. (Sec. 1431) Provides preemptions from certain State laws. (Sec. 1441) Specifies the Federal responsibilities with respect to multi-state employer plans and in case of State defaults. Subtitle F: Universal Coverage - Requires each citizen or lawful permanent resident to be covered under a qualified health plan or equivalent health care program by January 1, 2005. Provides an exception for any individual who is opposed for religious reasons to health plan coverage, including those who rely on healing using spiritual means through prayer alone. Subtitle G: Definitions - Defines terms used in this Act. Title II: Tax and Enforcement Provisions - Subtitle A: General Tax Provisions - Amends the Internal Revenue Code to exclude from an employee's gross income employer-provided coverage under a qualified health plan or employer-provided contributions to the employee's medical savings account. Includes excess employer contributions in such gross income. (Sec. 2002) Allows a business expense deduction for employer costs of qualified health plans or contributions to an employee's medical savings account. Increases the allowable deduction (from 25 percent to 100 percent) for the qualified health insurance costs of self-employed individuals. Makes such deduction permanent. (Sec. 2003) Allows individuals a tax deduction for contributions made to a medical care savings account established for the benefit of an eligible individual. Allows such deduction whether or not an individual itemizes deductions. Disallows distributions from such accounts as medical expense deductions. Excludes employer contributions to such accounts from employment taxes. Establishes an excise tax for excess contributions to medical care savings accounts. (Sec. 2004) Eliminates the commonality of interest and geographic location requirements with respect to group purchasing by large tax-exempt organizations. (Sec. 2005) Revises and repeals provisions concerning continuation coverage requirements of group health plans upon implementation of this Act. Subtitle B: Provisions Relating to Acceleration of Death Benefits - Requires payment under a life insurance contract on the life of an insured who is terminally ill to be treated as a death benefit, making such payment eligible for tax exclusion from gross income. (Sec. 2102) Provides that any reference to life insurance shall be treated as referring to a qualified terminal illness rider. Subtitle C: Long-Term Care Tax Provisions - Treats qualified long-term care services as medical care for purposes of the medical expense deduction. (Sec. 2202) Provides for the treatment of long-term care insurance as accident and health insurance. (Sec. 2301) Sets forth consumer protection provisions to be satisfied by qualified long-term care insurance contracts, including the model regulation and Act promulgated by National Association of Insurance Commissioners (NAIC). Requires NAIC to promulgate standards for the use of uniform language and definitions in such policies, with certain variations permitted. Subtitle D: Enforcement Provisions - Amends part A (General Provisions) of Social Security Act title XI to establish the Health Insurance Coverage Data Bank to: (1) further the purposes of coverage requirements under this Act; and (2) collect certain information reported by employers about individual employee group health plan coverage for purposes of identifying and collecting from responsible third parties any amounts owed to reimburse Medicare or Medicaid for health care items and services furnished to their beneficiaries. (Replaces the Medicare and Medicaid Coverage Data Bank.) (Sec. 2402) Amends the Internal Revenue Code to impose excise taxes on failures by employers and insurers to comply with provisions of this Act. (Sec. 2411) Amends the Employee Retirement Income Security Act of 1974 to make conforming changes regarding enforcement of employer failures. Title III: Quality Assurance and Simplification - Subtitle A: Quality Assurance - Directs the Secretary of Health and Human Services, in consultation with relevant agencies, to develop and publish standards for quality assurance programs and ensure that appropriate performance measures are established. Requires the standards to contain provider risk programs to prevent or provide early warning of practices that may result in injury. (Sec. 3002) Provides for the standardization of information through a national health data system. (Sec. 3003) Requires the Secretary to establish measures to determine quality of care in specialized centers of care. (Sec. 3004) Authorizes appropriations to examine the feasibility of creating an Agency for Clinical Evaluations by consolidating the responsibilities of specified other offices. (Sec. 3005) Requires the Secretary to report annually to the Congress on factors affecting universal coverage and make recommendations for increasing such coverage. (Sec. 3006) Requires the Secretary to monitor the reinsurance market for qualified health plans and periodically report to Congress on the financial implications. (Sec. 3101) Amends the Public Health Service Act to establish within the Agency for Health Care Policy and Research a clearinghouse for information and research data concerning clinical trials. Requires the appointment of a fund investigator for the Agency. (Sec. 3201) Amends the Internal Revenue Code to establish the National Fund for Medical Research and provide for the designation of tax overpayments to such fund. Subtitle B: Administrative Simplification - Establishes a health care data interchange system to make data available on a uniform basis to all participants in the health care system. (Sec. 3302) Requires the Health Care Data Panel to develop regulations for the operation of an integrated electronic health care data interchange system. (Sec. 3304) Sets forth requirements for such system including: data and transaction standards, uniform, working files, code sets, unique identifiers, standards for confidentiality, rules for the transfer of information, and periodic reviews. (Sec. 3313) Establishes the Health Care Data Panel and a National Health Informatics Commission to advise the Panel on its activities. Title IV: Judicial Reforms - Subtitle A: Medical Liability Reform - Requires a qualified health plan to provide effective mediation procedures for hearing and resolving health care malpractice claims. (Sec. 4013) Requires each State to adopt an alternative dispute resolution method for the resolution of health care malpractice claims and consumer grievances. (Sec. 4021) Establishes provisions with respect to liability under health care malpractice actions brought in State or Federal courts. (Sec. 4022) Limits attorney contingency fees and award amounts for noneconomic damages. (Sec. 4024) Establishes a two-year statute of limitations for health care malpractice claims, except in the case of minors. (Sec. 4025) Requires each State to establish a set of specialty clinical guidelines. Allows the use of such guidelines as a rebuttable presumption in a claim or action, if the service provided was the appropriate standard of medical care. (Sec. 4026) Prohibits the award of punitive damages against the producer of a drug or device that is approved by the Food and Drug Administration. (Sec. 4027) Requires a report to the appropriate congressional committees on the operation of this subtitle. Subtitle B: Anti-Fraud and Abuse Control Program - Requires the Secretary to establish in the Office of the Inspector General of the Department of Health and Human Services a program to control fraud and abuse under the universal health care plan. Establishes the Anti-Fraud and Abuse Trust Fund. (Sec. 4102) Amends title XI of the Social Security Act (SSA) to provide for the application of the penalties for Medicare and Medicaid fraud to all health care programs. (Sec. 4103) Requires the Secretary to establish a program through which Medicare-eligible individuals may report instances of suspected fraud under Medicare. (Sec. 4111) Revises current SSA title XI sanctions for fraud and abuse involving Medicare and State health care programs, with changes providing for: (1) program exclusion for individuals convicted of a felony relating to fraud or the unlawful manufacture or dispensing of a controlled substance; (2) new offenses under civil monetary penalty provisions, such as the presenting of claims for items or services which are not medically necessary; (3) establishment of a minimum period of exclusion for practitioners and persons who fail to meet statutory obligations; (4) intermediate sanctions on eligible health maintenance organizations for program violations; and (5) procedures for imposing such sanctions. Directs the Attorney General to establish a national health care fraud and abuse data collection program for the reporting by each government agency and health care plan of final adverse actions against health care providers, suppliers, and practitioners. (Sec. 4122) Amends SSA title XI to require the Secretary to publish in the Federal Register a listing of all final adverse actions taken during the quarter. (Sec. 4131) Amends the Federal criminal code to establish penalties for a health care provider that knowingly engages in any scheme or artifice to defraud a person in connection with the provision of health care. (Sec. 4132) Extends the application of the mail fraud statute to cover matter sent or delivered by private or commercial carriers. (Sec. 4133) Authorizes appropriations to hire, equip, and train no fewer than: (1) 275 Federal Bureau of Investigation special agents and support staff to investigate health care fraud cases; and (2) 50 assistant U.S. attorneys and staff to prosecute such cases. (Sec. 4134) Authorizes the Attorney General to pay a reward of up to $10,000 to a person who furnishes information unknown to the Government relating to a possible prosecution for health care fraud, with exceptions. (Sec. 4135) Directs the court to order a person convicted of a Federal health care offense that poses a serious threat to the health of any individual or that has a significant detrimental impact on the health care system, to forfeit property that was used in the commission of the offense or that constitutes or was derived from proceeds traceable to the offense and that is of a value proportionate to the seriousness of the offense. (Sec. 4136) Authorizes the Attorney General to commence a civil action in Federal court to enjoin a violation constituting a Federal health care offense. Subtitle C: Treatment of Certain Activities Under the Antitrust Laws - Exempts from the antitrust laws specified "safe harbor" activities related to the provision of health care services. Sets forth provisions regarding the award of attorney fees and costs of suit to the prevailing party in an action based on a claim involving activity found to be exempt. (Sec. 4202) Lists as safe harbors specified: (1) activities relating to health care services of combinations of health care providers with market share below a specified threshold; (2) activities of medical self-regulatory entities relating to standard setting or enforcement activities not conducted for purposes of financial gain; (3) participation of a health care provider in a written survey of the prices of services, reimbursement levels, or the compensation and benefits of employees and personnel; (4) activities relating to health care joint ventures for high technology and costly equipment and services; (5) activities relating to hospital mergers; (6) joint purchasing arrangements; and (7) negotiations. (Sec. 4203) Directs the Attorney General to publish a notice in the Federal Register soliciting proposals for additional safe harbors and to review and report to the Congress on proposed safe harbors. Sets forth criteria in establishing safe harbors, including: (1) the extent to which a competitive or collaborative activity will accomplish an increase in health care access and quality, the establishment of cost efficiencies, and increased ability of health care facilities to provide services in medically underserved areas or to underserved populations; and (2) whether designation as a safe harbor will result in specified desirable outcomes. (Sec. 4204) Directs the Attorney General to issue certificates of review for providers of health care services and to assist persons in applying for such certificates. Sets forth provisions regarding applications for, revocation of, and review of determinations regarding such certificates. Limits the disclosure of information. (Sec. 4205) Sets forth provisions regarding notifications providing for a reduction in certain penalties under the antitrust laws for health care cooperative ventures. (Sec. 4206) Directs the Attorney General to: (1) review the safe harbors and certificates of review periodically; and (2) promulgate such rules, regulations, and guidelines as necessary to carryout provisions of this subtitle. (Sec. 4208) Establishes within the Department of Health and Human Services an Office of Health Care Competition Policy. Title V: Special Assistance for Frontier, Rural, and Urban Underserved Areas - Subtitle A: Frontier, Rural, and Urban Underserved Areas - Amends the Public Health Service Act to establish a program of allotments to States for grants for community-based primary health services to low-income or medically underserved populations regarding infant mortality and referrals for the health management of infants and pregnant women. Earmarks for the allotments specified percentages of appropriations under certain provisions added by this Act. (Sec. 5002) Mandates grants to federally qualified health centers (FQHCs) and other entities for providing access to services for medically underserved populations or in high impact areas not currently being served by a FQHC. Authorizes appropriations. Directs the Secretary to report to the appropriate congressional committees on the relationship and interaction between community health centers and hospitals in providing services to such populations. (Sec. 5003) Amends the Internal Revenue Code to: (1) allow a nonrefundable credit for certain primary health services providers for mandatory service periods in health professional shortage areas; (2) exclude from gross income qualified loan repayments to the National Health Service Corps; (3) increase the dollar limitation allowed for expensing medical equipment used in rural health shortage areas; and (4) allow a deduction for student loan payments by medical professionals practicing in rural areas. (Sec. 5004) Amends title XVIII (Medicare) of the Social Security Act (SSA) to provide for: (1) establishment of rural emergency access care hospitals under Medicare; and (2) coverage of and payment for rural emergency access care hospital services under Medicare part B (Supplementary Medical Insurance). (Sec. 5005) Amends the Public Health Service Act to direct the Secretary to make grants to States to assist in the creation or enhancement of air medical transport systems that provide victims or medical emergencies in rural areas with access to treatments. Sets forth provisions regarding: (1) application and State plan requirements; (2) considerations in awarding grants; (3) State administration and use of grants; (4) the number of grants; and (5) reporting requirements. Authorizes appropriations. (Sec. 5006) Authorizes the Secretary to conduct a demonstration project and grant program to encourage the development and operation of rural health networks. Authorizes appropriations. (Sec. 5007) Requires the Secretary to report to the Congress on improving access to benefits under qualified health plans for individuals residing in rural areas. Subtitle B: Primary Care Provider Education - Requires the Secretary to provide for the establishment of demonstration projects to evaluate mechanisms to increase the number and percentage of medical students entering primary care practice through funds otherwise available for direct graduate medical education costs under the Medicare program. (Sec. 5102) Allows funding under Medicare for training in nonhospital-owned facilities. (Sec. 5103) Increases authorized funding for the National Health Service Corps Scholarship and Loan Repayment Programs. Authorizes funding through FY 1998. (Sec. 5104) Increases and extends through FY 1997 authorized funding for training for certain health service providers. Subtitle C: Programs Relating to Primary and Preventive Care Services - Authorizes appropriations for a grant program to improve coordination of maternal and infant care. (Sec. 5202) Amends the Elementary and Secondary Education Act of 1965 to authorize appropriations to carry out a comprehensive school health education and prevention program for elementary and secondary school students. (Sec. 5203) Allows frontier States (including Alaska, Wyoming and Montana) to implement proposals and participate in demonstration projects which give special consideration to their diverse needs. Title VI: Treatment of Existing Federal Programs - Subtitle A: Medicaid Program - Gives States the option of allowing the enrollment of Medicaid-eligible individuals (including a limited number of AFDC- and SSI-eligible individuals) in the standard benefit package under a qualified health plan, instead of enrollment in the State's Medicaid program. (Sec. 6001) Sets forth requirements for States exercising such option. Places a cap on Federal payments for acute medical services furnished under a State's Medicaid program. (Sec. 6011) Discontinues reimbursement standards for inpatient hospital services. Revises the Federal medical assistance percentage for certain States. Modifies Federal requirements to allow States more flexibility in contracting for coordinated care services under Medicaid. (Sec. 6021) Provides for waivers from requirements on coordinated care programs. Gives States the option to guarantee the continued Medicaid eligibility of individuals enrolled with risk contracting and other managed care entities. (Sec. 6031) Provides for phased-in elimination of Medicaid hospital disproportionate share adjustment payments. Subtitle B: Medicare - Requires the Secretary to: (1) submit to the Congress a proposal for legislation which provides for the enrollment of Medicare beneficiaries in qualified health plans; and (2) provide for a monthly payment to a qualified health plan on behalf of enrolled Medicare beneficiaries. (Sec. 6111) Amends the Omnibus Budget Reconciliation Act of 1990 (OMBRA '90) to revise provisions for a modified payment methodology for risk contractors. (Sec. 6112) Requires the Secretary to provide for adjustment in Medicare capitation payments to take into account secondary payer status. Authorizes the Secretary to make additional payments to eligible organizations with risk-sharing contracts. (Sec. 6121) Amends OMBRA '90 to: (1) make permanent the Medicare select policy program; and (2) allow access to Medicare select policies in all States. Amends Medicare to revise the Medicare select policy program and provide for a civil penalty for misrepresentations made in connection with such a policy. (Sec. 6131) Makes specified changes with regard to monthly Medicare part B premium determinations for part B enrollees. (Sec. 6132) Amends the Internal Revenue Code to provide for an increase in the Medicare part B premium for individuals with high income. (Sec. 6133) Makes permanent certain payment reductions relating to outpatient hospital services furnished under Medicare. (Sec. 6135) Imposes copayments for laboratory services and certain home health visits provided under Medicare. (Sec. 6137) Provides for phased-in elimination of Medicare disproportionate share hospital payments. (Sec. 6138) Directs the Secretary to discontinue hospital reimbursements for costs relating to the recovery of bad debts. (Sec. 6139) Makes specified changes with regard to Medicare as secondary payer. Title VII: Patient's Right to Self-Determination Regarding Health Care - Provides for the treatment of advance directives and other measures, including a study by the Secretary on issues relating to health care decisions by the patient, in addressing the patient's right to self-determination regarding health care.

Bill· HRH.R. 3716 (103rd)referred

To limit amounts expended by certain government entities for overhead expenses.

United States · United States Congress · 22 November 1993

Sets limits on the amounts which certain Government entities may obligate or expend over a five-year period for overhead expenses. Reduces discretionary spending limits over such period for purposes of the Congressional Budget Act of 1974 and the Balanced Budget and Emergency Deficit Control Act of 1985 (Gramm-Rudman-Hollings Act) as a result of the savings achieved by this Act.

Bill· HRH.R. 3645 (103rd)referred

Family, Investment, Retirement, Savings, and Tax Fairness Act of 1993

United States · United States Congress · 22 November 1993

TABLE OF CONTENTS: Title I: Family Tax Credit Title II: Reducing the Cost of Capital by Reducing Capital Gains Tax Rates and Indexing the Basis of Certain Assets Title III: Neutral Cost Recovery Title IV: Increasing National Savings Through Individual Retirement Plus Accounts, Indexing for Inflation the Income Thresholds for Taxing Social Security Benefits, etc. Title V: Cap on Federal Spending and Establishment of Commission to Reduce Federal Spending Title VI: Elimination of Social Security Earnings Test Family, Investment, Retirement, Savings, and Tax Fairness Act of 1993 - Title I: Family Tax Credit - Amends the Internal Revenue Code to allow individuals a tax credit of $500 multiplied by the number of qualifying children who have not attained age 18. Places limitations on such credit and adjusts it for inflation. Title II: Reducing the Cost of Capital by Reducing Capital Gains Tax Rates and Indexing the Basis of Certain Assets - Reduces the individual and corporate capital gains rate from 34 percent to 15 percent. Reduces such tax to 7.5 percent for low- and middle-income taxpayers. Provides for the phaseout of personal exemptions and the overall limitation on itemized deductions to take into account adjusted gross income which has been reduced by net capital gain. Requires indexing, based on the gross national product deflator, of the adjusted basis of certain assets (corporate stock and tangible property that is a capital asset of property used in a trade or business) that have been held for more than one year at the time of sale or other transfer, solely for the purpose of determining gain or loss. Provides for indexing the limitation on capital losses of noncorporate taxpayers. Title III: Neutral Cost Recovery - Allows the depreciation deduction to be computed based on a neutral recovery basis for property placed in service after December 31, 1993. Disallows the interest deduction for such property to ensure that equity financing receives the same treatment as debt financing. Provides special depreciation rules applicable under the adjusted current earnings provisions of the minimum tax for 1994. Title IV: Increasing National Savings Through Individual Retirement Plus Accounts, Indexing for Inflation the Income Thresholds for Taxing Social Security Benefits, etc. - Allows individuals to establish individual retirement plus accounts with tax treatment similar to that for individual retirement plans. Makes contributions to such account nondeductible. Provides for qualified distributions from such accounts. Other than for general retirement purposes, including special purpose distributions made for the purchase of a first home and for medical or educational purposes. Prohibits special purpose distributions from being made during the first five years of the account. Provides an inflation adjustment after 1996 for income thresholds in determining the taxation of social security benefits. Excludes income from individual retirement plans when determining modified adjusted gross income. Provides an inflation adjustment after 1996 for the maximum amount allowable as a deduction for retirement savings. Title V: Cap on Federal Spending and Establishment of Commission to Reduce Federal Spending - Establishes the Commission on Reduction of Federal Spending to: (1) recommend specific reductions in Federal activities to assure that spending does not grow at a rate in excess of two percent per year through FY 1998; and (2) report a bill to the Congress with changes necessary to achieve such reductions. Establishes an advisory council to assist the Commission. Amends the Balanced Budget and Emergency Deficit Control Act of 1985 (Gramm-Rudman-Hollings Act) to set forth sequestration procedures when the increase in annual Federal spending exceeds the amount resulting from an annual rate of inflation of two percent. Title VI: Elimination of Social Security Earnings Test - Amends title II (Old Age, Survivors and Disability Insurance) of the Social Security Act to remove the limitation on the amount of outside income which beneficiaries who have attained retirement age may earn without incurring a reduction in benefits.

Bill· HRH.R. 3633 (103rd)referred

Truth in Voting Act of 1993

United States · United States Congress · 22 November 1993

Truth in Voting Act of 1993 - Amends the Congressional Budget Act of 1974 to provide for downward adjustments in Appropriations Committees allocations and suballocations when bills are passed that reduce appropriations and require rescissions. Requires the Congressional Budget Office to provide scorecards for such measures. Amends rule XI of the Rules of the House of Representatives to prohibit proxy voting by any committee or subcommittee member. Establishes conditions under which meetings of the standing committees and subcommittees may be closed to the public. Requires proceedings of open committee hearings or meetings to be open to television or radio broadcast and still photography. Applies the Freedom of Information Act to the Congress as such Act applies to executive agencies. Prohibits the Committee on Rules from reporting any rule for the consideration of a measure commonly known as a "king of the hill" rule. Repeals rule XLIX (statutory limit on the public debt). Amends rule XXVIII to prohibit conference committee reports from funding any program or activity at a level higher than that contained in the bill or resolution as passed by the House or Senate or from funding any program not contained in such versions. Requires the President's annual budget to include estimated expenditures and proposed appropriations for each function and subfunction in the current fiscal year and the fiscal year for which the budget is submitted. Amends the Congressional Budget Act of 1974 to make the starting point for any deliberations on the budget in committee the estimated level of outlays for the current period in each function and subfunction. Requires the budget to include comparisons of current fiscal year and proposed subsequent fiscal year spending. Requires the Comptroller General to prepare an economic and employment impact statement to accompany each bill, resolution, or conference report reported by a committee or considered on the floor. Makes it out of order to consider any legislation that is not accompanied by such statement unless the point of order is waived by a two-thirds vote. Requires regulations and proposed regulations promulgated by Federal agencies to be accompanied by such statements as well.

