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Bill· HRH.R. 5066 (103rd)referred
United States · United States Congress · 20 September 1994
Amends the Public Health Service Act to modify the eligibility requirements for appointment as the Surgeon General of the Public Health Service by requiring that candidates have been continuously on active duty as members of the Regular Corps for at least 20 years. Makes this Act effective with respect to any individual holding such position on or after this Act's enactment date.
Bill· HJRESH.J.Res. 410 (103rd)referred
United States · United States Congress · 20 September 1994
Designates October 1994 as National Spina Bifida Month.
Bill· SS. 2440 (103rd)referred
United States · United States Congress · 19 September 1994
Prospective Payment System for Nursing Facilities - Makes this Act applicable to the payment for services of nursing facilities under federally funded long-term care programs. (Sec. 102) Sets forth as payment objectives to: (1) maintain an equitable and fair balance between cost containment and quality of care in nursing facilities; (2) maintain administrative simplicity for such facilities and the Secretary of Health and Human Services; (3) encourage nursing facilities to admit residents without regard to their source of payment; (4) encourage investment in buildings and improvements to nursing facilities as necessary to maintain quality and access; and (5) provide an incentive to nursing facilities to admit and provide care to persons in need of comparatively greater care. (Sec. 103) Sets forth provisions regarding: (1) powers and duties of the Secretary; and (2) the relationship of this Act to title XVIII (Medicare) of the Social Security Act. (Sec. 105) Directs the Secretary to: (1) establish a system which groups residents into classes according to similarity of their assessed condition and required services; (2) assign relative weights for resident classes based on the relative value of the resources required for each resident class, performed for each geographic region; and (3) designate no fewer than eight geographic regions. (Sec. 106) Requires the Secretary to determine payment rates for nursing facilities using the following cost-service groupings: (1) nursing service costs; (2) administrative and general costs; (3) fee-for-service ancillary services; (4) selected ancillary services and other costs; and (5) property costs. Directs that nursing facilities be: (1) paid a prospective, facility-specific, per diem rate based on the sum of the per diem rates established for the nursing service, administrative and general, and property cost centers and a facility-specific prospective rate for each unit of the fee-for-service ancillary services; and (2) reimbursed for selected ancillary services and other costs on a retrospective basis. (Sec. 107) Requires the nursing facility to perform periodic resident assessments to determine the resident class of each resident in the facility. (Sec. 108) Sets forth provisions regarding: (1) determination of the per diem rates for nursing service, administrative and general, and property costs; (2) payment for fee-for-service ancillary services; (3) reimbursement of selected ancillary services and other costs; (4) mid-year rate adjustments; and (5) exceptions to payment methods for new and low volume nursing facilities. (Sec. 114) Grants any person or legal entity aggrieved by a decision of the Secretary under this Act, which results in an amount in controversy of $10,000 or more, the right to appeal directly to the Provider Reimbursement Review Board.
Bill· HRH.R. 5056 (103rd)open
United States · United States Congress · 19 September 1994
Animal Drug Amendments of 1994 - Amends the Federal Food, Drug, and Cosmetic Act to permit the extra-label use of drugs in animals if an approval of an application is in effect with respect to a particular use or intended use of a new animal drug and such use is upon the order of a licensed veterinarian within the context of a veterinarian-client-patient relationship and is in compliance with regulations that establish the conditions for such use. Authorizes the Secretary of Health and Human Services, if the Secretary finds that there is a reasonable probability that such use may present a risk to the public health, to establish a safe level for a residue of an animal drug when used for such different use and require the development of a practical, analytical method for the detection of residues of the drug above the safe level established. Prohibits such use if it results in residues exceeding the safe level.
Bill· SS. 2433 (103rd)referred
United States · United States Congress · 13 September 1994
Nursing Education Consolidation and Reauthorization Act of 1994 - Amends the Public Health Service Act to revise provisions regarding the general student loan program for nursing education. Makes individuals who breach agreements for obligated service by failing to maintain an acceptable level of academic standing, by being dismissed for disciplinary reasons, by voluntarily terminating the program, or by failing to provide health services under the program for the applicable period liable for the amount of the award, including amounts provided for expenses related to such attendance and interest at the maximum legal prevailing rate. Waives or suspends such liability under specified circumstances. Sets forth provisions regarding: (1) application requirements, including a plan for carrying out a project, performance standards, and linkages with relevant educational and health care entities; (2) use of funds; (3) matching requirements; (4) preferences; (5) grant and contract awards; (6) information requirements; (7) training program requirements; (8) duration of assistance; and (9) peer review. Establishes a National Advisory Council on Nurse Education and Practice. Permits funds appropriated under the Act to be used by the Secretary to provide technical assistance. Provides for the recovery of construction assistance by the Secretary if specified conditions are not met. Specifies that the right of recovery of the United States shall not, prior to judgment, constitute a lien on any facility. Authorizes the Secretary to award grants to, and enter into contracts with, eligible entities to meet the costs of: (1) projects that support the enhancement of advanced practice nursing education; and (2) traineeships for individuals in advanced practice nursing programs. Specifies that nurse practitioner and nurse midwifery programs eligible for support are educational programs for registered nurses that meet specified guidelines and that have as their objective the education of nurses who will upon completion of their studies be qualified to effectively provide primary health care. Authorizes appropriations. Authorizes the Secretary to award grants to, and enter into contracts with, eligible entities to meet the costs of special projects to increase nursing education opportunities for individuals who are from disadvantaged racial and ethnic backgrounds underrepresented among registered nurses by providing student scholarships or stipends, pre-entry preparation, and retention activities. Authorizes appropriations. Authorizes the Secretary to award grants to, and enter into contracts with, eligible entities for projects to strengthen capacity for basic nurse education and practice. Authorizes appropriations.
Bill· HRH.R. 5037 (103rd)referred
United States · United States Congress · 13 September 1994
Bipartisan Health Care Reform Commission Act of 1994 - Establishes an independent Bipartisan Health Care Reform Commission to: (1) conduct an analysis of the health care systems of the States, as well as proposed or enacted reforms of such systems, and of the problems relating to Federal programs and policies relating to health care; (2) analyze private sector health systems; and (3) make recommendations on reforms that the Congress should consider in response to the findings of the analyses. Directs the Commission to: (1) hold at least five public hearings; and (2) report to the Congress on the state of health care in the United States. Sets forth provisions regarding procedures for congressional consideration of any recommendations of the Commission and review of any bill proposed by the Commission or an appropriate committee by the Director of the Congressional Budget Office.
Bill· HJRESH.J.Res. 409 (103rd)referred
United States · United States Congress · 13 September 1994
Designates the week of October 23 through 31, 1994, as National Red Ribbon Week for a Drug-Free America.
Resolution· HRESH.Res. 530 (103rd)referred
United States · United States Congress · 13 September 1994
Declares that no health care legislation should be considered by the House of Representatives that would cause a sequestration under the Balanced Budget and Emergency Deficit Control Act of 1985 (Gramm-Rudman-Hollings), or that would amend or supercede a sequestration.
Bill· HRH.R. 5013 (103rd)open
United States · United States Congress · 21 August 1994
TABLE OF CONTENTS: Title I: Leadership in Educational Technology Title II: State Planning for Improving Student Achievement Through Integration of Technology Into the Curriculum Title III: National Telecommunications and Information Infrastructure Development Title III: (sic): Universal Service for Education Classroom Technology Act of 1994 - Title I: Leadership in Educational Technology - Authorizes the Secretary of Education to carry out Federal leadership activities in promoting higher student achievement through the use of technology in education. Directs the Secretary to: (1) develop and publish a national long-range technology plan; and (2) provide assistance to States for planning use of technology in schools. (Sec. 103) Amends the Department of Education Organization Act and the General Education Provisions Act to establish an Office of Educational Technology, with a Director, in the Department of Education. (Sec. 104) Sets forth authorized uses of funds under this title and non-Federal share provisions. (Sec. 106) Amends the Training Technology Transfer Act of 1988 to: (1) transfer the Office of Training Technology Transfer to the Office of Educational Technology (from the Office of Educational Research and Improvement); and (2) authorize appropriations to carry out such Act. (Sec. 107) Authorizes appropriations to carry out this title. Title II: State Planning for Improving Student Achievement Through Integration of Technology into the Curriculum - Directs the Secretary of Education to award grants, according to an allocation formula, to State education agencies to plan for improved student learning in all schools through the use of technology as a integral part of the State improvement plan under the Goals 2000: Educate America Act. Authorizes appropriations. Title III: National Telecommunications and Information Infrastructure Development - Amends the National Telecommunications and Information Administration Organization Act to establish a Telecommunications and Information Infrastructure Development Program to promote widespread availability of advanced telecommunications technologies to: (1) enhance delivery of diverse social services, including education and health care, to the public; and (2) support formation of a nationwide, multimedia, high-speed, interactive infrastructure of varied information technologies, through interconnection and improvement of existing facilities and deployment of new ones. (Sec. 301) Authorizes the Secretary of Commerce to make program grants to eligible applicants. Gives special consideration to applications that will increase participation by underserved populations. Authorizes the Secretary of Commerce to provide funds for training, planning, and studies. Directs the Secretary of Commerce to provide for collection and dissemination of information on distance learning. Authorizes appropriations to carry out this title. Title III: (sic): Universal Service for Education - Amends the Communications Act of 1934 to establish requirements for universal service protection and advancement. (Sec. 301 (sic)) Makes it the duty of every common carrier engaged in intrastate, interstate, or foreign communication by wire or radio to contribute to the preservation and advancement of universal service. Includes among such contributions monetary payment, certain service obligations, in-kind payment, or other forms of contribution determined by the Federal Communications Commission (FCC) and States. Directs the FCC to: (1) set guidelines for defining universal service; and (2) prescribe and implement regulations to ensure that interstate telecommunications providers make such a contribution on a competitively neutral basis (with any funds so contributed to be distributed to each State). Establishes the Educational Telecommunications and Technology Fund for activities that ensure that elementary and secondary schools have complete access to existing and innovative telecommunications and information technologies and services. Directs the FCC to prescribe regulations relating to deposits in the Fund. Directs the FCC and the Secretaries of Education and Commerce to jointly prescribe regulations relating to disbursements from the Fund, including specified provisions. Directs the FCC to delegate to each State the primary responsibility for defining universal service and ensuring that universal service goals are met. Allows each State to impose a nondiscriminatory charge on intrastate telecommunications or take other actions to protect and advance universal service, considering specified options. Requires, to the extent a State establishes a fund to support universal service, that all telecommunications services providers be eligible to receive payments from such fund. Directs the FCC to assume such responsibilities if a State has not done so within two years after enactment of this Act. (Sec. 302) Amends the Communications Act of 1934 to make it the duty of all telecommunications carriers that use public rights of way to permit educational institutions, health-care institutions, local and State governments, public broadcast stations, public libraries, other public entities, community newspapers, and broadcasters in the smallest markets to obtain access at preferential rates to intrastate and interstate services provided by such carriers. Prohibits reselling such services, except to other entities eligible for such preferential rates. Directs the FCC to commence a rulemaking proceeding to prescribe regulations to: (1) enhance availability of advanced telecommunications services to all public elementary and secondary school classrooms, health-care institutions, and libraries; and (2) ensure establishment of appropriate functional requirements and/or interoperability standards for telecommunications arrangements that interconnect such entities with the public switched network. Directs the Assistant Secretary of Commerce for Communications and Information to issue a notice of inquiry, review alternatives, and publish recommendations to the FCC and the Secretaries of Education and of Commerce with respect to establishing an educational telecommunications corporation to provide credit and grant funds to support the national goal of access to existing and innovative telecommunications and information technologies and services.
Bill· HRH.R. 4988 (103rd)referred
United States · United States Congress · 18 August 1994
Amends title XVIII (Medicare) of the Social Security Act to cover preventive health care examinations for colon and prostate cancer and osteoporosis. Directs the Secretary of Health and Human Services to establish a demonstration project to test the cost-effectiveness of furnishing colon, prostate, and uterine cancer preventive screening examinations to a sample group of Medicare beneficiaries.
Bill· HRH.R. 4983 (103rd)referred
United States · United States Congress · 17 August 1994
TABLE OF CONTENTS: Title I: Family Investment Program and Other Welfare Reform Title II: Improvements in the Collection of Child Support Title III: Welfare Restrictions for Aliens Welfare to Self-Sufficiency Act of 1994 - Title I: Family Investment Program and Other Welfare Reform - Amends part A (Aid to Families with Dependent Children) (AFDC) of title IV of the Social Security Act (SSA) to require State AFDC plans in States without a waiver from the Secretary of Health and Human Services (Secretary) to provide for a program in which the State agency negotiates an agreement with each family on AFDC outlining the steps non-exempt family members must take. Includes among such steps participation in education or job training programs, or in substance abuse treatment or parenting programs, in order to obtain self-sufficiency within a certain period. Requires supplemental services, such as transportation and child care, when necessary for achieving such goal, as well as support and case management when adapting such agreement for changing family circumstances. Requires the State agency to offer such families enrollment in a limited benefit plan under which benefits are suspended after six months, and in which families failing to comply with the agreement are automatically enrolled. (Sec. 101) Requires the Secretaries of Health and Human Services, of Labor, and of Education to ensure appropriate coordination in the planning, development, and operation of the family investment program above and other specified programs, including the JOBS program under SSA title IV part F (Job Opportunities and Basic Skills Training Program) in order to improve departmental services and reduce program overlap and administrative costs. (Sec. 102) Makes numerous miscellaneous amendments to SSA title IV part A. Provides States with various specified options for moving AFDC recipients towards self-sufficiency, including options for: (1) increasing asset limits and disregards for work expenses, earned income, and automobiles; (2) disregarding interest income and certain earned income of new employees and dependent children as well as certain income and resources related to microenterprise and other employment and self-sufficiency initiatives; and (3) requiring certain unemployed parents to participate in job search and training activities. Eliminates the earned income disregard time limitation and various work-related requirements with regard to unemployed parent households. Provides for the inclusion of microenterprise training and activities in the JOBS program, and makes various specified changes with regard to program job searches, work assignments, and grievance procedures. (Sec. 106) Requires pregnant AFDC recipients to participate in the JOBS program. Changes payment formulae for the JOBS program and child care. Increases the JOBS program's authorization. (Sec. 109) Extends transitional child care benefits and the disregards for earned income and child care to non-recipient stepparents. Provides for timely preventive health care for children of AFDC recipients. (Sec. 110) Directs the Secretary to establish wage supplementation demonstration projects for certain AFDC-eligible individuals to provide an incentive to work. Title II: Improvements in the Collection of Child Support - Amends SSA title IV part D (Child Support and Establishment of Paternity) and the Internal Revenue Code to provide for the establishment of a system under which the Internal Revenue Service (IRS) would collect child support via wage withholding and estimated tax payments and disperse it as appropriate. Requires the entire amount of child support owed to be paid to the IRS by the end of the applicable tax year along with the individual's tax return. Subjects delinquent individuals to generally the same penalties applicable to back taxes. (Sec. 203) Gives States the option of periodically making available for publication the identity of individuals at least three months behind in child support payments. Title III: Welfare Restrictions for Aliens - Declares that no AFDC, Medicaid, food stamp, supplemental security income, or Federal unemployment compensation benefits shall be available to an unlawful alien, except pursuant to the Immigration and Nationality Act. (Sec. 301) Requires that any lawful alien receiving any such benefits for 12 months be reported to the Immigration and Naturalization Service (INS) and be treated as a public charge. Requires attribution of a sponsor's or spouse's income and resources to a family preference alien as unearned income and resources until such alien achieves U.S. citizenship. (Sec. 302) Requires State AFDC agencies to provide information on illegal aliens to the INS.
