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Bill· SS. 1774 (103rd)referred
United States · United States Congress · 22 November 1993
Bone Marrow Donor Program Reauthorization Act of 1993 - Amends the Public Health Service Act to provide for the terms of office for members of the board of the National Bone Marrow Donor Registry. Modifies Registry functions. Authorizes grants and contracts to increase bone marrow donation, including through public education, training individuals in requesting donations, and testing and enrolling marrow donors. Authorizes appropriations. Mandates establishment, through grant or contract, of an office of patient advocacy and case management. (Current law requires the Registry to establish a system for patient advocacy.)
Bill· SS. 1779 (103rd)open
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
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
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· HRH.R. 3698 (103rd)open
United States · United States Congress · 22 November 1993
TABLE OF CONTENTS: Title I: Tax and Insurance Provisions Subtitle A: Tax Treatment of Health Care Expenses Subtitle B: Insurance Provisions Subtitle C: Employer Provisions Subtitle D: State Plan Requirements Subtitle E: Federal Preemption Title II: Medicare and Medicaid Reforms Subtitle A: Medicare Subtitle B: Medicaid Title III: Health Care Liability Reform Title IV: Administrative Cost Savings Subtitle A: Standardization of Claims Processing Subtitle B: Electronic Medical Data Standards Subtitle C: Development and Distribution of Comparative Value Information Subtitle D: Preemption of State Quill Pen Laws Title V: Anti-Fraud Subtitle A: Criminal Prosecution of Health Care Fraud Subtitle B: Coordination of Health Care Anti-Fraud and Abuse Activities Title VI: Antitrust Provisions Title VII: Long-Term Care Title VIII: Welfare Restrictions for Aliens Title IX: Increase in Assistance to Community and Migrant Health Centers from Residual Savings Consumer Choice Health Security Act of 1993 - Title I: Tax and Insurance Provisions - Subtitle A: Tax Treatment of Health Care Expenses - Amends the Internal Revenue Code to allow a tax credit for health care expenses based upon percentages of qualified health insurance premiums and adjusted gross income. Provides for employers to make advance payments of such credit. (Sec. 102) Allows individuals a tax credit for a percentage of contributions made to a medical care savings account established for the benefit of an eligible individual. Exempts such accounts from taxation. Establishes an excise tax for excess contributions to medical care savings accounts and makes such accounts subject to the tax on prohibited transactions. (Sec. 103) Disallows the use of a personal exemption for an uninsured individual. Terminates the medical expense deduction, the deduction for health insurance costs of self-employed individuals, and the exclusion for employer-provided health insurance. Subtitle B: Insurance Provisions - Part I: Federally Qualified Health Insurance Plans - Sets forth requirements for federally qualified health insurance plans, including coverage for acute medical care, cost-sharing, premium rating practices, and guaranteed issuance and renewability. Part II: Certification of Federally Qualified Health Insurance Plans - Requires States to meet standards for regulatory programs for the certification of federally qualified health insurance plans. Subtitle C: Employer Provisions - Requires employers to: (1) withhold health insurance premiums from employee wages and remit such premiums to the employee's chosen insurer; and (2) notify each employee of their right to claim an advance refundable tax credit for such premiums. (Sec. 122) Provides for the conversion and continuation of existing insurance plans to required coverage under this Act. (Sec. 125) Establishes the Benefits Cash Out Commission to propose a procedure under which individuals may cash out Federal health benefits. Provides for congressional consideration of such proposal prior to its implementation. (Sec. 126) Imposes excise taxes on employers and health insurance carriers for noncompliance with this Act. Subtitle D: State Plan Requirements - Sets forth requirements for States to meet in order to receive Federal funds for health care programs. Subtitle E: Federal Preemption - Preempts specified State laws concerning health insurance. Title II: Medicare and Medicaid Reforms - Subtitle A: Medicare - Directs the Secretary to report to the Congress on the feasibility of allowing future Medicare beneficiaries to elect to receive certificates with which to purchase private health insurance coverage instead of receiving Medicare benefits. (Sec. 202) Eliminates disproportionate share hospital payments under Medicare. (Sec. 203) Provides for a reduction in the adjustment for indirect medical education costs under Medicare. (Sec. 204) Imposes copayments for skilled nursing facility services provided under Medicare. (Sec. 205) Moves payment updates to January for all payment rates under Medicare's hospital insurance program. (Sec. 206) Accelerates the transition to prospective rates for facility costs in hospital outpatient departments. Subtitle B: Medicaid - Places a cap on Federal payments for acute medical services furnished under a State's Medicaid program. (Sec. 212) Provides for waivers from Medicaid requirements in order to establish acute medical services programs. (Sec. 213) Terminates disproportionate share hospital payments under Medicaid. (Sec. 214) Directs the Secretary to provide grants to States for programs to provide health insurance coverage, acute medical services, preventive care, and disease prevention services to low-income individuals. Title III: Health Care Liability Reform - Health Care Liability Reform Act of 1993 - Limits payments, damages, and attorney's fees in health care malpractice actions and claims. (Sec. 304) Declares that a manufacturer or seller of a health care product shall not be strictly liable for injury from: (1) a defect in the design of the product; or (2) a failure to warn or instruct regarding a risk posed by the product that was not known or reasonably knowable. (Sec. 305) Limits the amount of noneconomic damages that may be awarded in a health care malpractice claim or a health care product liability claim. Allows several liability for noneconomic loss and for punitive damages. (Sec. 306) Allows punitive damages to be awarded only if the claimant establishes that the harm suffered was the result of conduct manifesting conscious, flagrant indifference to the health of those harmed by the product. Disallows punitive damges against a product approved by the Food and Drug Administration. Title IV: Administrative Cost Savings - Subtitle A: Standardization of Claims Processing - Directs the Secretary to adopt standards relating to: (1) data elements for use in paper and electronic claims processing under health benefit plans and in utilization review and mangement of care; (2) uniform claims forms; and (3) uniform electronic transmission of the data elements. (Sec. 402) Authorizes the Secretary, two years after standards are adopted for classes of services upon determining that a significant number of claims for benefits for such services under health benefit plans are not being submitted in accordance with such standards, to require that all providers of such services submit claims to health benefit plans in accordance with such standards. (Sec. 403) Directs the Secretary to: (1) provide for the ongoing receipt and review of comments and suggestions for changes in the standards adopted and promulgated; (2) establish a schedule for the periodic review of such standards; and (3) revise such standards. Subtitle B: Electronic Medical Data Standards - Directs the Secretary to promulgate standards for hospitals concerning electronic medical data, including standards for transmission of such data and confidentiality of patient-specific information. Authorizes the Secretary to periodically revise such standards. (Sec. 412) Sets forth requirements with respect to: (1) the sharing of hospital information under Medicare; (2) waiver of such requirements; and (3) application of such requirements to hospitals of the Department of Veterans Affairs. (Sec. 413) Authorizes the head of a Federal agency to require a provider to present and transmit a required data element electronically in accordance with applicable presentation or transmission standard. (Sec. 414) Sets forth limitations on data requirements where standards with respect to data elements are in effect. (Sec. 415) Directs the Secretary to establish an advisory commission on the standards established under this part and operational concerns about the implementation of such standards. Authorizes appropriations. Subtitle C: Development and Distribution of Comparative Value Information - Directs the Secretary to determine whether each State is developing and implementing a health care value information program that meets specified criteria and a specified schedule. Authorizes the Secretary to: (1) make grants to enable each State to plan development and initiate implementation of its health care value information program; and (2) recover the amount of such a grant by offset against any other amount payable to the State under the Social Security Act under specified circumstances. Authorizes appropriations. (Sec. 422) Directs the Secretary to take actions necessary to implement a comparable program in a State that fails to develop or implement a health care value information program in accordance with such criteria and schedule. Authorizes the Secretary to charge fees for the information materials provided pursuant to such a program. (Sec. 423) Directs the head of each Federal agency with responsibility for the provision of health insurance or health care services to individuals to develop health care value information relating to each program that such head administers and covering the same types of data that a State program meeting such criteria would provide. Subtitle D: Preemption of State Quill Pen Laws - Specifies that, effective January 1, 1996, no effect shall be given to any provision of State law that requires medical or health insurance records (including billing information) to be maintained in written, rather than electronic, form. Title V: Anti-Fraud - Subtitle A: Criminal Prosecution of Health Care Fraud - Amends the Federal criminal code to impose penalties upon a health care provider that knowingly engages in any scheme or artifice to defraud a person in connection with the provision of health care. (Sec. 502) Authorizes the Attorney General to pay a reward of up to $10,000 to a person who furnishes information unknown to the Government relating to a possible prosecution for health care fraud, with exceptions. Subtitle B: Coordination of Health Care Anti-Fraud and Abuse Activities - Amends the Social Security Act to provide for: (1) the application of Federal health anti-fraud and abuse sanctions to all fraud and abuse against any health insurance plan; and (2) treble damages for making or causing to be made false statements or representations involving Medicare or State health care programs, for illegal remuneration, and for false statements or representations with respect to the condition or operation of health care institutions. Directs the Secretary of Health and Human Services, in consultation with State and local health care officials, to: (1) identify opportunities for the satisfaction of community service obligations that a court may impose upon the conviction of a criminal offense involving Medicare or State health care programs; and (2) make information concerning such opportunities available to Federal and State law enforcement officers and State and local health care officials. Title VI: Antitrust Provisions - Exempts from the antitrust laws specified "safe harbor" activities related to the provision of health care services. Sets forth provision 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. 602) Lists as safe harbors specified: (1) activities relating to health care services of combinations of health care providers with market share below a specified threshold; (2) activities of medical self-regulatory entities relating to standard setting or enforcement activities not conducted for purposes of financial gain; (3) participation of a health care provider in a written survey of the prices of services, reimbursement levels, or the compensation and benefits of employees and personnel; (4) activities relating to health care joint ventures for high technology and costly equipment and services; (5) activities relating to hospital mergers; (6) joint purchasing arrangements; and (7) negotiations. (Sec. 603) Directs the Attorney General to publish a notice in the Federal Register soliciting proposals for additional safe harbors and to review and report to the Congress on proposed safe harbors. Sets forth criteria in establishing safe harbors, including: (1) the extent to which a competitive or collaborative activity will accomplish an increase in health care access and quality, the establishment of cost efficiencies, and increased ability of health care facilities to provide services in medically underserved areas or to underserved populations; and (2) whether designation as a safe harbor will result in specified desirable outcomes. (Sec. 604) Directs the Attorney General to issue certificates of review for providers of health care services and to assist persons in applying for such certificates. Sets forth provisions regarding applications for, revocation of, and review of determinations regarding such certificates. Limits the disclosure of information. (Sec. 605) Sets forth provisions regarding notifications providing for a reduction in certain penalties under the antitrust laws for health care cooperative ventures. (Sec. 606) Directs the Attorney General to: (1) review the safe harbors and certificates of review periodically; and (2) promulgate such rules, regulations, and guidelines as necessary to carry out provisions of this title. Title VII: Long-Term Care - Amends the Internal Revenue Code to exclude from gross income certain amounts withdrawn from individual retirement accounts and certain employer cash or deferred arrangements to pay long-term care premiums. (Sec. 702) Provides for the nonrecognition of gain or loss on the exchange of any life insurance contract or an endowment or annuity contract for a long-term care insurance contract. (Sec. 703) Provides for the exclusion as a death benefit of any amount paid or advanced to an individual under a life insurance contract because such individual is terminally ill, or chronically ill and has been permanently confined to a qualified facility. Title VIII: Welfare Restrictions for Aliens - Makes aliens ineligible for programs of public welfare assistance, other than medical assistance with respect to emergency services. (Sec. 802) Amends the Social Security Act to require State agencies to provide the Immigration and Naturalization Service with identifying information on individuals unlawfully in the United States whose children are citizens for purposes of the Aid to Families with Dependent Children program. Title IX: Increase in Assistance to Community and Migrant Health Centers from Residual Savings - Directs the Secretary of Health and Human Services to provide for a program of grants to migrant and community health centers to promote primary health care services for underserved individuals. Authorizes appropriations with limitations. Requires a report to the Congress on such program.
Bill· HRH.R. 3704 (103rd)open
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. 3650 (103rd)referred
United States · United States Congress · 22 November 1993
Dietary Supplement Access and Claims Moratorium Act of 1993 - Title I: Access to Dietary Supplements - Amends the Federal Food, Drug, and Cosmetic Act to prohibit the Secretary of Health and Human Services from requiring: (1) a prescription for a dietary supplement marketed on or before November 15, 1993; and (2) premarket approval for dietary supplements. Specifies that a food shall be deemed to be adulterated if it contains a dietary ingredient at a level that may be injurious to health or is a dietary supplement which when used in accordance with the conditions of use may be injurious to health. Title II: Moratorium on Dietary Supplement Claims - Amends the Prescription Drug User Fee Act of 1992 to prohibit the Secretary from implementing the Nutrition Labeling and Education Act of 1990 or any amendment made by such Act earlier than June 30, 1994, with respect to dietary supplements of vitamins, minerals, herbs, amino acids, or other similar nutritional substances. Prohibits the Secretary from issuing any final regulations applicable to such substances before that date. Specifies that any such proposed regulations shall not be considered to be final regulations until that date. Makes the effective date for provisions dealing with State enforcement with respect to such substances June 30, 1994. Permits the Secretary, earlier than that date, to approve specified health claims made with respect to such substances.