Bill· SS. 1757 (103rd)open

Health Security Act

United States · United States Congress · 20 November 1993

TABLE OF CONTENTS: Title I: Health Care Security Subtitle A: Universal Coverage and Individual Responsibility Subtitle B: Benefits Subtitle C: State Responsibilities Subtitle D: Health Alliances Subtitle E: Health Plans Subtitle F: Federal Responsibilities Subtitle G: Employer Responsibilities Subtitle J (sic): General Definitions; Miscellaneous Provisions Title II: New Benefits Subtitle A: Medicare Outpatient Prescription Drug Benefit Subtitle B: Long-Term Care Title III: Public Health Initiatives Subtitle A: Workforce Priorities Under Federal Payments Subtitle B: Academic Health Centers Subtitle C: Health Research Initiatives Subtitle D: Core Functions of Public Health Programs; National Initiatives Regarding Preventive Health Subtitle E: Health Services for Medically Underserved Populations Subtitle F: Mental Health; Substance Abuse Subtitle G: Comprehensive School Health Education; School-Related Health Services Subtitle H: Public Health Service Initiative Subtitle I: Coordination With COBRA Continuation Coverage Title IV: Medicare and Medicaid Subtitle A: Medicare and the Alliance System Subtitle B: Savings in Medicare Program Subtitle C: Medicaid Subtitle D: Increase in SSI Personal Needs Allowance Title V: Quality and Consumer Protection Subtitle A: Quality Management and Improvement Subtitle B: Information Systems, Privacy, and Administrative Simplification Subtitle C: Remedies and Enforcement Subtitle D: Medical Malpractice Subtitle E: Fraud and Abuse Subtitle F: McCarran-Ferguson Reform Title VI: Premium Caps; Premium-Based Financing; and Plan Payments Subtitle A: Premium Caps Subtitle B: Premium-Related Financing Subtitle C: Payments to Regional Alliance Health Plans Title VII: Revenue Provisions Subtitle A: Financing Provisions Subtitle B: Tax Treatment of Employer-Provided Health Care Subtitle C: Employment Status Provisions Subtitle D: Tax Treatment of Funding of Retiree Health Benefits Subtitle E: Coordination with COBRA Continuing Care Provisions Subtitle F: Tax Treatment of Organizations Providing Health Care Services and Related Organizations Subtitle G: Tax Treatment of Long-term Care Insurance and Services Subtitle H: Tax Incentives for Health Services Providers Subtitle I: Miscellaneous Provisions Title VIII: Health and Health-Related Programs of the Federal Government Subtitle A: Military Health Care Reform Subtitle B: Department of Veterans Affairs Subtitle C: Federal Employees Health Benefits Program Subtitle D: Indian Health Service Subtitle E: Amendments to the Employee Retirement Income Security Act of 1974 Subtitle F: Special Fund for WIC Program Title IX: Aggregate Government Payments to Regional Alliances Subtitle A: Aggregate State Payments Subtitle B: Aggregate Federal Alliance Payments Subtitle C: Borrowing Authority to Cover Cash-Flow Shortfalls Title X: Coordination of Medical Portion of Workers Compensation and Automobile Insurance Subtitle A: Workers Compensation Insurance Subtitle B: Automobile Insurance Subtitle C: Commission on Integration of Health Benefits Subtitle D: Federal Employees' Compensation Act Subtitle E: Davis-Bacon Act and Service Contract Act Subtitle F: Effective Dates Title XI: Transitional Insurance Reform Health Security Act - Title I: Health Care Security - Subtitle A: Universal Courage and Individual Responsibility - Entitles each eligible individual to: (1) the benefit provided under subtitle B through the applicable health plan in which the individual is enrolled; and (2) a health security card to be issued by the alliance or other entity that offers the applicable health plan in which the individual is enrolled. Defines an eligible individual as an individual who resides in the United States and is: (1) a citizen or national of the United States; (2) an alien permanently residing in the U.S. under color of law; or (3) a long-term nonimmigrant. Entitles a Medicare-eligible individual to benefits under Medicare instead of the above provisions of this Act. (Sec. 1002) Requires each eligible individual to enroll in an applicable health plan and pay any required premium. Prohibits disenrollment of an eligible individual until the individual is either enrolled in another plan or in Medicare. (Sec. 1003) States that nothing in this Act shall be construed as prohibiting: (1) an individual from purchasing any health services; (2) an individual from purchasing supplemental insurance; (3) an individual who is not an eligible individual from purchasing health insurance; or (4) employers from providing additional coverage. (Sec. 1004) States that a regional alliance health plan is the applicable plan for a family, unless a family member is eligible for a corporate alliance health plan. Allows military personnel, veterans, and Indians to enroll either with an alliance or with a military, veteran, or Indian plan respectively. (Sec. 1005) Prohibits an undocumented alien from enrolling in a health plan under this Act. (Sec. 1011) Defines a family as an eligible individual's eligible spouse and children. Defines couple as meaning an individual and the individual's spouse. Defines a child as being under age 18, or under age 24 in the case of a full-time student. Subtitle B: Benefits - Includes the following terms and services in the comprehensive benefit package: (1) hospital services; (2) services of health professionals; (3) emergency and ambulatory medical and surgical services; (4) clinical preventive services; (5) mental illness and substance abuse services; (6) family planning services and services for pregnant women; (7) hospice care; (8) home health care; (9) extended care services; (10) ambulance services; (11) outpatient laboratory, radiology, and diagnostic services; (12) outpatient prescription drugs and biologicals; (13) outpatient rehabilitation services; (14) durable medical equipment and prosthetic and orthotic devices; (15) vision care; (16) dental care; (17) health education classes; and (18) investigational treatments. Describes such items and services. (Sec. 1131) Requires each health plan to offer to its enrollees only one of the following cost sharing schedules: (1) lower cost sharing; (2) higher cost sharing; or (3) combination cost sharing. Provides that the annual maximum out-of-pocket expenses for an individual in any of the plans shall be $1500 and for a family the annual maximum shall be $3000. (Sec. 1135) Sets forth a table of copayments and coinsurance. (Sec. 1141) Excludes the following items and services: (1) an item or service that is not medically necessary or appropriate; (2) an item or service that the National Health Board may determine is not medically necessary or appropriate; (3) custodial care, except hospice care; (4) surgery performed solely for cosmetic purposes, unless required to correct a congenital anomaly or performed to correct a part of the body injured by either disease or accident; (5) hearing aids; (6) eyeglasses and contact lenses for individuals at least 18 years of age; (7) in vitro fertilization; (8) sex change surgery and related services; (9) private duty nursing; (10) personal comfort items, except in the case of hospice care; and (11) any dental procedures involving orthodontic care, inlays, gold or platinum fillings, bridges, crowns, pin/post retention, dental implants, surgical periodontal procedures, or the preparation of the mouth for the fitting or continued use of dentures, except as specified. (Sec. 1151) Gives the National Health Board the authority to promulgate such regulations or establish such guidelines as necessary to assure uniformity in the application of the comprehensive benefit package across all health plans. Permits the Board to expand the benefit package. (Sec. 1162) Permits a health professional or facility to refuse to provide a benefit if the professional or facility objects on the basis of a religious belief or moral conviction. Subtitle C: State Responsibilities - Requires a State, in order to be approved as a participating State, to submit a document describing the State's health care system. (Sec. 1201) Requires a participating State to: (1) establish one or more regional alliances; (2) establish and publish the criteria used in the certification of its health plan; (3) meet minimum financial solvency requirements for health plans established by the National Health Board; (4) designate an agency or official to coordinate State responsibilities under this Act; (5) conform State laws to meet the requirements of title X of this Act with respect to workers' compensation and automobile insurance; and (6) carry out all the responsibilities of a participating State specified in this Act. (Sec. 1221) Permits a State, with the Board's approval, to operate a single-payer system if specified requirements are met. Subtitle D: Health Alliances - Provides for regional alliances and corporate alliances. (Sec. 1302) Requires a regional alliance to be governed by a Board of Directors consisting of: (1) employers, including self-employed individuals; and (2) members who represent individuals purchasing coverage. Requires each regional alliance to establish a provider advisory board consisting of health care providers and professionals. (Sec. 1311) Includes in a corporate alliance an eligible sponsor who is either a large employer (more than 5,000 full-time employees) or a multiemployer plan (a plan with more than 5000 active participants). Excludes: (1) an employer whose primary business is employee leasing; (2) the Federal Government (other than the U.S. Postal Service); and (3) a State or local government. Excludes from corporate alliance eligibility the following classes of individuals: (1) AFDC recipients; (2) SSI recipients; (3) military personnel and families, veterans, and Indians who elect to enroll in specified plans specifically designed for them; and (4) seasonal or temporary employees. (Sec. 1321) Directs each regional alliance to enter into a contract with any State-certified health plan to contract with the alliance for the enrollment under the plan of eligible individuals. (Sec. 1322) Requires each regional alliance to offer a choice of health plans, including at least one fee-for-service plan. (Sec. 1326) Requires each regional alliance to establish and maintain an office of an ombudsman to assist consumers in dealing with problems that arise with health plans and the alliance. (Sec. 1329) Permits a regional alliance to adjust payments to plans or use other financial incentives to encourage health plans to expand into areas that have inadequate health services. (Sec. 1341) Set forth provisions concerning the collection of funds by regional alliances from individuals, employers, and others. (Sec. 1351) Requires each regional alliance to compute a blended plan per capita payment amount for each regional alliance health plan for enrollment in the alliance. (Sec. 1353) Requires each regional alliance to make payments to the Federal Government for academic health centers and graduate medical education. (Sec. 1361) Requires each regional alliance to comply with specified standards relating to the management of finances, maintenance of records, accounting practices, auditing procedures, financial reporting, and employer payments. (Sec. 1371) Provides for a reduction in cost sharing for low-income families. (Sec. 1373) Provides for premium discounts and reduction in liabilities for low-income families. (Sec. 1381) Permits each corporate alliance to: (1) offer coverage under either an appropriate self-insured health plan; or (2) negotiate with a State-certified plan to enter into a contract with the plan. (Sec. 1382) Requires each corporate alliance to provide a choice of health plans, including at least one fee-for-service plan and two health plans that are not fee-for-service plans. (Sec. 1385) Requires each corporate alliance to make an additional contribution towards the enrollment in health plans of the alliance by certain low-wage families. (Sec. 1386) Sets forth provisions relating to corporate alliances concerning: (1) consumer information and marketing; (2) plan and information requirements; (3) management of funds; (4) cost control; (5) payments by corporate alliance employers to corporate alliances; (6) ERISA; (7) disclosure and reserve requirements; (8) trusteeship of insolvent corporate alliance health plans; (9) imposition and collection of periodic assessments on self-insured corporate alliance plans; and (10) payments to the Federal Government by multiemployer corporate alliances for academic health centers and gradual medical education. Subtitle E: Health Plans - Requires a health plan to: (1) be either a self-insured plan (meaning a group health plan as defined by a the Employee Retirement Income Security Act of 1974) or a State-certified plan (meaning a plan certified by a State or the National Health Board); and (2) meet the applicable regulatory requirements. (Sec. 1402) Requires each health plan offered by either a regional or corporate alliance to accept for enrollment every alliance eligible individual, unless the plan has reached its enrollment limit. Prohibits the limit from being imposed on the basis of any personal characteristics of enrollees such as health status, need for health care, age, occupation, or affiliation with any person or entity. Prohibits a plan from: (1) restricting or terminating coverage for any reason, including nonpayment of premiums; (2) cancelling coverage for any eligible individual until that individual is enrolled in another plan; (3) excluding an eligible individual because of an existing medical condition; (4) imposing a waiting period before coverage begins; or (5) imposing a rider that excludes the coverage of particular eligible individuals. Prohibits discrimination by a health plan on the basis of race, national origin, sex, language, socio-economic status, age, disability, health status, or anticipated need for health services. (Sec. 1405) Requires each plan to have a grievance procedure. (Sec. 1421) Permits an entity to offer a supplemental insurance policy if the policy and the entity meet specified requirements. (Sec. 1431) Requires each health plan, with respect to each electing essential community provider located within the plan's service area, to either: (1) enter into a written provider participation agreement; or (2) enter into a written agreement under which the plan will make payment to the provider as specified. Provides a special rule for providers of school health services. Makes the provisions of the proceeding sentence applicable only to health plans offered by a health alliance during the five year period beginning with the first year in which any health plan is offered by the alliance. Directs the Secretary of Health and Human Services to study essential community providers and to make recommendations concerning such providers to the Congress. Provides that such recommendations shall apply unless a joint resolution of disapproval is enacted by the Congress. (Sec. 1441) Requires each health plan to meet specified requirements of title X of this Act with respect to workers' compensation and automobile medical liability services. Subtitle F: Federal Responsibilities - Establishes the National Health Board in the Executive Branch. Directs the President to appoint the Board's seven members. (Sec. 1503) Directs the Board to: (1) interpret the comprehensive benefit package; (2) adjust the delivery of preventive services; (3) take steps to assure that the comprehensive benefit package is available on a uniform national basis; (4) recommend to the President and the Congress appropriate revisions to the package; (5) oversee cost containment requirements; (6) develop and implement eligibility standards; (7) establish a performance based system of quality management; (8) develop and implement standards for a national health information system; (9) establish State requirements and monitor State compliance; (10) establish premium class factors; (11) develop a methodology for the risk-adjustment of premium payments; (12) establish financial requirements for guaranty funds; (13) establish standards for health plan grievance procedures; and (14) report annually to the President and the Congress. (Sec. 1506) Authorizes appropriations for the Board. (Sec. 1511) Requires the Board to approve a State health care system if the system meets the applicable requirements of this Act. Prohibits approval of a State health care system prior to 1996. (Sec. 1512) Provides for sanctions for States failing to meet conditions for compliance. (Sec. 1515) Provides for planning grants to States for implementation assistance. (Sec. 1521) Provides for the Federal assumption of responsibilities in the absence of a State system. Provides for increased premiums of 15 percent during Federal operation of a State system to provide reimbursement for the Federal cost of operating the system. (Sec. 1541) Directs the Board to develop a risk adjustment and reinsurance methodology. Sets forth guidelines for developing such methodology. (Sec. 1543) Directs the Board to establish an advisory committee to provide technical advice and recommendations regarding the risk adjustment and reinsurance methodology. (Sec. 1551) Directs the Board to establish minimum capital requirements for regional alliance health plans under which at least $500,000 of capital must be maintained for each plan in the area. Permits the Board to require additional capital. (Sec. 1552) Requires the Board to establish standards for guaranty funds established by the States. (Sec. 1571) Sets forth the responsibilities of the Secretary of Health and Human Services. Directs the Secretary to administer and implement all provisions of this Act, except those duties delegated to the Board, any other executive agency, or to any State. (Sec. 1572) Directs the Secretary to appoint an Advisory Council on Breakthrough Drugs that will examine the reasonableness of launch prices of new breakthrough drugs. (Sec. 1581) Provides for the certification of essential community providers. Sets forth the following categories of providers automatically certified (under provisions of the Public Health Service Act): (1) migrant health centers; (2) community health centers; (3) homeless program providers; (4) public housing providers; (5) family planning clinics; and (6) AIDS providers under the Ryan White Act. Includes as automatically certified (under other Acts) following: (1) Indian health programs under the Indian Health Act; and (2) maternal and child health providers and a federally qualified health center or rural health clinic under the Social Security Act. Includes as automatically certified (under provisions of this Act) the following: (1) providers of school health services; and (2) a qualified community practice network. Provides for the setting of standards for additional health providers. (Sec. 1591) Sets forth the responsibilities of the Secretary of Labor. Includes among those responsibilities the following: (1) enforcement requirements applicable to employers; (2) elections to become corporate alliances; (3) temporary assumption of insolvent self-insured corporate alliance health plans; (4) establishment and administration of the Corporate Alliance Health Plan Insolvency Fund; and (5) administering title I of ERISA as it relates to group health plans maintained by corporate alliances. Subtitle G: Employer Responsibilities - Requires employers to provide for the payments required under title VI of this Act. Sets forth other employer responsibilities including: (1) information reporting requirements; (2) requirements relating to new employees; (3) recordkeeping requirements; and (4) antidiscrimination requirements. (Sec. 1606) Prohibits self-funding of cost sharing benefits by regional alliance employers. (Sec. 1607) Requires an employer to make equal employer premium payments to all qualifying employees, if a voluntary premium payment is made. Places a limit on such voluntary employer premium payments. (Sec. 1608) Sets forth an employer's obligation to a qualifying retired beneficiary where the employer, as of October 1, 1993, was providing a threshold payment. (Sec. 1609) Authorizes the Secretary of Labor to impose a civil penalty of up to $10,000 for each violation of this subtitle with respect to each individual. Subtitle J (sic): General Definitions; Miscellaneous Provisions - Sets forth the definitions and rules used in this Act. Subtitle B: Miscellaneous Provisions (sic) - (Sec. 1911) Grants the National Health Board, the Secretary of Health and Human Services, and the Secretary of Labor authority to issue regulations as necessary to permit the timely implementation of this Act. Title II: New Benefits - Subtitle A: Medicare Outpatient Prescription Drug Benefit - (Secs. 2001 through 2005) Amends title XVIII of the Social Security Act to provide for: (1) Medicare coverage of covered outpatient prescription drugs and biologicals as well as home infusion drug therapy services; (2) payment rules and related requirements, such as those pertaining to deductibles, for covered outpatient prescription drugs; (3) manufacturer rebates to the Secretary under Medicare part B for covered outpatient prescription drugs; and (4) determination of the Medicare part B premium attributable to covered outpatient prescription drugs. Subtitle B: Long-Term Care - Establishes requirements for State plans for home and community-based services to individuals with disabilities. Includes among those requirements the following: (1) a prohibition of limiting eligibility of individuals with disabilities based on income, age, geography, severity of disability, residential setting, or other grounds specified by the Secretary; (2) a requirement to serve low-income individuals; (3) a requirement to specify how Federal and State funds will be managed; (4) quality assurance requirements; and (5) reporting requirements. Requires a State to consult with individuals and groups of individuals with disabilities when developing the plan in order to have the plan approved. (Sec. 2103) Defines "individuals with disabilities" to mean any individual within one or more of the following four categories: (1) individuals requiring help with the activities of daily living; (2) individuals with severe cognitive or mental impairment; (3) individuals with severe or profound mental retardation; and (4) severely disabled children. (Sec. 2104) Requires a State plan to specify the services available. Requires each individualized plan to be developed in close consultation with the individual and the individual's family. Prohibits a State plan from covering: (1) room and board; (2) services furnished in a hospital, nursing facility, intermediate care facility for the mentally retarded, or other specified institutional setting; or (3) items or services to the extent coverage is provided for an individual under a health plan or Medicare. (Sec. 2105) Sets forth provisions relating to: (1) cost sharing; (2) quality assurance and safeguards; (3) advisory groups; (4) payments to States; and (5) the total Federal budget for State plans and allotments to States. (Sec. 2301) directs the Secretary, with the advice and assistance of the National Long-Term Care Insurance Advisory Council to promulgate regulations as necessary to implement provisions concerning private long-term care insurance. Directs the Secretary to make appointments to such Council. Authorizes appropriations for such Council. (Sec. 2321) Directs the Secretary, after considering the Council's recommendations to promulgate regulations designed to: (1) standardize formats and terminology used in long-term care policies; (2) require insurers to provide information to customers on the range of public and private long-term care coverage available; and (3) establish other requirements promoting consumer understanding of benefits. (Sec. 2322) Directs the Secretary to promulgate regulations establishing requirements with respect to the terms of and benefits under long-term care policies, which shall include the following requirements that the policy may not: (1) limit coverage based on a preexisting condition, subject to an exception for a six month period; (2) condition eligibility for benefits based on the need or receipt of any other service; (3) condition eligibility for any benefit on any particular diagnosis; (4) condition eligibility for benefits by providers on compliance with requirements not required by State or Federal law; and (5) condition coverage of any service by a provider on the provision of such service at a higher level of care than required by the insured individual. Prohibits discrimination by diagnosis in the treatment of: (1) Alzheimer's disease; (2) any organic or inorganic mental illness; (3) mental retardation or any other cognitive or mental impairment; or (4) HIV infection or AIDS. Sets forth other requirements for such policies, including requirements related to: (1) premiums; (2) sales practices; (3) continuation, renewal, replacement, conversion, and cancellation of policies; and (4) payment of benefits. (Sec. 2342) Provides for grants to States to enforce the Federal standards concerning long-term care policies. Sets forth requirements for receiving such grants. Authorizes appropriations. Prohibits the sale of a long-term care policy in a State without a regulatory program. (Sec. 2361) Authorizes the Secretary to make grants for the development and implementation of long-term care information, counseling, and other programs to: (1) States; (2) regional alliances (at the option of States within which such alliances are located; and (3) national organizations representing insurance consumers, long-term care providers, and insurers. Authorizes appropriations for such grants. (Sec. 2601) Authorizes the Secretary to conduct a demonstration program to test the effectiveness of various approaches to financing and providing integrated acute and long-term care services for the chronically ill and disabled. Sets forth the services and benefits to be provided, including: (1) all benefits of the comprehensive benefit package provided under title I of this Act; (2) transitional benefits, including assessment and home care; (3) long-term care benefits, including adult day care, home-delivered meals, and nursing facility services in specialized care units; and (4) habilitation services. Permits any of the following to be eligible for such services under criteria to be established by the Secretary: (1) individuals with disabilities under a State program; (2) individuals entitled to benefits under the Medicare program; and (3) individuals entitled to Medicaid and who are also either entitled to Medicare or Supplemental Security Income benefits. Requires reports to the Congress on the demonstration program. Title III: Public Health Initiatives - Subtitle A: Workforce Priorities Under Federal Payments - Establishes within the Department of Health and Human Services the National Council on Graduate Medical Education. Directs the National Council to designate for each academic year the number of individuals nationwide who are authorized to be enrolled in each specified approval physician training program for each medical specialty. Sets forth provisions specifying: (1) Federal formula payments to approved physician training programs; (2) application for payments; and (3) amount of payments. (Sec. 3061) Directs the Secretary to carry out a program with respect to graduate nurse training programs that is equivalent to the program for approved physician training programs. Establishes a National Council on Graduate Nurse Education. (Sec. 3071) Authorizes appropriations for the following programs: (1) primary care physician and physician assistant training; (2) training of underrepresented minorities and disadvantaged persons; and (3) nurse training. (Sec. 3072) Authorizes appropriations for the following programs: (1) a program of skill upgrading and occupational retraining for health care workers; (2) a demonstration program to assist workers in health care institutions in obtaining advanced career positions; (3) a program to develop and operate health-worker job banks in local employment services agencies, subject to certain conditions; (4) a program to provide joint labor-management decision-making in the health care sector on workplace matters related to the restructuring of the health care delivery system of this Act; and (5) a program to facilitate the comprehensive workforce adjustment initiative. (Sec. 3073) Directs the Secretary of Health and Human Services and the Secretary of Labor to jointly establish the National Institute for Health Care Workforce Development. States that the Director of the Institute shall make recommendations to the Secretaries regarding: (1) the supply of health care workers; (2) the impact of this Act; and (3) the development and implementation of high-performance, high-quality health care delivery systems. Directs the Secretaries to establish an advisory board to assist in the development of such recommendations. Subtitle B: Academic Health Centers - Directs the Secretary to make payments to a qualified academic health center or qualified teaching hospital in order to assist such eligible institutions with costs that are not routinely incurred by other entities in providing health services, but are incurred by such institutions by virtue of the academic nature of such institutions. States that such costs include: (1) costs resulting from reduced staff productivity due to teaching responsibilities; (2) the uncompensated costs of clinical research; and (3) exceptional costs associated with an institutions specialized expertise. Provides that the funding for such payments will come from transfers from the Federal Hospital Insurance Trust Fund, payments made by regional alliances to the Federal government for academic health centers and graduate medical education, and payments from corporate alliances. (Sec. 3131) Provides for the access of regional and corporate alliance patients to academic health centers. Subtitle C: Health Research Initiatives - Amends the Public Health Service Act to ensure that the National Institutes of Health conducts and supports biomedical and behavioral research on promoting health and preventing diseases, disorders, and other health conditions. Provides for health services research. Authorizes appropriations for such research. Subtitle D: Core Functions of Public Health Programs; National Initiatives Regarding Preventive Health - Authorizes appropriations for the core functions of public health programs and national initiatives regarding health promotion and disease prevention. (Sec. 3312) Authorizes the Secretary to make grants to States to carry out one or more of the following core functions: (1) data collection; (2) activities to protect the environment and to assure the safety of housing, workplaces, and food and water; (3) investigation and control of adverse health conditions; (4) public information and education programs to reduce risks to health such as use of tobacco, alcohol, and drugs, sexual activities that increase the risk of HIV transmission and other sexually transmitted diseases, poor diet, physical inactivity, and low childhood immunization levels; (5) accountability and quality assurance activities; (6) provision of public health laboratory services to complement private clinical laboratory services that screen for diseases and conditions; (7) training and education to assure provision of care by all health professionals; and (8) leadership policy development and administrative activities. (Sec. 3331) Authorizes the Secretary to make grants to agencies of State or local government, private nonprofit organizations, and coalitions that link two or more of these groups for the purpose of carrying out projects to develop and implement innovative community-based strategies to provide for health promotion and disease prevention activities for which there is a significant need. Subtitle E: Health Services for Medically Underserved Populations - Directs the Secretary to make grants to migrant health centers and community health centers, which shall be in addition to other funds available to such centers. Authorizes appropriations. (Sec. 3412) Authorizes appropriations for: (1) grants and contracts for the development of qualified community health plans and practice networks; and (2) loans and guaranteeing the principal and interest to Federal and non-Federal lenders on behalf of public and private entities for the capital costs of developing qualified community health plans and practice networks. (Sec. 3461) Authorizes the Secretary to make grants and enter into contracts with qualified community health groups to provide enabling services such as transportation, community and patient outreach, patient education, and translation services in order to increase the capacity of individuals to utilize the items and services under title I of this Act. Authorizes appropriations. (Sec. 3471) Authorizes appropriations for: (1) the National Health Service Corps; and (2) such amounts as are necessary to ensure that at least 20 percent of participants in the Scholarship Program or the Loan Repayment Program of the Corps are nurses. (Sec. 3481) Entitles a hospital with a low-income utilization rate in a base year of at least 25 percent to a payment as specified. Requires 75 percent of the total available to be allocated to hospitals for low-income assistance. Requires 25 percent of the total available to be allocated to hospitals for assistance in furnishing inpatient hospital services that are not covered services under title I of this Act. Subtitle F: Mental Health; Substance Abuse - Authorizes appropriations to carry out this part. Provides for grants to: (1) increase access to mental health and substance abuse services; (2) improve State and local capacity to coordinate and monitor such services; (3) provide incentives to integrate public and private service systems; and (4) supplement any activity under part B (Alcohol and Drug Abuse and Mental Services Block Grant) of title XIX of the Public Health Service Act. (Sec. 3503) Authorizes the Secretary to make loans for the capital costs incurred in the development of non-acute, residential treatment centers and community-based ambulatory clinics. (Sec. 3521) Requires the establishment of a pilot program demonstrating the integration of the mental illness and substance abuse services of the States with the services included under title I of this Act. Subtitle G: Comprehensive School Health Education; School-Related Health Services - Authorizes appropriations for the programs of this subtitle. States that the purposes of the programs shall be to: (1) support, in kindergarten through grade 12, the provision of comprehensive health educator programs; (2) establish a national framework within which States can create comprehensive school health education programs that target the health risk behaviors of youth, including tobacco use, alcohol and drug abuse, sexual behaviors resulting in infections, injury prevention, dietary patterns, and sedentary lifestyles; (3) pay the initial costs of planning and establishing such programs; (4) support related Federal demonstrations and training; (5) motivate youth to stay in school, avoid teen pregnancy, and strive for success; (6) improve the knowledge of health education among youth; and (7) further the National Education Goals set forth in title I of the Goals 2000: Educate America Act. Defines "comprehensive school health education program." Requires such programs to be sensitive to cultural and ethnic issues, promote involvement by families, and promote personal responsibility. Sets forth requirements for applying for grants and selection of grantees. Subtitle H: Public Health Service Initiative - Establishes a Public Health Service Initiative consisting of specified amounts authorized to be appropriated for the Initiative. States that: (1) the Initiative includes the programs of subtitles C through G of this title and the programs of subtitle D of title VIII; and (2) amounts appropriated to carry out the Initiative, including subtitles A through F of this title, are available to carry out specific programs for which the amounts are appropriated. Subtitle I: Coordination with COBRA Continuation Coverage - Amends title XXII (Requirements for Certain Group Health Plans for Certain State and Local Employees) of the Public Health Service Act to provide for coordination with COBRA continuation