Bill· SS. 2396 (103rd)open
United States · United States Congress · 16 August 1994
TABLE OF CONTENTS: Title I: Improved Access to Affordable Health Care Subtitle A: Increased Availability and Continuity of Health Coverage for Individuals and Their Families Subtitle B: Reform of Health Insurance Subtitle C: Preemption Subtitle D: Health Deduction Fairness Subtitle E: Improved Access to Community Health Services Subtitle F: Improved Access to Rural Health Services Subtitle G: Assistance in Enrolling Uninsured Children in Health Insurance Subtitle H: Medicaid Reform Subtitle I: Remedies and Enforcement with Respect to Group Health Plans Subtitle J: Delivery of Health Care Services to Illegal Immigrants Title II: Health Care Cost Containment and Quality Enhancement Subtitle A: Medical Malpractice Liability Reform Subtitle B: Administrative Cost Savings and Fair Health Information Practices Subtitle C: Deduction for Cost of Catastrophic Health Plan; Medical Savings Accounts Subtitle D: Anti-Fraud Subtitle E: Increased Medicare Beneficiary Choice; Additional Medicare Reforms Subtitle F: Health Care Antitrust Improvements Subtitle G: Encouraging Enforcement Activities of Medical Self-Regulatory Entities Subtitle H: Reform of Clinical Laboratory Requirements for Simple Tests Subtitle I: Miscellaneous Provisions Title III: Long-Term Care Subtitle A: Tax Treatment of Long-Term Care Insurance Subtitle B: Establishment of Federal Standards for Long-Term Care Insurance Subtitle C: Protection of Assets Under Medicaid Through Use of Qualified Long-term Care Insurance Subtitle D: Studies Subtitle E: Volunteer Service Credit Demonstration Projects Affordable Health Care Now Act of 1994 - Title I: Improved Access to Affordable Health Care - Subtitle A: Increased Availability and Continuity of Health Coverage for Individuals and Their Families - Part 1: Required Coverage Options for Eligible Employees, Spouses, and Dependents - Requires each employer to make available to each eligible employee a group health plan under which: (1) coverage of each eligible individual with respect to such employee may be elected on an annual basis; (2) coverage is provided for at least the required coverage specified; and (3) employees may elect to have premiums collected through payroll deduction. Does not require employer contributions to the cost of coverage under such a plan. Provides for the exclusion of: (1) employers who have been employers for less than two years or who have no more than two eligible employees or no more than two eligible employees not covered under any group health plan; and (2) family members under specified circumstances. Specifies that a group health plan shall not be treated as failing to meet the requirements of this Act solely because a period of service by an eligible employee of not more than 60 days is required for coverage. Specifies that the required coverage is standard coverage, except that in the case of a small employer that has not contributed during the previous plan year to the cost of coverage for any eligible employee under any group health plan, the required coverage for the plan year is coverage under a MedAccess standard, MedAccess catastrophic, and MedAccess medisave plan. Requires standard coverage to include at least one option, either a fee-for-service option and if available, a point-of-service option and a managed care option. Provides for a five-year transition for existing group health plans. Part 2: Portability and Nondiscrimination - Prohibits a group health plan from imposing (and an insurer from requiring an employer from imposing through a waiting period for coverage under a plan or similar requirement) a limitation or exclusion of benefits relating to treatment of a preexisting condition if: (1) the condition relates to a condition that was not diagnosed or treated within three months before the date of coverage under the plan; (2) the limitation or exclusion extends over more than six months after the date of coverage, applies to an individual who, as of the date of birth, was covered under the plan, or relates to pregnancy; or (3) an eligible individual has such coverage at the time the individual first became eligible. Specifies that, in the case of an individual who is eligible for coverage under a plan but for a waiting period imposed by the employer, the individual shall be treated as having been covered under the plan as of the earliest date of the beginning of the waiting period. Provides a one-time amnesty period for pre-existing condition exclusions. (Sec. 1012) Requires each group health plan to waive any period applicable to a preexisting condition for similar benefits with respect to an individual to the extent that the individual, prior to enrollment in such plan, was covered for the condition under any other health plan. (Sec. 1013) Prohibits: (1) a multiemployer plan and an exempted multiple employer health plan from canceling or denying renewal of coverage under such a plan for an employer other than for nonpayment of contributions, fraud or other misrepresentation, noncompliance with plan provisions, or because the plan is ceasing to provide any coverage in a geographic area; (2) an insurer from canceling a health insurance plan or denying renewal of coverage other than as prescribed above; and (3) an insurer who terminates the offering of health insurance plans in an area from offering such a plan to any employer in the area until five years after the date of the termination. Part 3: Standards for Managed Care Arrangements and Essential Community Providers - Sets forth requirements for group health plans and insurers that provide health care coverage through managed care arrangements. Requires such arrangements to assure that covered individuals have reasonably prompt access through the entity's provider network to the benefits package and to centers of excellence. (Sec. 1022) Requires the Secretary of Health and Human Services (Secretary) to establish standards for utilization review programs and periodically review and update such standards to reflect changes in the delivery of health care services. Part 4: Enforcement; Effective Dates; Definitions - Makes provisions of the Employee Retirement Income Security Act of 1974 applicable with respect to enforcement of this Act (by the Department of Labor). Amends the Internal Revenue Code (Code) to impose a tax ($100 per day for each individual involved, subject to specified limitations) on the failure of an insurer to comply with the requirements under part 2, unless the Secretary determines that the State has in effect a regulatory enforcement mechanism that provides adequate sanctions. Subtitle B: Reform of Health Insurance - Part I: Marketplace for Small Business - Requires each insurer that makes available a health insurance plan to a small employer in a State to make available to each small employer in the State a MedAccess standard, MedAccess catastrophic, and MedAccess medisave plan, with exceptions for health maintenance organizations (HMOs) and if a State provides for guaranteed availability (rather than guaranteed issue). Requires each insurer that offers a MedAccess plan to a small employer in a State to accept: (1) every small employer in the State that applies for coverage; and (2) every eligible individual who applies for enrollment on a timely basis. Sets forth provisions regarding: (1) special rules for HMOs; (2) timely enrollment requirements; and (3) enrollment of spouses and dependents. Makes such requirements inapplicable in a State that has provided (in accordance with specified standards) a mechanism under which each insurer offering a health insurance plan to a small employer in the State must participate in a program for assigning high-risk small employer groups (or individuals within such a group) among some or all such insurers, if the insurers comply. (Sec. 1102) Defines "MedAccess coverage" as a health insurance plan that: (1) is designed to provide standard coverage with substantial cost-sharing, only catastrophic coverage, or medisave coverage; (2) includes only essential and medically necessary services; (3) meets applicable requirements relating to guaranteed issue; and (4) meets specifies consumer protection standards. Defines "MedAccess standard coverage," "MedAccess catastrophic coverage," and "MedAccess medisave coverage" to mean a MedAccess plan that provides for at least standard coverage, for only catastrophic coverage, or medisave coverage, respectively. Requests the National Association of Insurance Commissioners (NAIC) to submit to the Secretary a set of rules which is sufficient for determining the actuarial value of coverage offered by a plan. Directs the Secretary to certify such set of rules for use under this subtitle if they meet such requirements or establish such a set of rules. Specifies that a health insurance plan is considered to provide: (1) standard coverage if the benefits are determined, in accordance with certified rules of actuarial equivalence, to have a value that is within five percentage points of an established target actuarial value for standard coverage; (2) catastrophic coverage if benefits are available under the plan for a year only to the extent that expenses for covered services in a year exceed a deductible amount that is consistent with a specified requirement for a catastrophic health plan under the Code, and are determined, in accordance with certified actuarial equivalence rules, to have a value that is within five percentage points of an established target actuarial value for catastrophic coverage; and (3) medisave coverage if such plan consists of a catastrophic health plan within the meaning of the Code and a medical savings account. Requests NAIC to submit to the Secretary target actuarial values for standard and catastrophic coverage. Permits NAIC to submit periodic revisions of, and permits the Secretary to revise, the set of rules of actuarial equivalence and target actuarial values where necessary to take into account changes in the relevant types of health benefits provisions, in deductible levels for catastrophic coverage, or in relevant demographic conditions. (Sec. 1103) Directs the Secretary to request NAIC to develop model regulations that specify standards with respect to requirements: (1) that insurers make available MedAccess plans; (2) of guaranteed availability of MedAccess plans to small employers; (3) relating to limits on premiums and certain consumer protections; and (4) relating to limitation of annual premium increases. Requires the Secretary to review such standards and, if NAIC fails to specify standards meeting such requirements, to promulgate standards. Sets forth provisions regarding: (1) the application of MedAccess standards and consumer protection standards by the States; and (2) the Federal role. (Sec. 1104) Sets forth provisions: (1) regarding limits on premium rate variations, including discounts for employer wellness programs; and (2) requiring an insurer, at the time of offering a health insurance plan to a small employer, to fully disclose rating practices for health insurance plans, including rating practices for different populations and benefit designs. (Sec. 1105) Requires the Secretary of Labor to monitor the prevalence and impact of adverse risk selection in the full insured plans made available to small employers resulting from the decision of small employers to self-insure. (Sec. 1106) Directs the Secretary to: (1) request NAIC to develop models for reinsurance or allocation of risk mechanisms for health insurance plans made available to small employers for whom an insurer is at risk of incurring high costs under the plan; and (2) review such models or specify models. Sets forth provisions regarding implementation of reinsurance or allocation of risk mechanisms by the States and the Federal role. Part 2: Marketplace for Individuals - Makes the provisions of Part 1 applicable to insurers offering health insurance coverage to individuals and their dependents. Part 3: Voluntary Health Purchasing Arrangements - Provides for the establishment of voluntary health purchasing arrangements. (Sec. 1124) Requires such arrangements to offer enrollment in health insurance coverage only to: (1) all eligible employees employed by small employers in a service area; and (2) all eligible individuals residing in such area. Part 4: Definitions and Miscellaneous Provisions - Provides definitions for purposes of this subtitle. (Sec. 1134) Requires the Secretary to make annual reports to the Congress on the implementation of this subtitle and the need for additional reforms to assure and expand coverage. (Sec. 1135) Authorizes the Director to conduct: (1) research on the impact of this subtitle on the availability of affordable health coverage for employees and dependents in the small employers group health care coverage market and other specified topics; and (2) demonstration projects relating to such topics. Requires the Director to develop: (1) methods for measuring the relative health risks of eligible individuals in terms of the expected costs of providing benefits under health insurance plans and, in particular, MedAccess plans; and (2) a model for equitably distributing health risks among insurers in the small employer health care coverage market. Authorizes appropriations. Subtitle C: Preemption - Part 1: Scope of State Regulation - Makes inapplicable to a group health plan any State or local law requiring coverage of specific benefits, services, or categories of health care, or services of any class or type of provider of health care. (Sec. 1202) Makes inapplicable any State or local law prohibiting two or more employers from obtaining coverage under a multiple employer welfare arrangement under which all coverage: (1) consists of medical care described under specified provisions of the Employee Retirement Income Security Act of 1974 (ERISA); and (2) is fully insured. (Sec. 1203) Preempts, for a five-year period, State law provisions which restrict: (1) reimbursement rates or selective contracting; (2) differential financing incentives; and (3) utilization review methods. Directs the Comptroller General to study benefits and cost effectiveness of use of managed care in health services delivery and to report to the Congress, including recommendations as to whether such preemption should be extended. Part 2: Multiple Employer Health Benefits Protections - Amends the Employee Retirement Income Security Act of 1974 (ERISA) to provide a limited exemption from certain restrictions on ERISA preemption of State law for health plans maintained by multiple employers subject to certain Federal standards. Relieves such exempted multiple employer health plans of certain restrictions on preemption of State law, and treats them as employee welfare benefit plans. Sets forth exemption procedures, application and eligibility requirements, and additional notice, reporting, and actuarial requirements applicable to exempted multiple employer health plans. Requires multiple employer welfare arrangements providing certain medical care benefits to issue specified disclosures to participating employers. Requires each multiple employer welfare arrangement which is or has been an exempted multiple employer health plan, and under which coverage is not fully insured, to establish certain minimum reserves. Authorizes the Secretary of Labor to permit alternative means of compliance. Sets forth corrective actions, including actions to avoid depletion of reserves and actions in connection with termination of arrangements. Provides for expirations, renewals, suspensions, and revocations of exemptions. Provides for review of actions of the Secretary, including denials of applications and suspensions or revocations of exemptions. Provides for alternative means of distribution of summary plan descriptions. (Sec. 1212) Revises provisions relating to scope of preemption rules, treatment of single employer arrangements, and treatment of certain collectively bargained arrangements. (Sec. 1215) Sets forth special rules for employee leasing healthcare arrangements, providing that they be treated as multiple employer welfare arrangements. (Sec. 1216) Sets forth enforcement provisions relating to multiple employer welfare arrangements and employee leasing healthcare arrangements, including enforcement of filing requirements, actions by States in Federal court, criminal penalties for certain willful misrepresentations, cease activities orders, and responsibility for claims procedures. (Sec. 1217) Sets forth solvency requirements for certain self- insured group health plans. (Sec. 1218) Sets forth filing requirements for multiple employer welfare arrangements providing health benefits. (Sec. 1219) Provides for cooperation between Federal and State authorities, including: (1) agreements for State enforcement of ERISA provisions applicable to multiple employer welfare arrangements which are or have been exempted multiple employer health plans; and (2) enforcement and technical assistance to States with respect to issues involving multiple employer welfare arrangements. (Sec. 1220) Sets forth transitional rules. Part 3: Encouragement of Multiple Employer Arrangements Providing Basic Health Benefits - Amends the Internal Revenue Code to eliminate the commonality of interest or geographic location requirement for tax-exempt trust status in the case of determining whether any multiple employer health plan or insured multiple employer health plan is a voluntary employees' beneficiary association meeting certain requirements, if: (1) such plan provides at least standard coverage consistent with specified provisions of this Act (the Affordable Health Care Now Act of 1994); and (2) in the case of such an insured plan, it meets specified ERISA requirements not preempted by this Act. (Sec. 1222) Amends ERISA to direct the Secretary of Labor to prescribe an alternative method for the filing of a single annual report with respect to all employers participating under a multiple employer welfare arrangement under which all coverage consists of medical care and is fully insured. (Sec. 1223) Sets forth provisions for determining compliance with coverage requirements through multiple employer health arrangements. Subtitle D: Health Deduction Fairness - Amends the Internal Revenue Code to provide for: (1) a permanent extension and an increase in the health insurance tax deduction for self-employed individuals; and (2) a deduction of health insurance premiums for certain previously uninsured individuals. Subtitle E: Improved Access to Community Health Services - Part 1: Increased Authorization for Community and Migrant Health Centers - Directs the Secretary to provide for grants to migrant and community health centers to promote primary health care services for underserved individuals. Allows grants to be used to promote the provision of off-site services, to improve birth outcomes in areas with high infant mortality and morbidity, to establish primary care clinics in areas in need, and for recruitment and training costs of necessary providers and operating costs for unreimbursed services. Authorizes appropriations. Directs the Secretary to conduct a study of the impact of such grants on access to health care, birth outcomes, and the use of emergency room services. Part 2: Grants for Projects for Coordinating Delivery of Services - Amends the Public Health Service Act to authorize the Secretary to make grants to public and nonprofit private entities: (1) to carry out demonstration projects to increase access to outpatient primary health services in specified geographic areas (i.e., areas that are rational areas for the delivery of health services, have a population of not more than 500,000 individuals, and have been designated by the Secretary as areas with a shortage of personal health services or that have a significant number of individuals with low incomes or insufficient health care insurance) through coordinating the delivery of services under Federal, State, local, and private programs; and (2) for developing plans to carry out such projects. Authorizes appropriations. Part 3: Community Health Networks - Sets forth qualifications for community health network arrangements. Subtitle F: Improved Access to Rural Health Services - Part 1: Establishment of Rural Emergency Access Care Hospitals Under Medicare - Amends title XVIII (Medicare) of the Social Security Act (SSA) to provide for: (1) establishment of rural emergency access care hospitals under Medicare; and (2) coverage of and payment for rural emergency access care hospital services under Medicare part B (Supplementary Medical Insurance). Part 2: Rural Medical Emergencies Air Transport - Amends the Public Health Service Act to direct the Secretary to make grants to States to assist in the creation or enhancement of air medical transport systems that provide victims of medical emergencies in rural areas with access to treatments. Sets forth provisions regarding: (1) application and State plan requirements; (2) considerations in awarding grants; (3) State administration and use of grants; (4) the number of grants; and (5) reporting requirements. Authorizes appropriations. Part 3: Emergency Medical Services Amendments - Amends the Public Health Service Act to direct the Secretary to: (1) establish an Office of Emergency Medical Services, headed by a Director; (2) engage in specified emergency medical services activities, including disseminating information obtained in carrying out specified activities to public and private entities, providing technical assistance to State and local agencies, coordinating Department of Health and Human Services (DHHS) activities with those of other Federal agencies; and (3) ensure that such activities are carried out consistent with certain requirements regarding maintaining an adequate number of health professionals with expertise in the provision of services, developing, periodically reviewing, and revising as appropriate guidelines for the provision of such services, appropriately using available technologies, and serving the unique needs of underserved inner-city and rural areas. (Sec. 1522) Authorizes the Secretary to make grants to States for the purpose of improving the availability and quality of emergency medical services through the operation of State offices of emergency medical services, subject to specified matching fund, budgetary, and other requirements. (Sec. 1523) Provides for demonstration projects to establish telecommunications between rural medical facilities and medical facilities with expertise or equipment. Directs the Secretary to ensure that the telecommunications technologies demonstrated include interactive video telecommunications, static video imaging transmitted through the telephone system, and facsimiles transmitted through such system. (Sec. 1524) Authorizes appropriations for: (1) emergency medical services (including for State offices of Emergency Medical Services and for telecommunications demonstrations); and (2) trauma care and certain other activities. Part 4: Additional Rural Health Care Provisions - Authorizes the Secretary to make grants to public and nonprofit private entities to develop health plans to provide services exclusively in rural and frontier areas. Authorizes appropriations. (Sec. 1532) Authorizes the Secretary to make grants to public and nonprofit private hospitals in medically underserved rural communities, and to public and nonprofit outpatient facilities in such communities, to develop or increase capacity to provide primary health services. (Sec. 1533) Authorizes the Secretary to make grants to such entities to conduct research and carry out demonstration projects to develop innovative approaches to the delivery of health care in rural areas, such as the use of telemedicine and mobile delivery units. (Sec. 1534) Authorizes appropriations for the training of rural health professionals other than physicians. Subtitle G: Assistance in Enrolling Uninsured Children in Health Insurance - Amends title XIX (Medicaid) of the Social Security Act (SSA) to provide for the establishment of State premium subsidy programs to assist eligible needy children with premiums for standard health coverage. Subtitle H: Medicaid Reform - Amends SSA title XIX to: (1) provide for the establishment of State health allowance programs under which the State makes payments to an approved group health plan which provides coverage to eligible individuals as an allowance towards the costs of providing the individual with benefits under the plan; (2) modify Federal requirements to allow States more flexibility in contracting for coordinated care services under Medicaid; (3) make changes regarding the period of certain waivers under Medicaid; and (4) reduce the amount of Federal payment adjustments under Medicaid for disproportionate share hospitals. (Sec. 1713) Eliminates the duplicative pediatric immunization program under Medicare. Subtitle I: Remedies and Enforcement with Respect to Group Health Plans - Amends the Employee Retirement Income Security Act of 1974 (ERISA) to set forth claims procedure special rules for group health plans. Directs the Secretary of Labor to establish a mediation program for disputes involving group health plan claims. Requires the Secretary to maintain a list of individuals with expertise to serve as facilitators under such program, and to propose a facilitator for each mediation subject to one objection by each party. Sets forth provisions for participation of attorneys, initiation of mediation, mediation procedures, time limits, costs, legal effect of participation, and confidentiality and admissibility. Sets forth court remedies for participants and beneficiaries with respect to group health plans. Subtitle J: Delivery of Health Care Services to Illegal Immigrants - Directs the Secretary of Health and Human Services to conduct a study of health care to illegal immigrants, including the effect of illegal immigration on health costs and the shifting of health costs. Requires a report to the Congress, with recommendations on appropriate means of: (1) alleviating health problems peculiar to illegal immigrants; (2) financing health care provided to illegal immigrants; and(3) increasing intergovernmental cooperation and coordination of efforts of the United States and other countries to alleviate such health problems and finance such efforts. Title II: Health Care Cost Containment and Quality Enhancement - Subtitle A: Medical Malpractice Liability Reform - Part 1: General Provisions - Makes this subtitle applicable with respect to any medical malpractice liability claim and to any medical malpractice liability action brought in State or Federal court, except a claim or action for damages arising from a vaccine-related injury or death to the extent that title XXI of the Public Health Service Act applies. Sets forth provisions regarding: (1) preemption of State law; (2) effect on sovereign immunity and choice of law or venue; (3) jurisdiction; and (4) effective dates. Part 2: Medical Malpractice and Product Liability Reform - Prohibits a medical malpractice liability action from being brought in any State court during a calendar year unless the relevant claim has been initially resolved (i.e., a decision has been reached on whether the defendant is liable to the plaintiff for damages and on the amount of damages) under a certified alternative dispute resolution (ADR) system or an alternative Federal system. Prohibits a medical malpractice liability action from being brought in Federal court based on diversity of citizenship during a calendar year unless the relevant claim has been initially resolved under such a system in the State whose law applies. Directs the Attorney General to establish an ADR process for tort claims consisting of medical malpractice liability claims brought against the United States under chapter 171 of the Federal judicial code (U.S. Court of Federal Claims). Prohibits a medical malpractice liability action based on such a claim from being brought in any Federal court unless the claim has been initially resolved under such process. Sets forth procedures for filing actions. (Sec. 2012) Limits to $250,000 the amount of noneconomic damages that may be awarded to a claimant and family members in a medical malpractice liability action. Sets limits on punitive damages and on periodic payments for future losses. Reduces damages by any other payments made to compensate an individual for injuries. (Sec. 2013) Set forth provisions regarding: (1) limits on attorney fees and other costs; (2) joint and several liability (generally, liability may be found only for those damages directly attributable to the person's proportionate share of fault or responsibility for the injury); (3) a statute of limitations of seven years; and (4) a uniform standard for determining negligence (the defendant's conduct at the time of providing the health care services was not reasonable). (Sec. 2017) Specifies that in the case of a medical malpractice liability claim relating to services provided during labor or the delivery of a baby, if the health care professional did not previously treat the injured individual for the pregnancy, the trier of fact may not find that the defendant committed malpractice nor assess damages unless the malpractice is proven by clear and convincing evidence. Part 3: Requirements for State Alternative Dispute Resolution Systems - Lists requirements for State ADR systems, including that such a system: (1) applies to all medical malpractice liability claims under the jurisdiction of the courts of that State; (2) requires that a written opinion resolving the dispute be issued within six months after each party against whom the claim is filed has received notice of the claim; (3) is approved by the State or local governments; (4) provides for the transmittal to the State agency responsible for monitoring or disciplining health care professionals and providers of any findings of malpractice; and (5) provides for the regular transmittal of information on disputes resolved under the system to the Administrator for Health Care Policy and Research in a manner that protects the identity of the parties involved. (Sec. 2032) Directs the Secretary, by October 1 of each year, to certify State ADR systems that meet such requirements. Directs the Secretary to establish an alternative Federal ADR system for the resolution of medical malpractice liability claims in States that do not have in effect a certified ADR system. (Sec. 2033) Directs the Secretary, within five years, to submit to the Congress a report describing and evaluating State ADR systems and the alternative Federal system, including: (1) information on the effect of the ADR systems on health care costs, access to health care, and quality of care provided within the State; and (2) to the extent that such report does not provide information on no-fault systems operated by States as ADR systems, an analysis of the feasibility and desirability of establishing a system for resolving medical malpractice liability claims on a no-fault basis. Part 4: Other Provisions Relating to Medical Malpractice Liability - Authorizes a State agency responsible for disciplinary actions for a type of health care practitioner to enter into agreements with State or county professional societies to permit their participation in the licensing of such practitioner and to review any health care malpractice action, claims, or allegation, or other information concerning the practice patterns of any such practitioner. Sets forth agreement requirements. (Sec. 2042) Directs the Secretary to study incentives adopted by State and local governments, insurers, medical societies, and other entities to encourage physicians to volunteer to provide health care services in medically underserved areas. (Sec. 2043) Directs each State to require: (1) each health care professional and health care provider to participate in a risk management program to prevent, and provide early warning of, practices which may result in injuries to patients or endanger patient safety; and (2) each provider of health care professional and provider liability insurance in the State to establish risk management programs or sanction programs of risk management for health care professionals and providers provided by other entities, and require each such professional or provider, as a condition of maintaining insurance, to participate in one such program at least once in each three-year period. (Sec. 2044) Directs the Secretary to make grants: (1) for basic research in the prevention of, and compensation for, injuries resulting from health care professional or provider malpractice and for research of the outcomes of health care procedures; (2) to States to assist in improving their ability to license and discipline health care professionals; and (3) to States and local governments, private nonprofit organizations, and health professional schools for educating the general public about the appropriate use of health care, realistic expectations of medical intervention, and the resources and role of health care professional licensing and disciplinary boards in investigating claims of incompetence or health care malpractice, and for developing programs of faculty training and curricula for educating health care professionals in quality assurance, risk management, and medical injury prevention. Authorizes appropriations. Subtitle B: Administrative Cost Savings and Fair Health Information Practices - Part 1: Administrative Cost Savings - Subpart A: Standards for Data Elements and Transactions - Directs the Secretary to adopt standards and modifications to standards that are: (1) consistent with the objective of reducing the costs of providing and paying for health care; and (2) in use and generally accepted, developed, or modified by the standard-setting organizations accredited by the American National Standard Institute. (Sec. 2104) Directs the Secretary to adopt standards: (1) for data elements of health information; and (2) for transmitting information electronically. Subpart B: Requirements With Respect to Certain Transactions and Information - Specifies standard transactions. Subpart C: Miscellaneous Provisions - Requires the Secretary to establish standards with respect to the operation of health information network services. (Sec. 2124) Authorizes the Secretary to make grants for demonstration projects to promote the development and use of electronically integrated community-based clinical information systems and computerized patient medical records. Subpart D: Assistance to the Secretary - Establishes the Health Care Information Advisory Committee to: (1) assist the Secretary in complying with requirements under this Act; (2) be generally responsible for advising the Secretary and the Congress on the status of the health information network; and (3) make recommendations to correct problems in the network and to refine and improve the network. Part 2: Fair Health Information Practices - Subpart A: Duties of Health Information Trustees - Specifies the duties of health information trustees with respect to inspection of protected health information. (Sec. 2142) Provides a procedure to amend protected health information. Subpart B: Use and Disclosure of Protected Health Information - Sets forth general limitations on the use and disclosure of protected health information by health information trustees. (Sec. 2152) Authorizes a health information trustee to disclose protected health information pursuant to a written authorization by the protected individual. (Sec. 2153) Describes the circumstances under which health information trustees may disclose protected health information to: (1) health plans, health care providers, and oversight agencies; (2) next of kin; (3) public health authorities; (4) health research entities; (5) authorities under emergencies; (6) courts or administrative agencies; (6) law enforcement agencies; (7) entities under subpoenas, warrants, and search warrants; and (8) health information service organizations. Subpart C: Access Procedures and Challenge Rights - Prohibits a government authority from obtaining protected health information about a protected individual from a health information trustee through subpoenas, warrants, and search warrants unless there is probable cause that the information is relevant to the law enforcement inquiry. (Sec. 2172) Establishes challenge procedures to such subpoenas. Subpart D: Miscellaneous Provisions - Restricts the information a health information trustee may disclose when a protected individual pays for health care through a payment card or electronic means. (Sec. 2183) Directs the Secretary to develop standards for electronic documents and communications. (Sec. 2184) Provides for the disclosure of protected health information to affiliated persons and agents and attorneys. (Sec. 2187) Requires States to establish a process for the maintenance of certain protected health information. Subpart E: Enforcement - Provides for civil actions against health information trustees. (Sec. 2192) Authorizes the Secretary to impose a civil money penalty against such trustees for a demonstrated pattern of failure to comply with this subpart. (Sec. 2193) Requires the Secretary to develop an alternative dispute resolution method for resolving claims for civil actions. (Sec. 2194) Amends the Federal criminal code to impose penalties for violations in disclosing and obtaining protected health information. Subpart F: Amendments to Title 5, United States Code - Requires certain Federal agency heads to promulgate rules protecting health information. Subpart G: Regulations, Research, and Education; Effective Dates; Applicability; and Relationship to Other Laws - Requires the Secretary to prescribe regulations to carry out this part not later than July 1, 1996. (Sec. 2197) Makes this part effective on January 1, 1997, except for certain provisions that take effect upon enactment. Subtitle C: Deduction for Cost of Catastrophic Health Plan; Medical Savings Accounts - Amends the Internal Revenue Code to include under the medical expense deduction the portion of such expense attributable to coverage under a catastrophic health plan. (Sec. 2202) Allows individuals a tax deduction for a percentage of contributions made to a medical care savings account established for the benefit of an eligible individual. Allows such deduction whether or not an individual itemizes deductions. Disallows distributions from such accounts as medical expense deductions. Excludes employer contributions to such accounts from employment taxes. Establishes an excise tax for excess contributions to medical care savings accounts. Subtitle D: Anti-Fraud - Directs the Attorney General to establish an all-payer health care fraud and abuse control program. (Sec. 2302) Authorizes additional appropriations for such program and AG investigations of possible health care fraud. (Sec. 2303) Establishes in the Treasury the Anti-Fraud and Abuse Trust Fund for use in preventing anti-fraud and abuse law violations and repaying Medicaid and other beneficiaries for cost-sharing. (Sec. 2311) Amends SSA title XI and the Federal criminal code to: (1) revise current sanctions to provide for, among other things, mandatory exclusion from Medicare and State health care program participation of individuals or entities convicted of a fraud-related felony in connection with the delivery of a health care item or service, and criminal penalties of fines and imprisonment for health care fraud; and (2) authorize the Secretary of Health and Human Services (Secretary) to issue advisory opinions with regard to specified matters, including matters concerning prohibited remuneration and service inducements. (Sec. 2315) Modifies: (1) current limitations under Medicare (SSA title XVIII) on physician self-referral; and (2) effective date exceptions under the Omnibus Budget Reconciliation Act of 1993 for such referrals made for clinical laboratory services. (Sec. 2316) Directs the Comptroller General to study and report to the Congress on the costs of peer review contracts for Medicare HMOs. (Sec. 2332) Amends SSA title XVIII to require the Secretary to issue advisory opinions relating to prohibited referrals under Medicare. Directs the Secretary to issue regulations establishing systems under SSA titles XI and XVIII for the issuance of advisory opinions. Subtitle E: Increased Medicare Beneficiary Choice; Additional Medicare Reforms - Amends SSA title XVIII and the Omnibus Budget Reconciliation Act of 1990 to make specified changes in HMO and Medicare supplemental policy provisions. Imposes mandates on the Secretary in order to afford Medicare beneficiaries additional avenues for choosing health care coverage, including enrollment in private health insurance plans. (Sec. 2411) Extends current rules for computing Medicare part B (Supplementary Medical Insurance) premiums. (Sec. 2412) Amends the Internal Revenue Code to provide for the imposition of a Medicare part B premium tax for high-income Medicare part B beneficiaries. (Sec. 2413) Directs the Secretary to take such steps as necessary to consolidate administration of Medicare parts A (Hospital Insurance) and B. (Sec. 2414) Makes specified extensions with regard to Medicare as secondary payer, including those concerning data matches. Subtitle F: Health Care Antitrust Improvements - Exempts from all antitrust claims an activity relating to the provision of health care services that is: (1) within a "safe harbor" designated by the Attorney General, except for claims for injunctive relief asserted by the Attorney General or the Chair of the Federal Trade Commission in extraordinary circumstances; and (2) specified in and in compliance with the terms of a certificate of review issued by the Attorney General, where the activity occurs while the certificate is in effect, except for claims for injunctive relief. Sets forth provisions regarding the award of attorney fees and costs of suit to the prevailing party in an action based on a claim involving activity found to be exempt. (Sec. 2502) Directs the Attorney General to develop and designate specified safe harbors relating to the following, as well as to such other categories of activities as the Attorney General may designate (subject to specified requirements): (1) joint purchasing of health care services; (2) small hospital mergers; (3) startup and operation of collaborations