Bill· HRH.R. 3699 (103rd)referred
United States · United States Congress · 22 November 1993
TABLE OF CONTENTS: Title I: Health Policy Title II: Health Services Title III: Health Professions Title IV: Research and Data Collection Title V: Miscellaneous Minority Health Improvement Act of 1993 - Title I: Health Policy - Amends the Public Health Service Act to establish the Advisory Committee on Minority Health to advise the Secretary of Health and Human Services on the development of the goals of the Office of Minority Health for each racial and ethnic group. Authorizes appropriations for FY 1994 through 1998. (Sec. 102) Provides for the establishment of an Office of Minority Health at the Centers for Disease Control and Prevention, the Health Resources and Services Administration, the Substance Abuse and Mental Health Administration, and the Agency for Health Care Policy and Research. Requires such Offices to develop and implement health programs that target racial and ethnic minority populations. (Sec. 103) Authorizes the Secretary to make grants to States for the purpose of improving the health status in minority communities, through the operation of State offices of minority health established to monitor and facilitate the achievement of the Health Objectives for the Year 2000 as they affect minority populations. Authorizes appropriations for FY 1995 through 1997. (Sec. 104) Establishes in the Department of Health and Human Services an Assistant Secretary for Civil Rights, who shall be appointed by the President, by and with the advice and consent of the Senate. Title II: Health Services - Extends authorized appropriations for grants to States for the community scholarship program until FY 1996. Revises the eligibility requirements for such program. (Sec. 202) Extends the authorized appropriations for the grant program for health services for residents of public housing to FY 1996. (Sec. 203) Amends the Disadvantaged Minority Health Improvement Act of 1990 to allow substance abuse services under the grant program for health service for Pacific Islanders. Extends authorized appropriations for such program through FY 1996. Requires a report to the Congress on the effectiveness of projects funded under such program. Title III: Health Professions - Extends authorized appropriations until FY 1996 for: (1) loans for disadvantaged students; (2) the Cesar Chavez Scholarship Program (currently known as the Exceptional Financial Need Program); (3) the Thurgood Marshall Scholarship Program (currently known as the Scholarship for Disadvantaged Students program); (4) loan repayments and fellowships regarding faculty positions at health professions schools; (5) Centers of Excellence; and (6) educational assistance regarding undergraduates. Exempts from certain residency training requirements: (1) students from disadvantaged backgrounds who are underrepresented in the health professions; and (2) historically black colleges. (Sec. 305) Requires Centers of Excellence (health professions schools) to carry out community-based training programs to prepare students in secondary schools and institutions of higher education for attendance at such schools. Requires such schools to provide training to students to enable them to provide health service to minorities at community-based health facilities. Allows such schools to establish consortia. Allows schools of pharmacy and clinical psychology to be Centers of Excellence. Allows Centers of Excellence to collaborate with the National Institutes of Health. Title IV: Research and Data Collection - Requires the Director of the Office of Minority Health to ensure that activities address the most prevalent morbidity and mortality concerns of the various racial and ethnic minority groups. Establishes the Advisory Subcommittee on Research on Minority Health to advise the Advisory Committee to the Director of the National Institutes of Health. (Sec. 402) Extends authorized appropriations through FY 1997 for the National Center for Health Statistics. (Sec. 403) Requires that research, demonstration projects, and evaluations be carried out on the health status of, and the delivery of, health care to racial and ethnic minority groups residing in medically underserved urban and rural areas and low-income groups, including the elderly, women, and children with low incomes. Title V: Miscellaneous - Directs the Secretary to study and report to the Congress on the need to combine the designations of medically underserved area and health professional shortage area. (Sec. 502) Establishes in the Department of Health and Human Services the Office of Urban Health Policy to collect and disseminate information on health care issues, research findings, and innovative approaches to deliver health care to such areas. Authorizes the making of grants to States to improve health care in underserved urban areas. (Sec. 503) Authorizes the making of grants and contracts regarding organ and bone marrow transplantation for minority populations. (Sec. 504) Extends the demonstration project for grants to States for Alzheimer's disease through FY 1998. Requires improved access for individuals with Alzheimer's disease, particularly racial and ethnic minorities and individuals living in isolated rural areas, to services that are home-based or community-based. (Sec. 505) Waives individuals from disadvantaged backgrounds who are underrepresented in the health professions from certain obligations regarding training or practicing in primary health care.
Bill· HRH.R. 3696 (103rd)referred
United States · United States Congress · 22 November 1993
Amends the Federal National Mortgage Association Charter Act, the Federal Home Loan Mortgage Corporation Act, and the Higher Education Act of 1965 to subject the Federal Home Loan Mortgage Corporation, the Student Loan Marketing Association, and the Federal National Mortgage Association (including their franchises, capital, reserves, surplus, mortgages or other security holdings, income, and real property) to all taxation imposed by any State, territory, possession, Commonwealth, or dependency of the United States, the District of Columbia, or by any county, municipality, or local taxation authority. Requires the Mayor of the District of Columbia to study and report to specified congressional committees on the economic impact on the District of the Associations' and Corporation's activities, including an analysis of the potential effects on the revenues of the District resulting from the amendments made by this Act.
Bill· HRH.R. 3614 (103rd)referred
United States · United States Congress · 22 November 1993
Tobacco Education and Child Protection Act - Declares it to be unlawful to manufacture, package, distribute for sale, or advertise tobacco products without specified health warning labels. Repeals the Federal Cigarette Labeling and Advertising Act and the Comprehensive Smokeless Tobacco Health Education Act of 1986 one year after the effective date of this Act.
Resolution· HCONRESH.Con.Res. 192 (103rd)referred
United States · United States Congress · 22 November 1993
Expresses the sense of the Congress that: (1) all States should provide quality education in school sex education programs respecting acquired immune deficiency syndrome (AIDS) and human immunodeficiency virus (HIV) infections; (2) the Secretary of Health and Human Services and the Surgeon General should develop guidelines for prevention of such infections and distribute them for parents and their children; (3) the television and motion picture industry should encourage the use of condoms in movies, television shows, and public service announcements; (4) advertisements for condoms should be encouraged; and (5) the National Commission on AIDS should be reinstituted.
Bill· HRH.R. 3611 (103rd)referred
United States · United States Congress · 21 November 1993
Directs the Administrator of the Environmental Protection Agency to: (1) establish the California Urban Environmental Research and Training Center; and (2) enter into a cooperative agreement with California State University, Hayward, to establish the Center if the university agrees and meets a specified matching fund requirement. Authorizes universities in California to become members of the Center. Requires the Center to: (1) develop an ongoing program of environmental research, education, and outreach to ensure that future government policies to encourage economic development in California are grounded on sustainable environmental and economic policies; (2) foster public-private partnerships to find solutions to the environmental problems of California; (3) bring together researchers to focus on the most important environmental problems related to sustainable economic development; (4) support specified activities, including collaborative university research, analysis of public policy implications of economic development programs, the conduct of seminars and conferences, the development of educational programs, the preparation of minority students for environmental professions, and the development of a repository of information on key environmental and economic development issues; (5) assist small businesses in meeting environmental regulations by providing short courses and conferences; (6) work on alternative uses for military installations to assist in planning the environmental aspects of conversion and clean-up; and (7) develop a plan to extend its activities throughout the State within two years. Authorizes the Center to provide: (1) undergraduate scholarships for individuals studying in environmental fields at universities that are members of the Center; and (2) graduate assistantships and fellowships to encourage study in fields related to sustainable economic development and research grants to faculty. Authorizes appropriations.
Bill· HRH.R. 3603 (103rd)referred
United States · United States Congress · 21 November 1993
TABLE OF CONTENTS Title I: General Provisions Title II: Policy Coordination and Technology Programs Subtitle A: Policy Coordination and Program Planning Subtitle B: Environmental Technology Title III: Education Title IV: Standards Title V: International Programs Title VI: Financial and Regulatory Incentives Title VII: Authorization of Appropriations Title I: General Provisions - Environmental Technologies Act of 1993 - Sets forth congressional findings and purposes. Title II: Policy Coordination and Technology Programs - Subtitle A: Policy Coordination and Program Planning - Requires the Director of the Office of Science and Technology Policy 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. (Sec. 202) Requires the Director to coordinate Federal activities and resources that are applied to life-cycle assessment in order to maximize the contribution of such assessments to sustainable economic development. (Sec. 203) Amends the Stevenson-Wydler Technology Innovation Act of 1980 to include goals for sustainable economic development within technology innovation programs. Includes such goals in other existing programs under specified Acts. Subtitle B: Environmental Technology - Establishes an Environmental Technologies Development and Integration Program, to be administered by the Administrator of the Environmental Protection Agency (EPA), to promote the research, development, and integration of technologies that will contribute to sustainable economic development. Makes eligible for assistance projects that: (1) develop advanced, precommercial environmental technologies, with emphasis on technologies that will contribute to sustainable economic development; and (2) develop the integration of multiple steps in the conversion of materials that are involved in the manufacture, reuse, or recycling of a product, the recycling of process wastes, or the provision of a service. (Sec. 211) Prohibits intellectual property owned and developed by a business receiving financial assistance from being disclosed by the Federal Government except in accordance with an agreement. Provides that title to such property arising from assistance shall vest in a company incorporated in the United States or an institution of higher education in the United States. (Sec. 212) Directs the Administrator and the Secretaries of Energy and Defense to submit a strategic plan for interagency coordination of programs for the development, demonstration, and deployment of innovative environmental control and remediation technologies. (Sec. 213) Establishes the President's Total Environmental Quality Award to be awarded periodically to companies and other organizations which have benefited the United States through the development and deployment of environmental technologies. Establishes a National Environmentally Sound Technology Award for individuals who have pioneered the development and use of a highly innovative environmental technology. (Sec. 214) Directs the Administrator, 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. (Sec. 215) Directs the Administrator to establish a program to demonstrate the performance of environmental technologies at Federal laboratories and other Federal facilities. Makes U.S. companies and small businesses, nonprofit organizations, and institutions of higher education eligible to carry out demonstration projects. (Sec. 216) Directs the Administrator to establish a three-year pilot program to promote research on, and development of, environmentally efficient building materials through use of such materials in new and existing Federal facilities and buildings. Directs the Administrator to promulgate guidelines for Federal agencies on minimizing the creation of solid waste and maximizing the use of environmentally efficient building materials. Title III: Education - Requires the Director of the National Science Foundation to support undergraduate and graduate activities in the development of coursework materials and curricula in all scientific, engineering, and technical disciplines to incorporate environmental soundness and total cost accounting into the corresponding curricula. (Sec. 302) Requires the Director of the EPA Office of Research and Development to develop and support programs to improve understanding of the relationships between technology and the environment. Title IV: Standards - Directs the Secretary of Commerce to establish: (1) a program to support the clarification of standards of performance for environmental technologies to clarify quality, performance, and substitutability for conventional products; and (2) a mechanism for recognizing non-Federal organizations engaged in environmental standards setting and associated product performance verification activities for purposes of ensuring quality and enhancing consumer confidence and international recognition. (Sec. 402) Authorizes the Administrator to enter into joint agreements with State and local governments and private sector representatives to support Environmental Technology Verification Centers that verify, evaluate, and disseminate information on the performance and cost of environmental technologies. Authorizes financial assistance to such Centers. Authorizes the Administrator to engage directly with private sector organizations through verification partnerships if the Centers cannot verify the performance of technologies because of scale or complexity. (Sec. 403) Directs the Federal Trade Commission to: (1) conduct a study of scientific and technological information needed for the fair evaluation of commercial performance claims regarding environmental technologies; and (2) develop a plan for collaboration with Federal agencies that have expertise in such technologies to ensure the use of the best available scientific and technological information in evaluating such claims. Title V: International Programs - Encourages the Administrator to support programs in other nations for purposes of enhancing U.S. exports of environmental technologies and promoting the contribution of such technologies to international sustainable economic development. (Sec. 503) Directs the Secretary of Commerce to support activities to promote the export of U.S. environmental technologies. (Sec. 504) Establishes the Environmental Technologies Export Revolving Fund for purposes of providing financial assistance for the adaption and demonstration of U.S. environmental technologies to enhance exports to major international markets. Authorizes the Secretary to use the Fund for financial assistance to U.S. companies, research centers, institutions of higher education, and other appropriate organizations. Sets forth priority projects and conditions for financial assistance. Title VI: Financial and Regulatory Incentives - Directs the President to establish a program for evaluating and approving Federal purchases of environmental technology products. (Sec. 602) Requires the Administrator to study and report to the Congress on current environmental regulations and their effect upon innovation in environmental technologies and the introduction of new environmental products. (Sec. 603) Requires the President to study the potential for efficiently encouraging the development and use of environmental technologies through tax incentives. Title VII: Authorization of Appropriations - Authorizes appropriations.