coverage. Repeals such title XXII upon implementation of this Act. Title IV: Medicare and Medicaid - Subtitle A: Medicare and the Alliance System - Amends title XVIII (Medicare) of the Social Security Act to provide for optional State integration of Medicare beneficiaries into regional alliance plans. (Sec. 4002) Allows individuals to elect to remain in certain plans. (Sec. 4003) Provides for payments to regional alliances on behalf of certain Medicare-eligible individuals. (Sec. 4004) Extends protections for working aged and disabled individuals to group health plans of all employers. Repeals the limitation on the period of protection for individuals with end stage renal disease. Prohibits Medicare payment for items and services provided under any health plan under this Act. Simplifies Medicare benefit coordination in cases where the individual is also eligible for benefits under this Act's health plans. (Sec. 4011) Makes various changes concerning eligible organization and Medicare supplemental policy enrollment and comparative informational materials, eligible organization outlier payments, and participating provider point-of-service networks. (Sec. 4022) Provides for expanded Medicare coverage for physician assistant, nurse practitioner, and clinical nurse specialist services. (Sec. 4031) Amends title XI of the Social Security Act to: (1) provide for termination of the separate Medicare peer review program upon adoption of the National Quality Management Program above under subtitle A of title V of this Act; and (2) repeal provisions on surgical procedure review and second opinions. (Sec. 4032) Amends title XVIII of the Social Security Act to provide for mandatory assignment for all Medicare part B services. (Sec. 4033) Directs the Secretary of Health and Human Services to take such steps as may be necessary to consolidate administration of Medicare parts A and B and supersedes certain conflicting requirements to the extent required to achieve such purpose. (Sec. 4035) Prohibits the Secretary from implementing any change in procedures for billing and processing Medicare claims within six months of implementing any previous change. Adds advanced notification to providers as a requirement for carriers and fiscal intermediaries under Medicare. (Sec. 4041) Amends title XI of the Social Security Act to: (1) provide for civil monetary penalties for kickback violations under Medicare and State health care programs (the programs); (2) make other penalty-related changes, including increases in criminal and civil monetary penalties, a new criminal penalty exception for certain providers, additional civil monetary penalty offenses related to alliance systems, and requirements for the deposit of penalties collected into the All-Payer Account established above under title V of this Act; (3) revise exclusion provisions, with changes establishing a minimum period of exclusion for certain individuals and entities subject to permissive exclusion from the programs, and providing for program exclusions based on actions under alliance systems; and (4) modify sanction provisions, with changes removing certain conditions for imposing sanctions and setting specified civil money penalties for use in lieu of authorized sanctions. (Sec. 4042) Amends title XVIII of the Social Security Act to revise the limitations on physician self-referrals. (Sec. 4051) Provides for the termination of payments under Medicare for medical education costs and directs the Secretary to make specified transfers from certain Medicare trust funds to the new accounts established above for funding physician training programs and academic health centers. (Sec. 4061) Amends title XVIII of the Social Security Act to provide for the treatment of: (1) uniformed services and VA health plans as eligible organizations under Medicare; and (2) health care facilities of the Department of Veterans Affairs as providers under Medicare. Subtitle B: Savings in Medicare Program - Amends title XVIII of the Social Security Act to provide for: (1) reductions in the update for inpatient hospital services and the adjustment for indirect medical education costs, in payments for capital-related costs for inpatient hospital services; (2) revisions to payment adjustments for disproportionate share hospitals in States participating under this Act; and (3) an extension of the freeze on updates to routine service costs of skilled nursing facilities. (Sec. 4111) Amends title XVIII of the Social Security Act to provide for: (1) establishment of cumulative expenditure goals for physician services; (2) use of real gross domestic product for volume adjustments; (3) repeal of restrictions on the maximum reduction permitted in default update; (4) reduction in the conversion factor for the physician fee schedule for 1995; (5) place limitations on payment for physicians' services furnished by high-cost hospital medical staffs; (6) requirements for physicians to identify the hospital at which the service was furnished; (7) an increase in practice expense relative value units for certain services while assuring budget neutrality; (8) a study and report to the Congress by the Secretary on a resource-based system for determining practice expense relative value units for each physician's service; (9) an increase in work relative value units for office visits while assuring budget neutrality; (10) a reduction in relative values for office consultations; (11) adjustment of outlier intensity of relative values; (12) changes in underserved area bonus payments; (13) elimination of formula-driven payments for certain outpatient hospital services; (14) copayments for laboratory services; and (15) competitive acquisition procedures for Medicare part B items and services (including clinical diagnostic laboratory tests). (Sec. 4131) Makes changes with respect to: (1) Medicare as secondary payer; (2) payments for health maintenance organizations and competitive medical plans with risk-sharing contracts; and (3) routine cost limits and copayments for, respectively, home health services and visits. (Sec 4135) Directs the Secretary to use a competitive process to contract with centers of excellence for cataract surgery, coronary artery by-pass surgery, and such other services as the Secretary determines to be appropriate. (Sec. 4141) Amends title XVIII of the Social Security Act to revise Medicare part B premium provisions. (Sec. 4151) Requires the Secretary to submit a report to the Congress on the growth in spending under Medicare for FY 2000 through 2003. Subtitle C: Medicaid - Amends title XIX (Medicaid) of the Social Security Act to provide that if a State Medicaid plan provides for payment to regional alliances of the amounts required above it is not required to provide payment for items and services covered under the comprehensive benefit package for alliance eligible individuals and will receive no Federal financial assistance with respect to such items and services. (Sec. 4211) Provides for: (1) spenddown eligibility and increased income and resource disregard for nursing facility residents; (2) informing such residents about the availability of assistance for home and community-based services; (3) treatment of items and services not covered under the comprehensive benefit package; and (4) establishment of a program under Medicare of noncovered items and services for poor children. (Sec. 4231) Discontinues certain payment policies under Medicaid. (Sec. 4241) Limits the frequency of changes in a State's billing and claims processing system, and provides for advance notification to providers of any major billing change. (Sec. 4251) Establishes the Medicaid Commission to study, report, and make recommendations with respect to options involving block grant use, integration of long-term care services, and consolidation of institutional and home- and community-based long-term care in relation to the Medicaid program. Authorizes appropriations. Subtitle D: Increase in SSI Personal Needs Allowance - Amends title XVI (Supplemental Security Income) (SSI) to provide for an increase in the SSI personal needs allowance. Title V: Quality and Consumer Protection - Subtitle A: Quality Management and Improvement - Requires the National Health Board to establish and oversee a performance-based program of quality management and improvement designed to enhance the quality, appropriateness, and effectiveness of heath care services and access to such services which will be called the National Quality Management Program. (Sec. 5002) Establishes the National Quality Management Council which shall: (1) administer the National Quality Management Program; (2) perform any other duty specified in this subtitle; and (3) advise the National Health Board with respect to its duties under this subtitle. Requires the Council to develop a set of national measures of quality performance to be used in the assessment of and the provision of access to health care services. Requires the Council, in addition, to: (1) recommend to the Board establishing goals for performance by health plans and health care providers on a subset of national measures of quality performance; (2) direct the Administrator for Health Care Policy and Research to develop, review, and disseminate practice guidelines to determine how diseases can most effectively be prevented, diagnosed, treated, and managed; and (3) direct the Administrator for Health Care Policy and Research to support research related to a five year priority list of performance measures. (Sec. 5008) Directs the National Health Board to: (1) establish and oversee regional professional foundations to perform such duties as develop lifetime learning programs for health professionals and conduct research on health care quality; and (2) establish the National Quality Consortium to perform such duties as establishing continuing education for health professionals and provide advice on research priorities. (Sec. 5012) Requires each regional alliance and each corporate alliance to: (1) disseminate specified information to consumers; and (2) ensure that performance and quality standards are continually improved. Subtitle B: Information Systems, Privacy, and Administrative Simplification - Directs the National Health Board to develop and implement a health information system, in consultation with Federal agencies, States, employers, health plans, and others, by which the Board shall collect, report, and regulate the collection and dissemination of health care information which shall be used for: (1) health care planning by Federal, State, and local government; (2) establishing and monitoring payments for health services; (3) assessing and improving the quality of health care; (4) managing and containing costs at the alliance and plan levels; and (5) other specified purposes. Requires the establishment of an electronic data network to collect, compile, and transmit information. (Sec. 5120) Sets forth provisions providing for health information privacy standards. (Sec. 5130) Directs the National Health Board to develop the following standard health care benefit forms: (1) an enrollment and disenrollment form; (2) a clinical encounter record; and (3) a claim form. (Sec. 5140) Establishes the National Privacy and Health Data Advisory Council in order to advise the National Health Board with respect to its duties under this subtitle. (Sec. 5141) Sets forth monetary penalties for violating health information system standards. Subtitle C: Remedies and Enforcement - Sets forth provisions with respect to the review of benefit determinations for enrolled individuals, including provisions: (1) regulating the time limits for notice of disposition of a claim; (2) governing a plan's duty to review claim denials; (3) concerning urgent requests for preauthorization; and (4) concerning other time limits with respect to time limits and notice. (Sec. 5202) Requires each State to establish a complaint review office for each regional alliance established by a State. Permits aggrieved individuals to file complaints with the appropriate review office. (Sec. 5205) Provides for a Federal Health Plan Review Board to review the decisions of complaint review office hearing officers. (Sec. 5207) Sets monetary penalties for a plan which unreasonably denies or delays payment or provision of benefits. (Sec. 5211) Directs each State to establish and maintain an Early Resolution Program in each complaint review office. Requires a program to include: (1) forums for mediation disputes; and (2) other forums of alternative dispute resolution as may be prescribed. Establishes guidelines for the eligibility of cases for submission to the Early Resolution Program. States that conclusions of the mediation proceedings shall be treated as nonbinding and shall not affect any rights to review. (Sec. 5231) Sets forth additional remedies and enforcement provisions. Subtitle D: Medical Malpractice - Prohibits any medical malpractice liability action until the final resolution of the claim under alternative dispute resolution. Requires each regional alliance health plan and corporate alliance health plan to adopt at least one specified method of alternative dispute resolution. Prohibits an individual from bringing a medical malpractice liability action unless the individual submits an affidavit that includes a report by a qualified specialist that states that there is a meritorious cause for filing the action. (Sec. 5311) Directs the Secretary to establish: (1) a project to demonstrate whether substituting liability for medical malpractice on the part of the health plan in which a physician participates for the personal liability of the physician will result in improvements in the quality of care, reductions in defense medical practices, and better risk management; (2) a pilot program under which the Secretary provides funds to one or more eligible States to determine the effect of applying practice guidelines in the resolution of medical malpractice liability actions. Subtitle E: Fraud and Abuse - Directs the Secretary and the Attorney General to establish a program: (1) to coordinate the functions of the Attorney General, the Secretary, and other organizations with respect to the prevention, detection, and control of health care fraud and abuse; (2) to conduct investigations, audits, evaluations, and inspections relating to the delivery of and payment for health care; and (3) to facilitate the enforcement of this and other statutes applicable to health care fraud. (Sec. 5402) Creates, in the Treasury, the All-Payer Health Care Fraud and Abuse Control Account which shall consist of: (1) gifts and bequests; (2) administrative penalties and assessments and portions of civil monetary penalties imposed under provisions of the Social Security Act; (3) all criminal fines imposed in cases involving a Federal health care offense; (4) penalties imposed under the False Claims Act involving claims related to the provision of health care items and services; and (5) amounts resulting from the forfeiture of property by reason of Federal health care offense. States that amounts in the fund may be used to cover costs incurred in operating the Program. (Sec. 5411) Excludes from participation in any health plan any individual or entity excluded from participation in a public program under provisions of the Social Security Act. (Sec. 5413) Sets forth physician self-referral limitations. (Sec. 5431) Amends the Federal criminal code to set penalties for knowingly executing a scheme or artifice to: (1) defraud any health alliance, health plan, or other person (alliance) in connection with the delivery of, or payment for, health care benefits, items, or services (benefits); and (2) obtain, by false or fraudulent means, money or property owned by, or under the custody of control of, any such alliance in connection with the delivery of, or payment for, health care benefits. (Sec. 5432) Amends: (1) the Federal criminal code to require the court, in imposing sentence on a person convicted of a Federal health care offense that poses a serious threat to the health of any person or has a significant detrimental impact on the health care system, to order such person to forfeit property used in the commission of the offense or that constitutes, or is derived from, proceeds traceable to the commission of the offense which is of a value proportionate to the seriousness of the offense; and (2) the Federal judicial code to require that all proceeds of forfeiture relating to Federal health care offenses be deposited into the Department of Justice Assets Forfeiture Fund. (Sec. 5433) Amends the Federal criminal code to set penalties for: (1) knowingly and willfully falsifying, concealing, or covering up a material fact, making any false, fictitious, or fraudulent statements or representations, or making or using any false writing or document knowing it to contain any false, fictitious, or fraudulent statement or entry, in any matter involving a health alliance or health plan; and (2) bribery of, and graft by, a health care official. (Sec. 5435) Authorizes: (1) the Attorney General to commence a civil action in Federal court to enjoin a Federal health care offense; and (2) a person privy to certain grand jury information concerning a health law violation to disclose that information to an attorney for the Government to use in any civil proceeding related to a Federal health care offense. (Sec. 5437) Sets penalties for: (1) theft or embezzlement in connection with a health alliance, health plan, or fund connected with such alliance or plan; and (2) misuse of a health security card issued, or unique identifier provided, pursuant to this Act. (Sec. 5441) Makes provisions of the Civil False Claims Act applicable to the use of false records or statements made to a health plan. Includes within the definition of "claim" for purposes of such Act any request or demand for money or property which is made or presented to a health plan. Subtitle F: McCarran-Ferguson Reform - Amends the McCarran-Ferguson Act to repeal the exemption under specified antitrust laws for the business of insurance to the extent that such business relates to the provision of health benefits. Title VI: Premium Caps; Premium-Based Financing; and Plan Payments - Subtitle A: Premium Caps - Sets forth provisions which provide for the computation of factors that limit the growth of premiums for the comprehensive benefit package in regional alliance health plans, including the computation of a: (1) regional alliance inflation factor; and (2) general health care inflation factor. (Sec. 6002) Directs the Board to determine: (1) a national per capita baseline premium target; (2) the national average per capita current coverage health expenditures; and (3) current health care expenditures. (Sec. 6003) Directs the Board to determine a regional alliance per capita premium. (Sec. 6004) Requires a regional alliance to annually obtain premium bids from each plan seeking to participate as a regional alliance health plan with respect to the alliance. (Sec. 6005) Permits any participating State to assume responsibility for containment of health care expenditures in the State consistent with this Act. (Sec. 6006) Directs the chair of the Board to establish an advisory commission on regional variations in health expenditures. Requires the commission to examine methods of eliminating variation in regional alliance per capita premium targets due to variation in practice patterns, not due to other factors. Requires the Board to submit its recommendations to the Congress. Requires such recommendations to apply unless a joint resolution of disapproval is passed. (Sec. 6011) Subjects each noncomplying regional alliance health plan for a year to a reduction in plan payment as specified, in order to assure that payments to regional alliance health plans by a regional alliance are consistent. Defines a noncomplying plan to include a plan in which the final accepted bid exceeds the maximum complying bid for the per capita target premium. Defines "maximum complying bid." (Sec. 6021) Directs the Board to develop a methodology for calculating an annual per capita expenditure equivalent for amounts paid for coverage for the comprehensive benefit package within a corporate alliance. (Sec. 6022) Terminates a corporate alliance with two excess years in a three year period. Provides that employers that were corporate alliance employers with respect to a terminated alliance shall become regional alliance employers. Defines an excess year as one in which the rate of increase for the corporate alliance exceeds the national corporate inflation factor. Defines rate of increase and national corporate inflation factor. (Sec. 6031) Sets forth special rules for a single-payer State. (Sec. 6041) Directs the Secretary to establish a program to monitor prices and expenditures in the U.S. health care system. Subtitle B: Premium-Related Financings - Makes each family enrolled in a regional health alliance plan or in a corporate alliance health plan in a class of family enrollment responsible for payment of the family share of premium payable for enrollment. Provides for income related discounts and specified credits. (Sec. 6102) Establishes the formula for determining the premiums. (Sec. 6111) Provides for the repayment of credit by certain families. (Sec. 6114) Provides for the special treatment of certain retirees and qualified spouses and children. (Sec. 6121) Requires each regional alliance employer to pay a monthly premium to the regional alliance for a qualifying employee. Sets forth provisions for determining such premium. Varies the premium depending upon such factors as the employer's size and average wages paid. (Sec. 6126) Sets forth provisions applicable to self-employed individuals. (Sec. 6131) Sets forth provisions for determining the corporate employer premium. Subtitle C: Payments to Regional Alliance Health Plans - Sets forth provisions to determine the computation of: (1) the blended plan per capita payment amount; and (2) the plan bid, AFDC, and SSI proportions. Title VII: Revenue Provisions - Subtitle A: Financing Provisions - Amends the Internal Revenue Code to increase the excise taxes on cigarettes and other tobacco products. (Sec. 7113) Imposes an excise tax on the manufacture or importation of roll-your-own tobacco. (Sec. 7121) Imposes an assessment on each corporate alliance employer and a temporary assessment on employers with retiree health benefit costs. Requires such assessments to be paid in the same manner as employment taxes. (Sec. 7131) Provides for the recapture of certain health care subsidies received by high-income individuals. Transfers such amounts to the Supplemental Medical Insurance Trust Fund. (Sec. 7141) Requires certain shareholders of S corporations and limited partners who materially participate in corporate activities to include their share of income or loss from such corporation when determining net earnings from self-employment. (Sec. 7142) Provides for extending Medicare coverage and applying the hospital insurance tax to all State and local government employees. Subtitle B: Tax Treatment of Employer-Provided Health Care - Provides exceptions to the exclusion of employer-provided contributions to an accident or health plan from the gross income of an employee. (Sec. 7202) Prohibits the provision of health benefit under cafeteria plans. (Sec. 7203) Makes permanent the deduction for health insurance costs of self-employed individuals. Increases such deduction to 100 percent of the basic coverage purchased from a health alliance with limitations. Subtitle C: Employment Status Provisions - Requires the Secretary of the Treasury to prescribe regulations defining an employee for employment tax purposes. (Sec. 7302) Increases the penalty for failure to file correct returns involving payments for services. (Sec. 7303) Sets forth rules to limit retroactive employment tax reclassifications. Subtitle D: Tax Treatment of Funding of Retiree Health Benefits - Requires additional reserves for post-retirement medical and life insurance benefits to cover not less than ten years of the working lives of covered employees and to be maintained as separate accounts. (Sec. 7402) Terminates the authority of pension plans to maintain health benefits accounts. Subtitle E: Coordination with COBRA Continuing Care Provisions - Repeals provisions concerning continuation coverage requirements of group health plans upon implementation of this Act. Subtitle F: Tax Treatment of Organizations Providing Health Care Services and Related Organizations - Provides for the tax treatment of charitable organizations providing health care services, insurance provided by health maintenance organizations, and certain private foundations. (Sec. 7602) Sets forth transitional rules for taxing certain organizations providing health insurance and other prepaid health care services as insurance companies other than life insurance companies. (Sec. 7603) Exempts regional alliances from income tax. Subtitle G: Tax Treatment of Long-term Care Insurance and Services - Treats qualified long-term care services as medical care for purposes of the medical expense deduction. (Sec. 7702) Provides for the treatment of long-term care insurance as accident and health insurance. (Sec. 7703) Allows accelerated death benefits under life insurance contracts to be paid to terminally ill individuals. Subtitle H: Tax Incentives for Health Service Providers - Allows a tax credit for certain qualified individuals who provide primary health services full time in a health professional shortage area. (Sec. 7802) Increases the allowable depreciation deduction for expensing certain medical equipment. Subtitle I: Miscellaneous Provisions - Allows a tax credit for the cost of personal assistance services required by an employed individual who for medical reasons is unable to engage in substantial gainful activity. (Sec. 7902) Denies tax-exempt status for private activity bonds of regional alliances, corporate alliances, or guaranty funds established under this Act. Title VIII: Health and Health-Related Programs of the Federal Government - Subtitle A: Military Health Care Reform - Directs the Secretary of Defense to establish one or more uniformed services health plans in order to provide health care services to members of the armed forces on active duty for 30 or more days as well as their covered beneficiaries. Requires conformity of such plans with health plan requirements set forth in this Act. (Sec. 8001b) Allows any such plan to rely upon the use of military health care facilities, supplemented by civilian health care providers or health plans under agreements entered into by the Secretary. Requires at least the items and services in the comprehensive benefit package under this Act to be included in each such plan. Preempts any conflicting State health plan requirements. Provides for plan enrollment, effect of failure to enroll, and choosing between a uniformed services health plan and other available plans. Prohibits the imposition of plan charges to an active-duty member other than subsistence charges, but allows the Secretary to impose limited charges for covered beneficiaries. Establishes in the Department of Defense a financial account for payments received in connection with a uniformed services health plan, allowing such funds to be used only for purposes directly related to the delivery and financing of health care services under this Subtitle. Subtitle B: Department of Veterans Affairs - Allows each veteran who is an eligible individual under this Act and individuals currently enrolled in a health plan under the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) to be enrolled with a Department of Veterans Affairs (VA) health plan. Requires conformity of such plans with health plan requirements set forth in this Act, with all the items and services of the comprehensive benefit package under this Act included. Allows such plans to offer supplemental health benefits and cost-sharing policies as consistent with this Act. Provides a limitation with regard to veterans enrolled with health plans outside the VA. Prohibits the imposition of any plan enrollment charges upon service-connected disabled veterans, veterans receiving disability compensation from the VA, former prisoners of war, and veterans unable to defray the costs of such care. Allows the Secretary of Veterans Affairs to establish plan charges for other veterans. Deems a VA facility to be a Medicare provider for purposes of any program administered by the Secretary of Health and Human Services. Allows for the recovery of certain care and services provided under a VA plan in the case of an individual who has coverage under another plan. Establishes in the Treasury the Department of Veterans Affairs Health Plan Fund to be used for VA health plan payments and services. Preserves existing benefits for VA facilities not operating within a health plan certified under this Act. (Sec. 8102) Directs the Secretary of Veterans Affairs to organize health plans and operate VA facilities as, or within, health plans under this Act. Preempts existing State health plan standards or requirements. Authorizes the Secretary to contract for the provision of services by a VA health plan when cost-effective, or to share resources with other health care plans, providers, or organizations. Authorizes appropriations to the VA for FY 1995 through 1997 for VA health plans under this Subtitle, subject to availability of appropriations. Requires a report from the Secretary to the Congress concerning the operation of the VA health care system within the requirements of this Act. Authorizes the Secretary to accept and use grants for health care services provided to special populations if used by the VA while operating under a VA health plan. Subtitle C: Federal Employees Health Benefits Programs - (Secs. 8202 through 8204) Provides for termination of the Federal Employees Health Benefits Program (FEHB) and treatment of Federal employees, annuitants, and other individuals (including those residing abroad) who would otherwise have been eligible for FEHBP under this Act's health plans. Subtitle D: Indian Health Service - Makes qualifying Indians eligible to enroll in a comprehensive benefits health program of the Indian Health Service. (Sec. 8303) Authorizes appropriations for supplemental Indian health care benefits. (Sec. 8305) Exempts tribal governments and organizations from making employer payments. (Sec. 8306) Sets forth provisions regarding health service to non-enrollees and non-Indians. (Sec. 8311) Requires each health program of the Indian Health Service to establish a comprehensive benefit package fund. (Sec. 8313) Authorizes appropriations for the Indian Health Service programs. Subtitle E: Amendments to the Employee Retirement Income Security Act of 1974 - Amends the Employee Retirement Income Security Act of 1974 (ERISA) to revise and limit the coverage of group health plans under ERISA. Makes certain ERISA provisions inapplicable with respect to State-certified health plans. Provides for an exception from ERISA civil action provisions where review is otherwise available under the Health Security Act (this Act, HSA). (Sec. 8402) Establishes ERISA requirements for expeditious reporting and disclosure applicable to group health plans, through special rules consistent with ERISA and HSA purposes. Excludes plans maintained by regional alliances from treatment as multiple employer welfare arrangements. (Sec. 8403) Revises certain ERISA provisions relating to continuation coverage under group health plans. Repeals such provisions upon implementation of HSA. (Sec. 8404) Makes ERISA standards for group health plans regarding: (1) cases of adoption applicable except to the extent otherwise provided in regulations of the National Health Board under HSA; and (2) coverage of pediatric vaccines inapplicable to a group health plan upon its becoming a corporate alliance health plan under HSA. (Sec. 8405) Requires group health plans under ERISA to comply with HSA requirements relating to health plan claims procedure. Subtitle F: Special Fund for WIC Program - Authorizes appropriations through FY 2000 for the special supplemental food program for women, infants, and children under the Child Nutrition Act of 1966. Title IX: Aggregate Government Payments - Subtitle A: Aggregate State Payments - Sets forth provisions which have formulas for determining each participating State's payment to regional alliances within the State. Provides two different formulas. Establishes one payment formula for non-cash assistance recipients. Establishes another formula relating to cash assistance recipients. Defines a non-cash assistance adult as an individual who is: (1) over 21 years; (2) a U.S. citizen or lawful alien; and (3) is not an AFDC or SSI recipient or a Medicare-eligible individual. (Sec. 9022) Directs the National Health Board to review appropriateness of such payments. Subtitle B: Aggregate Federal Alliance Payments - Sets forth the formula for determining Federal payments to regional alliances for cash assistance recipients. (Sec. 9102) States that this section constitutes budget authority in advance of appropriation Acts and obligates the Federal Government to provide for the payment to regional alliances of a capped Federal alliance payment amount. Defines "capped Federal alliance payment amount." Subtitle C: Borrowing Authority to Cover Cash-flow Shortfalls - Authorizes the Secretary to make available loans to regional alliances to cover any period of temporary cash-flow shortfall attributable to: (1) any estimation discrepancy; (2) a period of temporary cash-flow shortfall attributable to an administrative error; or (3) a period of temporary cash-flow shortfall relating to the relative timing during the year in which amounts are received and payments are required. Sets forth loan terms and conditions. Title X: Coordination of Medical Portion of Workers Compensation and Automobile Insurance - Subtitle A: Workers Compensation Insurance - Requires each health plan that provides services to enrollees through participating providers to make arrangements to provide workers compensation to such enrollees. (Sec. 10002) Requires each workers' compensation carrier that is liable for payment for workers' compensation services furnished by or through a health plan, regardless of whether or not the services are included in the comprehensive benefit package, to make payment for such services. (Sec. 10011) Sets forth requirements for participating States. (Sec. 10031) Authorizes demonstration projects in one or more States with respect to the treatment of work-related injuries and illnesses. Subtitle B: Automobile Insurance - Requires an individual entitled to automobile insurance medical benefits and enrolled in a health plan to receive automobile insurance medical services through the provision of such services by the health plan. (Sec. 10102) Requires each automobile insurance carrier that is liable for payment for automobile insurance medical services furnished by or through a health plan, regardless of whether or not the services are included in the comprehensive benefit package, to make payment for such services. (Sec. 10111) Requires each participating State to develop a fee schedule applicable to payment for automobile insurance medical services for which a fee is not included in the applicable fee schedule. Subtitle C: Commission on Integration of Health Benefits - Establishes the Commission on Integration of Health Benefits which shall study and report on the feasibility and appropriateness of transferring financial responsibility for all medical benefits, including those currently covered by workers compensation and automobile insurance, to health plans. Authorizes appropriations. Subtitle D: Federal Employees' Compensation Act - Requires the Federal Employees' Compensation Act to be interpreted and administered consistent with the provisions of subtitle A. Subtitle E: Davis-Bacon Act and Service Contract Act - Amends the Davis-Bacon Act and the Service Contract Act of 1965 to require Health Security Act benefits. Subtitle F: Effective Dates - Sets forth effective date provisions. Title XI: Transitional Insurance Reform - Sets forth transitional provisions concerning: (1) enforcement; (2) preservation of current coverage; (3) restrictions on premium increases during transition; (4) portability requirements; (5) restrictions limiting benefit reductions; and (6) the establishment of the National Transitional Health Insurance Risk Pool.