between State-licensed providers through partial or full integration; (4) standard setting and enforcement activities by medical self-regulatory entities; (5) health care providers collectively supplying non-price medical information to buyers and consumers; (6) health care provider participation in surveys; (7) health care joint ventures' purchase or use of equipment or provision of advanced tertiary care services; (8) provision of market power screens at appropriate levels below which combinations of providers are too small to pose a realistic antitrust threat; (9) joint purchasing arrangements; and (10) good faith negotiations relating to legitimate collaborative activities. Directs the Attorney General to publish notice in the Federal Register soliciting proposals for additional safe harbors. Authorizes the Attorney General to modify or remove a safe harbor following notice and comment upon a determination that the safe harbor does not meet specified criteria. Sets forth criteria in establishing safe harbors, including: (1) the extent to which a competitive or collaborative activity will accomplish an increase in health care access and quality, the establishment of cost efficiencies, and increased ability of health care facilities to provide services in medically underserved areas or to underserved populations; and (2) whether designation as a safe harbor will result in specified desirable outcomes. (Sec. 2503) Directs the Attorney General to issue certificates of review for providers of health care services and to assist persons in applying for such certificates. Sets forth procedures regarding applications for, renovation of, and review of determinations regarding, such certificates. Limits the disclosure of information. (Sec. 2504) Sets forth provisions regarding notifications providing for a reduction in certain penalties under the antitrust laws for health care cooperative ventures. (Sec. 2505) Directs the Attorney General to periodically review the safe harbors, certificates of review, and notifications. (Sec. 2507) Establishes within the Department of Health and Human Services an Office of Health Care Competition Policy. Subtitle G: Encouraging Enforcement Activities of Medical Self- Regulatory Entities - Part 1: Application of the Clayton Act to Medical Self-Regulatory Entities - Provides that no damages, cost of suit, or attorney fee may be recovered under section 4, 4A, or 4C of the Clayton Act, or under any similar State law, except by a State or the United States, from any medical self-regulatory entity as a result of engaging in standard setting or enforcement activities that are: (1) designed to promote the quality of health care provided to patients; and (2) not conducted for purposes of financial gain. Directs the court to award the cost of such a suit, including a reasonable attorney fee, to a substantially prevailing defendant. Part 2: Consultation by Federal Agencies - Requires any Federal agency engaged in the establishment of medical professional standards to consult with appropriate medical societies or associations, specialty boards, or recognized accrediting agencies, if available, in carrying out medical professional standard setting and guidelines or standards relating to the practice of medicine. Subtitle H: Reform of Clinical Laboratory Requirements for Simple Tests - Amends the Public Health Service Act to exempt clinical laboratories performing only simple examinations and procedures from certificate requirements. (Sec. 2703) Directs the Secretary to use existing appropriations to conduct the study relating to the reliability and quality control procedures of clinical laboratory testing programs and the effect of errors in the testing procedures and results on the diagnosis and treatment of patients. (Sec. 2704) Directs the Secretary to revise the membership of the Clinical Laboratory Improvement Advisory Committee to contain a number of practicing physicians proportionate to the number of physician regulated clinical laboratories. Subtitle I: Miscellaneous Provisions - Requires certain Government agencies to refund health benefit contributions for their annuitants. (Sec. 2802) Makes aliens ineligible for social security and Medicaid benefits. (Sec. 2803) Limits the eligibility for social security benefits of certain drug and alcohol addicts. Title III: Long-Term Care - Subtitle A: Tax Treatment of Long-Term Care Insurance - Amends the Internal Revenue Code to provide for the treatment of qualified long-term care insurance as accident and health insurance for purposes of insurance company taxation. (Sec. 3002) Excludes from gross income benefits provided under a long-term care insurance contract. Includes in gross income employer-provided coverage for long-term care services. (Sec. 3003) Includes amounts paid for qualified long-term care services as medical expenses for individual itemized deductions. Includes any parent or grandparent as a dependent for purposes of such expenses. Subtitle B: Establishment of Federal Standards for Long-Term Care Insurance - Amends the Public Health Service Act to mandate the establishment of model Federal standards for long-term care insurance. Prohibits the offering of a long-term care insurance policy in a State unless the State has a regulatory program meeting the requirements of this Act or the policy has been certified by the Secretary of Health and Human Services. Authorizes grants to States for demonstration programs to improve enforcement of the standards. Authorizes appropriations. Imposes on agents selling long-term policies a duty of good faith and fair dealing. Prohibits twisting, high pressure tactics, and cold lead advertising. Mandates minimum financial standards, including income and asset criteria, for advising individuals considering the purchase of a long-term policy. Prohibits sales: (1) to an individual eligible for assistance under title XIX (Medicaid) of the Social Security Act; (2) of duplicate service policies; and (3) of policies that reduce, limit, or coordinate benefits on the basis of eligibility for other coverage or benefits. Provides for: (1) criminal and civil penalties; and (2) agent training and certification. Sets forth additional carrier responsibilities relating to refunding of premiums, mailing of policies, providing information on denials of claims, reporting of information, and limiting compensation to agents for the sale or renewal of policies. Prohibits cancellation or nonrenewal of a long-term care policy except for nonpayment of premium or material misrepresentation. Sets forth continuation and conversion rights for group policies, regulating premiums for converted policies. Requires guaranteed issuance to an individual if the individual meets the minimum medical requirements of the policy. Mandates standards regarding upgraded benefits. Limits cancellation for nonpayment by an incapacitated individual. Requires: (1) subject to exceptions, uniform language and definitions, a uniform format, and at least one standard benefit package; and (2) disclosure of certain matters, including an outline of coverage. Mandates recommendations by the National Association of Insurance Commissioners (NAIC) regarding informing consumers on the long-term economic viability of long-term care insurance carriers. Limits certain conditions on benefits. Requires, if benefits are provided for home health care or community-based services, that certain minimum benefits be provided. Prohibits treating cognitive or mental impairments (including Alzheimer's disease and mental illness) differently from other medical conditions. Limits preexisting condition requirements. Requires: (1) each claimant to have a functional assessment by an individual or entity meeting NAIC qualifications and unconnected to the policy issuer; (2) inflation protection, unless rejected in writing by a policyholder; (3) disclosure of certain premium increases; and (4) nonforfeiture benefits. Prohibits a carrier from contesting a policy or claim based on fraud or misrepresentation unless notice is provided within a time period set by NAIC. Establishes the right of a purchaser to return a policy within a specified period. Defines "long-term care insurance policy," excluding: (1) any basic Medicare supplemental policies; (2) other insurance offered primarily to provide specified types of coverage; and (3) certain life insurance policies. Authorizes grants for programs to provide information, counseling, and assistance regarding the procurement of long-term insurance. Authorizes appropriations. Subtitle C: Protection of Assets Under Medicaid Through Use of Qualified Long-term Care Insurance - Amends the title XIX of the Social Security Act to require State Medicaid plans to disregard some or all of the individual's assets attributable to coverage under a qualified long-term care insurance contract in determining the individual's eligibility for long-term care services. Subtitle D: Studies - Requires the Comptroller General to study the feasibility of: (1) encouraging health care providers to donate their services to homebound patients; and (2) providing heads of households who care for elderly family members in their home with an income tax credit. (Sec. 3303) Requires the Secretary of Health and Human Services to study and report to the Congress on the feasibility of encouraging or requiring the use of a single designated public or nonprofit agency to coordinate, through case management, the provision of long-term care benefits under current Federal, State, and local programs in a geographic area. Subtitle E: Volunteer Service Credit Demonstration Projects - Amends the Older Americans Act of 1965 to require the Commissioner of the Administration on Aging to establish and operate a volunteer service credit demonstration project in each State.
Bill· HRH.R. 4970 (103rd)referred
United States · United States Congress · 16 August 1994
Amends the Public Health Service Act to permit a petition for vaccine injury compensation to be submitted within 48 (currently, 36) months of the first symptom or manifestation of onset, or of the significant aggravation, of injury.
Bill· HRH.R. 4960 (103rd)referred
United States · United States Congress · 12 August 1994
TABLE OF CONTENTS: Title I: Duties of the Secretary and the States Title II: National Health Quality Management Program Title III: State Health Quality Management Programs Consumer Health Quality Protection Act of 1994 - Title I: Duties of the Secretary and the States - Sets forth the responsibilities of the Secretary of Health and Human Services under this Act, including: (1) determination of initial and ongoing compliance of each State health quality management program; and (2) establishment of a national quality management program, health quality improvement foundations, consumer health care advocates in each State, a national consumer representative support center, national measures of quality performance for health plans, and a relative value scale to reimburse pharmacists for certain patient counseling services. Requires a State, as a condition of receipt of Federal medical assistance payments under title XIX (Medicaid) of the Social Security Act, to certify health plan compliance with quality standards and assure State medical licensure board compliance with requirements of this Act. Title II: National Health Quality Management Program - Directs the Secretary to: (1) establish and oversee a performance-based program of quality management and improvement designed to enhance the quality, appropriateness, and effectiveness of health care items and services, to be known as the national quality management program; and (2) collect from each health plan certified under this Act a quarterly fee amounting to .25 percent of the premiums received by the plan, to be utilized by the Secretary solely to support the activities described in title I. Requires the Secretary to: (1) establish a program of grants to eligible organizations to serve as health quality improvement foundations and perform specified duties for the population of each State; and (2) oversee the operation of such foundations. Sets forth provisions regarding: (1) eligibility requirements; (2) grants to entities; (3) duties; and (4) limited liability. Requires the Secretary to: (1) make grants to an entity in each State which shall serve as the consumer health care advocate for the population of the State and grants of a total amount not exceeding $5 million per year to establish national consumer representative support centers; (2) develop a set of national measures of quality performance; (3) review and update such measures annually; (4) conduct periodic surveys of health care consumers; (5) develop and publish a relative value scale for evaluation and management services by pharmacists; and (6) report to the Congress. Title III: State Health Quality Management Programs - Requires that a health plan, to be certified by a State, be determined to be in substantial compliance with prescribed standards. Permits the Secretary to conduct onsite inspections and inspect documents generated by or in the possession of a plan, accreditation organization, or State to verify compliance with requirements of this Act. Sets forth provisions regarding: (1) accreditation; (2) compliance; and (3) fees. Requires each health plan to establish a quality improvement program to systematically measure, assess, and improve enrollee health status, patient outcomes, processes of care, and enrollee satisfaction associated with health care provided under the plan. Sets forth requirements pertaining to State boards of medical examiners.
Bill· SS. 2381 (103rd)open
United States · United States Congress · 11 August 1994
Directs the Secretary of Health and Human Services (HHS) annually to publish in the Federal Register a notice soliciting proposals for: (1) modifications to existing safe harbors issued pursuant to the Medicare and Medicaid Patient and Program Protection Act of 1987; (2) additional safe harbors specifying payment practices that shall not be treated as criminal offenses or serve as the basis for an exclusion; and (3) certain interpretive rulings and special fraud alerts. Prescribes the rulemaking process to follow, including criteria for modifying and establishing safe harbors. Authorizes any person to present, at any time, a request to the Inspector General of HHS for: (1) a statement (interpretive ruling) of the current interpretation of the meaning of a specific aspect of Social Security Act civil and criminal prohibitions with respect to Medicare and Medicaid; and (2) a notice (special fraud alert) which informs the public of practices considered suspect or of particular concern under specified kickback, bribe, or rebate prohibitions. Specifies criteria for such rulings and alerts.
Bill· HRH.R. 4934 (103rd)referred
United States · United States Congress · 10 August 1994
TABLE OF CONTENTS: Title I: Immigrants and Refugees Title II: Border Control Title III: Interior Enforcement Title IV: Document Reform Title V: State and Local Responsibilities Title VI: Public Benefits Abuse Title VII: Strengthening Citizenship Title VIII: Immigration and Naturalization Service Immigration Reduction Act of 1994 - Title I: Immigrants and Refugees - Amends the Immigration and Nationality Act to revise immigration levels with respect to: (1) the worldwide level of backlogged family-sponsored immigrants; and (2) allocations for priority-worker immigrants. (Sec. 102) Limits the number of refugees who may be admitted to the United States for special humanitarian concerns. (Sec. 103) Authorizes the granting of asylum to aliens who will be threatened in their country based upon race, religion, nationality, or political opinion. Prohibits such persons from receiving any preference or priority or from being discriminated against in the granting or termination of asylum based on race, sex, religion, or nationality. (Sec. 104) Repeals the authority to grant temporary protected status to aliens. Prohibits an alien who is excludable or deportable from remaining in the United States or engaging in employment in the United States. (Sec. 105) Prohibits the Attorney General from paroling into the United States groups or classes of aliens. Prohibits such aliens from being authorized to work in the United States. Limits the number of such parolees. Title II: Border Control - Increases the number of full-time border patrol personnel in the Immigration and Naturalization Service (INS). Authorizes appropriations for FY 1995 through 1999. (Sec. 202) Imposes a land border and port of entry user fee on persons entering the United States. Title III: Interior Enforcement - Increases the number of full-time investigative personnel in INS. (Sec. 302) Restores the authority of immigration officers and employees to conduct searches without warrants. (Sec. 303) Authorizes the Secretary of Defense to make available to the Attorney General defense facilities suitable for the detention of aliens. (Sec. 304) Grants the United States Court of Appeals for the Federal Circuit exclusive jurisdiction over immigration cases. (Sec. 305) Imposes a penalty on aliens for unlawful presence in the United States. Authorizes the seizure of certain property of deportable aliens. (Sec. 308) Requires the Attorney General to inform an alien who is departing voluntarily of the date and time such departure must be accomplished. Title IV: Document Reform - Revises provisions concerning the examination of work eligibility documents of aliens, including social security cards and identification cards issued by INS. (Sec. 402) Requires the Secretary of Health and Human Services to modify the Social Security data base to provide for an electronic verification system of information on aliens. (Sec. 403) Directs the Secretary to establish a national electronic network linking the vital statistics records of State agencies. (Sec. 404) Requires aliens who have not lawfully immigrated to the United States to be employed to obtain a visa for nonimmigrant status that explicitly contemplates employment. Title V: State and Local Responsibilities - Makes a State or local government or agency that does not cooperate with Federal immigration authorities ineligible for any Federal funds or assistance relating to law enforcement, education, public health, transportation, or public works. (Sec. 502) Requires State law enforcement agencies to notify the appropriate INS district office of alien arrests. (Sec. 503) Requires confidentiality of immigration-related communications. (Sec. 504) Authorizes the Attorney General to deputize state law enforcement officers to assist Federal officers in the apprehension of aliens in violation of immigration laws. Title VI: Public Benefits Abuse - Prohibits the payment of: (1) direct Federal financial or social insurance benefits to illegal aliens; or (2) unemployment benefits to aliens without employment authorization. (Sec. 603) Revises the requirements for immigrant sponsors with respect to their financial responsibilities. Title VII: Strengthening Citizenship - Prohibits automatic citizenship to persons born in the United States of parents who are not citizens. (Sec. 702) Restricts the voting privilege to citizens of the United States. (Sec. 703) Increases from 50 years to 60 years the age for which elderly aliens are exempt from English language requirements for naturalization. Declares that the commission of a fraud upon the INS shall be conclusive evidence that an alien lacks good moral character for purposes of naturalization requirements. (Sec. 704) Authorizes a State to commence a civil suit against the head of a Federal agency for immigration law violations. Title VIII: Immigration and Naturalization Service - Establishes INS as an agency of the Federal government outside of the Department of Justice.
Bill· HRH.R. 4929 (103rd)referred
United States · United States Congress · 10 August 1994
Women and Children's Health Outreach and Education Act of 1994 - Amends the Public Health Service Act to authorize the Secretary of Health and Human Services to make grants to public and nonprofit private entities to carry out demonstration projects for: (1) identifying individuals who may be eligible for, but who are not participating in, Federal, State, or local programs that provide health services to residents of eligible communities (whose residents include a significant number of medically underserved individuals, a health professional shortage area, or communities whose infant mortality rate is significantly above the national rate); (2) assisting individuals in establishing eligibility for the benefits of the programs; (3) educating individuals on obtaining and utilizing the benefits; and (4) providing transportation, child care, translation, and other specified services to enable individuals to utilize the benefits. Authorizes the Secretary to make such grants only if: (1) the applicant agrees that project services involved will be provided in the language and cultural context most appropriate for the individuals served; and (2) an application is submitted in such form and manner, and contains such agreements, assurances, and information, as the Secretary determines to be necessary. Authorizes appropriations.