Bill· SS. 1762 (103rd)open
United States · United States Congress · 20 November 1993
Dietary Supplement Regulation Moratorium Act of 1993 - Prohibits the Secretary of Health and Human Services from implementing the Nutrition Labeling and Education Act of 1990 or any amendment made by such Act earlier than April 15, 1994, with respect to dietary supplements of vitamins, minerals, herbs, amino acids, or other similar nutritional substances. Prohibits the Secretary from issuing any final regulations applicable to such substances before that date. Specifies that any such proposed regulations shall not be considered to be final regulations until that date. Makes the effective date for provisions dealing with State enforcement with respect to such substances April 30, 1994.
Bill· SS. 1743 (103rd)open
United States · United States Congress · 20 November 1993
TABLE OF CONTENTS: Title I: Tax and Insurance Provisions Subtitle A: Tax Treatment of Health Care Expenses Subtitle B: Insurance Provisions Subtitle C: Employer Provisions Subtitle D: Federal Preemption Subtitle E: Report Title II: Medicare and Medicaid Reforms Subtitle A: Medicare Subtitle B: Medicaid Title III: Health Care Liability Reform Title IV: Administrative Cost Savings Subtitle A: Standardization of Claims Processing Subtitle B: Electronic Medical Data Standards Subtitle C: Development and Distribution of Comparative Value Information Subtitle D: Preemption of State Quill Pen Laws Title V: Anti-Fraud Subtitle A: Criminal Prosecution of Health Care Fraud Subtitle B: Coordination of Health Care Anti-Fraud and Abuse Activities Title VI: Antitrust Provisions Title VII: Long-Term Care Consumer Choice Health Security Act of 1994 - Title I: Tax and Insurance Provisions - Subtitle A: Tax Treatment of Health Care Expenses - Amends the Internal Revenue Code to allow a tax credit for health care expenses based upon percentages of qualified health insurance premiums and adjusted gross income. Provides advance payments of such credit by employers. (Sec. 102) Allows individuals a tax credit for a percentage of contributions made to a medical care savings account established for the benefit of an eligible individual. Exempts such accounts from taxation. Establishes an excise tax for excess contributions to medical care savings accounts and makes such accounts subject to the tax on prohibited transactions. (Sec. 103) Terminates the medical expense deduction and the exclusion for employer-provided health insurance. Subtitle B: Insurance Provisions - Part I: Federally Qualified Health Insurance Plans - Sets forth requirements for federally qualified health insurance plans, including coverage for acute medical care, cost-sharing, premium rating practices, and guaranteed issuance and renewability. Part II: Certification of Federally Qualified Health Insurance Plans - Requires States to meet standards for regulatory programs for the certification of federally qualified health insurance plans. Subtitle C: Employer Provisions - Requires employers to: (1) withhold health insurance premiums from employee wages and remit such premiums to the employee's chosen insurer; and (2) notify employees of their right to claim an advance refundable tax credit for such premiums. (Sec. 122) Provides for the conversion and continuation of existing insurance plans to required coverage under this Act. (Sec. 125) Establishes the Benefits Cash Out Commission to propose a procedure under which individuals may cash out Federal health benefits. Provides for congressional consideration of such proposal prior to its implementation. (Sec. 126) Imposes excise taxes on employers and health insurance carriers for noncompliance with this Act. Subtitle D: Federal Preemption - Preempts specified State laws concerning health insurance. Subtitle E: Report - Requires the Secretary of Health and Human Services to report to the Congress five years after the enactment of this Act on certain aspects of health insurance coverage. Title II: Medicare and Medicaid Reforms - Subtitle A: Medicare - Directs the Secretary to report to the Congress on the feasibility of allowing future Medicare beneficiaries to elect to receive certificates with which to purchase private health insurance coverage instead of receiving Medicare benefits. (Sec. 202) Eliminates disproportionate share hospital payments under Medicare. (Sec. 203) Provides for a reduction in the adjustment for indirect medical education costs under Medicare. (Sec. 204) Imposes copayments for laboratory services, certain home health visits, and skilled nursing facility services provided under Medicare. (Sec. 207) Moves payment updates to January for all payment rates under Medicare's hospital insurance program. (Sec. 208) Accelerates the transition to prospective rates for facility costs in hospital outpatient departments. Subtitle B: Medicaid - Places a cap on Federal payments for acute medical services furnished under a State's Medicaid program. (Sec. 212) Provides for waivers from Medicaid requirements in order to establish acute medical services programs. (Sec. 213) Terminates disproportionate share hospital payments under Medicaid. (Sec. 214) Directs the Secretary to provide grants to States for programs to provide health insurance coverage, acute medical services, preventive care, and disease prevention services to low-income individuals. Title III: Health Care Liability Reform - Health Care Liability Reform Act of 1994 - Limits payments, damages, and attorney's fees in health care malpractice actions and claims. (Sec. 304) Declares that a manufacturer or seller of a health care product shall not be strictly liable for injury from: (1) a defect in the design of the product; or (2) a failure to warn or instruct regarding a risk posed by the product that was not known or reasonably knowable. (Sec. 305) Limits the amount of noneconomic damages that may be awarded in a health care malpractice claim or a health care product liability claim. Allows several liability for noneconomic loss and for punitive damages. (Sec. 306) Allows punitive damages to be awarded only if the claimant establishes that the harm suffered was the result of conduct manifesting conscious, flagrant indifference to the health of those harmed by the product. Disallows punitive damages against a product approved by the Food and Drug Administration. Title IV: Administrative Cost Savings - Subtitle A: Standardization of Claims Processing - Directs the Secretary to adopt standards relating to: (1) data elements for use in paper and electronic claims processing under health benefit plans and in utilization review and management of care; (2) uniform claims forms; and (3) uniform electronic transmission of the data elements. (Sec. 402) Authorizes the Secretary, two years after standards are adopted for classes of services upon determining that a significant number of claims for benefits for such services under health benefit plans are not being submitted in accordance with such standards, to require that all providers of such services submit claims to health benefit plans in accordance with such standards. (Sec. 403) Directs the Secretary to: (1) provide for the ongoing receipt and review of comments and suggestions for changes in the standards adopted and promulgated; (2) establish a schedule for the periodic review of such standards; and (3) revise such standards. Subtitle B: Electronic Medical Data Standards - Directs the Secretary to promulgate standards for hospitals concerning electronic medical data, including standards for transmission of such data and confidentiality of patient-specific information. Authorizes the Secretary to periodically revise such standards. (Sec. 412) Sets forth requirements with respect to: (1) the sharing of hospital information under Medicare; (2) waiver of such requirements; and (3) application of such requirements to hospitals of the Department of Veterans Affairs. (Sec. 413) Authorizes the head of a Federal agency to require a provider to present and transmit a required data element electronically in accordance with applicable presentation or transmission standards. (Sec. 414) Sets forth limitations on data requirements where standards with respect to data elements are in effect. (Sec. 415) Directs the Secretary to establish an advisory commission on the standards established under this part and operational concerns about the implementation of such standards. Authorizes appropriations. Subtitle C: Development and Distribution of Comparative Value Information - Directs the Secretary to determine whether each State is developing and implementing a health care value information program that meets specified criteria and a specified schedule. Authorizes the Secretary to: (1) make grants to enable each State to plan development and initiate implementation of its health care value information program; and (2) recover the amount of such a grant by offset against any other amount payable to the State under the Social Security Act under specified circumstances. Authorizes appropriations. (Sec. 422) Directs the Secretary to take actions necessary to implement a comparable program in a State that fails to develop or implement a health care value information program in accordance with such criteria and schedule. Authorizes the Secretary to charge fees for the information materials provided pursuant to such a program. (Sec. 423) Directs the head of each Federal agency with responsibility for the provision of health insurance or health care services to individuals to develop health care value information relating to each program that such head administers and covering the same types of data that a State program meeting such criteria would provide. Subtitle D: Preemption of State Quill Pen Laws - Specifies that, effective January 1, 1996, no effect shall be given to any provision of State law that requires medical or health insurance records (including billing information) to be maintained in written, rather than electronic, form. Title V: Anti-Fraud - Subtitle A: Criminal Prosecution of Health Care Fraud - Amends the Federal criminal code to impose penalties upon a health care provider that knowingly engages in any scheme or artifice to defraud a person in connection with the provision of health care. (Sec. 502) Authorizes the Attorney General to pay a reward of up to $10,000 to a person who furnishes information unknown to the Government relating to a possible prosecution for health care fraud, with exceptions. Subtitle B: Coordination of Health Care Anti-Fraud and Abuse Activities - Amends the Social Security Act to provide for: (1) the application of Federal health anti-fraud and abuse sanctions to all fraud and abuse against any health insurance plan; and (2) treble damages for making or causing to be made false statements or representatives involving Medicare or State health care programs, for illegal remuneration, and for false statements or representatives with respect to the condition or operation of health care institutions. Directs the Secretary of Health and Human Services, in consultation with State and local health care officials, to: (1) identify opportunities for the satisfaction of community service obligations that a court may impose upon the conviction of a criminal offense involving Medicare or State health care programs; and (2) make information concerning such opportunities available to Federal and State law enforcement officers and State and local health care officials. Title VI: Antitrust Provisions - Exempts from the antitrust laws specified "safe harbor" activities related to the provision of health care services. Sets forth provisions regarding the award of attorney's fees and costs of suit to the prevailing party in an action based on a claim involving activity found to be exempt. (Sec. 602) Lists as safe harbors specified: (1) activities relating to health care services of combinations of health care providers with market share below a specified threshold; (2) activities of medical self-regulatory entities relating to standard setting or enforcement activities not conducted for purposes of financial gain; (3) participation of a health care provider in a written survey of the prices of services, reimbursement levels, or the compensation and benefits of employees and personnel; (4) activities relating to health care joint ventures for high technology and costly equipment and services; (5) activities relating to hospital mergers; (6) joint purchasing arrangements; and (7) negotiations. (Sec. 603) Directs the Attorney General to publish a notice in the Federal Register soliciting proposals for additional safe harbors and to review and report to the Congress on proposed safe harbors. Sets forth criteria in establishing safe harbors, including: (1) the extent to which a competitive or collaborative activity will accomplish an increase in health care access and quality, the establishment of cost efficiencies, and increased ability of health care facilities to provide services in medically underserved areas or to underserved populations; and (2) whether designation as a safe harbor will result in specified desirable outcomes. (Sec. 604) Directs the Attorney General to issue certificates of review for providers of health care services and to assist persons in applying for such certificates. Sets forth provisions regarding applications for, revocation of, and review of determinations regarding such certificates. Limits the disclosure of information. (Sec. 605) Sets forth provisions regarding notifications providing for a reduction in certain penalties under the antitrust laws for health care cooperative ventures. (Sec. 606) Directs the Attorney General to: (1) review the safe harbors and certificates of review periodically and (2) promulgate such rules, regulations, and guidelines as necessary to carry out provisions of this title. Title VII: Long-Term Care - Amends the Internal Revenue Code to exclude from gross income certain amounts withdrawn from individual retirement accounts and certain employer cash or deferred arrangements to pay long-term care premiums. (Sec. 702) Provides for the nonrecognition of gain or loss on the exchange of any life insurance contract or an endowment or annuity contract for a long-term care insurance contract. (Sec. 703) Provides for the exclusion as a death benefit of any amount paid or advanced to an individual under a life insurance contract because such individual is terminally ill or chronically and has been permanently confined to ill and qualified facility.
Bill· SS. 1757 (103rd)open
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· HRH.R. 3600 (103rd)reported
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. 3582 (103rd)referred
United States · United States Congress · 20 November 1993
Amends the National School Lunch Act (NSLA) to make Head Start participants automatically eligible for free meals under the NSLA school lunch program and the school breakfast program of the Child Nutrition Act of 1966 (CNA). Revises the child and adult care food program under NSLA. Broadens the definition of eligible institution. Provides for additional reimbursement for family or group day care home sponsoring organizations and an enhanced administrative reimbursement rate for such organizations serving rural or low-income area providers. Increases the allowable amount of startup and expansion funds. Allows expansion funds to be used for outreach to unlicensed day care homes. Extends the authorization of appropriations for such program. Adds provisions relating to information about Medicaid and the special nutrition program for women, infants, and children (WIC). Expands eligibility for meal supplements for the afterschool care program to youths up to age 18. Requires the Secretary of Agriculture to report on demonstration projects to improve food service for homeless children. Directs the Secretary to use certain funds for nutrition counseling, assessments, and referrals for participants in such homeless demonstration program, WIC, Medicaid, and similar programs for homeless pregnant women or those at risk of becoming so, homeless mothers with newborn infants, or the guardians of boarder babies or other abandoned infants. Requires periodic reports. Amends the Child Nutrition Act of 1966 (CNA) to require States to use a portion of certain increased grant funds for nutrition education and training assistance for family day care home sponsors and day care center staff.