Bill· SS. 1760 (103rd)open

Public Buildings Reform Act of 1993

United States · United States Congress · 20 November 1993

Public Buildings Reform Act of 1993 - Amends the Public Buildings Act of 1959 (the Act) to require the Administrator of General Services to: (1) submit biennially to the Congress a public buildings plan for the first two fiscal years that begin after the date of submission for such projects relating to the construction, alteration, purchase, or acquisition of public buildings, or the lease of office or storage space that is necessary to carry out the duties of the Administrator under any law; and (2) hold a public hearing and certify in the biennial plan that the hearing was held in the locality of each major project included in the plan. Includes in the biennial plan, with respect to each project: (1) any final report that is required to be prepared pursuant to any applicable Federal law including any environmental assessment or impact statement pursuant to the National Environmental Policy Act of 1969; and (2) a report that indicates the consideration that was given to facts and issues concerning the project and the various alternatives that were raised during the hearing or that were otherwise considered. Authorizes the Administrator to include a project in the next biennial plan if such project is included in a biennial plan and the project is not approved in accordance with the Act or if funds are not made available to carry out the project. Prohibits the Administrator from obligating funds that are made available for any project for which approval is required unless the project was included in the biennial plan for the fiscal year and a prospectus for the project was submitted to the Congress. Reduces the ceiling on appropriations from $1.5 million to $1 million for the General Services Administration (GSA), without congressional approval, to construct, alter, purchase, or acquire any building to be used as a public building, or to lease any space at an average annual rental for public purpose use. Prohibits, without prior approval, the use of funds to: (1) alter a public building if the aggregate cost of such alteration exceeds the ceiling over a five-year period; or (2) lease space within a public building if the aggregate cost of the leased space annually exceeds the ceiling. Authorizes the Administrator to submit to specified congressional committees a written request for authority to carry out an emergency project if the Administrator determines that an overriding economic or safety interest requires such authority and it cannot be obtained in a timely manner through the biennial planning process. Requires a specific Act of the Congress before such emergency project can be carried out. Repeals provisions authorizing the Administrator to increase the estimated maximum cost of any project set forth in any prospectus that has been transmitted to the Congress. Authorizes the Administrator to: (1) include in a biennial public building plan a prospectus for the funding of an authorized uncompleted public building project; and (2) use the results of the continuing investigation and survey required by the Act to establish a central repository for Federal asset management information. Requires the Administrator to designate an official to act as ombudsman within the Public Building Service of the GSA. Requires the Director of the Office of Management and Budget to: (1) report to the Congress on ending GSA monopoly with respect to providing office and storage space for Federal agencies, including whether the ending of the monopoly is necessary and would be cost-effective; and (2) submit a plan for ending the monopoly, along with recommendations to implement the plan, if the report determines that it is feasible and desirable to do so. Requires: (1) each Federal agency to review and report to the Congress on the agency's long-term housing needs and to attempt to reduce such needs; and (2) the Administrator to designate two account managers for each agency to assist the agency in carrying out the review and to assist the Administrator in preparing uniform standards for housing needs for Federal executive agencies and establishments in the judicial branch. Directs each Federal agency, by the end of the third fiscal year that begins after the enactment of this Act, to reduce by at least five percent: (1) the aggregate office and storage space held on the enactment of this Act; or (2) the annual housing costs (including the costs of energy, supplies, furniture, and minor repairs) of the agency as compared to the housing costs of the agency for the fiscal year during which this Act was enacted.