Bill· SS. 2373 (103rd)open
United States · United States Congress · 9 August 1994
TABLE OF CONTENTS: Title I: Authorization Title II: Personnel Management Improvement Title III: Navigation Safety and Waterway Services Management Title IV: Miscellaneous Provisions Title V: Recreational Boating Safety Improvement Title VI: Towing Vessel Safety Title VII: Act to Prevent Pollution from Ships Amendments Coast Guard Authorization Act of 1994 - Title I: Authorization - Authorizes appropriations for the Coast Guard for: (1) operation and maintenance; (2) acquisition, construction, rebuilding, and improvement of aids to navigation, shore and offshore facilities, vessels, and aircraft; (3) research, development, test, and evaluation; (4) retirement pay and benefits; (5) alteration or removal of bridges; and (6) environmental compliance and restoration. (Sec. 102) Authorizes the Coast Guard end-of-year strength for active duty and the average military training student loads. Title II: Personnel Management Improvement - Authorizes the Commandant of the Coast Guard to make child development services available for members of the armed forces and Federal civilian employees. (Sec. 203) Authorizes homeowners' assistance to military personnel of the Coast Guard who were assigned to, or employed at, any Federal facility or installation in the vicinity of Homestead Air Force Base, Florida, during Hurricane Andrew. (Sec. 207) Allows the Commandant to obtain research on Coast Guard personnel resource and training needs and to employ special programs for recruiting women and minorities. (Sec. 208) Authorizes the Commandant to enter into contracts to carry out health care services for Coast Guard personnel and covered beneficiaries. Title III: Navigation Safety and Waterway Services Management - Amends the Dingell-Johnson Sport Fish Restoration Act to increase the amounts transferred from State fish restoration and management project appropriations for grants for recreational boating safety programs. Revises funding from the same appropriations for grants to coastal and inland States for: (1) the construction and renovation of pumpout stations and waste reception facilities; and (2) education of recreational boaters about the problems of human body waste discharges from vessels. (Sec. 301) Increases from 24 months to five years the period of validity for certificates of inspection maintained by vessels that have oil or hazardous substances on board. (Sec. 302) Authorizes eligible States to submit plans for the construction and renovation of public facilities for transient nontrailerable vessels to the Secretary of the Interior. Authorizes grants for such purposes. (Sec. 303) Repeals a provision requiring the Secretary of the department in which the Coast Guard is operating to collect and pay to the Treasury the same fees for the inspection of foreign vessels carrying passengers from the United States that a foreign country charges U.S. vessels trading to the ports of that country. (Sec. 304) Increases civil penalties for violations regarding documentation of vessels. Revises Federal provisions to make a vessel and its equipment liable to seizure by, and forfeiture to, the U.S. Government when: (1) the owner of the vessel or representative of the owner knowingly falsifies or conceals a material fact or makes a false statement or representation about the documentation when applying for documentation of the vessel; (2) a certificate of documentation is knowingly and fraudulently used for a vessel; (3) a vessel is operated after its endorsement has been denied or revoked; (4) a vessel is employed in a trade without an appropriate trade endorsement; (5) a documented vessel with only a recreational endorsement is operated other than for pleasure; or (6) a documented vessel is placed under the command of a person who is not a U.S. citizen. (Sec. 305) Amends the Outer Continental Shelf Lands Act to make persons who fail to comply with regulations issued by the Secretary of the department in which the Coast Guard is operating liable for a civil penalty. (Sec. 306) Requires uninspected commercial fishing industry vessels that operate beyond three nautical miles from the Great Lakes coastline to be equipped with alerting and locating equipment. (Sec. 308) Considers the knowing alteration of lifesaving, fire safety, or other specified equipment such that the equipment is rendered defective to be a class D felony. Title IV: Miscellaneous Provisions - Authorizes the Secretary of Transportation to convey all right, title, and interest of the United States in Thacher Island to the Town of Rockport, Massachusetts, except that the Coast Guard shall retain all right, title, and interest in any historical artifact. Conditions such conveyance on the maintenance of specified navigation functions by the United States. (Sec. 402) Directs the Secretary to convey to the Ketchikan Indian Corporation in Ketchikan, Alaska, all right, title, and interest of the United States in and to specified Coast Guard property for use by such corporation as a Native health clinic. (Sec. 403) Requires the Secretary, for purposes of alerting the Florida Avenue Bridge in Orleans Parish, Louisiana, to treat the drainage siphon that is adjacent to the bridge as an appurtenance of the bridge. (Sec. 404) Sets forth conditions under which transferring a tuna fishing vessel which is an agreement vessel documented under U.S. laws to foreign registry shall not be treated as a disposition of an agreement vessel or a failure to meet any substantial obligation under an agreement entered into between the owner or operator of the vessel and the approriate Secretary. Provides that all vessel income and expense will, after registry transfer, continue to be reported as income and taxed in the United States as if the vessels's registry had not been transferred. Title V: Recreational Boating Safety Improvement - Amends Federal boating safety law to prohibit a person from operating a recreational vessel under 26 feet in length unless each individual six years or younger wears a Coast Guard approved personal flotation device while on the vessel's deck. (Sec. 502) Sets forth a formula for the allocation of State recreational boating safety program funds based upon State adoption of prohibitions on the operation of recreational vessels while under the influence of alcohol or drugs. (Sec. 503) Directs the Secretary of Transportation to submit to specified congressional committees a plan to increase reporting of vessel accidents to State law enforcement officials. (Sec. 504) Declares that persons who operate a recreational vessel in violation of this Act may be ordered to complete an approved recreational boating safety course. Title VI: Towing Vessel Safety - Authorizes the Secretary of the department in which the Coast Guard is operating to require the use of specified navigation equipment on towing vessels. (Sec. 602) Directs individuals who apply for issuance or renewal of a towing vessel operator's license to demonstrate proficiency in the use of navigational safety equipment. (Sec. 603) Requires marine casualties to be reported as soon as practicable, but in no case later than within five days. Increases penalties for an individual in charge of a vessel for failing to report a casualty. (Sec. 604) Directs the Secretary of Transportation to report to the Congress on: (1) the adequacy and effectiveness of manning of towing vessels and progress made in implementing improvements in towing vessel operator licensing requirements; and (2) the feasibility of establishing a differential global positioning satellite navigation system and creating electronic charts for U.S. inland waterways. Title VII: Act to Prevent Pollution from Ships Amendments - Amends the Act to Prevent Pollution from Ships to authorize the Secretary of the department in which the Coast Guard is operating to issue a certificate attesting to the adequacy of garbage reception facilities at a port or terminal only if an inspection has been conducted prior to the issuance of a certificate. (Sec. 702) Makes such certificates valid for a period of five years unless there is a change of operator. Directs the Secretary to promulgate regulations that require the operators of ports or terminals subject to MARPOL Protocol (the Protocol of 1978 relating to the International Convention for the Prevention of Pollution From Ships, 1973) requirements relating to reception facilities to post placards stating that users should report facility inadequacies to the Secretary. Requires all vessels to display placards and conduct briefings that notify the crew and passengers of requirements of Annex V of the Convention. Authorizes the Secretary of the Treasury to refuse or revoke certain permits to proceed or depart of foreign vessels in violation of MARPOL requirements. Provides for a toll-free telephone number for reporting MARPOL violations. (Sec. 703) Amends the Marine Plastic Pollution Research and Control Act of 1987 to direct the Secretary of the department in which the Coast Guard is operating to report to the Congress on potential improvements of the waste management practices at port facilities. Expresses the sense of the Congress that certain shipper insurance policies should not provide for the payment of penalties under the Act to Prevent Pollution from Ships. Requires persons in charge of vessels to include information on the disposal of onboard waste in the notice of arrival to the port. Direct the Administrator of the Environmental Protection Agency to establish a Marine Debris Coordinating Committee.
Bill· SS. 2374 (103rd)open
United States · United States Congress · 9 August 1994
TABLE OF CONTENTS: Title I: Affordable Health Insurance Coverage Subtitle A: Tax Incentives Subtitle B: Premium Assistance Title II: Health Insurance and Delivery Systems Reform Subtitle A: Federal Standards for State Certification Programs Subtitle B: Consolidation of Federal Research Subtitle C: Self-Employed Individual and Small Employer Participation in Federal Employees Health Benefits Plans Subtitle D: Report on Health Care System Title III: Special Assistance for Rural, Frontier and Underserved Urban Areas Subtitle A: Planning, Demonstrations, and Grants Subtitle B: Technical Assistance Grants Subtitle C: Capital Assistance Loans and Loan Guarantees Subtitle D: Increasing Primary Care Providers Subtitle E: Payment Flexibility Subtitle F: Emergency Medical Systems Subtitle G: Studies and Reports Title IV: Long-Term Care Provisions Subtitle A: Long-Term Care Services and Contracts Subtitle B: Tax Treatment of Accelerated Death Benefits Subtitle C: Credit for Personal Assistance Title V: Health Care Providers Subtitle A: Education and Research Subtitle B: Health Care Liability Reform Subtitle C: Health Care Antitrust Improvements Title VI: Administrative Simplification and Privacy Title VII: Enhanced Penalties for Health Care Fraud Subtitle A: All-Payer Fraud and Abuse Control Program Subtitle B: Revisions to Current Sanctions for Fraud and Abuse Subtitle C: Administrative and Miscellaneous Provisions Subtitle D: Amendments to Criminal Law Subtitle E: Amendments to Civil False Claims Act Title VIII: Medicare and Medicaid Subtitle A: Medicare Subtitle B: Medicaid Program Title IX: Department of Veterans Affairs Title I: Affordable Health Insurance Coverage - Subtitle A: Tax Incentives - Amends the Internal Revenue Code to allow a deduction for the qualified health insurance costs of individuals (including self-employed individuals) that provide their own health insurance. (Sec. 111) Allows individuals a tax deduction for contributions made to a medical care savings account established for the benefit of one or more eligible individuals. Limits the amount of such deduction to specified amounts (dependent upon the tax filing category) or the high deductible health plan differential. Allows such deduction whether or not an individual itemizes deductions. (Sec. 112) Excludes employer contributions to medical savings accounts from the gross income of the employee, with a dollar limitation or the high deductible health plan differential. Excludes employer contributions to such accounts from employment taxes. (Sec. 113) Provides for the establishment of medical savings accounts. Sets contribution limitations, including that the individual on whose behalf such contributions are made is covered under a high deductible health plan. Subjects the account beneficiary to taxation as owner of the account. Imposes a penalty for distributions that are not used for qualified medical expenses. Subtitle B: Premium Assistance - Amends title XIX (Medicaid) of the Social Security Act (SSA) to require States with approved Medicaid plans to provide for State programs for furnishing certain low-income families with assistance in regard to certified health plan premiums. Establishes annual limitations on premium assistance spending. Requires the President's budget to include estimates of premium assistance expenditures under Medicare and Medicaid. Title II: Health Insurance and Delivery Systems Reform - Subtitle A: Federal Standards for State Certification Programs - Amends SSA title XIX to require State Medicaid plans to provide for State programs under a new SSA title XXI for certifying insured health plans in the State that meet certain Federal standards and delivery system guidelines developed by the Secretary of Health and Human Services (HHS) incorporating specified requirements pertaining, among other things, to guarantee issue and renewal, preexisting condition exclusions, minimum benefit packages, quality assurance, and access to health care services, as certified health plans. Requires State programs also to provide consumers in the State with comparative value information on the performance of all health plans in each community rating area established in the State. Requires risk adjustment programs. Authorizes appropriations. Requires the Secretary of Labor to develop similar standards and guidelines for Federal certification of self-insured health plans. Provides for: (1) the treatment of certain State laws with regard to health plans; and (2) expanded access to health plans through purchasing cooperatives, the Federal Employee Health Benefits Program in the case of small businesses, and certain multiple employer welfare arrangements maintained by qualified associations; (3) special rules for church, multiemployer, and certain rural cooperative plans; and (4) general employer responsibilities with regard to payroll deductions for certified health plan premiums. Subtitle B: Consolidation of Federal Research - Establishes the Agency for Quality Assurance and Consumer Information within the Department of Health and Human Services. Creates an Administrator for Quality Assurance and Consumer Information to head the Agency. (Sec. 211) Directs the Secretary of Health and Human Services, acting through the Administrator, to consolidate Federal research activities relating to quality and consumer information in health care to enable States to gain access to the results of such research from a central source. Lists current Federal responsibilities to be assumed by the Administrator. Authorizes appropriations. Subtitle C: Self-Employed Individual and Small Employer Participation in Federal Employees Health Benefits Plans - Amends Federal civil service law to require the Office of Personnel Management (OPM) to promulgate regulations applying the Federal Employees Health Benefits Program (FEHBP) to self-employed individuals and businesses employing 50 or fewer employees, allowing required enrollee and Government contributions to be made by the State or small business involved or else be made in full by the self-employed or small business enrollee. (Sec. 221) Extends continued coverage under FEHBP. Requires carriers under FEHBP and the small business health insurance program to submit periodic reports to OPM comparing costs between the programs. (Sec. 222) Prohibits the FEHBP and the program described by this subtitle from being offered exclusively to Members of the Congress and congressional employees. (Sec. 223) Directs the Secretary to study and report to the Congress on nonworker and noncovered employee buy-ins for FEHBP coverage. Subtitle D: Report on Health Care System - Directs the President to report to the Congress on specified aspects of the health care system. Title III: Special Assistance for Rural, Frontier and Underserved Urban Areas - Authorizes States to designate certain rural, frontier, or urban areas as underserved areas based on the lack of access to health plans, quality health providers, and health care facilities. (Sec. 302) Requires the Secretary, upon a State's request, to establish a procedure to certify such areas as underserved areas. Directs the Secretary to give priority in awarding assistance to applicants that serve such areas except with respect to assistance provisions that explicitly direct assistance to areas currently designated as underserved. Subtitle A: Planning, Demonstrations, and Grants - Authorizes the Secretary to conduct a demonstration project and grant program to encourage the development and operation of health networks. Authorizes appropriations. (Sec. 312) Amends title XX (Block Grants to States for Social Services) of the Social Security Act to provide for grants to private entities for developing health networks or health plans to serve underserved areas certified under section 302 of this Act. Authorizes appropriations. (Sec. 313) Amends the Public Health Service Act to establish a program of allotments to States for grants for community-based primary health services to low-income or medically underserved populations. Earmarks funding for such grants. Subtitle B: Technical Assistance Grants - Directs the Secretary to award technical assistance grants to public and private entities for establishing infrastructure for health networks and plans in underserved areas certified under section 302 of this Act. Authorizes appropriations. Subtitle C: Capital Assistance Loans and Loan Guarantees - Directs the Secretary to make loans to health networks, health plans that cover individuals residing in rural, frontier, or urban underserved areas, or health care providers that serve such areas for the capital costs of developing health delivery systems and expanding existing health delivery sites to make health care services available in underserved areas certified under section 302. Subtitle D: Increasing Primary Care Providers - Amends the Internal Revenue Code to: (1) allow a nonrefundable credit for certain primary health services providers for mandatory service periods in health professional shortage areas; and (2) increase the dollar limitation allowed for expensing medical equipment used in such areas. (Sec. 343) Mandates grants to federally qualified health centers (FQHCs) and other entities for providing access to services for medically underserved populations or in high impact areas not currently being served by a FQHC. Authorizes appropriations. (Sec. 345) Authorizes the Secretary to award grants to States for primary health care and social service programs targeted to pregnant women and infants. Authorizes appropriations. (Sec. 346) Amends the Elementary and Secondary Education Act of 1965 to revise provisions regarding the improvement of school health education. Requires the Secretary of Education to award grants to States for local programs of health education and prevention, early health intervention, and health education in pre-schools and elementary schools and to carry out other related activities. Authorizes appropriations. (Sec. 347) Authorizes frontier States (including Alaska, Wyoming, and Montana) to implement proposals to: (1) offer preventive services, including mobile preventive health centers; and (2) participate in demonstration projects to improve recruitment, retention, and training of rural providers. (Sec. 348) Authorizes specified amounts of appropriations for the National Health Service Corps Scholarship Program through FY 2000. (Currently, such sums as necessary are authorized to be appropriated.) Extends the authorization of appropriations for area