Bill· HRH.R. 3580 (103rd)referred
United States · United States Congress · 20 November 1993
TABLE OF CONTENTS: Title I: Amendments to National School Lunch Act Title II: Amendments to Child Nutrition Act of 1966 Title III: Effective Dates National School Lunch Act and Child Nutrition Act of 1966 Amendments of 1993 - Amends the Child Nutrition Act of 1966 (CNA) and the National School Lunch Act (NSLA) to revise and reauthorize child nutrition programs. Title I: Amendments to National School Lunch Act - Amends NSLA to direct the Secretary of Agriculture (the Secretary) to permit schools to offer low-fat yogurt (which may be required to be fortified) as a meat alternative in the school lunch program. (Sec. 102) Directs the Secretary to assist States through grants and other means to provide information to parents on the importance of nutrition, including parent-student education and parent visiting of school breakfast and lunch programs. Authorizes appropriations. (Sec. 103) Revises income guidelines for free lunches to increase the numbers of eligible elementary school students. (Sec. 104) Directs the Secretary to develop and make available public service advertisements that promote healthy eating habits for children. (Sec. 105) Directs the Secretary to award annual grants to private nonprofit educational organizations in three States to create and demonstrate food and nutrition projects that are fully integrated with elementary school curricula. Authorizes appropriations. (Sec. 106) Revises the summer food service program for children, expanding or making more flexible such program with respect to: (1) defining areas in which poor economic conditions exist; (2) private nonprofit organizations' number of sites and children served, and waiting period for a waiver to use a vendor; (3) second helpings; (4) single rate for operational and administrative costs; (5) offer vs. serve option; and (6) startup costs. Extends such program's authorization of appropriations. (Sec. 107) Reauthorizes the commodity distribution program. Directs the Secretary to: (1) improve overall nutritional quality of entitlement commodities provided in schools; and (2) require that nutritional content information labels be placed on packages or shipments of such entitlement commodities or otherwise provide such information. (Sec. 108) Requires that specified activities be conducted with assistance for food service management institutes and other institutions. Extends the authorization of appropriations for training, technical assistance, and food service management institutes. (Sec. 109) Requires the Secretary to report to specified congressional committees on the coordinated review system under NSLA. (Sec. 110) Requires revision of menu planning guides with respect to reduction of fat and saturated fat. Requires the Secretary to report to the Congress on compliance with such fat guidelines as well as those for dietary fiber, sodium, and sugar in school breakfast and lunch programs. Title II: Amendments to Child Nutrition Act of 1966 - (Sec. 201) Amends CNA to provide for increased payments for State administrative expenses under CNA and NSLA programs. (Sec. 202) Increases funding and activities under the WIC breastfeeding promotion program. (Sec. 203) Expands the WIC farmers' market program. Directs the Secretary of Agriculture to promote use of farmers' markets by recipients of Federal nutrition programs administered by the Secretary. Extends the authorization of appropriations for such program. (Sec. 204) Adds several authorized uses of funds under nutrition education and training programs. Extends and increases the authorization of appropriations for such programs. (Sec. 205) Revises a formula for carryover funds. Changes the name of the WIC program to the special nutrition program for women, infants, and children. Title III: Effective Dates - Sets forth effective dates.
Bill· SS. 1727 (103rd)open
United States · United States Congress · 19 November 1993
National Maritime Heritage Act of 1993 - Declares that it shall be the policy of the Federal Government, in partnership with State and local governments and private organizations and individuals, to support and encourage Federal, State, and local governmental and private conservation of historic maritime resources. Creates the National Maritime Trust to receive, preserve, and administer donations of real property and objects significant in American maritime history and culture and accept, hold, and administer gifts to carry out a maritime preservation and education program. Establishes the National Maritime Heritage Grants Program to foster a greater awareness and appreciation of the role of maritime endeavors in our nation's history and culture. Authorizes the Secretary of the Interior to make a cooperative agreement with the Trust for assistance in administration of the Program. Provides for a matching grants-in-aid program to carry out this Act. Authorizes the Secretary, to administer a program of direct grants for the preservation of maritime resources, including direct preservation, demonstration projects, training, and educational programs. Authorizes conveyance to the Trust, without consideration, of each vessel in the National Defense Reserve Fleet that has no usefulness to the Government and is scheduled to be scrapped. Requires the Trust to sell: (1) the vessels for scrap and use the proceeds for the purposes of this Act; and (2) sufficient vessels to derive a minimum annual dollar amount. Declares that amounts available to, or used by, the Trust under these provisions shall not be considered in any determination of amounts available to the Department of the Interior. Establishes the Maritime Heritage Grants Committee to perform certain duties, including overseeing the grants program and reviewing grant proposals. Requires the Committee to determine whether any projects exist that meet specified criteria regarding receiving a grant prior to issuance of implementing regulations. Provides for disbursal of scrapped vessel funds to approved projects. Mandates an annual audit of Trust accounts by independent accountants and authorizes annual audits by the General Accounting Office.
Bill· SS. 1723 (103rd)open
United States · United States Congress · 19 November 1993
Amends the Tech-Prep Education Act to revise tech-prep education program contents to include the two or four years of secondary school preceding graduation (currently just the final two years), as well as two years of higher education or an apprenticeship program. Includes among consortia members businesses, industries, or labor unions, and institutions of higher education that award baccalaureate degrees. Revises special consideration provisions. Gives highest priority to applications that provide for effective employment placement activities or transfer of students to four-year baccalaureate programs.
Bill· SS. 1729 (103rd)referred
United States · United States Congress · 19 November 1993
Persons With Disabilities Trusts Tax Rate Restoration Act - Amends the Internal Revenue Code to repeal the 1993 rate increase in the rate of income tax as applied to trusts established for: (1) individuals who are disabled; (2) support and maintenance of individuals under age 21 whose parents are deceased; and (3) higher education costs of the grantor's children or grandchildren.
Bill· SS. 1713 (103rd)referred
United States · United States Congress · 19 November 1993
Work Force Diversity Partnership Act of 1993 - Authorizes the Secretary of Labor to award grants for public-private partnerships to encourage work force diversity through study of relevant issues and development of education and training materials and programs. Makes eligible for such grants institutions of higher education in partnership with for-profit or nonprofit corporations, businesses, or partnerships, labor organizations, or organizations with demonstrated interest or expertise in such issues. Gives priority to grant proposals demonstrating availability of sufficient amounts of non-Federal contributions, or resources from non-governmental entities. Requires peer review panels, recipient reports, and annual reports by the Secretary. Authorizes appropriations.
Bill· SS. 1695 (103rd)referred
United States · United States Congress · 19 November 1993
Apollo 11 Moon Landing 25th Anniversary Commemorative Coin Act - Directs the Secretary of the Treasury to: (1) issue coins emblematic of humans first landing on the moon 25 years ago; and (2) pay surcharges received from coin sales to the Aerospace Education Alliance to develop and implement a math and science skills program for America's teachers in grades kindergarten through eight.
Bill· HRH.R. 3546 (103rd)open
United States · United States Congress · 19 November 1993
Propane Education and Research Act of 1993 - Directs the Secretary of Energy (the Secretary) to conduct a referendum among producers and retail marketers to authorize the creation of the Propane Education and Research Council and the levying of an assessment on odorized propane. Makes it the Council's mission to develop programs and enter into contracts for: (1) propane research and development; (2) consumer education; (3) propane market development; and (4) payment for program costs with funds collected under this Act. Prescribes guidelines under which the Council shall set annual assessments to cover program costs. Authorizes the Secretary to establish a program to coordinate Council operations with any State propane education and research council. Proscribes the use of Council funds for lobbying activities. Directs the Secretary to issue implementation regulations.
Bill· HRH.R. 3561 (103rd)referred
United States · United States Congress · 19 November 1993
Mickey Leland Adolescent Pregnancy Prevention and Parenthood Act of 1993 - Amends the Public Health Service Act to replace the title on adolescent family life demonstration projects with a title on adolescent pregnancy prevention, care, and research grants. Authorizes the Secretary of Health and Human Services to make grants to provide, supplement, or improve the quality of prevention and care services to pregnant adolescents and their male partners, adolescent parents, and nonpregnant adolescents. Requires grantees to charge fees for services only under a fee schedule, approved by the Secretary, based on the income of the person and taking into account the difficulty adolescents face in obtaining resources to pay for services. Prohibits discrimination because of an individual's inability to pay for services. Sets forth priorities in making grants, including giving priority to applicants that: (1) serve an area with a high incidence of adolescent pregnancy; and (2) serve an area with a high proportion of low-income families and low availability of care programs. Directs the Secretary to coordinate Federal policies and programs providing services relating to the prevention of initial and recurrent adolescent pregnancies and providing care services, including by requiring grantees under these provisions to report concerning Federal, State, and local policies that interfere with delivery and coordination of programs of care for pregnant adolescents and adolescent parents. Authorizes the Secretary to make grants to institutions of higher education to support and disseminate the results of research relating to adolescent pregnancy. Limits grants or contracts to: (1) one year, subject to renewal for four additional one-year periods; and (2) subject to waiver, a specified dollar amount. Directs the Secretary to establish a system for the review of grant and contract applications which is similar to the system of scientific peer review of the National Institutes of Health. Allows grants only to programs determined by the review panel to have scientific merit. Authorizes appropriations. Prohibits using grant funds for the performance of an abortion.
Bill· HRH.R. 3568 (103rd)referred
United States · United States Congress · 19 November 1993
Environmentally Advanced Technologies Education Act - Requires the Director of the Office of Research and Development of the Environmental Protection Agency to develop and support programs to improve understanding of the relationships between technology and the environment, including information on: (1) relations between economic activity and the environment; and (2) systems which encompass resource extraction or introduction, transformation, consumption, recycling, and disposal, and the energy and resources consumed and the value-yielding results. Requires such programs to include, at a minimum, the development of educational materials and the training of students and educational professionals.
Bill· HRH.R. 3562 (103rd)referred
United States · United States Congress · 19 November 1993
National Education Statistics Act of 1993 - Reauthorizes and revises provisions for the National Center for Education Statistics (the Center) and the National Assessment of Educational Progress. (Establishes the Center, within the Office of Educational Research and Improvement in the Department of Education and headed by the Commissioner of Education Statistics, under this Act while repealing similar provisions under the General Education Provisions Act.) Revises provisions for the Center's: (1) duties; (2) performance; (3) reports; (4) Advisory Council on Education Statistics; (5) confidentiality; (6) dissemination; (7) cooperative education statistics systems; (8) National Assessment of Educational Progress; and (9) National Assessment Governing Board. Authorizes appropriations.
Bill· HRH.R. 3535 (103rd)referred
United States · United States Congress · 18 November 1993
Directs the Secretary of Education to permit student loan borrowers under the Higher Education Act of 1965 to defer repayment during periods for which the borrower or a spouse is eligible for leave under the Family and Medical Leave Act of 1993. Requires the Secretary to publicize the availability of such deferment and of other deferments available to borrowers for whom repayment has caused or will cause economic hardship.
Bill· HRH.R. 3530 (103rd)referred
United States · United States Congress · 18 November 1993
Environmental Technology Demonstration Act of 1993 - Directs the Administrator of the Environmental Protection Agency to establish a program to demonstrate the performance of environmental technologies at Federal laboratories and other Federal facilities. Makes U.S. companies and small businesses, nonprofit organizations, and institutions of higher education eligible to carry out demonstration projects, as well as other organizations that the Administrator considers appropriate.
Bill· SS. 1668 (103rd)open
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
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. 3508 (103rd)open
United States · United States Congress · 15 November 1993
Tribal Self-Governance Act of 1993 - Amends the Indian Self-Determination and Education Assistance Act to establish within the Department of the Interior a program of Tribal Self-Governance. Authorizes up to 20 additional tribal participants each year. Directs the Secretary of the Interior to enter into annual funding agreements with the governing body of each participating tribe. Authorizes appropriations.
Law· HRH.R. 3499 (103rd)enacted
United States · United States Congress · 10 November 1993
Amends the Defense Department Overseas Teachers Pay and Personnel Practices Act to require the Director of Dependents' Education to establish for teachers a voluntary leave transfer program and a voluntary leave bank program. Provides that under a recertification program professional personnel employed in the defense dependents' education system may obtain not more than six semester hours of graduate or undergraduate coursework in any discipline or subject area taught by schools of such system.