Bill· HRH.R. 3600 (103rd)reported

Health Security Act

United States · United States Congress · 20 November 1993

TABLE OF CONTENTS: Title I: Health Care Security Subtitle A: Universal Coverage and Individual Responsibility Subtitle B: Benefits Subtitle C: State Responsibilities Subtitle D: Health Alliances Subtitle E: Health Plans Subtitle F: Federal Responsibilities Subtitle G: Employer Responsibilities Subtitle J (sic): General Definitions; Miscellaneous Provisions Title II: New Benefits Subtitle A: Medicare Outpatient Prescription Drug Benefit Subtitle B: Long-Term Care Title III: Public Health Initiatives Subtitle A: Workforce Priorities Under Federal Payments Subtitle B: Academic Health Centers Subtitle C: Health Research Initiatives Subtitle D: Core Functions of Public Health Programs; National Initiatives Regarding Preventive Health Subtitle E: Health Services for Medically Underserved Populations Subtitle F: Mental Health; Substance Abuse Subtitle G: Comprehensive School Health Education; School-Related Health Services Subtitle H: Public Health Service Initiative Subtitle I: Coordination With COBRA Continuation Coverage Title IV: Medicare and Medicaid Subtitle A: Medicare and the Alliance System Subtitle B: Savings in Medicare Program Subtitle C: Medicaid Subtitle D: Increase in SSI Personal Needs Allowance Title V: Quality and Consumer Protection Subtitle A: Quality Management and Improvement Subtitle B: Information Systems, Privacy, and Administrative Simplification Subtitle C: Remedies and Enforcement Subtitle D: Medical Malpractice Subtitle E: Fraud and Abuse Subtitle F: McCarran-Ferguson Reform Title VI: Premium Caps; Premium-Based Financing; and Plan Payments Subtitle A: Premium Caps Subtitle B: Premium-Related Financing Subtitle C: Payments to Regional Alliance Health Plans Title VII: Revenue Provisions Subtitle A: Financing Provisions Subtitle B: Tax Treatment of Employer-Provided Health Care Subtitle C: Employment Status Provisions Subtitle D: Tax Treatment of Funding of Retiree Health Benefits Subtitle E: Coordination with COBRA Continuing Care Provisions Subtitle F: Tax Treatment of Organizations Providing Health Care Services and Related Organizations Subtitle G: Tax Treatment of Long-term Care Insurance and Services Subtitle H: Tax Incentives for Health Services Providers Subtitle I: Miscellaneous Provisions Title VIII: Health and Health-Related Programs of the Federal Government Subtitle A: Military Health Care Reform Subtitle B: Department of Veterans Affairs Subtitle C: Federal Employees Health Benefits Program Subtitle D: Indian Health Service Subtitle E: Amendments to the Employee Retirement Income Security Act of 1974 Subtitle F: Special Fund for WIC Program Title IX: Aggregate Government Payments to Regional Alliances Subtitle A: Aggregate State Payments Subtitle B: Aggregate Federal Alliance Payments Subtitle C: Borrowing Authority to Cover Cash-Flow Shortfalls Title X: Coordination of Medical Portion of Workers Compensation and Automobile Insurance Subtitle A: Workers Compensation Insurance Subtitle B: Automobile Insurance Subtitle C: Commission on Integration of Health Benefits Subtitle D: Federal Employees' Compensation Act Subtitle E: Davis-Bacon Act and Service Contract Act Subtitle F: Effective Dates Title XI: Transitional Insurance Reform Health Security Act - Title I: Health Care Security - Subtitle A: Universal Courage and Individual Responsibility - Entitles each eligible individual to: (1) the benefit provided under subtitle B through the applicable health plan in which the individual is enrolled; and (2) a health security card to be issued by the alliance or other entity that offers the applicable health plan in which the individual is enrolled. Defines an eligible individual as an individual who resides in the United States and is: (1) a citizen or national of the United States; (2) an alien permanently residing in the U.S. under color of law; or (3) a long-term nonimmigrant. Entitles a Medicare-eligible individual to benefits under Medicare instead of the above provisions of this Act. (Sec. 1002) Requires each eligible individual to enroll in an applicable health plan and pay any required premium. Prohibits disenrollment of an eligible individual until the individual is either enrolled in another plan or in Medicare. (Sec. 1003) States that nothing in this Act shall be construed as prohibiting: (1) an individual from purchasing any health services; (2) an individual from purchasing supplemental insurance; (3) an individual who is not an eligible individual from purchasing health insurance; or (4) employers from providing additional coverage. (Sec. 1004) States that a regional alliance health plan is the applicable plan for a family, unless a family member is eligible for a corporate alliance health plan. Allows military personnel, veterans, and Indians to enroll either with an alliance or with a military, veteran, or Indian plan respectively. (Sec. 1005) Prohibits an undocumented alien from enrolling in a health plan under this Act. (Sec. 1011) Defines a family as an eligible individual's eligible spouse and children. Defines couple as meaning an individual and the individual's spouse. Defines a child as being under age 18, or under age 24 in the case of a full-time student. Subtitle B: Benefits - Includes the following terms and services in the comprehensive benefit package: (1) hospital services; (2) services of health professionals; (3) emergency and ambulatory medical and surgical services; (4) clinical preventive services; (5) mental illness and substance abuse services; (6) family planning services and services for pregnant women; (7) hospice care; (8) home health care; (9) extended care services; (10) ambulance services; (11) outpatient laboratory, radiology, and diagnostic services; (12) outpatient prescription drugs and biologicals; (13) outpatient rehabilitation services; (14) durable medical equipment and prosthetic and orthotic devices; (15) vision care; (16) dental care; (17) health education classes; and (18) investigational treatments. Describes such items and services. (Sec. 1131) Requires each health plan to offer to its enrollees only one of the following cost sharing schedules: (1) lower cost sharing; (2) higher cost sharing; or (3) combination cost sharing. Provides that the annual maximum out-of-pocket expenses for an individual in any of the plans shall be $1500 and for a family the annual maximum shall be $3000. (Sec. 1135) Sets forth a table of copayments and coinsurance. (Sec. 1141) Excludes the following items and services: (1) an item or service that is not medically necessary or appropriate; (2) an item or service that the National Health Board may determine is not medically necessary or appropriate; (3) custodial care, except hospice care; (4) surgery performed solely for cosmetic purposes, unless required to correct a congenital anomaly or performed to correct a part of the body injured by either disease or accident; (5) hearing aids; (6) eyeglasses and contact lenses for individuals at least 18 years of age; (7) in vitro fertilization; (8) sex change surgery and related services; (9) private duty nursing; (10) personal comfort items, except in the case of hospice care; and (11) any dental procedures involving orthodontic care, inlays, gold or platinum fillings, bridges, crowns, pin/post retention, dental implants, surgical periodontal procedures, or the preparation of the mouth for the fitting or continued use of dentures, except as specified. (Sec. 1151) Gives the National Health Board the authority to promulgate such regulations or establish such guidelines as necessary to assure uniformity in the application of the comprehensive benefit package across all health plans. Permits the Board to expand the benefit package. (Sec. 1162) Permits a health professional or facility to refuse to provide a benefit if the professional or facility objects on the basis of a religious belief or moral conviction. Subtitle C: State Responsibilities - Requires a State, in order to be approved as a participating State, to submit a document describing the State's health care system. (Sec. 1201) Requires a participating State to: (1) establish one or more regional alliances; (2) establish and publish the criteria used in the certification of its health plan; (3) meet minimum financial solvency requirements for health plans established by the National Health Board; (4) designate an agency or official to coordinate State responsibilities under this Act; (5) conform State laws to meet the requirements of title X of this Act with respect to workers' compensation and automobile insurance; and (6) carry out all the responsibilities of a participating State specified in this Act. (Sec. 1221) Permits a State, with the Board's approval, to operate a single-payer system if specified requirements are met. Subtitle D: Health Alliances - Provides for regional alliances and corporate alliances. (Sec. 1302) Requires a regional alliance to be governed by a Board of Directors consisting of: (1) employers, including self-employed individuals; and (2) members who represent individuals purchasing coverage. Requires each regional alliance to establish a provider advisory board consisting of health care providers and professionals. (Sec. 1311) Includes in a corporate alliance an eligible sponsor who is either a large employer (more than 5,000 full-time employees) or a multiemployer plan (a plan with more than 5000 active participants). Excludes: (1) an employer whose primary business is employee leasing; (2) the Federal Government (other than the U.S. Postal Service); and (3) a State or local government. Excludes from corporate alliance eligibility the following classes of individuals: (1) AFDC recipients; (2) SSI recipients; (3) military personnel and families, veterans, and Indians who elect to enroll in specified plans specifically designed for them; and (4) seasonal or temporary employees. (Sec. 1321) Directs each regional alliance to enter into a contract with any State-certified health plan to contract with the alliance for the enrollment under the plan of eligible individuals. (Sec. 1322) Requires each regional alliance to offer a choice of health plans, including at least one fee-for-service plan. (Sec. 1326) Requires each regional alliance to establish and maintain an office of an ombudsman to assist consumers in dealing with problems that arise with health plans and the alliance. (Sec. 1329) Permits a regional alliance to adjust payments to plans or use other financial incentives to encourage health plans to expand into areas that have inadequate health services. (Sec. 1341) Set forth provisions concerning the collection of funds by regional alliances from individuals, employers, and others. (Sec. 1351) Requires each regional alliance to compute a blended plan per capita payment amount for each regional alliance health plan for enrollment in the alliance. (Sec. 1353) Requires each regional alliance to make payments to the Federal Government for academic health centers and graduate medical education. (Sec. 1361) Requires each regional alliance to comply with specified standards relating to the management of finances, maintenance of records, accounting practices, auditing procedures, financial reporting, and employer payments. (Sec. 1371) Provides for a reduction in cost sharing for low-income families. (Sec. 1373) Provides for premium discounts and reduction in liabilities for low-income families. (Sec. 1381) Permits each corporate alliance to: (1) offer coverage under either an appropriate self-insured health plan; or (2) negotiate with a State-certified plan to enter into a contract with the plan. (Sec. 1382) Requires each corporate alliance to provide a choice of health plans, including at least one fee-for-service plan and two health plans that are not fee-for-service plans. (Sec. 1385) Requires each corporate alliance to make an additional contribution towards the enrollment in health plans of the alliance by certain low-wage families. (Sec. 1386) Sets forth provisions relating to corporate alliances concerning: (1) consumer information and marketing; (2) plan and information requirements; (3) management of funds; (4) cost control; (5) payments by corporate alliance employers to corporate alliances; (6) ERISA; (7) disclosure and reserve requirements; (8) trusteeship of insolvent corporate alliance health plans; (9) imposition and collection of periodic assessments on self-insured corporate alliance plans; and (10) payments to the Federal Government by multiemployer corporate alliances for academic health centers and gradual medical education. Subtitle E: Health Plans - Requires a health plan to: (1) be either a self-insured plan (meaning a group health plan as defined by a the Employee Retirement Income Security Act of 1974) or a State-certified plan (meaning a plan certified by a State or the National Health Board); and (2) meet the applicable regulatory requirements. (Sec. 1402) Requires each health plan offered by either a regional or corporate alliance to accept for enrollment every alliance eligible individual, unless the plan has reached its enrollment limit. Prohibits the limit from being imposed on the basis of any personal characteristics of enrollees such as health status, need for health care, age, occupation, or affiliation with any person or entity. Prohibits a plan from: (1) restricting or terminating coverage for any reason, including nonpayment of premiums; (2) cancelling coverage for any eligible individual until that individual is enrolled in another plan; (3) excluding an eligible individual because of an existing medical condition; (4) imposing a waiting period before coverage begins; or (5) imposing a rider that excludes the coverage of particular eligible individuals. Prohibits discrimination by a health plan on the basis of race, national origin, sex, language, socio-economic status, age, disability, health status, or anticipated need for health services. (Sec. 1405) Requires each plan to have a grievance procedure. (Sec. 1421) Permits an entity to offer a supplemental insurance policy if the policy and the entity meet specified requirements. (Sec. 1431) Requires each health plan, with respect to each electing essential community provider located within the plan's service area, to either: (1) enter into a written provider participation agreement; or (2) enter into a written agreement under which the plan will make payment to the provider as specified. Provides a special rule for providers of school health services. Makes the provisions of the proceeding sentence applicable only to health plans offered by a health alliance during the five year period beginning with the first year in which any health plan is offered by the alliance. Directs the Secretary of Health and Human Services to study essential community providers and to make recommendations concerning such providers to the Congress. Provides that such recommendations shall apply unless a joint resolution of disapproval is enacted by the Congress. (Sec. 1441) Requires each health plan to meet specified requirements of title X of this Act with respect to workers' compensation and automobile medical liability services. Subtitle F: Federal Responsibilities - Establishes the National Health Board in the Executive Branch. Directs the President to appoint the Board's seven members. (Sec. 1503) Directs the Board to: (1) interpret the comprehensive benefit package; (2) adjust the delivery of preventive services; (3) take steps to assure that the comprehensive benefit package is available on a uniform national basis; (4) recommend to the President and the Congress appropriate revisions to the package; (5) oversee cost containment requirements; (6) develop and implement eligibility standards; (7) establish a performance based system of quality management; (8) develop and implement standards for a national health information system; (9) establish State requirements and monitor State compliance; (10) establish premium class factors; (11) develop a methodology for the risk-adjustment of premium payments; (12) establish financial requirements for guaranty funds; (13) establish standards for health plan grievance procedures; and (14) report annually to the President and the Congress. (Sec. 1506) Authorizes appropriations for the Board. (Sec. 1511) Requires the Board to approve a State health care system if the system meets the applicable requirements of this Act. Prohibits approval of a State health care system prior to 1996. (Sec. 1512) Provides for sanctions for States failing to meet conditions for compliance. (Sec. 1515) Provides for planning grants to States for implementation assistance. (Sec. 1521) Provides for the Federal assumption of responsibilities in the absence of a State system. Provides for increased premiums of 15 percent during Federal operation of a State system to provide reimbursement for the Federal cost of operating the system. (Sec. 1541) Directs the Board to develop a risk adjustment and reinsurance methodology. Sets forth guidelines for developing such methodology. (Sec. 1543) Directs the Board to establish an advisory committee to provide technical advice and recommendations regarding the risk adjustment and reinsurance methodology. (Sec. 1551) Directs the Board to establish minimum capital requirements for regional alliance health plans under which at least $500,000 of capital must be maintained for each plan in the area. Permits the Board to require additional capital. (Sec. 1552) Requires the Board to establish standards for guaranty funds established by the States. (Sec. 1571) Sets forth the responsibilities of the Secretary of Health and Human Services. Directs the Secretary to administer and implement all provisions of this Act, except those duties delegated to the Board, any other executive agency, or to any State. (Sec. 1572) Directs the Secretary to appoint an Advisory Council on Breakthrough Drugs that will examine the reasonableness of launch prices of new breakthrough drugs. (Sec. 1581) Provides for the certification of essential community providers. Sets forth the following categories of providers automatically certified (under provisions of the Public Health Service Act): (1) migrant health centers; (2) community health centers; (3) homeless program providers; (4) public housing providers; (5) family planning clinics; and (6) AIDS providers under the Ryan White Act. Includes as automatically certified (under other Acts) following: (1) Indian health programs under the Indian Health Act; and (2) maternal and child health providers and a federally qualified health center or rural health clinic under the Social Security Act. Includes as automatically certified (under provisions of this Act) the following: (1) providers of school health services; and (2) a qualified community practice network. Provides for the setting of standards for additional health providers. (Sec. 1591) Sets forth the responsibilities of the Secretary of Labor. Includes among those responsibilities the following: (1) enforcement requirements applicable to employers; (2) elections to become corporate alliances; (3) temporary assumption of insolvent self-insured corporate alliance health plans; (4) establishment and administration of the Corporate Alliance Health Plan Insolvency Fund; and (5) administering title I of ERISA as it relates to group health plans maintained by corporate alliances. Subtitle G: Employer Responsibilities - Requires employers to provide for the payments required under title VI of this Act. Sets forth other employer responsibilities including: (1) information reporting requirements; (2) requirements relating to new employees; (3) recordkeeping requirements; and (4) antidiscrimination requirements. (Sec. 1606) Prohibits self-funding of cost sharing benefits by regional alliance employers. (Sec. 1607) Requires an employer to make equal employer premium payments to all qualifying employees, if a voluntary premium payment is made. Places a limit on such voluntary employer premium payments. (Sec. 1608) Sets forth an employer's obligation to a qualifying retired beneficiary where the employer, as of October 1, 1993, was providing a threshold payment. (Sec. 1609) Authorizes the Secretary of Labor to impose a civil penalty of up to $10,000 for each violation of this subtitle with respect to each individual. Subtitle J (sic): General Definitions; Miscellaneous Provisions - Sets forth the definitions and rules used in this Act. Subtitle B: Miscellaneous Provisions (sic) - (Sec. 1911) Grants the National Health Board, the Secretary of Health and Human Services, and the Secretary of Labor authority to issue regulations as necessary to permit the timely implementation of this Act. Title II: New Benefits - Subtitle A: Medicare Outpatient Prescription Drug Benefit - (Secs. 2001 through 2005) Amends title XVIII of the Social Security Act to provide for: (1) Medicare coverage of covered outpatient prescription drugs and biologicals as well as home infusion drug therapy services; (2) payment rules and related requirements, such as those pertaining to deductibles, for covered outpatient prescription drugs; (3) manufacturer rebates to the Secretary under Medicare part B for covered outpatient prescription drugs; and (4) determination of the Medicare part B premium attributable to covered outpatient prescription drugs. Subtitle B: Long-Term Care - Establishes requirements for State plans for home and community-based services to individuals with disabilities. Includes among those requirements the following: (1) a prohibition of limiting eligibility of individuals with disabilities based on income, age, geography, severity of disability, residential setting, or other grounds specified by the Secretary; (2) a requirement to serve low-income individuals; (3) a requirement to specify how Federal and State funds will be managed; (4) quality assurance requirements; and (5) reporting requirements. Requires a State to consult with individuals and groups of individuals with disabilities when developing the plan in order to have the plan approved. (Sec. 2103) Defines "individuals with disabilities" to mean any individual within one or more of the following four categories: (1) individuals requiring help with the activities of daily living; (2) individuals with severe cognitive or mental impairment; (3) individuals with severe or profound mental retardation; and (4) severely disabled children. (Sec. 2104) Requires a State plan to specify the services available. Requires each individualized plan to be developed in close consultation with the individual and the individual's family. Prohibits a State plan from covering: (1) room and board; (2) services furnished in a hospital, nursing facility, intermediate care facility for the mentally retarded, or other specified institutional setting; or (3) items or services to the extent coverage is provided for an individual under a health plan or Medicare. (Sec. 2105) Sets forth provisions relating to: (1) cost sharing; (2) quality assurance and safeguards; (3) advisory groups; (4) payments to States; and (5) the total Federal budget for State plans and allotments to States. (Sec. 2301) directs the Secretary, with the advice and assistance of the National Long-Term Care Insurance Advisory Council to promulgate regulations as necessary to implement provisions concerning private long-term care insurance. Directs the Secretary to make appointments to such Council. Authorizes appropriations for such Council. (Sec. 2321) Directs the Secretary, after considering the Council's recommendations to promulgate regulations designed to: (1) standardize formats and terminology used in long-term care policies; (2) require insurers to provide information to customers on the range of public and private long-term care coverage available; and (3) establish other requirements promoting consumer understanding of benefits. (Sec. 2322) Directs the Secretary to promulgate regulations establishing requirements with respect to the terms of and benefits under long-term care policies, which shall include the following requirements that the policy may not: (1) limit coverage based on a preexisting condition, subject to an exception for a six month period; (2) condition eligibility for benefits based on the need or receipt of any other service; (3) condition eligibility for any benefit on any particular diagnosis; (4) condition eligibility for benefits by providers on compliance with requirements not required by State or Federal law; and (5) condition coverage of any service by a provider on the provision of such service at a higher level of care than required by the insured individual. Prohibits discrimination by diagnosis in the treatment of: (1) Alzheimer's disease; (2) any organic or inorganic mental illness; (3) mental retardation or any other cognitive or mental impairment; or (4) HIV infection or AIDS. Sets forth other requirements for such policies, including requirements related to: (1) premiums; (2) sales practices; (3) continuation, renewal, replacement, conversion, and cancellation of policies; and (4) payment of benefits. (Sec. 2342) Provides for grants to States to enforce the Federal standards concerning long-term care policies. Sets forth requirements for receiving such grants. Authorizes appropriations. Prohibits the sale of a long-term care policy in a State without a regulatory program. (Sec. 2361) Authorizes the Secretary to make grants for the development and implementation of long-term care information, counseling, and other programs to: (1) States; (2) regional alliances (at the option of States within which such alliances are located; and (3) national organizations representing insurance consumers, long-term care providers, and insurers. Authorizes appropriations for such grants. (Sec. 2601) Authorizes the Secretary to conduct a demonstration program to test the effectiveness of various approaches to financing and providing integrated acute and long-term care services for the chronically ill and disabled. Sets forth the services and benefits to be provided, including: (1) all benefits of the comprehensive benefit package provided under title I of this Act; (2) transitional benefits, including assessment and home care; (3) long-term care benefits, including adult day care, home-delivered meals, and nursing facility services in specialized care units; and (4) habilitation services. Permits any of the following to be eligible for such services under criteria to be established by the Secretary: (1) individuals with disabilities under a State program; (2) individuals entitled to benefits under the Medicare program; and (3) individuals entitled to Medicaid and who are also either entitled to Medicare or Supplemental Security Income benefits. Requires reports to the Congress on the demonstration program. Title III: Public Health Initiatives - Subtitle A: Workforce Priorities Under Federal Payments - Establishes within the Department of Health and Human Services the National Council on Graduate Medical Education. Directs the National Council to designate for each academic year the number of individuals nationwide who are authorized to be enrolled in each specified approval physician training program for each medical specialty. Sets forth provisions specifying: (1) Federal formula payments to approved physician training programs; (2) application for payments; and (3) amount of payments. (Sec. 3061) Directs the Secretary to carry out a program with respect to graduate nurse training programs that is equivalent to the program for approved physician training programs. Establishes a National Council on Graduate Nurse Education. (Sec. 3071) Authorizes appropriations for the following programs: (1) primary care physician and physician assistant training; (2) training of underrepresented minorities and disadvantaged persons; and (3) nurse training. (Sec. 3072) Authorizes appropriations for the following programs: (1) a program of skill upgrading and occupational retraining for health care workers; (2) a demonstration program to assist workers in health care institutions in obtaining advanced career positions; (3) a program to develop and operate health-worker job banks in local employment services agencies, subject to certain conditions; (4) a program to provide joint labor-management decision-making in the health care sector on workplace matters related to the restructuring of the health care delivery system of this Act; and (5) a program to facilitate the comprehensive workforce adjustment initiative. (Sec. 3073) Directs the Secretary of Health and Human Services and the Secretary of Labor to jointly establish the National Institute for Health Care Workforce Development. States that the Director of the Institute shall make recommendations to the Secretaries regarding: (1) the supply of health care workers; (2) the impact of this Act; and (3) the development and implementation of high-performance, high-quality health care delivery systems. Directs the Secretaries to establish an advisory board to assist in the development of such recommendations. Subtitle B: Academic Health Centers - Directs the Secretary to make payments to a qualified academic health center or qualified teaching hospital in order to assist such eligible institutions with costs that are not routinely incurred by other entities in providing health services, but are incurred by such institutions by virtue of the academic nature of such institutions. States that such costs include: (1) costs resulting from reduced staff productivity due to teaching responsibilities; (2) the uncompensated costs of clinical research; and (3) exceptional costs associated with an institutions specialized expertise. Provides that the funding for such payments will come from transfers from the Federal Hospital Insurance Trust Fund, payments made by regional alliances to the Federal government for academic health centers and graduate medical education, and payments from corporate alliances. (Sec. 3131) Provides for the access of regional and corporate alliance patients to academic health centers. Subtitle C: Health Research Initiatives - Amends the Public Health Service Act to ensure that the National Institutes of Health conducts and supports biomedical and behavioral research on promoting health and preventing diseases, disorders, and other health conditions. Provides for health services research. Authorizes appropriations for such research. Subtitle D: Core Functions of Public Health Programs; National Initiatives Regarding Preventive Health - Authorizes appropriations for the core functions of public health programs and national initiatives regarding health promotion and disease prevention. (Sec. 3312) Authorizes the Secretary to make grants to States to carry out one or more of the following core functions: (1) data collection; (2) activities to protect the environment and to assure the safety of housing, workplaces, and food and water; (3) investigation and control of adverse health conditions; (4) public information and education programs to reduce risks to health such as use of tobacco, alcohol, and drugs, sexual activities that increase the risk of HIV transmission and other sexually transmitted diseases, poor diet, physical inactivity, and low childhood immunization levels; (5) accountability and quality assurance activities; (6) provision of public health laboratory services to complement private clinical laboratory services that screen for diseases and conditions; (7) training and education to assure provision of care by all health professionals; and (8) leadership policy development and administrative activities. (Sec. 3331) Authorizes the Secretary to make grants to agencies of State or local government, private nonprofit organizations, and coalitions that link two or more of these groups for the purpose of carrying out projects to develop and implement innovative community-based strategies to provide for health promotion and disease prevention activities for which there is a significant need. Subtitle E: Health Services for Medically Underserved Populations - Directs the Secretary to make grants to migrant health centers and community health centers, which shall be in addition to other funds available to such centers. Authorizes appropriations. (Sec. 3412) Authorizes appropriations for: (1) grants and contracts for the development of qualified community health plans and practice networks; and (2) loans and guaranteeing the principal and interest to Federal and non-Federal lenders on behalf of public and private entities for the capital costs of developing qualified community health plans and practice networks. (Sec. 3461) Authorizes the Secretary to make grants and enter into contracts with qualified community health groups to provide enabling services such as transportation, community and patient outreach, patient education, and translation services in order to increase the capacity of individuals to utilize the items and services under title I of this Act. Authorizes appropriations. (Sec. 3471) Authorizes appropriations for: (1) the National Health Service Corps; and (2) such amounts as are necessary to ensure that at least 20 percent of participants in the Scholarship Program or the Loan Repayment Program of the Corps are nurses. (Sec. 3481) Entitles a hospital with a low-income utilization rate in a base year of at least 25 percent to a payment as specified. Requires 75 percent of the total available to be allocated to hospitals for low-income assistance. Requires 25 percent of the total available to be allocated to hospitals for assistance in furnishing inpatient hospital services that are not covered services under title I of this Act. Subtitle F: Mental Health; Substance Abuse - Authorizes appropriations to carry out this part. Provides for grants to: (1) increase access to mental health and substance abuse services; (2) improve State and local capacity to coordinate and monitor such services; (3) provide incentives to integrate public and private service systems; and (4) supplement any activity under part B (Alcohol and Drug Abuse and Mental Services Block Grant) of title XIX of the Public Health Service Act. (Sec. 3503) Authorizes the Secretary to make loans for the capital costs incurred in the development of non-acute, residential treatment centers and community-based ambulatory clinics. (Sec. 3521) Requires the establishment of a pilot program demonstrating the integration of the mental illness and substance abuse services of the States with the services included under title I of this Act. Subtitle G: Comprehensive School Health Education; School-Related Health Services - Authorizes appropriations for the programs of this subtitle. States that the purposes of the programs shall be to: (1) support, in kindergarten through grade 12, the provision of comprehensive health educator programs; (2) establish a national framework within which States can create comprehensive school health education programs that target the health risk behaviors of youth, including tobacco use, alcohol and drug abuse, sexual behaviors resulting in infections, injury prevention, dietary patterns, and sedentary lifestyles; (3) pay the initial costs of planning and establishing such programs; (4) support related Federal demonstrations and training; (5) motivate youth to stay in school, avoid teen pregnancy, and strive for success; (6) improve the knowledge of health education among youth; and (7) further the National Education Goals set forth in title I of the Goals 2000: Educate America Act. Defines "comprehensive school health education program." Requires such programs to be sensitive to cultural and ethnic issues, promote involvement by families, and promote personal responsibility. Sets forth requirements for applying for grants and selection of grantees. Subtitle H: Public Health Service Initiative - Establishes a Public Health Service Initiative consisting of specified amounts authorized to be appropriated for the Initiative. States that: (1) the Initiative includes the programs of subtitles C through G of this title and the programs of subtitle D of title VIII; and (2) amounts appropriated to carry out the Initiative, including subtitles A through F of this title, are available to carry out specific programs for which the amounts are appropriated. Subtitle I: Coordination with COBRA Continuation Coverage - Amends title XXII (Requirements for Certain Group Health Plans for Certain State and Local Employees) of the Public Health Service Act to provide for coordination with COBRA continuation