health education centers through FY 2000. (Sec. 349) Directs the Secretary of Health and Human Services to establish the Interagency Task Force on Rural Telemedicine. (Sec. 350) Requires the Secretary, acting through the Office of Rural Health, to award grants to eligible entities to promote the use of telemedicine to strengthen health care in rural areas. Authorizes appropriations. Subtitle E: Payment Flexibility - Amends SSA title XVIII (Medicare) to: (1) make various specified changes in essential access community hospital (EACH) program provisions, including changes allowing an unlimited number of States to participate in the program, and eliminating grant tie-in requirements for EACH or rural primary care hospital designation. Extends the deadline for development of a prospective payment system (PPS) for inpatient rural primary care hospital services. Provides for the implementation of a PPS for outpatient rural primary care hospital services. Revises the physician staffing requirements for rural primary care hospitals. Authorizes increased appropriations for the EACH program. (Sec. 352) Amends Medicare part A to provide for medical assistance facility and emergency access care hospital demonstration projects for improving access to health care in rural areas. Authorizes appropriations. (Sec. 353) Makes various specified changes with regard to Medicare-dependent, small rural hospitals. (Sec. 354) Provides for expanded coverage for physician assistants and nurse practitioners. Subtitle F: Emergency Medical Systems - Amends the Public Health Service Act to prove for grants to States for systems to transport rural victims of medical emergencies by air. Authorizes appropriations. Subtitle G: Studies and Reports - Amends SSA title VII (Administration) to: (1) provide for the appointment of an Assistant Secretary for Rural Health in the Office of Rural Health Policy; and (2) make administrative changes respecting the Office and duties of the new assistant secretary. (Sec. 372) Requires: (1) the Prospective Parent Assessment Commission to study and report to the Congress on the need for legislation or regulations to ensure that vulnerable populations have adequate access to health plans and health care providers and services; and (2) the Secretary of HHS to study and report to the Congress on expanding the benefits under health plans for individuals residing in rural areas. Title IV: Long-Term Care Provisions - Subtitle A: Long-Term Care Services and Contracts - Amends the Internal Revenue Code to treat qualified long-term care services as medical care for purposes of the medical expense deduction. (Sec. 402) Provides for the treatment long-term care insurance as accident or health insurance. Excludes qualified long-term care insurance contracts from cafeteria plans. (Sec. 406) Sets forth consumer protection provisions to be satisfied by qualified long-term care insurance contracts, including the model regulation and model Act promulgated by the National Association of Insurance Commissioners (NAIC). (Sec. 407) Imposes an excise tax on insurers who fail to meet requirements for long-term care insurance policies. (Sec. 409) Requires NAIC to promulgate standards for the use of uniform language and definitions in such policies, with certain variations permitted. Subtitle B: Tax Treatment of Accelerated Death Benefits - Provides for the exclusion as a death benefit of any amount received under a life insurance contract because such individual is terminally ill. Allows insurance companies to issue accelerated death benefit riders on life insurance contracts. Subtitle C: Credit for Personal Assistance - Allows a tax credit for the cost of personal assistance services required by certain individuals. Describes such individuals as those who, by reason of a medically determinable physical impairment which can be expected to last for a continuous period of not less than 12 months, are unable to engage in any substantial gainful employment activity without personal assistance services appropriate to carry out activities of daily living. Limits the amount of such credit and provides a cost-of- living adjustment. Title V: Health Care Providers - Subtitle A: Education and Research - Amends SSA title XVIII to: (1) require the Director of the Office of Technology Assessment to provide for the appointment of an Advisory Commission on Workforce to develop recommendations and assessments with regard to national health care workforce policy and payment for a report to the Congress. Authorizes appropriations. (Sec. 502) Requires the Secretary of HHS to provide for a consortium demonstration program for testing and evaluating mechanisms for increasing the number of medical students entering primary care practice through the use of funds available for direct graduate medical education (GME) costs. Authorizes appropriations. (Sec. 503) Requires that residency training time spent in nonhospital-owned facilities be counted in determining full-time- equivalent residents for direct and indirect GME payments. (Sec. 504) Amends the Internal Revenue Code to create in the Treasury the National Fund for Medical Research consisting of designated overpayments and cash contributions for use by the National Institutes for Health (NIH) for medical research and construction and acquisition of equipment and facilities for NIH, and for health information communications under the Public Health Service Act. Subtitle B: Health Care Liability Reform - Amends SSA title XI part A to provide for various specified changes with regard to civil actions in State or Federal court for damages arising out of alleged injuries caused by health care providers or payors, including among such changes: (1) limitations on noneconomic damages, attorney contingency fees, and action time frames; (2) requirements for pleading of punitive damages, periodic damage payments, and risk management programs for health care providers; and (3) providing for State health care quality assurance programs funded out of a portion of all punitive damages awarded in the State. Subtitle C: Health Care Antitrust Improvements - Exempts from all antitrust claims an activity relating to the provision of health care services that is: (1) within a "safe harbor" designated by the Attorney General, except for claims for injunctive relief asserted by the Attorney General or the Chair of the Federal Trade Commission in extraordinary circumstances; and (2) specified in and in compliance with the terms of a certificate of review issued by the Attorney General, where the activity occurs while the certificate is in effect, except for claims for injunctive relief. Sets forth provisions regarding the award of attorney fees and costs of suit to the prevailing party in an action based on a claim involving an activity found to be exempt. (Sec. 522) Directs the Attorney General to develop and designate specified safe harbors relating to the following, as well as to such other categories of activities as the Attorney General may designate (subject to specified requirements): (1) joint purchasing of health care services; (2) small hospital mergers; (3) startup and operation of collaborations between State-licensed providers through partial or full integration; (4) standard-setting and enforcement activities by medical self-regulatory entities; (5) health care providers collectively supplying non-price medical information to buyers and consumers; (6) health care provider participation in surveys; (7) health care joint venture's purchase or use of new or existing high technology or costly equipment or the provision of advanced tertiary care services; (8) provision of market power screens at appropriate levels below which combinations of providers are too small to pose a realistic antitrust threat; (9) joint purchasing arrangements; and (10) good faith negotiations relating to legitimate collaborative activities. Directs the Attorney General to publish a notice in the Federal Register soliciting proposals for additional safe harbors. Authorizes the Attorney General to modify or remove a safe harbor following notice and comment upon a determination that the safe harbor does not meet specified required criteria. Sets forth criteria to be considered in establishing safe harbors, including: (1) the extent to which a competitive or collaborative activity will accomplish an increase in health care access and quality, the establishment of cost efficiencies, and increased ability of health care facilities to provide services in medically underserved areas or to underserved populations; and (2) whether designation as a safe harbor will result in specified desirable outcomes. (Sec. 523) Directs the Attorney General to issue certificates of review for providers of health care services and to assist persons in applying for such certificates. Sets forth procedures regarding applications for, revocation of, and review of determinations regarding such certificates. Limits the disclosure of information. (Sec. 524) Sets forth provisions regarding notifications providing for a reduction in certain penalties under the antitrust laws for health care cooperative ventures. (Sec. 525) Directs the Attorney General to: (1) periodically review the safe harbors, certificates of review, and notifications; and (2) publish, and periodically update, specified guidelines intended to promote greater certainty regarding the application of the antitrust laws to activities in the health care market. Title VI: Administrative Simplification and Privacy - Amends SSA title XI to provide for administrative simplification in the health care system including Medicare and Medicaid, by directing the Secretary of HHS to adopt specified standards for: (1) data elements and information transactions to electronic transmission of certain health information; (2) locating and accessing for authorized purposes health information available through the health information network developed through requirements under this title for electronic transmission of such information; and (3) certifying such information networks. Provides penalties for failure to comply with such standards and requirements. Authorizes appropriations. Establishes a Health Care Information Advisory Committee to advise the Secretary of HHS and the Congress on the status of the network. Authorizes appropriations. Directs the Secretary to make grants for electronically integrated demonstration projects for community-based clinical information systems and computerized patient medical records. (Sec. 601) Makes amendments with regard to the Medicare and Medicaid Coverage Data Bank and related identification processes. (Sec. 602) Provides for the establishment of a mechanism for protecting the privacy of individuals with respect to individually identifiable health care information that is created or maintained as part of health treatment, enrollment, payment, testing, or research processes. Establishes civil and criminal penalties for violations of such privacy protections. Authorizes appropriations. Title VII: Enhanced Penalties for Health Care Fraud - Subtitle A: All-Payer Fraud and Abuse Control Program - Directs the Secretary of HHS to establish a program to: (1) coordinate Federal, State, and local law enforcement programs to control fraud and abuse with respect to the delivery of and payment for health care; and (2) perform other specified tasks applicable to controlling health care fraud and abuse. (Sec. 701) Creates in the Treasury the Anti-Fraud and Abuse Trust Fund for use in conjunction with such program. (Sec. 702) Amends SSA title XI to provide for the application of Federal health anti-fraud and abuse sanctions to all fraud and abuse against any health care plan. (Sec. 703) Directs the Secretary of HHS to publish notice in the Federal Register soliciting proposals for certain: (1) safe harbor activities related to payment for health care services; and (2) interpretive rulings and special alerts concerning health care fraud and abuse. (Sec. 704) Directs the Secretary to establish a program through which individuals entitled to Medicare benefits may report to the Secretary on a confidential basis instances of suspected Medicare fraud by program providers. Subtitle B: Revisions to Current Sanctions for Fraud and Abuse - Amends SSA title XI to revise current sanctions for fraud and abuse involving Medicare and State health care programs, providing for: (1) program exclusion for individuals convicted of a felony relating to fraud or the unlawful manufacture or dispensing or a controlled substance; (2) new offenses under civil monetary penalty provisions, such as the offering of inducements to program-eligible individuals and the misuse of health security cards or unique health identifiers; (3) establishment of a minimum period of exclusion for practitioners and persons who fail to meet statutory obligations; (4) intermediate sanctions on eligible HMOs for program violations; and (5) procedures for imposing such sanctions. Subtitle C: Administrative and Miscellaneous Provisions - Directs the Secretary to establish a national health care fraud and abuse data collection program for the reporting by government health care providers, suppliers, and practitioners. Requires program information to be made available to Federal and State governments, subject to a possible fee. Subtitle D: Amendments to Criminal Law - Amends the Federal criminal code to set penalties for knowingly executing a scheme or artifice to: (1) defraud any health care plan in connection with the delivery of, or payment for, health care benefits, items, or services; or (2) obtain, by means of false or fraudulent pretenses, representations, or promises, money or property owned by, or under the custody or control of, any health care plan or person in connection with delivery of or payment for health care benefits. (Sec. 731) Requires the Secretary of the Treasury to deposit into the Anti-Fraud and Abuse Trust Fund an amount equal to criminal fines imposed. (Sec. 732) Makes other specified criminal law changes with regard to forfeitures and injunctive relief with respect to Federal health care offenses and provides for similar deposits into the Anti-Fraud and Abuse Trust Fund. Subtitle E: Amendments to Civil False Claims Act - Makes provisions of the Civil False Claims Act applicable to the use of false records or statements made to a health care plan. Includes within the definition of "claim" for purposes of such Act, a request or demand for money or property which is made or presented to a health care plan. Provides for deposits into the Anti-Fraud and Abuse Trust Fund of amounts equal to penalties and damages imposed under the Civil False Claims Act. Title VIII: Medicare and Medicaid - Subtitle A: Medicare - Directs the Secretary to study and report to the Congress on allowing payment under Medicare for certain Medicare beneficiaries enrolled in either private or other Federal health care plans. (Sec. 802) Revises Medicare provisions on payments to HMOs and competitive medical plans. Directs the Secretary of HHS to establish certain demonstration projects in designated areas for paying such organizations on the basis of a special payment methodology. Amends the Omnibus Budget Reconciliation Act of 1987 to provide for an extension of social health maintenance organizations. (Sec. 803) Amends: (1) the Omnibus Budget Reconciliation Act of 1990 (OMBRA '90) to permit Medicare supplemental policies to be offered in all States; and (2) SSA title XVIII to make technical corrections to provisions on Medicare supplemental policies. (Sec. 811) Makes specified changes with regard to Medicare part A (Hospital Insurance) provisions with regard to: (1) inpatient hospital services updates for PPS hospitals; (2) payment reductions for capital-related costs for inpatient hospital services; (3) payment adjustments for disproportionate share hospitals in participating States; (4) moratoriums on new long-term hospitals; (5) adjustment reductions for indirect medical education; and (6) routine service cost limit reductions for skilled nursing facilities. (Sec. 821) Makes specified changes with regard to Medicare part B (Supplementary Medical Insurance) provisions with regard to: (1) physicians' services updates and payments; (2) establishment of hospital outpatient PPS for hospital outpatient departments; and (3) general Medicare part B premiums. (Sec. 831) Makes specified changes with regard to Medicare parts A and B provisions with regard to: (1) Medicare as secondary payer; and (2) routine cost limit reductions for home health services. Subtitle B: Medicaid Program - Provides for coordination of the Medicaid program with the new health care system established under this Act through such changes as: (1) establishing a cap on payments for certain acute medical services furnished under Medicaid; (2) providing for the integration of certain Medicaid eligibles into the new system; (3) providing for State programs for supplemental benefits; and (4) providing for optional coverage under certified health plans of SSI-eligible individuals. (Sec. 861) Amends SSA title XIX to modify Federal requirements to allow State flexibility in contracting for coordinated care services under Medicaid. (Sec. 871) Amends: (1) Medicaid long-term care provisions, permitting certain demonstration projects and relief from third party liability requirements when cost-effective, among other changes; and (2) the Omnibus Budget Reconciliation Act of 1986 with regard to frail elderly demonstration projects. (Sec. 878) Modifies Medicaid provisions on case management services and home and community-based waivers. (Sec. 881) Makes specified changes in provisions concerning: (1) disproportionate share hospital (DSH) payment adjustments; (2) the Federal medical assistance percentage for certain States; and (3) criteria for determining the amount of disallowances. (Sec. 882) Directs the Secretary to submit recommendations to the Congress on a phased-in elimination of Medicaid DSH payment adjustments. (Sec. 885) Makes technical corrections relating to OMBRA '90 provisions on physicians' services. Title IX: Department of Veterans Affairs - Veterans Health Care Administrative Flexibility Act of 1994 - Expresses as the intent of the Congress that Department of Veterans Affairs health care facilities participate as health care providers recognized under health care reform legislation enacted by the States. Directs the Secretary of Veterans Affairs to provide health care services in a State enacting such reform legislation. Prohibits any State from denying Department participation as a health care provider under such legislation unless the State's chief executive officer certifies that: (1) the benefits to be provided by the Department do not meet the State quality benefits standard; or (2) the location of Department facilities does not meet State proximity requirements. Authorizes the Secretary, in order to facilitate the provision of Department health care services in a manner that is responsive to local market and regulatory conditions, to designate Department health care facilities which shall be exempt from specified Federal regulatory provisions. Allows exempted Department facilities to enter into contracts and agreements for the provision of health care and related services under a State health care reform plan. Exempts such contracts and agreements for less than $250,000 from prior review by the Department's Central Office. Provides for review of contracts or agreements of such amount or greater. Authorizes the Secretary to utilize Department personnel to provide necessary health care services under this title. Provides funding by establishing in the Treasury a Department of Veterans Affairs Health Care Reform Fund, into which shall be deposited certain funds collected by the Secretary from third party payers to defray the costs of providing health care services to veterans. Requires a separate account to be maintained in the Fund for each exempted Department health care facility. Allows exempted Department facilities to expend funds to cover marketing, advertising, legal, acquisition, construction, repair, and renovation costs.