Bill· HRH.R. 3500 (103rd)referred
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. 3501 (103rd)referred
United States · United States Congress · 10 November 1993
TABLE OF CONTENTS: Title I: Violent Crimes Title II: Fraud Senior Citizen Protection Act of 1993 - Title I: Violent Crimes - Amends the Federal criminal code to require a mandatory sentence upon conviction of a felony against an individual age 65 or over (elderly victim). Bars the court from suspending such sentence or giving the defendant probation. Requires that such a sentence be served consecutively and that the court reject specified plea agreements. Authorizes the death penalty in any case in which Federal law punishes conduct that is first-degree murder. Title II: Fraud - Directs the Federal Trade Commission (FTC) to participate in, and be on the receiving list of law enforcement products of, the Treasury Department's Financial Crimes Enforcement Center. Revises provisions of the Federal Trade Commission Act to authorize: (1) service of process wherever a party may be found in certain cases of fraud; and (2) the FTC to bring a criminal contempt action for violations of orders in such cases. Requires: (1) the U.S. Sentencing Commission to amend its sentencing guidelines to provide for increased offense levels based on the number of victims in cases of fraud and deceit and based on victims being elderly; and (2) (current law authorizes) the court to order restitution to victims of specified violations of the Federal Aviation Act of 1958. Expresses the sense of the Congress that: (1) all U.S. Attorneys should regularly enter information on telemarketing fraud into the database of the National Telemarketing Fraud Working Group; and (2) such Group and the States should continue to cooperate in coordinating the prosecution of offenders in venues that are convenient to the victims. Subjects to civil forfeiture any property traceable to the proceeds of violations of specified anti-fraud provisions which relate to crimes against elderly victims. Requires the court to order violators to forfeit property constituting or derived from proceeds obtained as the result of such a violation. Permits up to 25 percent of the amounts so forfeited to be used to provide restitution to victims. Directs: (1) the Attorney General to prepare model State laws on licensing of home repair contractors, mortgage companies, and prize giveaway companies and to designate 50 positions for attorneys and support staff for the prosecution of consumer fraud and for law enforcement and consumer fraud education programs; and (2) the Social Security Administration to conduct a study of Medicaid and social security fraud. Extends mail fraud provisions to cover private courier services.
Bill· HRH.R. 3480 (103rd)referred
United States · United States Congress · 9 November 1993
Apollo 11 Moon Landing 25th Anniversary Commemorative Coin Act - Directs the Secretary of the Treasury to: (1) issue coins emblematic of humans first landing on the moon 25 years ago; and (2) pay surcharges received from coin sales to the Aerospace Education Alliance to develop and implement a math and science skills program for America's teachers in grades kindergarten through eight.
Bill· SS. 1633 (103rd)referred
United States · United States Congress · 8 November 1993
TABLE OF CONTENTS: Title I: Federal Banking Commission Title II: Abolition of Federal Banking Agencies Regulatory Consolidation Act of 1993 - Title I: Federal Banking Commission - Establishes the Federal Banking Commission (the Commission) as an independent agency in the executive branch. Transfers to the Commission all functions vested in: (1) the Comptroller of the Currency for the regulation of national banks; (2) the Director of the Office of Thrift Supervision for the regulation of savings associations and savings and loan holding companies; (3) the Board of Governors of the Federal Reserve System for certain banking activities; (4) the Federal Deposit Insurance Corporation for the regulation of State nonmember banks (excluding insurance-related functions); and (5) the Federal Financial Institutions Examination Council for the conduct of schools for bank examiners. Directs the Secretary of the Treasury (the Secretary) to designate a single calendar date by which to complete the transfer of functions. Expresses the sense of the Senate that the initial Commission appointments by the President be completed within a specified deadline. Grants the Federal Reserve Board access to the Commission's records. Title II: Abolition of Federal Banking Agencies - Abolishes the office and the position of: (1) Comptroller of the Currency; (2) Office of Thrift Supervision; and (3) the Federal Financial Institutions Examination Council. Amends the Federal Financial Institutions Examination Council Act of 1978 to redesignate the Appraisal Subcommittee as the Appraisal Committee.
Bill· HRH.R. 3465 (103rd)open
United States · United States Congress · 8 November 1993
Wetlands Protection and Management Act - Prohibits the revision of the 1987 Corps of Engineers Wetlands Delineation Manual before the Committee on Wetlands Characterization of the National Research Council publishes a specified report. Permits revisions afterward if the revisions: (1) take into account the findings and recommendations of the report; and (2) are made after field testing and public notice and comment. Requires wetlands identification and delineation to be carried out through the Manual until revised in accordance with this Act. Directs the Chief of the Soil Conservation Service (SCS), the Administrator of the Environmental Protection Agency, and the Secretaries of the Army and the Interior to issue a memorandum of agreement which sets forth procedures for identifying and delineating wetlands on agricultural lands. Requires the SCS Chief, after the issuance of the memorandum, to carry out such activities on agricultural lands and on non-agricultural lands which are contiguous to, or contained within, agricultural lands. Amends the Federal Water Pollution Control Act to authorize grants to States for wetlands conservation planning. Requires the Secretary of the Army, acting through the Chief of Engineers, to ensure, in issuing permits for the discharge of dredged or fill material into navigable waters, that there is no net loss of wetland acreage, functions, and values. Establishes procedures for the issuance of permits for minor discharges into wetlands. Creates a Small Landowners Assistance Account to provide technical assistance to private landowners to aid in compliance with permit requirements. Authorizes the issuance of general permits on a State or nationwide basis for any category of activities involving discharges of dredged or fill material if the activities are similar in nature and will cause only minimal adverse environmental effects when performed separately and cumulatively. Exempts prior converted cropland (unless abandoned) and certain waters and activities from regulation under dredged and fill permit provisions. Establishes administrative appeal procedures for determinations of regulatory jurisdiction over property, permit issuance or denial, and imposition of administrative penalties. Requires the Administrator to establish compensatory wetlands mitigation guidelines. Provides for mitigation banks (wetlands restoration projects that provide advance mitigation to offset foreseeable wetlands losses from future discharges of dredged or fill material). Establishes wetlands delineator training and certification programs and wetlands education and outreach programs. Includes "wetlands" in the definition of navigable waters. Expresses the sense of the Congress that the Wetlands Reserve Program is an effective program and should be fully funded.
Bill· SS. 1618 (103rd)open
United States · United States Congress · 4 November 1993
Tribal Self-Governance Act of 1993 - Amends the Indian Self-Determination and Education Assistance Act to establish within the Department of the Interior a program of Tribal Self-Governance. Authorizes up to 20 additional tribal participants each year. Directs the Secretary of the Interior to enter into annual funding agreements with the governing body of each participating tribe. Authorizes appropriations.
Bill· HRH.R. 3453 (103rd)open
United States · United States Congress · 4 November 1993
Drug-Free Schools and Communities Act Amendments of 1993 - Amends the Drug-Free Schools and Communities Act of 1986 to extend the authorization of appropriations for programs under such Act, including training of teachers, counselors, and school personnel, and emergency grants.
Bill· HRH.R. 3449 (103rd)referred
United States · United States Congress · 4 November 1993
Amends the Internal Revenue Code to allow an individual income tax deduction for contributions to a savings account established to pay the educational expenses (tuition, supplies, meals, and lodging) of the taxpayer's child or certain other relatives at an institution of higher education or a vocational school. Limits the deduction to $1,500 annually (adjusted for inflation) for each account. Disallows the deduction for contributions to an account maintained for any individual aged 19 or older. Requires any account balance to be distributed after the beneficiary attains age 30. Permits an exclusion from the gross income of the contributor or the beneficiary of account distributions used to pay educational expenses of the latter. Exempts an account from taxation (except for the tax on unrelated business income of a charitable organization), unless a contributor or the beneficiary engages in specified prohibited transactions. Imposes a ten percent surtax on distributions not used for educational purposes. Requires the account trustee to report to the Secretary of the Treasury and to the account's beneficiary concerning the account. Imposes a penalty for failure to report. Allows taxpayers who do not otherwise itemize deductions to deduct for contributions to an education savings account. Imposes penalty taxes in connection with excess contributions or prohibited transactions associated with an account. Exempts from annual contribution limitations distributions from education savings accounts into individual retirement accounts. Excludes from gross income distributions from individual retirement accounts into education savings accounts.
Bill· HRH.R. 3438 (103rd)referred
United States · United States Congress · 3 November 1993
Coordinate to Educate Act - Authorizes the Secretary of Education to make grants to local educational agencies to develop and implement coordinated services programs. Requires special consideration to be given to: (1) geographic distribution of awards, including urban, suburban, and rural districts; (2) districts with concentrated pockets of educationally at-risk students; (3) local educational agencies with high proportions of educationally at-risk students; and (4) areas with a large number of single parent or two-parent, working families. Authorizes appropriations.
Bill· HRH.R. 3430 (103rd)referred
United States · United States Congress · 3 November 1993
Environmental Defense Act of 1993 - Directs the Secretary of Education to investigate the feasibility of the Federal Government establishing a National Environmental Science and Policy Academy. Requires a report, with recommendations, to the Congress.
Law· SS. 1614 (103rd)open
United States · United States Congress · 2 November 1993
TABLE OF CONTENTS: Title I: Special Nutrition Program for Women, Infants, and Children Title II: School Breakfast and Related Programs Title III: School Lunch and Related Programs Title IV: Program Integrity Title V: Effective Dates Better Nutrition and Health for Children Act of 1993 - Amends the Child Nutrition Act of 1966 (CNA) and the National School Lunch Act (NSLA) to revise and reauthorize child nutrition programs. Title I: Special Nutrition Program for Women, Infants, and Children - Amends CNA to extend and increase the authorization of appropriations for the special nutrition program for women, infants, and children (WIC) (currently named the special supplemental food program for WIC). (Sec. 102) Increases funding and activities under the WIC breastfeeding promotion program. (Sec. 103) Expands the WIC farmers market program. Directs the Secretary of Agriculture to promote use of farmers markets by recipients of Federal nutrition programs. Title II: School Breakfast and Related Programs - Amends CNA to remove certain limitations on providing milk to low-income children. (Sec. 202) Eliminates the cost basis for the severe need reimbursement rate under CNA, if at least 40 percent of a school's students participating in the school lunch program under the NSLA are eligible to receive meals for free or at reduced prices. (Sec. 203) Directs the Secretary to permit schools to offer low-fat yogurt (which may be required to be enriched) as a meat alternative in the school breakfast program. (Sec. 205) Extends and increases the authorization of appropriations for startup costs for school breakfast programs. (Sec. 206) Provides for: (1) expansion of school breakfast programs through competitive grants to States; and (2) increased payments for State administrative expenses under CNA and NSLA programs. (Sec. 208) Authorizes State agencies and school food authorities to establish more stringent rules and policies than the minimum Federal requirements under CNA and NSLA, including prohibiting or controlling sale of competitive (or junk) food throughout the school campus during the school day. Directs the Secretary to develop model language for banning sale of competitive foods of minimal nutritional value anywhere on school grounds before the end of the last lunch period. (Sec. 209) Adds several authorized uses of funds under nutrition education and training programs. Authorizes appropriations. Title III: School Lunch and Related Programs - Amends NSLA to require that school lunch program lunches offer students fluid milk, removing the requirement that there be a choice of both whole milk and unflavored lowfat milk. (Sec. 302) Directs the Secretary to permit schools to offer low-fat yogurt (which may be required to be fortified) as a meat alternative in the school lunch program. (Sec. 303) Requires various reports by the Secretary to the appropriate congressional committees on increasing consumption of healthy foods in school lunches. (Sec. 304) Directs the Secretary to assist States through grants and other means to provide information to parents on the importance of nutrition, including parent-student education and parent visiting of school breakfast and lunch programs. Authorizes appropriations. (Sec. 305) Revises income guidelines for free lunches to increase the numbers of eligible elementary school students. (Sec. 306) Allows State agencies or local food authorities to use a determination of eligibility of a child for free or reduced price meals to demonstrate the child's eligibility for benefits under other Federal, State, or local means-tested programs. (Sec. 307) Makes Head Start participants automatically eligible for free breakfasts and lunches under CNA and NSLA. (Sec. 308) Revises the formula for special assistance payments to consider the number of free meals served (currently only lunches are considered). (Sec. 309) Directs the Secretary to develop and make available public service advertisements that promote healthy eating habits for children. (Sec. 310) Establishes a program to encourage use of organically produced foods in school breakfast and lunch programs. Allows priority to be given to socially disadvantaged, very rural, or small-scale farmers or ranchers. (Sec. 311) Directs the Secretary to award annual grants to private nonprofit educational organizations in three States to create food and nutrition projects fully integrated with elementary school curricula. Authorizes appropriations. (Sec. 312) Revises the summer food service program for children, expanding or making it more flexible with respect to specified features. Authorizes appropriations. (Sec. 313) Reauthorizes the commodity distribution program. Directs the Secretary to: (1) improve overall nutritional quality of entitlement commodities provided to schools; and (2) require that nutritional content information labels be placed on packages or shipments of such entitlement commodities or otherwise provide such information. (Sec. 314) Revises the child and adult care food program. Allows expansion funds to be used for outreach to unlicensed day care homes. Authorizes appropriations. Provides for dissemination of Medicaid and WIC information in connection with such program. (Sec. 315) Makes a child automatically eligible for a free or reduced price meal supplement in afterschool care if already certified eligible for free or reduced price school breakfasts or lunches. (Sec. 316) Reauthorizes appropriations for demonstration projects to improve food service to homeless children under age six in emergency shelters. Authorizes appropriations. (Sec. 317) Establishes pilot programs, under the school breakfast and lunch programs, to increase: (1) offerings of fruits and vegetables; (2) consumption of low-fat dairy products and lean meats; and (3) use of fortified fluid milk, including an information program. Authorizes appropriations. (Sec. 320) Requires that specified activities be conducted with assistance for food service management institutes and other institutions. Authorizes appropriations. (Sec. 321) Requires the Secretary to report to specified congressional committees on the coordinated review system under NSLA. (Sec. 322) Requires revision of menu planning guides with respect to reduction of fat and saturated fat. Requires the Secretary to report to the Congress on compliance with such fat guidelines as well as those for dietary fiber, sodium, and sugar in school breakfast and lunch programs. (Sec. 323) Directs the Secretary to enter into a contract with a nongovernmental organization for an information clearinghouse for nongovernmental groups that assist low-income individuals or communities with food assistance or self-help or other empowering activities. Authorizes appropriations. Title IV: Program Integrity - Amends NSLA to set forth duties of the Secretary relating to anticompetitive activities under various child nutrition programs under CNA and NSLA, including debarment policy. (Sec. 403) Authorizes the Secretary to provide grants to State educational agencies and other State agencies that administer child nutrition programs for prevention and control of anticompetitive activities. Authorizes appropriations. Title V: Effective Dates - Sets forth effective dates.