coverage. Repeals such title XXII upon implementation of this Act. Title IV: Medicare and Medicaid - Subtitle A: Medicare and the Alliance System - Amends title XVIII of the Social Security Act to provide for optional State integration of Medicare beneficiaries into regional alliance plans. (Sec. 4002) Allows individuals to elect to remain in certain plans. (Sec. 4003) Provides for payments to regional alliances on behalf of certain Medicare-eligible individuals. (Sec. 4004) Extends protections for working aged and disabled individuals to group health plans of all employers. Repeals the limitation on the period of protection for individuals with end stage renal disease. Prohibits Medicare payment for items and services provided under any health plan under this Act. Simplifies Medicare benefit coordination in cases where the individual is also eligible for benefits under this Act's health plans. (Sec. 4011) Makes various changes concerning eligible organization and Medicare supplemental policy enrollment and comparative informational materials, eligible organization outlier payments, and participating provider point-of-service networks. (Sec. 4022) Provides for expanded Medicare coverage for physician assistant, nurse practitioner, and clinical nurse specialist services. (Sec. 4031) Amends title XI of the Social Security Act to: (1) provide for termination of the separate Medicare peer review program upon adoption of the National Quality Management Program above under subtitle A of title V of this Act; and (2) repeal provisions on surgical procedure review and second opinions. (Sec. 4032) Amends title XVIII of the Social Security Act to provide for mandatory assignment for all Medicare part B services. (Sec. 4033) Directs the Secretary of Health and Human Services to take such steps as may be necessary to consolidate administration of Medicare parts A and B and supersedes certain conflicting requirements to the extent required to achieve such purpose. (Sec. 4035) Prohibits the Secretary from implementing any change in procedures for billing and processing Medicare claims within six months of implementing any previous change. Adds advanced notification to providers as a requirement for carriers and fiscal intermediaries under Medicare. (Sec. 4041) Amends title XI of the Social Security Act to: (1) provide for civil monetary penalties for kickback violations under Medicare and State health care programs (the programs); (2) make other penalty-related changes, including increases in criminal and civil monetary penalties, a new criminal penalty exception for certain providers, additional civil monetary penalty offenses related to alliance systems, and requirements for the deposit of penalties collected into the All-Payer Account established above under title V of this Act; (3) revise exclusion provisions, with changes establishing a minimum period of exclusion for certain individuals and entities subject to permissive exclusion from the programs, and providing for program exclusions based on actions under alliance systems; and (4) modify sanction provisions, with changes removing certain conditions for imposing sanctions and setting specified civil money penalties for use in lieu of authorized sanctions. (Sec. 4042) Amends title XVIII of the Social Security Act to revise the limitations on physician self-referrals. (Sec. 4051) Provides for the termination of payments under Medicare for medical education costs and directs the Secretary to make specified transfers from certain Medicare trust funds to the new accounts established above for funding physician training programs and academic health centers. (Sec. 4061) Amends title XVIII of the Social Security Act to provide for the treatment of: (1) uniformed services and VA health plans as eligible organizations under Medicare; and (2) health care facilities of the Department of Veterans Affairs as providers under Medicare. Subtitle B: Savings in Medicare Program - Amends title XVIII of the Social Security Act to provide for: (1) reductions in the update for inpatient hospital services and the adjustment for indirect medical education costs, in payments for capital-related costs for inpatient hospital services; (2) revisions to payment adjustments for disproportionate share hospitals in States participating under this Act; and (3) an extension of the freeze on updates to routine service costs of skilled nursing facilities. (Sec. 4111) Amends title XVIII of the Social Security Act to provide for: (1) establishment of cumulative expenditure goals for physician services; (2) use of real gross domestic product for volume adjustments; (3) repeal of restrictions on the maximum reduction permitted in default update; (4) reduction in the conversion factor for the physician fee schedule for 1995; (5) place limitations on payment for physicians' services furnished by high-cost hospital medical staffs; (6) requirements for physicians to identify the hospital at which the service was furnished; (7) an increase in practice expense relative value units for certain services while assuring budget neutrality; (8) a study and report to the Congress by the Secretary on a resource-based system for determining practice expense relative value units for each physician's service; (9) an increase in work relative value units for office visits while assuring budget neutrality; (10) a reduction in relative values for office consultations; (11) adjustment of outlier intensity of relative values; (12) changes in underserved area bonus payments; (13) elimination of formula-driven payments for certain outpatient hospital services; (14) copayments for laboratory services; and (15) competitive acquisition procedures for Medicare part B items and services (including clinical diagnostic laboratory tests). (Sec. 4131) Makes changes with respect to: (1) Medicare as secondary payer; (2) payments for health maintenance organizations and competitive medical plans with risk-sharing contracts; and (3) routine cost limits and copayments for, respectively, home health services and visits. (Sec 4135) Directs the Secretary to use a competitive process to contract with centers of excellence for cataract surgery, coronary artery by-pass surgery, and such other services as the Secretary determines to be appropriate. (Sec. 4141) Amends title XVIII of the Social Security Act to revise Medicare part B premium provisions. (Sec. 4151) Requires the Secretary to submit a report to the Congress on the growth in spending under Medicare for FY 2000 through 2003. Subtitle C: Medicaid - Amends title XIX (Medicaid) of the Social Security Act to provide that if a State Medicaid plan provides for payment to regional alliances of the amounts required above it is not required to provide payment for items and services covered under the comprehensive benefit package for alliance eligible individuals and will receive no Federal financial assistance with respect to such items and services. (Sec. 4211) Provides for: (1) spenddown eligibility and increased income and resource disregard for nursing facility residents; and (2) informing such residents about the availability of assistance for home and community-based services. (Sec. 4221) Provides for: (1) treatment of items and services not covered under the comprehensive benefit package; and (2) establishment of a program under Medicare of noncovered items and services for poor children. (Sec. 4231) Discontinues certain payment policies under Medicaid. (Sec. 4241) Limits the frequency of changes in a State's billing and claims processing system, and provides for advance notification to providers of any major billing change. (Sec. 4251) Establishes the Medicaid Commission to study, report, and make recommendations with respect to options involving block grant use, integration of long-term care services, and consolidation of institutional and home- and community-based long-term care in relation to the Medicaid program. Authorizes appropriations. Subtitle D: Increase in SSI Personal Needs Allowance - Amends title XVI (Supplemental Security Income) (SSI) to provide for an increase in the SSI personal needs allowance. Title V: Quality and Consumer Protection - Subtitle A: Quality Management and Improvement - Requires the National Health Board to establish and oversee a performance-based program of quality management and improvement designed to enhance the quality, appropriateness, and effectiveness of heath care services and access to such services which will be called the National Quality Management Program. (Sec. 5002) Establishes the National Quality Management Council which shall: (1) administer the National Quality Management Program; (2) perform any other duty specified in this subtitle; and (3) advise the National Health Board with respect to its duties under this subtitle. Requires the Council to develop a set of national measures of quality performance to be used in the assessment of and the provision of access to health care services. Requires the Council, in addition, to: (1) recommend to the Board establishing goals for performance by health plans and health care providers on a subset of national measures of quality performance; (2) direct the Administrator for Health Care Policy and Research to develop, review, and disseminate practice guidelines to determine how diseases can most effectively be prevented, diagnosed, treated, and managed; and (3) direct the Administrator for Health Care Policy and Research to support research related to a five year priority list of performance measures. (Sec. 5008) Directs the National Health Board to: (1) establish and oversee regional professional foundations to perform such duties as develop lifetime learning programs for health professionals and conduct research on health care quality; and (2) establish the National Quality Consortium to perform such duties as establishing continuing education for health professionals and provide advice on research priorities. (Sec. 5012) Requires each regional alliance and each corporate alliance to: (1) disseminate specified information to consumers; and (2) ensure that performance and quality standards are continually improved. Subtitle B: Information Systems, Privacy, and Administrative Simplification - Directs the National Health Board to develop and implement a health information system, in consultation with Federal agencies, States, employers, health plans, and others, by which the Board shall collect, report, and regulate the collection and dissemination of health care information which shall be used for: (1) health care planning by Federal, State, and local government; (2) establishing and monitoring payments for health services; (3) assessing and improving the quality of health care; (4) managing and containing costs at the alliance and plan levels; and (5) other specified purposes. Requires the establishment of an electronic data network to collect, compile, and transmit information. (Sec. 5120) Sets forth provisions providing for health information privacy standards. (Sec. 5130) Directs the National Health Board to develop the following standard health care benefit forms: (1) an enrollment and disenrollment form; (2) a clinical encounter record; and (3) a claim form. (Sec. 5140) Establishes the National Privacy and Health Data Advisory Council in order to advise the National Health Board with respect to its duties under this subtitle. (Sec. 5141) Sets forth monetary penalties for violating health information system standards. Subtitle C: Remedies and Enforcement - Sets forth provisions with respect to the review of benefit determinations for enrolled individuals, including provisions: (1) regulating the time limits for notice of disposition of a claim; (2) governing a plan's duty to review claim denials; (3) concerning urgent requests for preauthorization; and (4) concerning other time limits with respect to time limits and notice. (Sec. 5202) Requires each State to establish a complaint review office for each regional alliance established by a State. Permits aggrieved individuals to file complaints with the appropriate review office. (Sec. 5205) Provides for a Federal Health Plan Review Board to review the decisions of complaint review office hearing officers. (Sec. 5207) Sets monetary penalties for a plan which unreasonably denies or delays payment or provision of benefits. (Sec. 5211) Directs each State to establish and maintain an Early Resolution Program in each complaint review office. Requires a program to include: (1) forums for mediation disputes; and (2) other forums of alternative dispute resolution as may be prescribed. Establishes guidelines for the eligibility of cases for submission to the Early Resolution Program. States that conclusions of the mediation proceedings shall be treated as nonbinding and shall not affect any rights to review. (Sec. 5231) Sets forth additional remedies and enforcement provisions. Subtitle D: Medical Malpractice - Prohibits any medical malpractice liability action until the final resolution of the claim under alternative dispute resolution. Requires each regional alliance health plan and corporate alliance health plan to adopt at least one specified method of alternative dispute resolution. Prohibits an individual from bringing a medical malpractice liability action unless the individual submits an affidavit that includes a report by a qualified specialist that states that there is a meritorious cause for filing the action. (Sec. 5311) Directs the Secretary to establish: (1) a project to demonstrate whether substituting liability for medical malpractice on the part of the health plan in which a physician participates for the personal liability of the physician will result in improvements in the quality of care, reductions in defense medical practices, and better risk management; (2) a pilot program under which the Secretary provides funds to one or more eligible States to determine the effect of applying practice guidelines in the resolution of medical malpractice liability actions. Subtitle E: Fraud and Abuse - Directs the Secretary and the Attorney General to establish a program: (1) to coordinate the functions of the Attorney General, the Secretary, and other organizations with respect to the prevention, detection, and control of health care fraud and abuse; (2) to conduct investigations, audits, evaluations, and inspections relating to the delivery of and payment for health care; and (3) to facilitate the enforcement of this and other statutes applicable to health care fraud. (Sec. 5402) Creates, in the Treasury, the All-Payer Health Care Fraud and Abuse Control Account which shall consist of: (1) gifts and bequests; (2) administrative penalties and assessments and portions of civil monetary penalties imposed under provisions of the Social Security Act; (3) all criminal fines imposed in cases involving a Federal health care offense; (4) penalties imposed under the False Claims Act involving claims related to the provision of health care items and services; and (5) amounts resulting from the forfeiture of property by reason of Federal health care offense. States that amounts in the fund may be used to cover costs incurred in operating the Program. (Sec. 5411) Excludes from participation in any health plan any individual or entity excluded from participation in a public program under provisions of the Social Security Act. (Sec. 5413) Sets forth physician self-referral limitations. (Sec. 5431) Amends the Federal criminal code to set penalties for knowingly executing a scheme or artifice to: (1) defraud any health alliance, health plan, or other person (alliance) in connection with the delivery of, or payment for, health care benefits, items, or services (benefits); and (2) obtain, by false or fraudulent means, money or property owned by, or under the custody of control of, any such alliance in connection with the delivery of, or payment for, health care benefits. (Sec. 5432) Amends: (1) the Federal criminal code to require the court, in imposing sentence on a person convicted of a Federal health care offense that poses a serious threat to the health of any person or has a significant detrimental impact on the health care system, to order such person to forfeit property used in the commission of the offense or that constitutes, or is derived from, proceeds traceable to the commission of the offense which is of a value proportionate to the seriousness of the offense; and (2) the Federal judicial code to require that all proceeds of forfeiture relating to Federal health care offenses be deposited into the Department of Justice Assets Forfeiture Fund. (Sec. 5433) Amends the Federal criminal code to set penalties for: (1) knowingly and willfully falsifying, concealing, or covering up a material fact, making any false, fictitious, or fraudulent statements or representations, or making or using any false writing or document knowing it to contain any false, fictitious, or fraudulent statement or entry, in any matter involving a health alliance or health plan; and (2) bribery of, and graft by, a health care official. (Sec. 5435) Authorizes: (1) the Attorney General to commence a civil action in Federal court to enjoin a Federal health care offense; and (2) a person privy to certain grand jury information concerning a health law violation to disclose that information to an attorney for the Government to use in any civil proceeding related to a Federal health care offense. (Sec. 5437) Sets penalties for: (1) theft or embezzlement in connection with a health alliance, health plan, or fund connected with such alliance or plan; and (2) misuse of a health security card issued, or unique identifier provided, pursuant to this Act. (Sec. 5441) Makes provisions of the Civil False Claims Act applicable to the use of false records or statements made to a health plan. Includes within the definition of "claim" for purposes of such Act any request or demand for money or property which is made or presented to a health plan. Subtitle F: McCarran-Ferguson Reform - Amends the McCarran-Ferguson Act to repeal the exemption under specified antitrust laws for the business of insurance to the extent that such business relates to the provision of health benefits. Title VI: Premium Caps; Premium-Based Financing; and Plan Payments - Subtitle A: Premium Caps - Sets forth provisions which provide for the computation of factors that limit the growth of premiums for the comprehensive benefit package in regional alliance health plans, including the computation of a: (1) regional alliance inflation factor; and (2) general health care inflation factor. (Sec. 6002) Directs the Board to determine: (1) a national per capita baseline premium target; (2) the national average per capita current coverage health expenditures; and (3) current health care expenditures. (Sec. 6003) Directs the Board to determine a regional alliance per capita premium. (Sec. 6004) Requires a regional alliance to annually obtain premium bids from each plan seeking to participate as a regional alliance health plan with respect to the alliance. (Sec. 6005) Permits any participating State to assume responsibility for containment of health care expenditures in the State consistent with this Act. (Sec. 6006) Directs the chair of the Board to establish an advisory commission on regional variations in health expenditures. Requires the commission to examine methods of eliminating variation in regional alliance per capita premium targets due to variation in practice patterns, not due to other factors. Requires the Board to submit its recommendations to the Congress. Requires such recommendations to apply unless a joint resolution of disapproval is passed. (Sec. 6011) Subjects each noncomplying regional alliance health plan for a year to a reduction in plan payment as specified, in order to assure that payments to regional alliance health plans by a regional alliance are consistent. Defines a noncomplying plan to include a plan in which the final accepted bid exceeds the maximum complying bid for the per capita target premium. Defines "maximum complying bid." (Sec. 6021) Directs the Board to develop a methodology for calculating an annual per capita expenditure equivalent for amounts paid for coverage for the comprehensive benefit package within a corporate alliance. (Sec. 6022) Terminates a corporate alliance with two excess years in a three year period. Provides that employers that were corporate alliance employers with respect to a terminated alliance shall become regional alliance employers. Defines an excess year as one in which the rate of increase for the corporate alliance exceeds the national corporate inflation factor. Defines rate of increase and national corporate inflation factor. (Sec. 6031) Sets forth special rules for a single-payer State. (Sec. 6041) Directs the Secretary to establish a program to monitor prices and expenditures in the U.S. health care system. Subtitle B: Premium-Related Financings - Makes each family enrolled in a regional health alliance plan or in a corporate alliance health plan in a class of family enrollment responsible for payment of the family share of premium payable for enrollment. Provides for income related discounts and specified credits. (Sec. 6102) Establishes the formula for determining the premiums. (Sec. 6111) Provides for the repayment of credit by certain families. (Sec. 6114) Provides for the special treatment of certain retirees and qualified spouses and children. (Sec. 6121) Requires each regional alliance employer to pay a monthly premium to the regional alliance for a qualifying employee. Sets forth provisions for determining such premium. Varies the premium depending upon such factors as the employer's size and average wages paid. (Sec. 6126) Sets forth provisions applicable to self-employed individuals. (Sec. 6131) Sets forth provisions for determining the corporate employer premium. Subtitle C: Payments to Regional Alliance Health Plans - Sets forth provisions to determine the computation of: (1) the blended plan per capita payment amount; and (2) the plan bid, AFDC, and SSI proportions. Title VII: Revenue Provisions - Subtitle A: Financing Provisions - Amends the Internal Revenue Code to increase the excise taxes on cigarettes and other tobacco products. (Sec. 7113) Imposes an excise tax on the manufacture or importation of roll-your-own tobacco. (Sec. 7121) Imposes an assessment on each corporate alliance employer and a temporary assessment on employers with retiree health benefit costs. Requires such assessments to be paid in the same manner as employment taxes. (Sec. 7131) Provides for the recapture of certain health care subsidies received by high-income individuals. Transfers such amounts to the Supplemental Medical Insurance Trust Fund. (Sec. 7141) Requires certain shareholders of S corporations and limited partners who materially participate in corporate activities to include their share of income or loss from such corporation when determining net earnings from self-employment. (Sec. 7142) Provides for extending Medicare coverage and applying the hospital insurance tax to all State and local government employees. Subtitle B: Tax Treatment of Employer-Provided Health Care - Provides exceptions to the exclusion of employer-provided contributions to an accident or health plan from the gross income of an employee. (Sec. 7202) Prohibits the provision of health benefit under cafeteria plans. (Sec. 7203) Makes permanent the deduction for health insurance costs of self-employed individuals. Increases such deduction to 100 percent of the basic coverage purchased from a health alliance with limitations. Subtitle C: Employment Status Provisions - Requires the Secretary of the Treasury to prescribe regulations defining an employee for employment tax purposes. (Sec. 7302) Increases the penalty for failure to file correct returns involving payments for services. (Sec. 7303) Sets forth rules to limit retroactive employment tax reclassifications. Subtitle D: Tax Treatment of Funding of Retiree Health Benefits - Requires additional reserves for post-retirement medical and life insurance benefits to cover not less than ten years of the working lives of covered employees and to be maintained as separate accounts. (Sec. 7402) Terminates the authority of pension plans to maintain health benefits accounts. Subtitle E: Coordination with COBRA Continuing Care Provisions - Repeals provisions concerning continuation coverage requirements of group health plans upon implementation of this Act. Subtitle F: Tax Treatment of Organizations Providing Health Care Services and Related Organizations - Provides for the tax treatment of charitable organizations providing health care services, insurance provided by health maintenance organizations, and certain private foundations. (Sec. 7602) Sets forth transitional rules for taxing certain organizations providing health insurance and other prepaid health care services as insurance companies other than life insurance companies. (Sec. 7603) Exempts regional alliances from income tax. Subtitle G: Tax Treatment of Long-term Care Insurance and Services - Treats qualified long-term care services as medical care for purposes of the medical expense deduction. (Sec. 7702) Provides for the treatment of long-term care insurance as accident and health insurance. (Sec. 7703) Allows accelerated death benefits under life insurance contracts to be paid to terminally ill individuals. Subtitle H: Tax Incentives for Health Service Providers - Allows a tax credit for certain qualified individuals who provide primary health services full time in a health professional shortage area. (Sec. 7802) Increases the allowable depreciation deduction for expensing certain medical equipment. Subtitle I: Miscellaneous Provisions - Allows a tax credit for the cost of personal assistance services required by an employed individual who for medical reasons is unable to engage in substantial gainful activity. (Sec. 7902) Denies tax-exempt status for private activity bonds of regional alliances, corporate alliances, or guaranty funds established under this Act. Title VIII: Health and Health-Related Programs of the Federal Government - Subtitle A: Military Health Care Reform - Directs the Secretary of Defense to establish one or more uniformed services health plans in order to provide health care services to members of the armed forces on active duty for 30 or more days as well as their covered beneficiaries. Requires conformity of such plans with health plan requirements set forth in this Act. (Sec. 8001b) Allows any such plan to rely upon the use of military health care facilities, supplemented by civilian health care providers or health plans under agreements entered into by the Secretary. Requires at least the items and services in the comprehensive benefit package under this Act to be included in each such plan. Preempts any conflicting State health plan requirements. Provides for plan enrollment, effect of failure to enroll, and choosing between a uniformed services health plan and other available plans. Prohibits the imposition of plan charges to an active-duty member other than subsistence charges, but allows the Secretary to impose limited charges for covered beneficiaries. Establishes in the Department of Defense a financial account for payments received in connection with a uniformed services health plan, allowing such funds to be used only for purposes directly related to the delivery and financing of health care services under this Subtitle. Subtitle B: Department of Veterans Affairs - Allows each veteran who is an eligible individual under this Act and individuals currently enrolled in a health plan under the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) to be enrolled with a Department of Veterans Affairs (VA) health plan. Requires conformity of such plans with health plan requirements set forth in this Act, with all the items and services of the comprehensive benefit package under this Act included. Allows such plans to offer supplemental health benefits and cost-sharing policies as consistent with this Act. Provides a limitation with regard to veterans enrolled with health plans outside the VA. Prohibits the imposition of any plan enrollment charges upon service-connected disabled veterans, veterans receiving disability compensation from the VA, former prisoners of war, and veterans unable to defray the costs of such care. Allows the Secretary of Veterans Affairs to establish plan charges for other veterans. Deems a VA facility to be a Medicare provider for purposes of any program administered by the Secretary of Health and Human Services. Allows for the recovery of certain care and services provided under a VA plan in the case of an individual who has coverage under another plan. Establishes in the Treasury the Department of Veterans Affairs Health Plan Fund to be used for VA health plan payments and services. Preserves existing benefits for VA facilities not operating within a health plan certified under this Act. (Sec. 8102) Directs the Secretary of Veterans Affairs to organize health plans and operate VA facilities as, or within, health plans under this Act. Preempts existing State health plan standards or requirements. Authorizes the Secretary to contract for the provision of services by a VA health plan when cost-effective, or to share resources with other health care plans, providers, or organizations. Authorizes appropriations to the VA for FY 1995 through 1997 for VA health plans under this Subtitle, subject to availability of appropriations. Requires a report from the Secretary to the Congress concerning the operation of the VA health care system within the requirements of this Act. Authorizes the Secretary to accept and use grants for health care services provided to special populations if used by the VA while operating under a VA health plan. Subtitle C: Federal Employees Health Benefits Programs - (Secs. 8202 through 8204) Provides for termination of the Federal Employees Health Benefits Program (FEHB) and treatment of Federal employees, annuitants, and other individuals (including those residing abroad) who would otherwise have been eligible for FEHBP under this Act's health plans. Subtitle D: Indian Health Service - Makes qualifying Indians eligible to enroll in a comprehensive benefits health program of the Indian Health Service. (Sec. 8303) Authorizes appropriations for supplemental Indian health care benefits. (Sec. 8305) Exempts tribal governments and organizations from making employer payments. (Sec. 8306) Sets forth provisions regarding health service to non-enrollees and non-Indians. (Sec. 8311) Requires each health program of the Indian Health Service to establish a comprehensive benefit package fund. (Sec. 8313) Authorizes appropriations for the Indian Health Service programs. Subtitle E: Amendments to the Employee Retirement Income Security Act of 1974 - Amends the Employee Retirement Income Security Act of 1974 (ERISA) to revise and limit the coverage of group health plans under ERISA. Makes certain ERISA provisions inapplicable with respect to State-certified health plans. Provides for an exception from ERISA civil action provisions where review is otherwise available under the Health Security Act (this Act, HSA). (Sec. 8402) Establishes ERISA requirements for expeditious reporting and disclosure applicable to group health plans, through special rules consistent with ERISA and HSA purposes. Excludes plans maintained by regional alliances from treatment as multiple employer welfare arrangements. (Sec. 8403) Revises certain ERISA provisions relating to continuation coverage under group health plans. Repeals such provisions upon implementation of HSA. (Sec. 8404) Makes ERISA standards for group health plans regarding: (1) cases of adoption applicable except to the extent otherwise provided in regulations of the National Health Board under HSA; and (2) coverage of pediatric vaccines inapplicable to a group health plan upon its becoming a corporate alliance health plan under HSA. (Sec. 8405) Requires group health plans under ERISA to comply with HSA requirements relating to health plan claims procedure. Subtitle F: Special Fund for WIC Program - Authorizes appropriations through FY 2000 for the special supplemental food program for women, infants, and children under the Child Nutrition Act of 1966. Title IX: Aggregate Government Payments - Subtitle A: Aggregate State Payments - Sets forth provisions which have formulas for determining each participating State's payment to regional alliances within the State. Provides two different formulas. Establishes one payment formula for non-cash assistance recipients. Establishes another formula relating to cash assistance recipients. Defines a non-cash assistance adult as an individual who is: (1) over 21 years; (2) a U.S. citizen or lawful alien; and (3) is not an AFDC or SSI recipient or a Medicare-eligible individual. (Sec. 9022) Directs the National Health Board to review appropriateness of such payments. Subtitle B: Aggregate Federal Alliance Payments - Sets forth the formula for determining Federal payments to regional alliances for cash assistance recipients. (Sec. 9102) States that this section constitutes budget authority in advance of appropriation Acts and obligates the Federal Government to provide for the payment to regional alliances of a capped Federal alliance payment amount. Defines "capped Federal alliance payment amount." Subtitle C: Borrowing Authority to Cover Cash-flow Shortfalls - Authorizes the Secretary to make available loans to regional alliances to cover any period of temporary cash-flow shortfall attributable to: (1) any estimation discrepancy; (2) a period of temporary cash-flow shortfall attributable to an administrative error; or (3) a period of temporary cash-flow shortfall relating to the relative timing during the year in which amounts are received and payments are required. Sets forth loan terms and conditions. Title X: Coordination of Medical Portion of Workers Compensation and Automobile Insurance - Subtitle A: Workers Compensation Insurance - Requires each health plan that provides services to enrollees through participating providers to make arrangements to provide workers compensation to such enrollees. (Sec. 10002) Requires each workers' compensation carrier that is liable for payment for workers' compensation services furnished by or through a health plan, regardless of whether or not the services are included in the comprehensive benefit package, to make payment for such services. (Sec. 10011) Sets forth requirements for participating States. (Sec. 10031) Authorizes demonstration projects in one or more States with respect to the treatment of work-related injuries and illnesses. Subtitle B: Automobile Insurance - Requires an individual entitled to automobile insurance medical benefits and enrolled in a health plan to receive automobile insurance medical services through the provision of such services by the health plan. (Sec. 10102) Requires each automobile insurance carrier that is liable for payment for automobile insurance medical services furnished by or through a health plan, regardless of whether or not the services are included in the comprehensive benefit package, to make payment for such services. (Sec. 10111) Requires each participating State to develop a fee schedule applicable to payment for automobile insurance medical services for which a fee is not included in the applicable fee schedule. Subtitle C: Commission on Integration of Health Benefits - Establishes the Commission on Integration of Health Benefits which shall study and report on the feasibility and appropriateness of transferring financial responsibility for all medical benefits, including those currently covered by workers compensation and automobile insurance, to health plans. Authorizes appropriations. Subtitle D: Federal Employees' Compensation Act - Requires the Federal Employees' Compensation Act to be interpreted and administered consistent with the provisions of subtitle A. Subtitle E: Davis-Bacon Act and Service Contract Act - Amends the Davis-Bacon Act and the Service Contract Act of 1965 to require Health Security Act benefits. Subtitle F: Effective Dates - Sets forth effective date provisions. Title XI: Transitional Insurance Reform - Sets forth transitional provisions concerning: (1) enforcement; (2) preservation of current coverage; (3) restrictions on premium increases during transition; (4) portability requirements; (5) restrictions limiting benefit reductions; and (6) the establishment of the National Transitional Health Insurance Risk Pool.