Bill· HRH.R. 4916 (103rd)referred
United States · United States Congress · 8 August 1994
TABLE OF CONTENTS: Title I: Community Participation and Human Health Title II: State Roles Title III: Voluntary Response Title IV: Liability and Allocation Title V: Remedy Selection and Cleanup Standards Title VI: Miscellaneous Title VII: Funding Title VIII: Environmental Insurance Resolution Fund Title IX: Taxes Superfund Reform Act of 1994 - Title I: Community Participation and Human Health - Amends the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA or Superfund) to authorize the Administrator of the Environmental Protection Agency (EPA) to make technical assistance grants available to any group of individuals who may be affected by the release or threatened release of hazardous substances or pollutants at any facility on the State Registry or National Priorities List (NPL). (Sec. 101) Requires the President to provide for public participation in significant phases of response activities under CERCLA. Makes all nonprivileged information available to the public throughout all phases of the response action. Directs the President to ensure that the presentation of information on risk is unbiased and informative. (Sec. 102) Requires the President to provide the opportunity for the establishment of a representative public forum, known as a Community Working Group (CWG), to achieve direct, regular, and meaningful consultation with all interested parties throughout all stages of a response action whenever: (1) the President determines such a group will be helpful; or (2) 50 citizens, or at least 20 percent of the population of a locality in which the NPL facility is located, petition for a CWG to be established. Authorizes CWGs to offer recommendations on the anticipated future use of land at an affected facility prior to the selection of a remedy. Establishes a Citizen Information and Access Office within each State to provide information regarding State Registry and NPL sites, citizens' rights, facility records and health data, public meetings, removal and remedial actions, and outreach activities. Authorizes Indian tribes to petition the Administrator to form a body equivalent to such Office. Directs the Administrator to submit a biennial Environmental Justice Study to the Congress. (Sec. 103) Requires the President, in setting priorities for taking remedial action, to: (1) group facilities together, even if they are not adjacent, and score them as a single facility where more than one facility on the State Registry results in hazardous substances exposures to the same population; (2) take into account the use of land or waterways for subsistence, religious, or cultural practices where such use results in additional exposures, in placing facilities on the NPL; (3) conduct interviews with persons affected by the facility and solicit their input in the hazard ranking system evaluation; and (4) place highest priority on facilities with releases of hazardous substances which result in actual ongoing human exposures at levels resulting in demonstrated adverse health effects as identified in specified health assessments. Authorizes the President to take into account any history of exposure to hazardous substances in the community regardless of the source of exposure, in placing facilities on the NPL. Requires the Administrator to: (1) evaluate major urban areas and other areas where environmental justice concerns may warrant special attention; and (2) identify five facilities in each EPA region that are, or should be, on the State Registry and that are likely to warrant inclusion on the NPL. Accords such facilities a priority in evaluation for NPL listing and scoring. (Sec. 109) Requires the Agency for Toxic Substances and Disease Registry (ATSDR) Administrator to develop and distribute educational materials on human health effects of hazardous substances to the public. (Sec. 110) Authorizes the ATSDR Administrator to provide grant or contract assistance to individuals who may be affected by releases or threatened releases when: (1) a public health assessment is conducted at a facility on the NPL; or (2) a release is being evaluated for inclusion on the NPL. Authorizes the ATSDR Administrator, pursuant to such grants or contracts, to provide for health services to communities affected by the release of hazardous substances. (Sec. 113) Permits the EPA Administrator to carry out a demonstration program to assist in the recruitment and training of individuals from areas affected by NPL facilities for employment in remediation activities. Encourages parties conducting response actions under CERCLA to have their contractors train minorities and other disadvantaged persons from the affected community in remediation skills. Title II: State Roles - Authorizes States, pursuant to contracts or cooperative agreements, to apply to the Administrator to take or require: (1) preremedial actions at any non-federally owned or operated facility that is not listed on the NPL; or (2) response actions at non-federally owned or operated NPL facilities or removal actions at any facility proposed for listing on the NPL. Sets forth requirements for State enforcement and allocation of liability. (Sec. 202) Prohibits funding to States for response actions, except for emergency removal actions, unless the affected State provides assurances that it will pay 15 percent of the cost of the action or funding and will assure oversight of any operation and maintenance of response actions. (Sec. 206) Directs the Administrator to study the feasibility of authorizing States to use their own laws to carry out CERCLA in lieu of the Federal program under such Act. (Sec. 207) Authorizes States to apply to the Administrator to exercise the Administrator's authorities with respect to response actions at Federal facilities. Bases approval of transfer of authorities in part on a State's hazardous waste program authorization under the Solid Waste Disposal Act. Continues the existing limitations on transfers of authority from the Administrator to any other person under provisions regarding Federal facilities. Title III: Voluntary Response - Directs the Administrator to establish a program to provide assistance to States to establish and expand voluntary response programs. (Sec. 301) Provides that no portion of a facility subject to a response action plan under a qualified State program shall be proposed for listing on the NPL so long as substantial and continual response activities are being undertaken to complete the response action in a timely fashion. Directs the Administrator to promulgate regulations describing circumstances in which States with qualified programs and the authority to issue permits under Federal environmental statutes may waive permit requirements with respect to approved voluntary response plans under certain conditions. Provides that performance of a voluntary response action shall not constitute an admission of liability under any Federal, State, or local law or regulation or in any private action. Title IV: Liability and Allocation - Authorizes the Administrator to issue administrative subpoenas to require the attendance and testimony of witnesses and production of information regarding response actions. Revises confidentiality requirements with respect to such information and applies confidentiality requirements to contractors. (Sec. 403) Absolves of liability for response actions a person who does not impede a response action or natural resource restoration to the extent liability is based solely on: (1) arrangement, transportation, or acceptance provisions relating to disposal or treatment of hazardous substances and such activities only involved municipal solid waste or sewage sludge possessed by the person and the person is the owner, operator, or lessee of residential property or a small business or small nonprofit organization; (2) such provisions and such activities involved fewer than 55 gallons of liquid materials (or 100 pounds of solid materials) containing hazardous substances, pollutants, or contaminants or such amount as the Administrator may determine; (3) ownership or operation of a vessel or facility and the person is a bona fide prospective purchaser of the facility; (4) ownership and the person acquired the facility by inheritance after disposal of the hazardous substances took place, did not contribute to the release, and exercised due care with respect to such substances; (5) ownership by a Federal, State, or local entity of a road or other right-of-way (other than railroads) over which hazardous substances are transported or on the granting of a license or a permit to conduct business; or (6) actions of a Federal agency in response to a natural disaster. Makes persons who are solely liable under arrangement, transportation, or acceptance provisions regarding disposal or treatment of hazardous substances liable for no more than ten percent of total response costs if such activities only involved municipal solid waste or sewage sludge. Applies such limitation to the aggregate liability of all persons involved. Applies such limitation only if acts or omissions giving rise to liability occurred before the date 36 months after enactment of this Act or the person asserting the limitation participates in a qualified household hazardous waste collection program. Limits the liability of persons who do not impede the performance of a response action or natural resource restoration with respect to a release to the lesser of the fair market value of a vessel or facility or the actual proceeds of the sale of the vessel or facility subject to certain conditions. Provides that a person who owns or operates real property contiguous to property on which there has been a release of a hazardous substance and that may be contaminated shall not be considered an owner or operator, for liability purposes, if such persons: (1) exercised due care with respect to such substance; (2) took precautions against foreseeable acts or omissions that resulted in the release; and (3) did not cause or contribute to the release and provides access to persons authorized to conduct response actions. Authorizes the President to issue assurances of no enforcement action to such person and grant such person protection against cost recovery and contribution actions. Grants the United States a lien, subject to certain conditions, on any facility for which the prospective purchaser is not liable for unrecovered response costs. Provides that no lien shall arise with respect to property: (1) for which the property owner preceding the first bona fide prospective purchaser is not liable or has resolved liability; or (2) where an audit required by an environmental professional gives the purchaser no reason to know of the release of hazardous substances. (Sec. 404) Directs the Administrator to calculate the EPA response action oversight costs for which potentially responsible parties (PRPs) are liable on a national basis as a percentage of total response costs incurred by PRPs (the national oversight rate). Limits the rate to ten percent of total response costs incurred by all PRPs. Provides that when the President responds at facilities on the NPL, liability for pollutants and contaminants shall be identical to that for hazardous substances only if such pollutants and contaminants: (1) constitute an imminent and substantial danger to human health; and (2) are not associated with the production or extraction of any hydrocarbon. Prohibits liability based solely on a person's construction activities at a facility if a person can demonstrate that the activities were carried out in accordance with a contract with the owner or operator and the person is a small business construction contractor. (Sec. 405) Revises contribution provisions to require an action by a PRP against another PRP for recovery of costs to be commenced within the later of: (1) three years after completion of a removal action or within six years after initiation of physical on-site construction of the remedial action; or (2) three years after the date of judgment in any action for recovery or the date of any administrative order or judicial settlement for recovery of costs or damages. (Sec. 406) Provides that a person who has resolved liability to a State or an Indian tribe in an administrative or judicially approved settlement shall not be liable for claims by persons other than the United States regarding response costs or damages addressed in the settlement. Provides the same protection for persons who have resolved liability to the United States. Includes protection against all claims that may be asserted against the settling party for recovery of costs or damages paid by another person if addressed in the settlement, except claims based on contractual indemnification. Limits the right to seek contribution from other parties where: (1) the person asserting the right has waived such right in a settlement; (2) the person from whom the contribution is sought is not liable under CERCLA; or (3) the person from whom the contribution is sought has entered into a final settlement with the United States. Makes any person who commences a contribution action liable to the person against whom the action is brought for all reasonable costs of defending against the claim if the action: (1) is barred for the reasons stated above; (2) is brought against a person who is protected from suits by reason of settlement with the United States; or (3) is brought during a specified moratorium period. (Sec. 408) Provides that response action contractors shall not be liable solely as a result of testing or implementation of alternative or innovative treatment or containment technologies with respect to a response action if use of the technology has been approved by the authorized Federal or State regulatory agency. (Sec. 409) Requires consent decrees pursuant to settlements to require the parties to attempt expeditiously to resolve disagreements concerning implementation of the remedial action informally with Federal and State agencies. Requires such decrees to contain stipulated penalties for violations in an amount of up to $25,000 per day. Waives certain conditions to expand the scope of eligibility for de minimis settlements. Authorizes the Administrator, if a PRP will be paying amounts to the President as part of a settlement for carrying out a response action, to accept ownership of a financial instrument running irrevocably to the benefit of the United States to conduct such response actions. (Sec. 411) Requires (current law authorizes) the President to offer PRPs (currently, any person) who enter into settlement agreements that are in the public interest a final covenant not to sue concerning liability to the United States for response actions or costs, provided that: (1) the settling party agrees to perform a final remedial action for the release that is the subject of the settlement; (2) the remedial action does not provide any hazardous substances will remain at the facility at concentrations above the protective concentration levels established after completion of the final action; (3) the agreement has been reached prior to the commencement of litigation against the settling party; (4) the settling party waives all contribution rights against other PRPs at the facility; (5) the settling party pays a premium that compensates for the risks of remedy failure, unanticipated increases in the cost of any uncompleted action (unless the party is performing the action), and the U.S. litigation risk with respect to persons who have not resolved liability to the United States unless the settlement covers 100 percent of U.S. response costs; and (6) the settlement is otherwise acceptable to the United States. Authorizes the President, for settlements for which covenants are unavailable, to provide any person with a covenant not to sue concerning any liability to the United States if the covenant not to sue is in the public interest. (Sec. 412) Adds the following to the list of conditions that a PRP must meet in order to be eligible for an expedited settlement: (1) liability must be based solely on provisions regarding arrangement, transportation, or acceptance of municipal solid waste or sewage sludge for treatment or disposal; and (2) the PRP must be a natural person, small business, or a municipality that has demonstrated a limited ability to pay response costs. (Sec. 413) Directs the Administrator to initiate the allocation process under this Act for each nonfederally-owned facility on the NPL that involves two or more PRPs: (1) for which the President selects a remedial action on or after February 3, 1994; and (2) for any such action selected before such date if requested by a PRP which has resolved liability to the United States with respect to the remedial action. Authorizes the Administrator to initiate such process for any facility involving two or more PRPs. Makes the allocation process inapplicable to a facility: (1) for which there has been a final settlement, decree, or order that determines all liability or allocated shares of PRPs; or (2) at which all of the PRPs are facility owners or operators. Authorizes the Administrator to initiate a single allocation process for more than one facility. Places a moratorium on the commencement or continuation of liability claims or recovery actions in connection with responses for which allocation is required until 90 days after the issuance of the allocator's report. Sets forth requirements concerning the allocation process, including those for the notification of PRPs and determinations regarding de minimis parties. Provides that de minimis parties that are potentially liable but entitled to expedited settlements shall not be subject to the allocation process unless they fail to settle with the President within 30 days of the offer. Requires the allocation parties to select an allocator from a list provided by the Administrator or from candidates proposed by the parties. Authorizes PRPs, prior to the issuance of the allocator's report, to submit a private allocation for the remedial action to the allocator. Requires the allocator to adopt such report if it meets specified conditions. Directs the allocator to conduct an allocation process culminating in the issuance of a report with a nonbinding, equitable allocation of the percentage shares of responsibility, including the orphan share, within 180 days of the issuance of the final list of parties or the date of the contract for allocation service, whichever is later. Bases allocation shares on the following factors: (1) the amount of hazardous substances contributed by each party; (2) the degree of toxicity and mobility of such substances; (3) the degree of involvement of each party in the generation, transportation, treatment, storage, and disposal of such substances; (4) the degree of care exercised by the party; (5) the cooperation of the party in contributing to the response action; and (6) other factors determined by the Administrator. Sets forth components of orphan shares. Requires shares that the allocator cannot attribute to any party to be distributed among parties, including the orphan share. Authorizes the Administrator and the Attorney General to reject the allocator's report under certain conditions. Permits settling parties to seek a new allocation if there is convincing evidence that the allocator did not have certain information when the report was issued. Includes within settlements based on allocated shares: (1) a waiver of contribution rights against all PRPs for the response action as well as a waiver of rights to challenge any settlement the President enters into with any other PRP; (2) covenants not to sue; (3) a site-specific premium that compensates for the U.S. litigation risk with respect to PRPs who have not resolved liability (unless the settlement covers 100 percent of response costs); (4) contribution protection regarding matters addressed in the settlement; and (5) provisions through which the settling parties shall receive reimbursement from Superfund for response costs incurred in excess of the aggregate of their allocated share and any premia required by the settlement. Lists maximum amounts for premia authorized for litigation risk. Permits the Administrator to modify such amounts. Authorizes the United States to commence actions against liable persons who have not resolved liability following allocation. Sets forth conditions under which a party that performs work in excess of its allocated share may be reimbursed. Limits Superfund financing for reimbursements of costs incurred by parties that are attributable to orphan shares. Authorizes appropriations. Makes Federal agencies named as PRPs subject to the allocation process to the same extent as any other party. Declares that the procedures set forth in this Act shall not be construed to modify the principles of retroactive, strict, joint, and several liability. Provides that persons who are potentially liable solely as response action contractors shall not be named as allocation parties under this section. (Sec. 414) Absolves persons (other than owners or operators) who arranged for the recycling of recyclable material from liability for environmental response actions. Deems transactions involving scrap paper, plastic, glass, textiles, or rubber (other than whole tires) to be arranging for recycling if the person who arranged the transaction demonstrates that the following criteria were met: (1) the recyclable material met a commercial specification grade and a market existed for the material; (2) a substantial portion of the material was made available for use as a feedstock for the manufacture of a new saleable product; (3) the material (or product made from the material) could have been a replacement for a virgin raw material; and (4) with respect to transactions occurring 90 days after this Act's enactment, the person exercised reasonable care to determine that the facility where the material would be managed by another was in compliance with Federal, State, or local environmental laws or regulations. Deems transactions involving scrap metal to be arranging for recycling if the person who arranged the transaction demonstrates that: (1) the criteria for scrap materials were met; (2) he/she complied with applicable standards regarding activities associated with the recycling of scrap metals; and (3) the scrap metal was not melted prior to the transaction. Deems transactions involving spent lead-acid, nickel-cadmium, or other batteries to be arranging for recycling if the person involved demonstrates that: (1) the criteria for scrap materials were met; and (2) he/she complied with applicable Federal environmental standards regarding such batteries. Makes the exemptions from liability under this Act inapplicable if the person: (1) had an objectively reasonable basis to believe at the time of the recycling transaction that the recyclable material would not be recycled or would be burned as fuel or for energy recovery or incineration or that the consuming facility was not in compliance with Federal, State, or local environmental laws or regulations; (2) added hazardous substances to the material for purposes other than processing or recycling; or (3) failed to exercise reasonable care with respect to the management of the material. Makes such exemptions inapplicable if the recyclable material contained polychlorinated biphenyls in excess of 50 parts per million or any new Federal standard. Title V: Remedy Selection and Cleanup Standards - Revises provisions regarding cleanup standards to direct the Administrator to promulgate national goals to be applied at all facilities subject to remedial action under this Act. Requires such goals to be expressed as a single numerical level for chemical carcinogens and noncarcinogens. (Sec. 501) Directs the Administrator to promulgate a national risk protocol for conducting risk assessments under CERCLA. Requires the risk protocol to be used for risk assessment underlying determinations of the need for remedial action, the establishment of protective concentration levels of chemicals, and the evaluation of remedial alternatives. Requires remedial actions to: (1) comply with substantive requirements of Federal, or more stringent State, environmental or facility siting laws; (2) attain any promulgated concentration levels applicable to determining the level of cleanup for such actions; and (3) comply with any other standard under State environmental or facility siting laws that the State demonstrates is consistently applied to remedial actions. States that a goal of this Act is to restore any contaminated groundwater or surface water that may be used for drinking water to: (1) the level of any maximum contaminant level or level goal for the hazardous substance or contaminant that has been established under the Safe Drinking Water Act; and (2) a protective concentration level that attains such goal for any other hazardous substance, pollutant, or contaminant. Requires the achievement of such goal unless the President finds that such goal is technically impracticable from an engineering perspective or, under certain conditions, unreasonably costly. Requires remedial actions for contaminated groundwater (other than that used for drinking water) to attain levels appropriate to the current or anticipated use of such water. Authorizes the President to select a remedial action that does not comply with Federal and State standards subject to certain conditions. (Sec. 502) Revises general rules for remedial actions. Directs the President, in selecting a remedy, to take into account the reasonably anticipated future uses of land at a facility. Provides certain procedures for the remediation of hot spots. Requires the President to establish cost-effective generic remedies for categories of facilities. Sets forth factors to be taken into consideration with respect to selection of response actions for groundwater. (Sec. 504) Removes a condition on the President's authority to acquire property needed to conduct a response action that requires the State in which the property is located to agree to accept transfer of the property when the action is completed. (Sec. 505) Alters the criteria for the continuance of obligations for removal actions to provide that actions shall not continue after $4 million (currently, $2 million) has been obligated or two years (currently, 12 months) have elapsed from the date of initial response to a release or threatened release of hazardous substances. Requires Federal agencies, before the commencement of any non-emergency removal action, to notify the EPA and the State of the planned action and obtain, in the case of facilities listed or proposed for listing on the NPL, concurrence in the planned action from the EPA or the State. (Sec. 506) Authorizes the President, in order to respond to a release of a hazardous substance, to acquire a hazardous substance easement which limits or controls the use of land or other natural resources. Permits easements and notices of property use restrictions to be used whenever institutional controls have been selected as a component of a removal or remedial action. Makes easements enforceable in perpetuity (unless terminated pursuant to this Act) against owners of affected property or persons who acquire interest in, or rights to use, the property. Title VI: Miscellaneous - Makes a Federal agency subject to certain actions required for Federal facilities under CERCLA, with the exception of certain reporting requirements, if the agency owned or operated a facility over which it exercised no regulatory or other control over activities that resulted in a release of a hazardous substance unless: (1) no Federal agency was the primary or sole source or cause of such release; (2) the activities resulting in the release were pursuant to statutory authority and occurred prior to 1976; and (3) the persons primarily responsible for the release are financially viable and capable of performing or financing the response action. (Sec. 605) Authorizes the use of the Superfund to pay up to 50 percent of response costs incurred by a potentially liable party in taking approved actions to achieve response after employing an alternative or innovative technology that fails to achieve the required level of response. (Sec. 606) Includes trusts, estates, or persons who hold title to a vessel or facility or are otherwise affiliated with a vessel or facility in a fiduciary capacity within the definition of "owner or operator" for purposes of determining liability under CERCLA. Limits the personal obligations and liabilities of a fiduciary to the extent to which the assets of the trust or estate are sufficient to indemnify the fiduciary, subject to certain conditions. Excludes from such definition the United States, a Federal agency, or a conservator or receiver appointed by a Federal agency which acquired ownership of a facility or vessel in connection with receivership or conservatorship and forfeiture or seizure authority, provided such entity does not participate in operations that result in a release. (Sec. 608) Directs the Administrator to establish a small business Superfund assistance section within the small business ombudsman office to provide assistance and information regarding CERCLA and the allocation and settlement processes. (Sec. 611) Requires the Administrator to study and report to the Congress on EPA procedures for suspension and debarment of persons and business entities, particularly response action contractors, and to assess the feasibility and cost of creating a nationwide data base to track such persons. (Sec. 613) Directs the Administrator to publish guidelines for a model State program for the training and certification of individuals to perform Phase I Environmental Site Assessments. Establishes the Environmental Certification Board. (Sec. 615) Revises provisions regarding the application of CERCLA to Federal agencies to make such agencies subject to all Federal, State, interstate, and local requirements regarding response actions related to, or management of, hazardous substances, pollutants, and contaminants in the same manner as such requirements apply to nongovernmental entities. Absolves Federal employees of personal liability for civil penalties under Federal or State response laws with respect to acts or omissions within their official duties. Makes such employees subject to criminal sanctions under such laws, but exempts Federal agencies from such sanctions. (Sec. 616) Increases the authorization from Superfund for worker training and education grants. (Sec. 619) Makes States eligible for reimbursement currently available to local governments for emergency response actions. (Sec. 620) Directs the Administrator to study and report to the Congress on the feasibility of instituting a small disadvantaged business goal program for all Federal contracts under CERCLA. Title VII: Funding - Extends the authorization of appropriations to carry out specified Superfund authorities through FY 1999. Title VIII: Environmental Insurance Resolution Fund - Environmental Insurance Resolution and Equity Act of 1994 - Establishes the Environmental Insurance Resolution Fund to provide for the resolution of disputes between certain PRPs and their insurers. (Sec. 805) Authorizes the Fund to decide not to make an offer unless an eligible person has filed and is actively pursuing a claim with an insurer. (Sec. 806) Requires the Fund to make resolution offers to eligible persons equal to the applicable percentage of the lesser of the eligible costs incurred by the persons or the available coverage. Describes applicable percentages based on facility location and size, litigation venues, and State. (Sec. 807) Directs eligible persons that accept Fund resolutions to waive existing and future claims against an insurer for eligible costs. (Sec. 808) Requires the Fund to make pre- and post-resolution payments to eligible persons who accept a resolution. Treats payments made by the Fund to an eligible person as payments made by an insurer. (Sec. 809) Requires the Fund, in cases where an eligible person rejects a resolution offer, litigates a claim against an insurer, and obtains a final judgment against, or enters into a settlement with, the insurer, to reimburse the insurer for the lesser of the amount of the resolution offer or the final judgment or settlement. Authorizes the Fund, in such cases, to reimburse an insurer for unrecovered reasonable costs and legal fees if the resolution offer exceeded such final judgment or settlement. (Sec. 811) Provides that this title acts as a stay of all pending litigation regarding claims for indemnity or arising from insurance coverage for eligible costs. Bars stays of litigation ten years after this Act's enactment with respect to: (1) a person that becomes an eligible person on or after such date; and (2) an eligible person that has not filed a request for a resolution offer and has not rejected an offer before such date. (Sec. 815) Directs the President to report on: (1) the potential liability of the Fund; and (2) the number of non-NPL facilities and their average cleanup cost. (Sec. 817) Terminates the Fund's authority to: (1) accept requests for resolution ten years after this Act's enactment date; and (2) offer resolutions ten years and 180 days after such date. Title IX: Taxes - Amends the Internal Revenue Code to extend the applicability of the environmental tax to tax years before January 1, 2001 (currently, 1996). Extends certain provisions regarding the Superfund financing rate. (Sec. 903) Requires all expenditures of the Resolution Fund to be paid out of fees and assessments imposed by the Internal Revenue Code. Exempts the Fund from Federal, State, and local taxation.