Bill· SS. 1607 (103rd)open
United States · United States Congress · 1 November 1993
TABLE OF CONTENTS: Title I: Public Safety and Policing Title II: Death Penalty Title III: Habeas Corpus Reform Title IV: Gun Crime Penalties Title V: Obstruction of Justice Title VI: Youth Violence Subtitle A: Increased Penalties for Drug Trafficking and Criminal Street Gangs Subtitle B: Juvenile Drug Trafficking and Gang Prevention Grants Subtitle C: Bindover System for Certain Violent Juveniles Title VII: Terrorism Subtitle A: Maritime Navigation and Fixed Platforms Subtitle B: General Provisions Title VIII: Sexual Violence and Child Abuse Subtitle A: Sexual Abuse Subtitle B: Child Protection Subtitle C: Crimes Against Children Title IX: Crime Victims Subtitle A: Victims' Rights Subtitle B: Crime Victims' Fund Title X: State and Local Law Enforcement Subtitle A: DNA Identification Subtitle B: Department of Justice Community Substance Abuse Prevention Subtitle C: Racial and Ethnic Bias Study Grants Title XI: Provisions Relating to Police Officers Subtitle A: Law Enforcement Family Support Subtitle B: Police Pattern or Practice Subtitle C: Police Corps and Law Enforcement Officers Training and Education Title XII: Drug Court Programs Title XIII: Prisons Subtitle A: Federal Prisons Subtitle B: State Prisons Title XIV: Rural Crime Subtitle A: Fighting Drug Trafficking in Rural Areas Subtitle B: Drug Free Truck Stops and Safety Rest Areas Title XV: Drug Control Subtitle A: Increased Penalties Subtitle B: Precursor Chemicals Act Subtitle C: General Provisions Title XVI: Drunk Driving Provisions Title XVII: Commissions Subtitle A: Commission on Crime and Violence Subtitle B: National Commission to Study the Causes of the Demand for Drugs in the United States Subtitle C: National Commission to Support Law Enforcement Title XVIII: Bail Posting Reporting Title XIX: Motor Vehicle Theft Prevention Title XX: Protection for the Elderly Title XXI: Consumer Protection Title XXII: Financial Institution Fraud Prosecutions THIS Title XXIII: Savings and Loan Prosecution Task Force Title XXIV: Sentencing Provisions Title XXV: Sentencing and Magistrates Amendments Title XXVI: Computer Crime Title XXVII: International Parental Kidnapping Title XXVIII: Safe Schools Title XXIX: Miscellaneous Subtitle A: Increases in Penalties Subtitle B: Extension of Protection of Civil Rights Statutes Subtitle C: Audit and Report Subtitle D: Gambling Subtitle E: White Collar Crime Amendments Subtitle F: Safer Streets and Neighborhoods Subtitle G: Other Provisions Title XXX: Technical Corrections Violent Crime Control and Law Enforcement Act of 1993 - Title I: Public Safety and Policing - Public Safety Partnership and Community Policing Act of 1993 - Amends the Omnibus Crime Control and Safe Streets Act of 1968 (Omnibus Act) to authorize the Attorney General to make grants and provide technical assistance to units of State and local government, and to other public and private entities, to increase police presence (including the rehiring of law enforcement officers laid off as a result of State and local budget reductions, as well as the hiring of new, additional career law enforcement officers, for deployment in community-oriented policing), expand and improve cooperative efforts between law enforcement agencies (LEAs) and members of the community, and otherwise enhance public safety. Sets forth matching fund, application, and related requirements. Authorizes appropriations. Title II: Death Penalty - Federal Death Penalty Act of 1993 - Amends the Federal criminal code to provide for imposition of the death penalty for various offenses, including: (1) murder by a Federal prisoner; (2) civil rights murders; (3) drive-by shootings and carjackings resulting in death; (4) foreign murder of U.S. nationals; (5) rape and child molestation murders; (6) gun murders during Federal crimes of violence and drug trafficking crimes; and (7) murder in the course of alien smuggling. (Sec. 202) Sets forth procedures for the imposition, implementation, and review of such sentence. Limits mitigating factors (such as impaired capacity, duress, minor participation, and victim's consent) and aggravating factors (such as involvement of a firearm or previous conviction of a violent felony involving a firearm, previous conviction of other serious offenses, vulnerability of victim, and continuing criminal enterprise involving drug sales to minors). Requires a special hearing to determine whether a death sentence is justified. Directs the court to instruct the jury not to consider the race, color, religious beliefs, national origin, or sex of the defendant or of any victim. Prohibits the execution of a woman while she is pregnant and of a person who is mentally retarded. Title III: Habeas Corpus Reform - An Act to enforce the fourteenth amendment and to reform habeas corpus - Amends the Federal judicial code to impose a 180-day limitations period for the filing of Federal habeas corpus petitions, applicable in both capital and non-capital cases in which the State has offered the petitioner counsel for State post-conviction review, which begins from the time the petitioner's conviction becomes final on State direct review. Tolls such period while the petitioner pursues State post-conviction remedies, unless the petitioner fails to initiate post-conviction review within 270 days in capital cases or 180 days in non-capital cases. Provides for a one-time 60-day extension of the period upon a showing of good cause. (Sec. 303) Provides an automatic stay of execution in capital cases through the consideration of the first Federal habeas corpus petition. Permits a stay of execution to be granted thereafter only if the petition on its face satisfies the requirements for successive petitions. (Sec. 304) Prohibits a Federal court from announcing or applying a new rule to grant relief to a habeas corpus petitioner, except where the new rule places a class of individual conduct beyond the power of the criminal lawmaking authority to proscribe or prohibits the imposition of a certain type of punishment for a class of persons because of their status or offense, or constitutes a watershed rule of criminal procedure implicating the fundamental fairness and accuracy of the criminal proceeding. Codifies caselaw providing for an independent Federal habeas corpus review of claims under Federal law, except for fourth amendment exclusionary rule claims. Specifies that the State bears the burden of proving harmless error in Federal habeas corpus review of State criminal convictions. (Sec. 305) Sets forth provisions regarding: (1) limits on successive petitions (allows a prisoner to bring a second or subsequent petition only upon a showing of cause for not having brought the claim before and prejudice if the claim is not heard); and (2) new evidence (allows prisoners in capital cases to present claims of actual innocence based on newly discovered evidence that the petitioner did not previously know about). (Sec. 308) Sets standards and procedures for the provision of counsel for indigent defendants at all stages of State capital litigation. Requires each State in which a sentence of death may be imposed to establish a State counsel certification authority, comprised of members of the State's criminal defense bar, to create a roster of qualified lawyers eligible for court appointment and monitor the performance of attorneys so certified. (Sec. 309) Amends the Omnibus Act to require the Director of the Bureau of Justice Assistance (BJA) to make grants to States to help fund the provision of defense counsel. Authorizes: (1) Federal grants of up to 75 percent of the additional costs imposed by the new counsel requirements during the first three years following enactment of this title and 50 percent thereafter; and (2) grants for the prosecution of Federal habeas corpus cases in an amount equal to that allocated to capital resource centers. (Sec. 310) Abrogates State sovereign immunity from suit in Federal court for a violation of specified provisions regarding the establishment of a State certification authority and attorney compensation. Title IV: Gun Crime Penalties - Directs the U.S. Sentencing Commission to amend its sentencing guidelines to enhance the penalty for: (1) use of a semiautomatic firearm during a crime of violence or a drug trafficking crime; (2) a second offense of using an explosive to commit a Federal felony; (3) use of a firearm in the commission of counterfeiting or forgery; and (4) firearms possession by violent felons and serious drug offenders. (Sec. 403) Prohibits and sets penalties for: (1) smuggling firearms in aid of drug trafficking; (2) theft of firearms and explosives; (3) the transfer of firearms to a nonresident of a State, except for lawful sporting purposes; (4) conspiracies to commit firearms and explosives crimes; and (5) the distribution of explosives to a person who is legally disqualified from having the explosives. (Sec. 405) Mandates the revocation of: (1) supervised release and the institution of a prison term for a defendant who possesses a controlled substance or firearm in violation of a condition of such release, or who refuses to cooperate with drug testing; and (2) probation for possession of a controlled substance or firearms in violation of a condition of probation, or who refuses to cooperate with drug testing. (Sec. 407) Increases the penalty for: (1) knowingly making a false, material statement in connection with the acquisition of a firearm from a licensed dealer; and (2) interstate gun trafficking. Title V: Obstruction of Justice - Increases the penalties for threats and intimidation of jurors and court officers, obstruction of justice, and attempted retaliatory killings of witnesses, victims, and informants. (Sec. 501) Provides the death penalty for: (1) the murder of jurors and court officers; (2) retaliatory killings of witnesses, victims, and informants; (3) the murder of State officials working with Federal law enforcement officials in connection with Federal criminal investigations; and (4) the murder of Federal witnesses. (Sec. 503) Creates an exception to current law requiring that persons charged with capital offenses be furnished with a list (with addresses) of veniremen and witnesses, if the court finds by a preponderance of the evidence that providing such list may jeopardize the life or safety of any person. Title VI: Youth Violence - Subtitle A: Increased Penalties for Drug Trafficking and Criminal Street Gangs - Amends: (1) the Controlled Substances Act (CSA) to increase penalties for employing children to distribute drugs or avoid apprehension for a drug offense; and (2) the Federal criminal code to provide for imprisonment of up to ten years for a gang member or person acting on behalf of a criminal street gang who commits a Federal drug or violent crime offense and who has had a prior drug or crime of violence conviction, with the penalty to run consecutively to any other sentence imposed. Subtitle B: Juvenile Drug Trafficking and Gang Prevention Grants - Amends the Juvenile Justice and Delinquency Prevention Act of 1974 to authorize the Administrator of the Office of Juvenile Justice and Delinquency Prevention to make grants for: (1) programs to reduce the formation or continuation of juvenile gangs and the use and sale of illegal drugs by juveniles; (2) public or non-profit private organizations or individuals to identify promising new juvenile drug reduction and enforcement programs; and (3) public or non-profit private organizations or individuals to support promising new programs that specifically address the unique crime, drug, and alcohol related challenges faced by juveniles living at or near international ports of entry and in other international border communities. Authorizes appropriations. Subtitle C: Bindover System for Certain Violent Juveniles - Amends the Omnibus Act to authorize grants for bindover systems for the prosecution of 16- and 17-year-olds as adults for certain violent crimes (first- and second-degree murder, attempted murder, armed robbery with a firearm, aggravated battery or assault with a firearm, criminal sexual penetration when armed with a firearm, and drive-by shooting). Title VII: Terrorism - Subtitle A: Maritime Navigation and Fixed Platforms - Amends the Federal criminal code to prohibit and set penalties for the seizure of a ship or fixed platform by force, an act of violence against a person aboard, damage or destruction, or the injuring or killing of a person in connection with such activities. Provides the death penalty where death results. Subtitle B: General Provisions - Provides the death penalty where death results from the use of a weapon of mass destruction. (Sec. 714) Extends: (1) the application of State, territory, or district law for offenses committed in territorial waters not otherwise committed within a State's territory or district; (2) special maritime and territorial jurisdiction to offenses committed by or against a U.S. national during a voyage on a foreign vessel scheduled to depart from or arrive in the United States; and (3) the statute of limitations to ten years for certain terrorist offenses. (Sec. 716) Provides: (1) the death penalty for the commission of torture outside the United States and for the killing of a U.S. national outside the country; (2) the Federal Bureau of Investigation (FBI) with access to telephone subscriber information if the Director or Deputy Assistant Director certifies that such information is relevant to a foreign counterintelligence investigation and that it pertains to an agent of a foreign power; and (3) criminal penalties for willful violations of airport or airline security regulations. (Sec. 719) Prohibits: (1) acts of terrorism at U.S. international airports (and provides the death penalty where death results), subject to certain limitations; and (2) counterfeiting U.S. currency abroad (and sets penalties). Enhances penalties for any felony that involves or is intended to promote international terrorism. Sets penalties for those who provide material support to terrorists. (Sec. 722) Creates an Economic Terrorism Task Force. (Sec. 725) Amends the Immigration and Nationality Act to authorize the Attorney General to grant a nonimmigrant visa to an alien who possesses critical information about a criminal organization and whose presence in the United States is essential to an investigation or prosecution of such organization. Title VIII: Sexual Violence and Child Abuse - Subtitle A: Sexual Abuse - Amends the Federal criminal code to include within the definition of "sexual act" the intentional touching, not through the clothing, of the genitalia of another person who has not attained age 16 with intent to abuse, humiliate, harass, degrade, or arouse or gratify the sexual desire of any person. Subtitle B: Child Protection - National Child Protection Act of 1993 - Provides for the establishment of a national background check system whereby child care organizations can determine whether prospective employees have histories of child abuse or other serious crimes. Requires States to have at least 80 percent currency of crime cases in their systems within three years. Directs the Administrator of the Office of Juvenile Justice and Delinquency Prevention to begin a study of child abusers' criminal records. (Sec. 816) Amends the Omnibus Act to provide for the use of drug control and system improvement grants for the improvement of State record systems and the sharing of records of child abuse crime