Bill· HRH.R. 3584 (103rd)open

Truth in Sentencing Act of 1993

United States · United States Congress · 20 November 1993

Truth in Sentencing Act of 1993 - Authorizes the Director of the Bureau of Justice Assistance to provide grants to States to build, expand, or operate space in correctional facilities in order to implement specified "truth in sentencing" requirements. Requires a State, to be eligible for funding under this Act, to have in effect throughout the State such requirements, including provisions which: (1) restrict parole, good-time credit release, or other forms of early release to require that criminals convicted of crimes of violence serve at least 85 percent of the sentence imposed by a judge or jury; (2) require the sentencing authority to allow the defendant's victim or the victim's family the opportunity to be heard regarding the issue of sentencing; (3) allow as a sentencing option a "life sentence" without the possibility of parole; and (4) provide that the victim and the victim's family shall be notified whenever such defendant is to be released. Makes exceptions that: (1) allow the State to provide that the Governor may permit the release of a prisoner after a public hearing in which representatives of the public and the prisoner's victims have an opportunity to be heard regarding the proposed release; and (2) make a State eligible for funding under this Act when that State has enacted legislation that provides for the State to be in compliance with this Act within three years of the enactment of such legislation. Sets forth provisions regarding the distribution of, and limitations on, funds. Authorizes appropriations. Provides for a reduction of full-time equivalent positions in all Federal agencies. Sets forth requirements regarding monitoring and notification of the President and the Congress as to whether such reductions are taking place (and, if they are not being met in a given agency, prohibits hiring for any position in such agency until the Office of Management and Budget notifies the President that the agency is in compliance).

Bill· SS. 1701 (103rd)referred

Social Security Administration Services Preservation Act

United States · United States Congress · 19 November 1993

Social Security Administration Services Preservation Act - Amends title VII (Administration) of the Social Security Act to require the Social Security Administration (SSA) to provide advance public notice of a determination to close, consolidate, or recategorize an SSA office. Requires the SSA, when making such determination, to consider: (1) the effect of such change on the community served; (2) the community's need for personal as opposed to mail or telephone service; (3) the effect of such determination on office employees; and (4) SSA'S economic savings attributable to such change. Directs the Commissioner or Deputy Commissioner of Social Security to personally approve all preliminary and final determinations to close full-time offices that provide a full range of services. Requires that a public hearing on a preliminary determination to close, consolidate, or recategorize an office be held upon written request at or near the location of the affected office. Directs SSA to issue a final report within 30 days after such hearing or 90 days after public notice of its preliminary determination, whichever is later, to the local press and appropriate Members of Congress specifying its final determination. Provides the public with notice of and access to such final report. Authorizes persons served by an affected office to appeal a final determination to close, consolidate, or recategorize an office after adequate public notice of such determination. Requires SSA to include in its annual budget submission to the Congress a list of its offices and contact stations which were closed or discontinued during the preceding year and those scheduled to be closed or discontinued and the date such action is planned.

Bill· HRH.R. 3560 (103rd)referred

To establish certain requirements relating to the transfer or disposal of public lands managed by the Bureau of Land Management, and for other purposes.

United States · United States Congress · 19 November 1993

Requires annual budget requests submitted by the Secretary of the Interior to include information as to whether the Bureau of Land Management, through preparation of land-use plans pursuant to the Federal Land Policy and Management Act of 1976, has identified public lands which are suitable for transfer to other management or for disposal which transfer or disposal has been delayed because of incomplete surveys or other reasons. Authorizes the Secretary to include a proposal for additional legislation in such request to facilitate such transfer or disposal.

Bill· HRH.R. 3566 (103rd)referred

Comprehensive Campaign Finance Reform Act

United States · United States Congress · 19 November 1993

TABLE OF CONTENTS: Title I: Expenditure Limitations, Contribution Limitations, Matching Funds, and Reduced Third-Class Mail Rate for Eligible House of Representatives Candidates Title II: Elimination of Multicandidate Political Committee Contributions in House of Representatives Elections; Miscellaneous Provisions Relating to Contributions Under the Federal Election Campaign Act of 1971 Title III: Requirement of Budget Neutrality Title IV: Independent Expenditures Title V: Contributions Through Intermediaries and Conduits; Provisions Relating to Political Party Committees Title VI: Prohibitions Relating to Political Committees and Foreign Nationals Title VII: Limitation on Carryover of Campaign Funds Title VIII: Campaign Advertising Title IX: Contribution Solicitation Title X: Reporting Requirements Title XI: Effective Date Comprehensive Campaign Finance Reform Act - Title I: Expenditure Limitations, Contribution Limitations, Matching Funds, and Reduced Third-Class Mail Rate for Eligible House of Representatives Candidates - Amends the Federal Election Campaign Act of 1971 (FECA) to set forth limitations regarding House of Representatives (House) election expenditures, contributions, and matching funds. Limits aggregate expenditures made by an eligible House of Representatives candidate in an election cycle to $500,000, with specified limitations in primary, special, and runoff elections. Sets forth graduated civil penalties for excess expenditures and contributions. Establishes the Make Democracy Work Fund (the Fund) for payment of matching funds and initial expenditures incurred by the Federal Election Commission (FEC) in the administration of this Act. Outlines FEC examination, audit, and repayment procedures. Subjects FEC actions to judicial review. Precludes a House candidate from receiving Fund assistance without prior certification that any television commercial prepared or distributed by the candidate permits closed captioning. Amends Federal Postal Service law to provide reduced third-class mailing rates to eligible House of Representatives candidates during a general election period. Title II: Elimination of Multicandidate Political Committee Contributions in House of Representatives Elections; Miscellaneous Provisions Relating to Contributions Under the Federal Election Campaign Act of 1971 - Amends FECA to prohibit a House candidate from accepting any multicandidate political committee (PAC) contributions. (Sec. 202) Treats contributions by dependents not of voting age as contributions of the persons upon whom they are dependent. (Sec. 203) Aggregates, for contribution limit purposes, contributions from State and local party committees with all contributions from such political party. (Sec. 204) Excludes from the meaning of "contribution" certain reimbursed campaign expenses voluntarily paid for by a campaign worker as an advance to the campaign. (Sec. 205) Reduces the maximum Federal election contribution permitted to be made by a person other than a PAC. Title III: Requirement of Budget Neutrality - Provides that the net costs of providing certain benefits under this Act must be fully offset by specified measures that either raise revenues or reduce spending by a specified deadline (thus achieving budget neutrality). Title IV: Independent Expenditures - Sets forth reporting requirements for certain independent expenditures. Title V: Contributions Through Intermediaries and Conduits; Provisions Relating to Political Party Committees - Amends FECA to delineate circumstances where a person's contribution shall be considered as being made through an intermediary or a conduit (and therefore treated as contributions from such person). (Sec. 502) Defines "State Party Grassroots Fund." (Sec. 503) Subjects national, State, and local party committees to "soft money" limitations, prohibitions, and reporting requirements. (Sec. 504) Prohibits Federal office holders or candidates from soliciting contributions from tax-exempt organizations significantly involved in voter registration or get-out-the-vote campaigns. Title VI: Prohibitions Relating to Political Committees and Foreign Nationals - Prohibits the use of leadership committees and establishes a deadline for their disbursement of funds. Prohibits an unauthorized political committee from using the name of any candidate in any fundraising activity on its behalf in a context which suggests that the committee is the candidate's authorized committee. (Sec. 602) Prohibits a foreign national from controlling, influencing, or participating in election-related activities, including making contributions or expenditures. Title VII: Limitation on Carryover of Campaign Funds - Amends FECA to limit the carryover of surplus House campaign funds for a subsequent election. Title VIII: Campaign Advertising - Amends FECA to prescribe guidelines for print and broadcast campaign advertising. (Sec. 802) Amends the Communications Act of 1934 to require equal candidate broadcasting time. (Sec. 803) Revises broadcast rate determinations. Prohibits licensee preemption of a candidate's broadcast time except in an emergency. Title IX: Contribution Solicitation - Amends FECA to prohibit the solicitation of contributions by false representation by any person as a candidate or as a representative of a candidate or of a political party or committee. Title X: Reporting Requirements - Amends FECA to require certain reports to identify any person (other than a committee) who contributes more than $50 (currently, more than $200). Directs the FEC to: (1) require that operating expenditures be reported on an election cycle basis, by category; and (2) maintain computerized indices of contributions of $50 or more. Title XI: Effective Date - Sets forth the effective date of this Act.

Bill· HRH.R. 3555 (103rd)referred

Environmental Technology Research Integration and Coordination Act

United States · United States Congress · 19 November 1993

Environmental Technology Research Integration and Coordination Act - Requires the Director of the Office of Science and Technology Policy to take any action necessary to: (1) ensure the coordinated, interagency promotion of the research, development, and adoption of environmental technologies; and (2) develop priorities for Federal environmental technology research, development, and adoption efforts. Requires the Director to: (1) assess the budget estimate of each relevant Federal agency for consistency with plans, reviews, and priorities on an annual basis; (2) make assessment results available to the Executive Office of the President for use in the preparation of the President's budget; (3) report annually to the Congress on the progress of Federal efforts to advance the research, development, and adoption of environmental technologies; and (4) establish mechanisms to ensure the participation of non-Federal entities. Directs the Administrator of the Environmental Protection Agency (EPA), acting through the EPA Office of Research and Development, to use existing information network capabilities to provide access to data on environmental technologies developed, tested, or verified by programs under this Act and by other appropriate sources. Authorizes the Administrator to enter into partnership agreements ("alliances") with State or local government agencies and other specified entities to: (1) facilitate access to information incorporated in the networks; and (2) transfer to such entities other information that would enhance the development and adoption of environmental technologies. Encourages alliances to disseminate information, and provide technical assistance, to U.S. companies on opportunities for the more efficient use of materials and energy and for waste minimization, materials conversion, and recycling. Authorizes the Administrator to provide financial assistance to alliances under certain conditions. Directs the President to establish a program for evaluating and approving Federal Government purchases of environmental technology products. Requires the Administrator to study and report to the Congress on the effect of current environmental regulations upon innovation in environmental technologies and the introduction of new environmental products, including actions that could be taken to increase the regulatory incentives for industrial use of new environmental technologies. Directs the President to study the potential for efficiently encouraging the development and use of environmental technologies through tax incentives.

Bill· SS. 1676 (103rd)referred

Spending Reduction Enforcement Act of 1993

United States · United States Congress · 18 November 1993

Spending Reduction Enforcement Act of 1993 - Establishes the Spending Reduction Commission to propose cost savings and changes in law to achieve at least $65 billion of budget outlay reductions for the budget year and each outyear until a balanced budget is reached. Sets forth the procedure for implementation of the Commission's recommendations by the Office of Management and Budget, the President, and the Congress. Makes budget outlay reductions permanent. Establishes sequester provisions if the full amount of savings required by this Act is not achieved in a session of the Congress.