information to implement this subtitle. Subtitle C: Crimes Against Children - Jacob Wetterling Crimes Against Children Registration Act - Directs the Attorney General to establish guidelines for State programs requiring any person convicted of a criminal offense against a victim who is a minor to register a current address with a designated State LEA for ten years after release from prison or being placed on parole or supervised release. Subjects to criminal penalties a person required to register under a State program who knowingly fails to register and keep such registration current. (Sec. 823) Specifies that the allocation of BJA grant funds (under the Omnibus Act) received by a State not complying with provisions of this Act three years after its enactment shall be reduced by ten percent, with the unallocated funds to be reallocated to the States in compliance with this Act. Title IX: Crime Victims - Subtitle A: Victims' Rights - Amends Rule 32 of the Federal Rules of Criminal Procedure to give victims of violent crimes and sexual abuse the right to address the court concerning the sentence to be imposed on convicted offenders. Permits such right to be exercised by a parent or guardian if the victim is under 18, or by one or more family members if the victim is deceased or incapacitated. (Sec. 902) Requires courts to order criminal defendants who are convicted to pay restitution to victims. Specifies that a restitution order shall constitute a lien against real or personal property. Subtitle B: Crime Victims' Fund - Amends the Victims of Crime Act of 1984 to provide that if the compensation paid by an eligible crime victim compensation program would cover costs that a Federal, or a federally financed State or local, program would otherwise pay: (1) such victim compensation program shall not pay such compensation; and (2) the other program shall make its payments without regard to the existence of the crime victim compensation program. (Sec. 913) Allows: (1) up to five percent of a victim compensation or assistance program grant to be used for administrative costs; and (2) the Director of the Office for Victims of Crime to use unspent compensation funds for assistance programs in either the year such funds are not spent or in the following year. (Sec. 917) Requires grantees to certify that no grant funds will be used to supplant State and local funds, but rather will supplement those otherwise available funds. Title X: State and Local Law Enforcement - Subtitle A: DNA Identification - DNA Identification Act of 1993 - Amends the Omnibus Act to authorize the use of drug control and system improvement grants to develop or improve in a forensic laboratory a capability to analyze deoxyribonucleic acid (DNA) for specified identification purposes. Sets forth provisions regarding: (1) restrictions on the use of funds; and (2) reporting and recordkeeping (including access to records) requirements. Authorizes appropriations. (Sec. 1003) Requires the Director of: (1) the FBI to appoint a distinct advisory board on DNA quality assurance methods from among nominations proposed by the National Academy of Sciences and professional societies of crime laboratory officials and issue standards for quality assurance; and (2) the National Institute of Justice (NIJ) to make specified certifications to the House and Senate Judiciary Committees regarding the establishment of a proficiency testing program for DNA analyses. (Sec. 1004) Authorizes the Director to establish an index of DNA identification records of persons convicted of crimes, and of analyses of DNA samples recovered from crime scenes and from unidentified human remains. (Sec. 1005) Sets forth proficiency testing and privacy protection requirements, and penalties for violations. (Sec. 1006) Authorizes appropriations. Subtitle B: Department of Justice Community Substance Abuse Prevention - Department of Justice Community Substance Abuse Prevention Act of 1993 - Amends the Omnibus Act to authorize the Attorney General to make grants to eligible coalitions to develop and implement substance abuse prevention programs, with the efforts of such coalitions involving substantial community participation. Grants priority to communities providing evidence of significant abuse. Authorizes appropriations. Subtitle C: Racial and Ethnic Bias Study Grants - Authorizes the Attorney General to make grants to States that have established, by State law or the court of last resort, plans for analyzing the role of race in their criminal justice systems. Requires State plans to include recommendations designed to correct any findings of racial and ethnic bias. Authorizes appropriations. Title XI: Provisions Relating to Police Officers - Subtitle A: Law Enforcement Family Support - Amends the Omnibus Act to: (1) require the Director of the BJA to establish guidelines and oversee the implementation of family-friendly policies in law enforcement divisions of the Department of Justice (DOJ), identify model programs that provide support to law enforcement families, and provide technical assistance for stress reduction and family support efforts by State and local LEAs; and (2) authorize the Director to make grants to States and local LEAs and organizations representing State or local law enforcement personnel to provide family support services to law enforcement personnel. Authorizes appropriations. Subtitle B: Police Pattern or Practice - Prohibits any governmental authority, or any agent or person acting on behalf of such authority, from engaging in a pattern or practice of conduct by law enforcement officers that deprives persons of their constitutional or Federal rights. Authorizes the Attorney General to bring a civil action against such officers to eliminate such practices. (Sec. 1112) Directs the Attorney General to acquire data about the use of excessive force by law enforcement officers. Subtitle C: Police Corps and Law Enforcement Officers Training and Education - Chapter 1: Police Corps - Police Corps Act - Establishes in DOJ an Office of the Police Corps and Law Enforcement Education, headed by a Director. Authorizes the Director to award college and graduate school scholarships (of up to $30,000 per student) in exchange for four years work with a State or local police force upon graduation. Requires participants who do not follow through on their commitment to pay back all the scholarship money plus ten percent interest. (Sec. 1127) Sets forth provisions regarding: (1) selection and training of participants; (2) swearing in, discipline, and layoffs; (3) State plan requirements; and (4) assistance to States and localities employing police corps officers. Authorizes appropriations. Chapter 2: Law Enforcement Scholarship Program - Law Enforcement Scholarships and Recruitment Act - Requires the Director to provide scholarships for in-service law enforcement personnel who seek further education, allotting 80 percent of funds based on the relative number of law enforcement officers per State and 20 percent based on the relative shortage of officers. Provides grants for summer jobs or part-time jobs during the year for high school students interested in law enforcement careers. Authorizes appropriations. Title XII: Drug Court Programs - Amends the Omnibus Act to authorize the BJA to make grants to States: (1) for drug testing upon arrest, during the pretrial period, or during participation in any pre- or post-conviction diversion program; (2) to develop alternative methods of punishment for young nonviolent offenders to traditional forms of incarceration and probation; and (3) for residential substance abuse treatment programs in State prisons. Authorizes appropriations. Title XIII: Prisons - Subtitle A: Federal Prisons - Amends the Federal criminal code to: (1) prohibit the Bureau of Prisons from showing favoritism to prisoners of high social or economic status in designating their place of imprisonment; and (2) require that any submission of legislation by the judicial or executive branch that might affect prison populations be accompanied by an impact statement (and requires the Attorney General to prepare and transmit to the Congress annual prison impact assessments). (Sec. 1303) Federal Prisoner Drug Testing Act of 1993 - Requires the Director of the Administrative Office of the U.S. Courts to establish a program of drug testing of Federal offenders on post-conviction release. (Sec. 1304) Drug Treatment in Federal Prisons Act of 1993 - Establishes a schedule for the Bureau of Prisons to place all eligible prisoners into residential substance abuse treatment programs for between nine and 12 months, in facilities separate from the general prison population. Specifies that prisoners who successfully complete such programs could be released up to a year early. Authorizes appropriations. (Sec. 1305) Directs the court, in imposing sentence, to consider the expected costs to the Government of any imprisonment, supervised release, or probation. Authorizes the Sentencing Commission, in promulgating guidelines, to include as a component of a fine the expected costs to the Government of any imprisonment, supervised release, or probation sentence that is ordered. Subtitle B: State Prisons - Authorizes the Attorney General to make grants to States and to multi-State compact associations for the development and operation of boot camp prisons (for prisoners not convicted of violent felonies, providing a highly regimented schedule of strict discipline, physical training, and work, as well as remedial education and treatment for substance abuse) and regional prisons (for violent offenders with serious substance abuse problems). Specifies that grants may support the activation of boot camp and regional prison facilities already constructed by State or local governments, and shall support aftercare services (to reduce the likelihood of repeat criminality following release). Authorizes appropriations. (Sec. 1323) Requires the Director of NIJ to study: (1) the feasibility of establishing an information clearinghouse to facilitate the interstate transfer of prisoners to facilities near their families; (2) the recidivism rates of persons who were under the influence of alcohol at the time they committed their crimes, comparing recidivism rates of those who participated in a residential treatment program while in custody with those who did not; and (3) the use of alcohol, alone or in combination with other drugs, as a factor in criminal activity. (Sec. 1324) Requires the Bureau of Prisons to notify State and local law enforcement authorities concerning the release or relocation to their areas of Federal offenders under post-release supervision, with respect to prisoners convicted of drug trafficking and violent crimes. Title XIV: Rural Crime - Subtitle A: Fighting Drug Trafficking in Rural Areas - Amends the Omnibus Act to authorize appropriations, and increase the base allocation, for rural drug enforcement assistance. (Sec. 1402) Directs the Attorney General, subject to the availability of appropriations, to establish a Rural Drug Enforcement Task Force in each of the Federal judicial districts which encompass significant rural lands. (Sec. 1403) Authorizes the Attorney General to cross-designate up to 100 Federal officers with jurisdiction to enforce CSA provisions on non-Federal lands to the extent necessary to effect the purposes of this title. (Sec. 1404) Requires the Director of the Federal Law Enforcement Training Center to develop a specialized course of instruction devoted to training law enforcement officers from rural agencies in the investigation of drug trafficking and related crimes. Authorizes appropriations. Subtitle B: Drug Free Truck Stops and Safety Rest Areas - Amends the CSA to enhance penalties for drug distribution at or near truck stops and safety rest areas. Title XV: Drug Control - Subtitle A: Increased Penalties - Amends: (1) the Federal criminal code to enhance penalties for drug trafficking and illegal drug use in prisons; (2) the Tariff Act of 1930 to make the penalty for failure to declare a controlled substance 1,000 percent of the value of the article (as under current law) or $500, whichever is greater; and (3) the CSA to enhance penalties for drug dealing in or near public housing authority facilities, and to set penalties for any physical trainer or adviser who endeavors to persuade or induce an individual to possess or use anabolic steroids in violation of such Act. (Sec. 1505) Directs the Sentencing Commission to amend the sentencing guidelines to increase penalties for drug-dealing in "drug-free" zones. Subtitle B: Precursor Chemicals Act - Chemical Control Amendments Act of 1993 - Amends the CSA to impose registration requirements for precursor chemicals. (Sec. 1514) Requires manufacturers to submit annual reports concerning listed chemicals manufactured during the year. (Sec. 1515) Amends the Controlled Substances Import and Export Act to: (1) subject brokers and traders to the same recordkeeping and reporting requirements for international transactions, and the same criminal penalties, as exporters; and (2) authorize the Attorney General to require that the 15-day advance notice requirement with respect to the importation and exportation of listed chemicals apply to all exports of specific listed chemicals to specified countries, regardless of the status of certain customers in such countries as regular customers, if necessary to support effective diversion control programs or as required by treaty; and (3) establish criminal penalties for attempting to evade reporting requirements and for smuggling listed drugs. (Sec. 1519) Grants the Attorney General the same inspection authority for listed chemicals as presently exists with respect to controlled substances. (Sec. 1521) Makes it a felony to violate the Solid Waste Disposal Act in the handling of chemicals used to illegally manufacture a controlled substance. Requires that violators be assessed costs of the initial cleanup an disposal of the listed chemical and contaminated property and the costs of restoring property damaged by exposure to such chemical. Subtitle C: General Provisions - Prohibits advertising which aims to illegally solicit or sell drugs. (Sec. 1535) Includes among the long-term goals of the National Drug Control Strategy making drug treatment available to all who need it. (Sec. 1536) Amends the Federal Aviation Act of 1958 to require the Administrator of the Federal Aviation Administration to issue regulations requiring employees to report to law enforcement authorities the discovery of illegal drugs or amounts of cash over $10,000 in airport security screenings. Title XVI: Drunk Driving Provisions - Drunk Driving Child Protection Act of 1993 - Amends the Federal criminal code to provide supplementary prison terms and fine authorizations in cases where drunk driving endangers or injures a person under 18 years of age. (Sec. 1603) Expresses the sense of the Congress that in determining child custody and visitation rights the courts should consider the history of drunk driving of anyone involved in the determination. Title XVII: Commissions - Subtitle A: Commission on Crime and Violence - Establishes the National Commission on Crime and Violence in America to develop a comprehensive crime control plan for the 1990's. Subtitle B: National Commission to Study the Causes of the Demand for Drugs in the United States - National Commission to Study the Causes of the Demand for Drugs in the United States - Establishes a National Commission to Study the Causes of the Demand for Drugs in the United States. Subtitle C: National Commission to Support Law Enforcement - National Commission to Support Law Enforcement Act - Establishes a National Commission to Support Law Enforcement. Title XVIII: Bail Posting Reporting - Illegal Drug Profits Act of 1993 - Requires State and Federal criminal court clerks to report to the Internal Revenue Service (IRS) and prosecutors the name and taxpayer identification number of anyone accused of a drug, money laundering, or racketeering crime who posts cash bail exceeding $10,000. Title XIX: Motor Vehicle Theft Prevention - Motor Vehicle Theft Prevention Act - Directs the Attorney General to develop a national voluntary motor vehicle theft prevention program which would involve placing identifiable decals on the vehicles of consenting owners, whereby such vehicles could then be stopped by law enforcement officers upon a reasonable suspicion that the vehicles were not being operated by or with the consent of their owners. (Sec. 1903) Prohibits and sets penalties for tampering with the decals, with exceptions. Title XX: Protections for the Elderly - Directs the Attorney General, subject to the availability of appropriations, to make grants in support of programs to protect and locate missing patients with Alzheimer's disease and related dementias. Authorizes appropriations. (Sec. 2002) Directs the Sentencing Commission to ensure that the sentences for those convicted of crimes of violence against elderly victims be sufficiently stringent to deter such crimes, protect the public from additional crimes of such a defendant, and provide enhanced penalties under specified criteria. Title XXI: Consumer Protection - Amends the Federal criminal code to set penalties for insurance industry crimes, including embezzling from insurance companies, making false entries in insurance company books with intent to deceive, and corruptly influencing or obstructing proceedings before State insurance regulatory agencies or insurance examiners. Prohibits persons convicted of criminal felonies involving dishonesty or breach of trust from engaging in the insurance business without the written consent of an insurance regulatory official authorized to regulate the insurer. (Sec. 2102) Consumer Protection Against Credit Card Fraud Act of 1993 - Prohibits the sale of credit cards without credit card company authorization, fraudulent receipt of payments via credit card for goods never received or inferior to those promised, and laundering to credit card receipts. (Sec. 2103) Extends the mail fraud statute to include mail sent by private interstate carriers. Title XXII: Financial Institution Fraud Prosecutions - Financial Institutions Fraud Prosecution Act of 1991 (sic) - Amends the Federal Deposit Insurance Act and the Federal Credit Union Act to disqualify certain persons with criminal records from participating in the affairs of insured depository institutions and credit unions. (Sec. 2204) Amends the Crime Control Act of 1990 to encourage the Attorney General to report to the Congress on the collapse of private insurance deposit corporations. Title XXIII: Savings and Loan Prosecution Task Force - Directs the Attorney General to establish within DOJ a savings and loan criminal fraud task force to prosecute those criminal cases involving savings and loan institutions. Title XXIV: Sentencing Provisions - Amends the Federal criminal code to allow the court, in determining the sentence to be imposed in the case of a violation of probation or supervised release, to consider guidelines or policy statements issued by the Sentencing Commission. (Sec. 2403) Directs the court to revoke a term of supervised release and require the defendant to serve in prison all or part of the term of release authorized by statute for the offense that resulted in such term, without credit for time previously served on post-release supervision, if the court finds that the defendant violated a condition of supervised release, subject to specified limitations. Authorizes the court to include a requirement that the defendant be placed on supervised release after imprisonment when a term of supervised release is revoked and the defendant is required to serve a term of imprisonment less than the maximum authorized. Specifies that the power of the court to revoke a term of supervised release for violation of a condition of such release extends beyond the expiration of the term of release for a period reasonably necessary for the adjudication of matters arising before its expiration if, prior to such expiration, a warrant or summons ha been issued on the basis of an allegation of such a violation. (Sec. 2404) Provides for the application of the sentencing guidelines (and any pertinent policy statement issued by the U.S. Sentencing Commission) for certain nonviolent drug offenses in which a mandatory minimum term of imprisonment would otherwise be required. Directs the Sentencing Commission to: (1) review the consideration of defendants' criminal histories under the guidelines; and (2) monitor the operation of this Act. Title XXV: Sentencing and Magistrates Amendments - Permits concurrent sentencing of a defendant to imprisonment and probation for petty offenses. (Sec. 2502) Authorizes the trial of petty offenses by magistrate judges. Title XXVI: Computer Crime - Computer Abuse Amendments Act of 1993 - Amends the Computer Fraud and Abuse Act to make it a felony to knowingly transmit an unauthorized program or code that alters the information stored in a computer with the intent to damage the system or information contained within the affected computer or system, or to withhold or deny the use of such system or information, if the transmission: (1) occurred without the authorization of the person responsible for the computer system receiving the program; and (2) causes damage exceeding $1,000 in any one-year period or modifies or impairs the medical care of one or more individuals. Makes it a misdemeanor to recklessly transmit a destructive computer program or code. Creates a civil cause of action for persons suffering damage or loss by virtue of a violation of this Act. Modifies the prohibition against accessing a Government computer where such conduct affects the use of the Government's operation of such computer to cover only actions that "adversely" affect such use. Title XXVII: International Parental Kidnapping - International Parental Kidnapping Crime Act of 1993 - Amends the Federal criminal code to establish penalties for removing a child from, or retaining a child outside, the United States with intent to obstruct the lawful exercise of parental rights. (Sec. 2703) Authorizes appropriations to carry out under the State Justice Institute Act of 1984 national, regional, and in-State training and educational programs dealing with criminal and civil aspects of interstate and international parental child abduction. Title XXVIII: Safe Schools - Safe Schools Act of 1993 - Amends the Omnibus Act to: (1) authorize the Director of the BJA to make grants to local educational agencies for the purpose of providing assistance to such agencies most directly affected by crime and violence; and (2) require the Director to develop a written safe schools model in English and in Spanish and make such model available to any such agency that requests it. Authorizes appropriations. Title XXIX: Miscellaneous - Subtitle A: Increases in Penalties - Increases penalties for assault: (1) of Federal officers, foreign officials, and official guests and internationally protected persons; (2) within a maritime and territorial jurisdiction; and (3) of the President, presidential staff, congressional leaders, cabinet officials, and Supreme Court justices. (Sec. 2902) Increases the maximum penalties for voluntary and involuntary manslaughter. (Sec. 2903) Broadens the scope and increases the penalties for conspiracies to deprive persons of their civil rights. (Sec. 2904) Increases penalties for: (1) trafficking in counterfeit goods and services; (2) conspiracy to commit murder for hire; and (3) Travel Act violations. Subtitle B: Extension of Protection of Civil Rights Statutes - Extends the protections of the criminal civil rights statute to any person in a State. (Currently, the statute only covers State "inhabitants.") Subtitle C: Audit and Report - Directs the Attorney General to: (1) require State and local LEAs to annually audit and detail the uses and expenses to which forfeiture funds were dedicated and the amount used for each use or expense; and (2) report to the Congress on the administrative and contracting expenses paid from the DOJ Assets Forfeiture Fund. Subtitle D: Gambling - Grants a State gaming enforcement office located within a State Attorney General's office access to FBI criminal history record information for licensing purposes. Subtitle E: White Collar Crime Amendments - Establishes penalties for knowingly receiving the proceeds of: (1) extortion; (2) a kidnapping; and (3) a postal robbery. (Sec. 2943) Extends the prohibition against obstructing civil investigative demands to include obstruction in racketeering and false claims investigations. Subtitle F: Safer Streets and Neighborhoods - Safer Streets and Neighborhoods Act of 1993 - Amends the Omnibus Act to authorize the Director of the BJA to make grants to, or enter into contracts with, non-Federal public or private agencies, institutions, or organizations to carry out specified purposes of such Act (current law does not specify "non-Federal"), effective October 1, 1993. Subtitle G: Other Provisions - Authorizes the venue for espionage and related offenses to be in the District of Columbia or in any other district authorized by law. (Sec. 2963) Amends the Anti-Drug Abuse Act to make amendments with respect to certain IRS undercover operations effective from the date of this Act's enactment through December 31, 1994. (Sec. 2964) Directs the Attorney General and the Secretary of Health and Human Services to report to the Congress on the medical and psychological basis of "battered women's syndrome" and the extent to which evidence of the syndrome has been held to be admissible as evidence of guilt or as a defense in a criminal trial. (Sec. 2966) Amends the Federal criminal code to set penalties for: (1) the theft of major art works from museums; (2) misuse of the words "Drug Enforcement Administration" or the initials "DEA"; and (3) attempted robbery, kidnapping, smuggling, and property damage offenses. (Sec. 2971) Extends the statute of limitations of arson. Title XXX: Technical Corrections - Makes technical corrections to various criminal law provisions.
Bill· HRH.R. 3408 (103rd)open
United States · United States Congress · 28 October 1993
New Orleans Jazz National Historical Park Act of 1993 - Establishes the New Orleans Jazz National Historical Park, Louisiana, (Park) to be administered and managed as a unit of the Jean Lafitte National Historical Park and Preserve. Requires the Secretary of the Interior to prepare a general management plan for the Park. Establishes the New Orleans Jazz Commission to: (1) advise the Secretary in the preparation of the general management plan, assist in public discussions of planning proposals, and assist the National Park Service in working with individuals, groups, and organizations in determining programs in which the Secretary should participate through cooperative agreements; (2) develop partnerships with educational groups, schools, universities, and other groups, including city-wide organizations, in furtherance of this Act; (3) raise and disperse funds for programs that assist mutual aid and benevolent societies in encouraging the continuation of and enhancement of jazz cultural traditions; (4) acquire or lease property for jazz education, and advising on hiring brass bands and musical groups to participate in education programs and help train young musicians; (5) assist in providing recommendations for the location of the Park's visitor center and other interpretive sites and funds to support research on the origins and early history of jazz in New Orleans; and (6) seek and accept donations to use for providing services, programs, and facilities for jazz education or assisting in the rehabilitation and restoration of structures identified in the national historic landmark study as having outstanding significance to the history of jazz in New Orleans. Authorizes appropriations.
Bill· HRH.R. 3404 (103rd)referred
United States · United States Congress · 28 October 1993
Cardiopulmonary Resuscitation and First Aid School Training Act of 1993 - Amends the Elementary and Secondary Education Act of 1965 to direct the Secretary of Education to make at least ten demonstration grants to local educational agencies to provide secondary school students with instruction, training, and programs in cardiopulmonary resuscitation and first aid.
Bill· HRH.R. 3415 (103rd)referred
United States · United States Congress · 28 October 1993
Family Violence Prevention Act - Amends the Family Violence Prevention and Services Act to require: (1) State demonstration grant applications to contain a plan to address the needs of specified underserved populations; (2) State grantees to file performance reports as a prerequisite for funding; and (3) the Secretary of Health and Human Services to delegate to the Secretary of Education the power to implement and evaluate model programs to educate young people about domestic violence and violence among intimate partners and to transmit an evaluation of those plans to relevant congressional committees for review. Authorizes appropriations.
Bill· HRH.R. 3403 (103rd)referred
United States · United States Congress · 28 October 1993
TABLE OF CONTENTS: Title I: National Leadership for Educational Technology Title II: State Planning Grants Title III: Local Challenge Grants Title IV: Miscellaneous Programs Technology for Excellence in Education Act - Title I: National Leadership for Educational Technology - Directs the Secretary of Education to appoint a Director of Educational Technology within the Department of Education, with specified duties. Title II: State Planning Grants - Authorizes the Secretary to make one-time competitive grants to State educational agencies (SEAs), according to a specified allotment formula, for: (1) a comprehensive, long-term State educational technology plan; and (2) competitive subgrants to local educational agencies (LEAs) to implement such plan strategies. Authorizes appropriations. Title III: Local Challenge Grants - Authorizes the Secretary to make grants to SEAs for use by LEAs of three-year competitive demonstration grants to implement State technology plans. Gives priority to demonstration programs that: (1) provide access to quality educational technology to disadvantaged urban and rural areas; and (2) may be replicated in other areas nationwide. Reserves certain funds for the Director to disseminate effective models of the use of high-quality educational technology on a national basis. Sets certain matching funds requirements. Authorizes appropriations. Title IV: Miscellaneous Programs - Makes acquisition and use of, and training for, educational technology authorized activities for existing Federal education programs, through various amendments to the Elementary and Secondary Education Act of 1965, Indian Education Act of 1988, Head Start Act, Head Start Transition Project Act, Carl D. Perkins Vocational and Applied Technology Act, and Individuals with Disabilities Education Act.