Bill· SS. 1668 (103rd)open

Social Security Act Amendments of 1993

United States · United States Congress · 17 November 1993

TABLE OF CONTENTS: Title I: Medicare Provisions Subtitle A: Provisions Relating to Part A Subtitle B: Provisions Relating to Part B Subtitle C: Provisions Relating to Parts A and B Subtitle D: Provisions Relating to Medicare Supplemental Insurance Policies Title II: Medicaid Provisions Subtitle A: Substantive Provisions Subtitle B: Miscellaneous and Technical Corrections Relating to OBRA-90 Subtitle C: Miscellaneous and Technical Corrections Relating to OBRA-1993 Title III: Income Security, Human Resources, and Related Programs Subtitle A: Child Welfare, Foster Care, Adoption Subtitle B: Child Support Enforcement Subtitle C: Supplemental Security Income Subtitle D: Aid to Families With Dependent Children Subtitle E: Jobs Program Subtitle F: Unemployment Insurance Subtitle G: Other Provisions Social Security Act Amendments of 1993 - Title I: Medicare Provisions - Subtitle A: Provisions Relating to Part A - Amends title XVIII (Medicare) of the Social Security Act (SSA) to: (1) authorize the Secretary of Health and Human Services to take occupational mix into account in developing Medicare Geographic Classification Review Board (MGCRB) guidelines for determining the area wage index; (2) provide that if labor markets are no longer based on Metropolitan Statistical Areas, the method of calculating the wage index for reclassification would not apply and the MGCRB guidelines may be revised; and (3) require the Secretary to set the labor and non-labor portion of each standardized amount equal to the national average beginning in FY 1995. (Sec. 102) Revises the essential access community hospital (EACH) program, with changes: (1) increasing the number of participating States; (2) providing for treatment of inpatient hospital services provided in rural primary care hospitals; (3) extending the authorization of appropriations for grants to States and hospitals; and (4) addressing adjoining State hospital designation, rural primary care hospital skilled nursing services, payment for inpatient and outpatient hospital services, and physician staffing. (Sec. 103) Amends the Omnibus Budget Reconciliation Act of 1987 (OMBRA' 87) to: (1) authorize appropriations for the rural health transition grant program; and (2) make rural primary care hospitals eligible for program grants. (Sec. 104) Revises requirements with regard to hospital psychology services, Medicare-dependent, small rural and sole community hospitals, notification of hospice services availability, qualifications for service on the Prospective Payment Assessment Commission, budget neutral adjustments for changes in payment amounts for transfer cases, and DRG payment window expansion. (Sec. 106) Requires the Secretary to begin collecting the data necessary to compute a wage index based on wages specific to skilled nursing facilities. Subtitle B: Provisions Relating to Part B - Part I: Physicians' Services - Requires the Secretary to develop and report to the Congress on a methodology for implementing a resource-based system for determining practice expense relative value units for each physicians' service. Repeals the existing payment methodology when the new payment methodology takes effect for services provided in years beginning with 1997. (Sec. 122) Requires the Secretary to: (1) review and revise the geographic practice cost indices; (2) use the most recent available data on practice and malpractice expenses and physician work effort in establishing such indices; and (3) study and report to the Congress on index construction, data used for indices revision, and other related specified matters. (Sec. 123) Revises rules for billing Medicare part B (Supplementary Medical Insurance) beneficiaries for physician services in excess of the applicable limiting charge involved (extra-billing limits). Imposes new obligations on carriers before making payment. Provides for refunds of excess amounts billed. (Sec. 124) Requires the Secretary to: (1) fully develop and refine the relative values for the full range of pediatric physicians' services; and (2) study and report to the Congress on such values to determine whether there are significant variations in the resources used for similar services to different populations. (Sec. 125) Prohibits the Secretary or a carrier from imposing fees for filing claims for physicians' services, claims errors or denials, administrative appeals, obtaining unique identifiers, or responding to inquiries concerning physicians' services. Permits the Secretary to recognize substitute billing arrangements between two physicians under specified conditions. Part II: Durable Medical Equipment - Requires suppliers of medical equipment and supplies to have a certified supplier number, except with regard to medical equipment and supplies furnished as incident to a physician's service, in order to be reimbursed under Medicare. Prohibits a supplier from having a number without meeting prescribed standards. Prohibits the issuance of more than one supplier number, except in certain circumstances. (Sec. 131) Requires the Secretary to develop one or more standardized certificates of medical necessity for medical equipment and supplies. Allows suppliers to distribute to physicians or beneficiaries a certificate of medical necessity containing certain limited information. Requires that any supplier distributing a certificate with such information must also list the fee schedule amount and charge involved before distributing it to the physician for completion. Requires the Secretary to: (1) develop and establish uniform national coverage and utilization review criteria for select items of medical equipment and supplies; (2) review annually and determine whether to subject to such criteria any items not already subject; (3) study and report to the Congress on the effects of the methodology for determining payments for items of durable medical equipment (DME) on the ability of persons entitled to disability benefits to obtain such items; and (4) report to the Congress on prosthetic devices or orthotics and prosthetics that do not require individualized or custom fitting and adjustment. (Sec. 132) Prohibits suppliers from submitting claims to any carrier other than the one having jurisdiction over the geographic area where the patient to whom the item is furnished resides, unless otherwise permitted by the Secretary. (Sec. 133) Places restrictions on certain telephone marketing and sales activities by DME suppliers. (Sec. 134) Amends SSA title XI to exclude certain clerical, warehousing, and stock inventory tasks from the exemption from anti-kickback penalties for employees in bona-fide employment relationships with covered service providers and suppliers. (Sec. 135) Specifies the circumstances under which Medicare beneficiaries are not financially liable for covered items furnished by a supplier. (Sec. 136) Requires the Secretary to: (1) determine whether the payment amounts for decubitus care equipment, transcutaneous electrical nerve stimulators, and any other items considered appropriate are inherently reasonable; and (2) adjust payments for such items if the amounts are not inherently reasonable. (Sec. 137) Requires the Administrator of the Health Care Financing Administration (HCFA) to collect and report to the Congress on data on DME supplier costs and analyze them to determine costs attributable to service and product components and the extent to which they vary by type of equipment and geographic region. Part III: Other Items and Services - Addresses payment adjustments for ambulatory surgical center services and new technology intraocular lenses. (Sec. 142) Requires the Secretary to study and report to the Congress on: (1) patient care costs for Medicare beneficiaries enrolled in clinical trials of new cancer therapies; and (2) continuation of the annual limitation on the payment amount for outpatient services of independently practicing physical and occupational therapists. (Sec. 144) Authorizes the Secretary to enter into agreements with the States for allowing them to pay the penalties applicable to individuals for late enrollment premium payments under Medicare part B. (Sec. 145) Provides that rural health clinics (RHC) and federally qualified health centers (FQHC) are not limited to providing services solely to outpatients. Covers diagnostic x-ray services as RHC and FQHC services. (Sec. 146) Requires mammography facilities providing covered screening or diagnostic mammograms to Medicare beneficiaries to hold a certificate (or provisional certificate) issued under the Public Health Service Act. (Sec. 147) Changes the terms "speech therapy" and "speech pathology services" to "speech-language pathology services." (Sec. 148) Makes miscellaneous and technical amendments, among other things, to: (1) apply outpatient payment limits to diagnostic services; (2) exclude the services of nurse practitioners and clinical nurse specialists from the definition of inpatient hospital services; and (3) allow individuals who have employer group health coverage to enroll in part B at any time they are enrolled in the group health plan, rather than after they leave the plan. Subtitle C: Provisions Relating to Parts A and B - Makes various specified changes with regard to Medicare as secondary payer. (Sec. 152) Modifies reporting requirements under physician ownership and self-referral prohibitions to require physicians to report investment and compensation arrangements (in addition to ownership) with respect to designated health services provided. Includes magnetic resonance imaging, computerized axial tomography scans, and ultrasound services among those subject to such prohibitions. (Sec. 153) Allows the Secretary to recognize any successor exam to the Foreign Medical Graduate Examination in the Medical Sciences for payment of direct graduate medical education. (Sec. 154) Requires the Secretary to establish and implement a method for obtaining information from newly eligible Medicare beneficiaries that may be used to determine eligibility for Medicaid payment of their out-of-pocket Medicare expenses. (Sec. 155) Amends SSA title XI to require hospitals and rural primary care hospitals to enter into an agreement with the organ procurement agency designated by the Secretary for the service area in which the facility is located, unless it has obtained a waiver, in order to participate in Medicare or Medicaid. Requires an Office of Technology Assessment study and report to the Congress with respect to such hospital agreements and organ procurement and distribution. (Sec. 156) Amends SSA title XI to: (1) repeal the requirement that peer review organizations (PROs) precertify selected surgical procedures; and (2) revise provisions on the notification of State licensing boards by PROs. (Sec. 157) Requires the Secretary to: (1) treat as a separate class Medicare beneficiaries with respect to whom there is a primary group health plan in defining classes to be used in determining the annual per capita rate of payment to an eligible health maintenance organization with a risk-sharing contract; and (2) submit a proposal to the Congress providing for revisions to the payment method. Requires the Comptroller General to report to the Congress on the proposed revisions. (Sec. 158) Requires use of the most recent hospital wage data in constructing the home health wage index for cost reporting periods beginning July 1, 1996. Extends the limits on liability under the Consolidated Omnibus Budget Reconciliation Act of 1985 for claims disallowed by a lack of medical necessity. (Sec. 159) Makes permanent the authority provided under the Deficit Reduction Act of 1984 for the Secretary to enter into agreements with fiscal intermediaries and carriers on other than a cost basis. (Sec. 160) Provides that user fees imposed under the Clinical Laboratories Improvement Act of 1967 are not subject to Medicare's general ban on user fees. Modifies the phase-in schedule under the Omnibus Budget Reconciliation Act of 1993 (OMBRA '93) for Medicare beneficiaries who receive immunosuppressive drugs following an organ transplant. Subtitle D: Provisions Relating to Medicare Supplemental Insurance Policies - Makes various technical corrections to provisions relating to Medicare supplemental policies. Title II: Medicaid Provisions - Subtitle A: Substantive Provisions - Part I: Managed Care Provisions - Amends SSA title XIX (Medicaid) to prohibit Medicaid managed care entities from having: (1) as a director, officer, or partner any person with a beneficial ownership greater than five percent of the organization's equity if that person (or an affiliate) has been debarred or suspended from Government contracting; and (2) business affiliations with such a person for the provision of goods and services that are significant and material to the entity's obligations under its contract with the State. (Sec. 201) Requires a State to certify to the Secretary that it has safeguards against conflicts of interest between State employees responsible for Medicaid managed care contracting and Medicaid managed care contractors. Requires Medicaid managed care contractors to: (1) report financial information specified by the Secretary and the States related to fiscal solvency; (2) agree to make available certain specified information to its enrollees upon request; and (3) provide annually to the Secretary and the State an audited financial statement and a report on any benefits provided to Medicaid clients in excess of what was required under the contract. Requires the Secretary to prescribe: (1) procedures on marketing for enrollment and re-enrollment purposes in order to provide prospective clients with information adequate for an informed decision; and (2) solvency standards for Medicaid managed care contractors. (Sec. 202) Extends various waivers for certain managed care organizations in Tennessee, the District of Columbia, and Wisconsin. (Sec. 205) Amends the Family Support Act of 1988 to extend the Minnesota Prepaid Demonstration Project and provides authority and conditions for the imposition of premium charges on project participants. Part II: Home and Community-Based Services Waiver Provisions - Eliminates the prior institutionalization requirement for habilitation services provided under a home and community-based waiver program. (Sec. 212) Relieves States of the obligation to pursue payment from third parties for the costs of Medicaid case management services when cost-effective. (Sec. 223) Revises the home- and community-based services waiver formula for medical assistance. Part III: Other Provisions - Permits State employees to make presumptive eligibility determinations for pregnant women with regard to prenatal care available under Medicaid, under certain conditions. (Sec. 222) Allows States to make a showing of certain factors for the Secretary and the Departmental Appeals Board to consider in determining the amount of a Medicaid disallowance. (Sec. 223) Amends SSA title XI to provide for intermediate sanctions for kickback violations involving Medicare or State health care program providers. Allows the Secretary to impose civil monetary penalties if the Attorney General does not initiate action in district court within one year after the Secretary presents the Attorney General for consideration a case involving a State health care program provider. (Sec. 224) Amends SSA title XIX to prohibit double taxation of certain health maintenance organization (HMO) services. (Sec. 225) Requires a Medicaid mammography facility to be certified (provisionally or otherwise) under the Public Health Service Act in order to be paid for mammography screening. (Sec. 226) Makes various specified changes with regard to nursing facility care under Medicaid. (Sec. 227) Amends SSA title V (Maternal and Child Health Services) to increase the authorization of appropriations for the Maternal and Child Health Services Block Grant Program. Subtitle B: Miscellaneous and Technical Corrections Relating to OBRA-90 - Makes various technical corrections to OBRA-1990 provisions regarding: (1) the Medicaid drug rebate program; (2) enrollment under group health plans; (3) low-income Medicare beneficiaries; (4) child health; (5) outreach locations; (6) payment for hospital services for children under six; (7) payment adjustments for disproportionate share hospitals; (8) federally-qualified health centers; (9) substitute physicians; (10) home and community care for frail elderly; (11) community supported living arrangements; (12) COBRA continuation coverage; (13) Medicaid transition for family assistance; (14) medically needy income levels for certain one member families; (15) the Medicaid spend-down option; (16) optional State disability determinations; (17) special rules for HMOs; (18) coverage of HIV-positive individuals; (19) advanced directives; (20) physicians' services; and (21) nursing home reform. Subtitle C: Miscellaneous and Technical Corrections Relating to OBRA-1993 - Makes various technical corrections to OBRA-1993 provisions regarding: (1) personal care services; (2) emergency services for aliens; (3) transfers of assets and treatment of certain trusts; (4) Medicaid estate recoveries; (5) liability for third parties to pay for care and services; (6) medical child support; (7) physician referrals; and (8) Medicaid pediatric immunization. (Sec. 280) Makes technical corrections to OBRA-1990 Medicaid provisions on demonstration projects to study the effect of allowing States to extend Medicaid coverage to certain low-income families not otherwise qualified to receive Medicaid benefits. Title III: Income Security, Human Resources, and Related Programs - Subtitle A: Child Welfare, Foster Care, Adoption - Amends SSA title IV part B (Child-Welfare Services) to repeal provisions requiring foster care protection for additional Federal payments and require instead that the State part B plan provide for such protections. Requires: (1) State review of its policies and administrative and judicial procedures in effect for children abandoned at or shortly after birth; and (2) implementation of those policies and procedures determined necessary to enable permanent decisions to be made expeditiously regarding the placement of such children. (Sec. 301) Prohibits reallotment among other States of any funds withheld or recovered from a State due to its failure to provide the above protections. (Sec. 302) Amends SSA title XI part A to require the Secretary to promulgate regulations to determine whether programs under SSA title IV parts B and E are in substantial conformity with State plan requirements, implementing regulations, and the relevant approved State plans. (Sec. 303) Requires a State part B plan to describe specific measures taken by the State to comply with the Indian Child Welfare Act. (Sec. 304) Specifies the assurances that grant applications for child welfare traineeships must provide in order to win approval. (Sec. 305) Amends SSA title IV part E (Foster Care and Adoption Assistance) to: (1) require each foster child's case plan to be designed not only to achieve placement in the least restrictive (most family-like) setting available, but in the most appropriate setting available as well; (2) require subsequent dispositional hearings to take place not less frequently than every 12 months after the first one, rather than periodically; (3) eliminate foster care ceiling and fund transfer provisions; (4) provide for accountability in cases of children placed in foster care a substantial distance from the home of their parents, or outside the State; and (5) codify the regulations for the treatment of State claims for foster care and adoption assistance. (Sec. 307) Amends SSA title XI part A to: (1) authorize the Secretary to permit up to ten States to conduct demonstration projects which the Secretary finds likely to promote the objectives of SSA title IV parts B or E; and (2) overturn certain limitations in Suter v. Artist M. on private enforceability of State plan requirements. Subtitle B: Child Support Enforcement - Amends SSA title IV part D (Child Support and Establishment of Paternity) to require State child support enforcement agencies to report periodically the names of obligors who are at least two months delinquent in support payments as well as the amount of the delinquency to consumer reporting agencies choosing to receive such information. Repeals provisions on payment of fees by consumer reporting agencies. (Sec. 313) Requires the Secretary to enter into an agreement with the Attorney General under which the services of the Parent Locator Service shall be made available to the Office of Juvenile Justice and Delinquency Prevention, upon request, for the purpose of locating any parent or child. Subtitle C: Supplemental Security Income - Amends SSA title XVI (Supplemental Security Income) (SSI) to extend the SSI childhood definition of disability to any person under 18. (Sec. 322) Requires the Secretary to appoint a Commission on the Evaluation of Disability in Children to study and report to the Congress on the effects of the current SSI definition of disability as it applies to children under 18 and their receipt of SSI benefits. (Sec. 323) Provides that, for the purpose of determining under the aggregate spending level option whether a State's expenditures for SSI payments during a specified 12-month period are not less than its expenditures for such payments in the preceding 12-month period, retroactive SSI payments required to be made in connection with the retroactive SSI benefits referred to in OBRA-1990 may, pursuant to a State's one-time election, be excluded from the computation of the State's expenditures. Subtitle D: Aid to Families with Dependent Children - Amends SSA title XI to allow any adult member of a family or household to sign a declaration, under penalty of perjury, on behalf of other adults in the household for purposes of receiving welfare payments. Provides that in the case of a newborn child, an adult member of the family or household may sign a declaration on behalf of the child no later than the next redetermination of the eligibility of the family or household. (Sec. 332) Welfare Indicators Act of 1993 - Declares certain policies of the United States, among them: (1) reducing the rate at and the degree to which families depend on welfare and its duration; (2) strengthening families; (3) improving the education and job skills of welfare recipients and individuals at risk of welfare receipt; and (4) providing the public with generally accepted measures of welfare receipt so that it can track it over time and determine whether progress is being made in reducing family dependency on welfare. Requires the Secretary to develop indicators and predictors of welfare receipt for a report to the Congress. Creates an Advisory Board on Welfare Indicators to provide advice and recommendations to the Secretary on the development of indicators, and on the development and presentation of annual reports on welfare receipt by the Secretary. (Sec. 333) Requires the Secretary to provide for a demonstration project for a qualified program in Milwaukee, Wisconsin, operated by The New Hope Project, Inc., a private not-for-profit corporation offering low-income Milwaukee residents employment, wage supplements, health and child care, and counseling and training for job retention or advancement. (Sec. 334) Amends the Family Support Act of 1988 to delay the requirement for implementation of the Unemployed Parent program in Puerto Rico, Guam, the Virgin Islands, and American Samoa until repeal of the limitations on Federal matching payments to these jurisdictions for making Aid to Families with Dependent Children (AFDC) and other maintenance payments. (Sec. 335) Extends the New York State operated Child Assistance Program demonstration for an additional five years. (Sec. 336) Gives States the option to decide, with respect to categories of families, whether or not to use monthly reporting, retrospective budgeting, or a combination of the two. Subtitle E: Jobs Program - Amends SSA title IV part F (Job Opportunities and Basic Skills Training Program) (JOBS) to count all Indians who live on a reservation, regardless of whether they are members of the tribe, in determining the tribe's allocation of JOBS funds. (Sec. 342) Delays the submission date for the Secretary's recommendations to the Congress with regard to JOBS performance standards. Requires the Secretary to develop criteria for the performance standards, rather than the standards themselves. Subtitle F: Unemployment Insurance - Postpones for one year the report of the Advisory Council on Unemployment Compensation. (Sec. 352) Repeals language (inadvertently included in the Unemployment Compensation Amendments of 1992) that relates to the transfer of funds from the State administration account to the extended unemployment compensation account, within the Federal Unemployment Trust Fund. Subtitle G: Other Provisions - Amends the Family Support Act of 1988 to reauthorize and extend for two additional years certain demonstration projects to create employment opportunities for low-income individuals. (Sec. 362) Authorizes appropriations for early childhood development projects. (Sec. 363) Reallocates to the States certain funds received by an empowerment zone or enterprise community but not used, for use under SSA title XX (Block Grants to States for Social Services).

Bill· HRH.R. 3511 (103rd)open

Fiscal Year 1994 Rescission Act

United States · United States Congress · 16 November 1993

Fiscal Year 1994 Rescission Act - Rescinds certain budget authority made to the following entities: (1) the Department of Agriculture; (2) the Department of Commerce; (3) the Department of State; (4) judicial defender services; (5) the Board for International Broadcasting; (6) the United States Information Agency; (7) the Civil Corps of Engineers; (8) the Department of the Interior; (9) the Department of Energy; (10) certain economic assistance funds and military assistance funds appropriated to the President; (11) the Department of the Treasury; (12) the Department of Labor; (13) the Department of Health and Human Services; (14) the Department of Education; (15) the House of Representatives and certain congressional agencies; (16) Department of Defense military construction; (17) the Department of Transportation; (18) the General Services Administration; (19) the Department of Veterans Affairs; (20) the Department of Housing and Urban Development; (21) the Environmental Protection Agency; (22) the Federal Emergency Management Agency; (23) the National Aeronautics and Space Administration; (24) the National Science Foundation; and (25) the National Service Initiative.

Bill· HRH.R. 3500 (103rd)referred

Responsibility and Empowerment Support Program Providing Employment, Child Care, and Training Act

United States · United States Congress · 10 November 1993

TABLE OF CONTENTS: Title I: AFDC Transition and Work Program Title II: Paternity Establishment Title III: Expansion of Statutory Flexibility of States Title IV: Expansion of State and Local Flexibility Title V: Child Support Enforcement Title VI: Welfare Restrictions for Aliens Title VII: Controlling Welfare Costs Title VIII: Consolidated Block Grant to States for Food Assistance Title IX: Miscellaneous Responsibility and Empowerment Support Program Providing Employment, Child Care, and Training Act - Title I: AFDC Transition and Work Program - Amends part F (Job Opportunities and Basic Skills Training Program) (JOBS) of title IV of the Social Security Act (SSA) to give the JOBS program the new purpose of assuring that needy families with children obtain not only the education and training needed to prepare them for a life without welfare, but the work experience as well. (Sec. 101) Requires State JOBS programs to include a transition component and a work supplementation component that: (1) are each allowed to include any State work experience program approved by the Secretary; and (2) with respect to the first component, must include the State's job search program, and, with respect to the second component, may include the State's work supplementation or community work experience program. Amends part A (Aid to Families with Dependent Children) (AFDC) of SSA title IV to revise State AFDC plan participation requirements to incorporate participation in the two JOBS program components above under specified guidelines as a requirement for qualified individuals to receive AFDC. Imposes sanctions for a qualified individual's failure to participate in the JOBS program as required under such guidelines, which include a reduction in AFDC benefits and eventual benefit termination for repeated failures. Revises the exemptions from JOBS program participation requirements. Extends to all States the option to limit AFDC-UP. Increases State JOBS program and work program participation rates with regard to, respectively, AFDC-eligible individuals and unemployed parents. Provides for additional payments to States for JOBS programs. (Sec. 102) Amends community work experience and work supplementation program provisions. Title II: Paternity Establishment - Amends SSA title IV part A to: (1) provide for denial or reduction of AFDC for children whose paternity is not established; and (2) require unmarried individuals under 19 who are eligible for AFDC and are pregnant or with dependent children under their care to reside at home in order to receive AFDC. (Sec. 203) Amends SSA title IV part D (Child Support and Establishment of Paternity) to require earlier specified paternity establishment efforts by States. Expresses the encouragement of the Congress for States to develop procedures in public hospitals and clinics to facilitate the acknowledgment of paternity. (Sec. 204) Increases the paternity establishment percentage. Title III: Expansion of Statutory Flexibility of States - Amends SSA title IV part A to give States the option to: (1) convert AFDC into a block grant program; (2) exempt themselves from otherwise mandatory denial of AFDC where either parent is a minor; (3) treat families moving interstate who apply for AFDC in their new State of residence (where they have resided for less than on year) under the AFDC rules of their former State of residence; (4) reduce AFDC for parents under 21 who have dropped out of school and dependent children who, without good cause, do not maintain minimum school attendance; (5) exempt themselves from otherwise mandatory denial of AFDC for additional children; (6) modify certain AFDC income disregard rules; (7) provide for a married couple transitional benefit in cases where an AFDC recipient marries an individual who is not a parent of the recipient's child, and the resulting family would become ineligible for AFDC by reason of the marriage; (8) disregard certain savings and income of a family on AFDC designated for education, training, employability, home purchase, or residence change in determining eligibility for AFDC; and (9) condition the receipt of AFDC on the recipient's attendance at parenting and money management classes and prior approval of any action requiring a change in the educational institution attended by the recipient's dependent child. Title IV: Expansion of State and Local Flexibility -Establishes an Interagency Waiver Request Board in order to provide a focal point within the Federal Government for the development and coordination of waiver requests to improve opportunities for low-income individuals and families. (Sec. 402) Prescribes contents of applications to implement Federal assistance plans, as well as the review, approval, implementation, and evaluation processes. (Sec. 405) Requires any entity applying for plan approval to establish a Public Private Partnership Committee to advise it on plan development and implementation. Title V: Child Support Enforcement - Provides for a national system for employee reporting of any child support owed, the obligee involved, and other specified related information on W-4 forms for employer withholding and distribution of support owed, and reporting of related information to the State involved for availability to other States through the Interstate Locate Network established under this title. (Sec. 502) Makes various changes with regard to State child support order registries, the Parent Locater Service, regulations for sharing child support information, withholding orders, and noncustodial parents with child support arrearages who are receiving certain public welfare assistance. Title VI: Welfare Restrictions for Aliens - Makes aliens (except refugees, permanent residents, and certain current residents) ineligible for various specified types of public welfare assistance, including non-emergency related assistance under Medicaid, food stamps, and job training assistance. (Sec. 602) Amends part A (Aid to Families with Dependent Children) (AFDC) of title IV of the Social Security Act (SSA) to require State AFDC agencies to provide information on illegal aliens to the Immigration and Naturalization Service. Title VII: Controlling Welfare Costs - Amends the Congressional Budget Act of 1974, the Balanced Budget and Emergency Deficit Control Act of 1985 (Gramm-Rudman-Hollings Act), and other Federal law to establish various specified measures for controlling welfare costs, including Federal spending caps. Title VIII: Consolidated Block Grant to States for Food Assistance - Repeals the Food Stamp Act of 1977, National School Lunch Act, Commodity Distribution Reform Act and WIC Amendments of 1987, and other specified Federal laws and replaces them with a: (1) State food assistance block grant program to provide food assistance to economically disadvantaged individuals and families (eligible populations); and (2) new food coupon program. Authorizes appropriations. (Sec. 803) Grants the Secretary of Agriculture and the Commodity Credit Corporation the authority to sell surplus commodities and foodstuffs to the States to provide food assistance to eligible populations. Title IX: Miscellaneous - Amends SSA title IV part A to require AFDC applicants and recipients to undergo any necessary substance abuse treatment as a condition of receiving AFDC. (Sec. 902) Amends SSA title XVI (Supplemental Security Income) (SSI) to: (1) make ineligible for SSI benefits individuals receiving SSI on the basis of a disability resulting from illegal drug addiction who continue to use illegal drugs or refuse to be tested for them; and (2) make representative payee changes. (Sec. 903) Directs the Secretary of Health and Human Services to: (1) conduct research projects to evaluate the impact of education and training programs on the ability of individuals to end participation in the AFDC program; (2) conduct demonstration projects and report to the Congress on whether providing benefits based on need through the use of electronic cards and automatic teller machines would reduce administrative costs and fraud; and (3) establish a commission to determine the cost and feasibility of creating an interstate system to compare the social security numbers of all AFDC recipients in order to identify those recipients receiving AFDC from multiple States. (Sec. 904) Amends SSA to require State AFDC applicants to participate in job search activities while the application is pending, unless a State by law exempts itself from this requirement. (Sec. 906) Public Housing Rent Reform and Empowerment Act - Amends the United States Housing Act of 1937 with regard to the determination of income and rent charges. Authorizes the Secretary of Housing and Urban Development to allow, upon request, under certain circumstances, a public housing agency or resident management corporation to carry out a demonstration program to determine the feasibility and desirability of providing such entities with the authority to establish policies for agency-administered public housing projects, without regard to the public housing requirements of the United States Housing Act of 1937. (Sec. 907) Amends SSA title IV part A to deny AFDC for certain children who have not received appropriate medical examinations and immunizations. Amends the Child Care and Development Block Grant Act with regard to childhood immunizations. Requires the Surgeon General to issue and periodically revise recommendations for the immunization of children under age six.

Bill· HRH.R. 3503 (103rd)referred

International Peacekeeping Policy Act of 1993

United States · United States Congress · 10 November 1993

International Peacekeeping Policy Act of 1993 - Prohibits funds appropriated to the Department of State Contributions for International Peacekeeping Account or funds appropriated to pay for contributions for United Nations peacekeeping activities from being available to the United Nations for the establishment, expansion, or modification in mission of a United Nations peacekeeping operation unless the President makes the certification required by this Act. Directs the President to certify that the peacekeeping operation meets the following policy guidelines: (1) the operation involves an international conflict in which hostilities have ceased and all significant parties to the conflict agree to the imposition of United Nations forces to seek a solution to the conflict; (2) the Congress was notified of the intent to support the operation under specified reprogramming procedures at least 15 days before approval of the operation by the United Nations Security Council; (3) the percentage of the U.S.-assessed share of the operation is no greater than the percentage assessment for the regular United Nations budget; (4) no U.S. intelligence information involving sensitive sources and methods of intelligence gathering will be provided to support the operation; and (5) with respect to units of the armed forces trained to carry out direct combat missions, the operation advances U.S. national security interests, the units are critical to the success of the operation and will be under the command of the United States, and any armed forces member would be protected by the Geneva Convention Relative to the Treatment of Prisoners of War.

Bill· HRH.R. 3489 (103rd)referred

Infrastructure Reinvestment and Economic Revitalization Act of 1993

United States · United States Congress · 10 November 1993

Infrastructure Reinvestment and Economic Revitalization Act of 1993 - Amends the Internal Revenue Code to require the Secretary of the Treasury to pay from time to time from the Highway Trust Fund into the Infrastructure Reinvestment Fund Reinvestment Fund amounts equivalent to 2.5 cents per gallon of the taxes imposed on diesel and special motor fuels and on the removal, entry, or sale of gasoline between September 30, 1994, and October 1, 2024. Establishes the Infrastructure Reinvestment Fund. Makes the Fund off-budget. Authorizes appropriations from such Fund for surface transportation programs.

Bill· HRH.R. 3476 (103rd)open

National Science and Technology Policy, Organization, and Priorities Act Amendments of 1994

United States · United States Congress · 9 November 1993

National Science and Technology Policy, Organization, and Priorities Act Amendments of 1993 - Amends the National Science and Technology Policy, Organization, and Priorities Act of 1976 to revise provisions concerning: (1) the findings and declaration of policy; and (2) the functions of the Office of Science and Technology Policy and its Director. Sets forth science and technology budget priorities. Abolishes the following three organizations: (1) the President's Committee on Science and Technology; (2) the Federal Coordinating Council for Science, Engineering, and Technology; and (3) the National Critical Technologies Panel. Replaces such organizations with the following three organizations, respectively: (1) the Presidents' Committee of Advisors on Science and Technology; (2) the National Science and Technology Council; and (3) the National Sciences and Technologies Assessment Panel. Sets forth provisions concerning the membership of such organizations and the duties of such organizations. Establishes the Science and Technology Policy Institute which shall: (1) provide support to the National Science and Technology Council and its Interagency Working Groups; (2) initiate studies and analyses which will ensure long-term leadership by the United States in the research, development, production capability, and application of identified technologies; and (3) assemble information regarding significant developments and trends in science and technology and analyze and interpret such information to determine whether such developments and trends are likely to affect U.S. science and technology policies.

Resolution· HRESH.Res. 300 (103rd)referred

Providing for the consideration of the bill (H.R. 3266) to provide for automatic downward adjustments in the discretionary spending limits for fiscal year 1994 set forth in the Congressional Budget Act of 1974 equal to the amount of rescissions contained in this Act.

United States · United States Congress · 9 November 1993

Sets forth the rule for the consideration of H.R. 3266 (providing for automatic downward adjustments in the discretionary spending limits for FY 1994).

Budget

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