Bill· HJRESH.J.Res. 399 (103rd)referred
United States · United States Congress · 8 August 1994
Designates August 29, 1994, as National Sarcoidosis Awareness Day.
Resolution· HCONRESH.Con.Res. 277 (103rd)referred
United States · United States Congress · 4 August 1994
Expresses the sense of the Congress that legislation providing for a national program for health care reform which would restrict the freedom of any individual State in setting its own course toward health care reform that is reflective of the unique experience of such State, should provide for the inclusion of such State only upon approval by a majority of the voters in a State referendum.
Bill· SS. 2357 (103rd)open
United States · United States Congress · 3 August 1994
TABLE OF CONTENTS: Title I: Improved Access to Standardized and Affordable Health Plans Subtitle A: Rules and Definitions of General Applicability Subtitle B: Health Plan Standards Subtitle C: Benefits and Cost-Sharing Subtitle D: Access to Health Plans Subtitle E: Federal Responsibilities Subtitle F: Participating State Responsibilities Subtitle G: Miscellaneous Provisions Title II: New Benefits Subtitle A: Coverage of Outpatient Prescription Drugs in Medicare Subtitle B: Home and Community-Based Services Subtitle C: Long-Term Care Insurance Improvement and Accountability Subtitle D: Life Care Subtitle E: Study and Report Title III: Health Professions Workforce Subtitle A: Workforce Priorities Under Federal Payments Subtitle B: Academic Health Centers Subtitle C: Health Research Initiatives Subtitle D: Core Functions of Public Health Programs; National Initiatives Regarding Preventive Health Subtitle E: Health Services for Medically Underserved Populations Subtitle F: Mental Health; Substance Abuse Subtitle G: Comprehensive School Health Education; School-Related Health Services Subtitle H: Public Health Service Initiative Subtitle I: Additional Provisions Regarding Public Health Subtitle J: Occupational Safety and Health Subtitle K: Full Funding for WIC Subtitle L: Border Health Improvement Title IV: Medicare and Medicaid Subtitle A: Medicare Subtitle B: Medicaid Program Title V: Quality and Consumer Protection Subtitle A: Quality Management and Improvement Subtitle B: Administrative Simplification Subtitle C: Privacy of Health Information Subtitle D: Expanded Efforts to Combat Health Care Fraud and Abuse Affecting Federal Outlay Programs Subtitle E: Medical Liability Reform Subtitle F: Remedies and Enforcement Subtitle G: Repeal of Exemption Title VI: Individual and Employer Subsidies Subtitle A: Individual Premium and Cost-Sharing Assistance Subtitle B: Employer Subsidies Title VII: Revenue Provisions Subtitle A: Financing Provisions Subtitle B: Tax Treatment of Employer-Provided Health Care Subtitle C: Exempt Health Care Organizations Subtitle D: Tax Treatment of Long-Term Care Insurance and Services Subtitle E: Other Revenue Provisions Subtitle F: Graduate Medical Education and Academic Health Centers Trust Fund Title VIII: Other Federal Programs Subtitle A: Indian Health Services Title IX: Workers Compensation Medical Services Title X: Premium Financing Subtitle A: National Health Care Cost and Coverage Commission Subtitle B: Employer and Individual Premium Requirements and Assistance Title XI: Ensuring Health Care Reform Financing Health Security Act - Title I: Improved Access to Standardized and Affordable Health Plans: Subtitle A: Rules and Definitions of General Applicability - Directs each participating State to require that each health plan or long-term care policy issued, sold, offered for sale, or operated in the State shall be certified by the appropriate certifying authority as one of the following: (1) a certified standard health plan; (2) a certified supplemental health benefits plan; or (3) a certified long-term care policy. Applies the following principles to all standard health plans: (1) no standard health plan may discriminate on the basis of medical history, health status, preexisting medical conditions, or genetic predisposition to medical conditions; (2) a standard plan shall offer an annual open enrollment period and accept all eligible individuals for coverage, shall not impose a rider that serves to exclude coverage to an individual, and shall not impose waiting periods before coverage begins; (3) a standard health plan shall ensure that all medically necessary or appropriate services, as defined in the benefits package, are provided; and (4) health benefits coverage shall be portable from one standard health plan to another. (Sec. 1003) States that nothing in this Act shall be construed as prohibiting the following: (1) an individual from purchasing any health care services; (2) an individual from purchasing supplemental insurance to cover health care services not included within the standard benefits package; (3) an individual who is not an eligible individual from purchasing health insurance; (4) employers from providing coverage for benefits in addition to such standard benefits package; or (5) an individual from obtaining health care from any health care provider of such individual's choice. Subtitle B: Health Plan Standards - Sets forth the following standards which a standard health plan must meet: (1) insurance market reform standards; (2) delivery system reform standards; (3) standards for participation in a guaranty fund; (4) standards for the collection and reporting of data; and (5) standards for effective grievance procedures for enrollees. (Sec. 1111) Requires a standard health plan sponsor to: (1) when offering a community-rated standard health plan, offer such plan to any community-rated individual applying for coverage; and (2) when offering an experience-rated standard health plan, offer such plan to any experience-rated indivudal eligible for coverage under the plan through such individuals' experience-rated employer. Defines: (1) a standard health plan as one providing the standard benefits package under subtitle C; (2) a community-rated plan as a plan provided to community-rated individuals; (3) a community-rated individual as one who not an experience-rated individual; (4) an experience-rated plan as a health plan which is a self-insured plan of an experience-rated employer or is an insured health plan which is experience-rated, but which covers only experience-rated individuals; (5) an experience-rated employer as an employer employing more than 500 employees or a multiemployer plan that covers 500 or more employees; and (6) an experience-rated individual as one who is an employee of an experience-rated employer. Requires a community-rated standard health plan to be made available to community-rated individuals throughout the entire community-rating area. Requires a State to be divided into one or more community rating areas in which there must be a minimum of 250,000 individuals residing. Prohibits a metropolitan statistical area in a State from being incorporated into more than one community rating area. Permits a standard health plan sponsor to refuse to renew an individual's plan only for: (1) fraud or materials misrepresentation on the individuals' part; or (2) nonpayment of premiums. (Sec. 1112) Sets forth enrollment process requirements, including the requirement of an annual open enrollment period. (Sec. 1113) Includes in the definition of children, for purposes of coverage, a child who is under 25 years of age or disabled and who is unmarried. (Sec. 1114) Prohibits discrimination based on health status including medical condition, lack of evidence of insurability, or anticipated need for health care services. Prohibits imposing a waiting period before coverage begins. Permits a standard health plan to impose a limitation or exclusion of benefits relating to treatment of a condition based on a preexisting condition if: (1) the condition was diagnosed or treated during the three-month period ending on the day before the date of enrollment; (2) the limitation or exclusion extends for not more than six months; (3) the limitation or exclusion does not apply to an individual who, as of the date of birth, was covered under the plan; or (4) the limitation or exclusion does not relate to pregnancy. (Sec. 1116) Requires a plan to have uniform premiums within a community rating area. (Sec. 1117) Requires each standard health plan to participate in a standard health plan risk adjustment program and a reinsurance program. (Sec. 1118) Sets forth financial solvency requirements. (Sec. 1121) Sets forth provisions concerning: (1) antidiscrimination requirements; (2) quality assurance standards; (3) the consumer grievance process; (4) the issuance of a health security card to each individual enrolled in each standard health plan; (5) information and marketing standards; (6) patient's rights to self-determination in health care; and (7) contracts with purchasing cooperatives. (Sec. 1128) Requires each standard health plan to ensure that all health care providers reimbursed by the plan are authorized under State law to provide applicable services. Requires a plan to ensure that all nonnetwork items and services covered are reasonably available and accessible. Requires covered services to be available to all enrollees throughout the service plan area with reasonable promptness. Requires each plan to establish a program under which participating physicians shall agree to accept the plan's payment schedule as payment in full. States that nothing in this Act shall be construed to: (1) force an individual to receive health care solely through the individual's standard plan; or (2) prohibit any individual from privately contracting with any health care provider and paying for such treatment as agreed to between the individual and the provider. (Sec. 1141) States that nothing in this Act shall be construed as to prevent a standard health plan sponsor from offering and pricing supplemental health benefits plans pursuant to a State certification plan. Applies the same standards to supplemental plans as are applicable to the standard plan concerning issue, availability, enrollment, nondiscrimination, and rating limitation. Sets forth provisions concerning marketing abuses and requirements for cost-sharing plans. Subtitle C: Benefits and Cost-Sharing - Defines a standard benefits package as a benefit package that: (1) provides all the items and services under the categories of health care items and services described in section 1202; (2) provides for at least one of the three cost-sharing schedules established under section 1213 by the National Health Benefits Board; and (3) has an actuarial value that is equivalent to the actuarial value of the benefits package provided by the Blue Cross/Blue Shield Standard Option under the Federal Employees Health Benefits Program as in effect during 1994. Defines an alternative standard benefits package as a benefits package that: (1) provides all the items and services under the categories of health care items and services described in section 1202; (2) provides for the very high deductible cost-sharing schedule established under 1213 by the Board; and (3) has an actuarial value that is less than the actuarial value of the benefits package provided by the Blue Cross/Blue Shield Standard Option as in effect during 1994. (Sec. 1202) Lists the following items and services as categories of medical care to be furnished to health plan enrollees when medically necessary or appropriate: (1) hospital services, including inpatient hospital services, outpatient hospital services, and 24-hour a day hospital emergency services; (2) health professional services, including consultations that are provided in a home, office, or other ambulatory care setting, or an institutional setting and services and supplies furnished as incident to such health professional services; (3) 24-hour a day emergency services and ambulatory medical or surgical services; (4) clinical preventive services, including services for high risk populations, age-appropriate immunizations, tests, and clinician visits furnished consistent with any periodicity schedule specified by the Board; (5) mental illness and substance abuse services, including inpatient, outpatient, residential non-hospital, and intensive non-residential services, for the treatment of mental illness and substance abuse disorders; (6) voluntary comprehensive family planning services, including counseling and education, contraceptive drugs and devices, and services for pregnant women; (7) items and services provided for end of life care (hospice care); (8) home health care and home infusion drug therapy services provided as an alternative to inpatient hospital treatment, treatment in a skilled nursing facility, or treatment in a rehabilitation facility; (9) extended care services described in title XVIII (Medicare) of the Social Security Act, when provided to an inpatient of a skilled nursing facility or a rehabilitation facility and when provided as an alternative to receiving inpatient hospital services; (10) ambulance services; (11) laboratory, radiology, and diagnostic services provided upon prescription to individuals who are not inpatients of a hospital, hospice, skilled nursing facility, or rehabilitation facility; (12) outpatient prescription drugs, blood clotting factors, drugs used for home infusion therapy, biologicals, and accessories and supplies used directly with the above items; (13) outpatient occupational therapy, physical therapy, respiratory therapy, speech-language pathology services, and outpatient audiology services when used to restore or maintain functional capacity or prevent or minimize limitations on physical and cognitive functions as a result of an illness or other health condition, including attaining new functional abilities at an age-appropriate rate; (14) durable medical equipment, prosthetic devices, orthotics and prosthetics, and accessories and supplies used directly with the above equipment or devices; (15) routine eye examinations, diagnosis, and treatment for defects in vision furnished to individuals who are under 22 years of age, including eyeglasses and contact lenses furnished according to a periodicity schedule established by the Board; (16) to individuals under 22 years of age, emergency dental treatment, prevention and diagnosis of dental disease, treatment of dental disease, space maintenance procedures to prevent orthodontic complications, and interceptive orthodontic treatment to prevent severe malocclusion; (17) for individuals who are over 22 years of age, emergency dental treatment, as specified by the Board; (18) routine ear examinations and diagnosis for defects in hearing as part of a physician visit and hearing aids when recommended by a physician or audiologist; and (19) items and services required to provide patient care pursuant to the design of a qualified investigation treatment. (Sec. 1211) Establishes a National Health Benefits Board to: (1) promulgate regulations or establish guidelines as may be necessary to clarify and refine items and services under the categories of health care items and services described in section 1202; (2) establish and update periodicity schedules for the items and services in the categories of health care items and services described in section 1202; and (3) design mental illness substance and abuse services so as to achieve parity with services for other medical conditions. Authorizes the Board to establish: (1) criteria for determinations of medical necessity or appropriateness; (2) procedures for determinations of medical necessity or appropriateness; and (3) regulations or guidelines to be used in determining whether an item or service is medically necessary. Requires the Board to establish cost-sharing schedules to be provided by health plans providing a standard benefits package or an alternative standard benefits package. Authorizes the Board to develop legislative proposals for modifications to the actuarial equivalence provisions of section 1201 and the categories of items and services under section 1202. Authorizes appropriations to the Bord. (Sec. 1217) Sets forth procedures for the congressional consideration of Board proposals. Subtitle D: Access to Health Plans - Requires each employer to make available to each employee the opportunity: (1) in the case of an experience-rated employer, to enroll through the employer in one of at least three certified experience-rated standard health plans; or (2) in the case of a community-rated employer, to enroll in any community-rated plan offered through a purchasing cooperative operating in the community rating area of the employer and, at the employer's option, to enroll in one of at least three community-rated standard health plans. (Sec. 1321) Directs a State, in accordance with specified provisions, to certify health insurance purchasing cooperatives. Requires that each cooperative be chartered under State law and operated as a not-for-profit corporation. Permits a State to establish or sponsor a purchasing cooperative to serve a community rating area. Requires each purchasing cooperative to: (1) negotiate (regarding premiums and marketing fees) with and enter into agreements with standard health plans; (2) enter into agreements with community-rated employers; (3) enroll community-rated employees and community-rated individuals in standard health plans; (4) collect premiums and make payments to standard health plans on behalf of community-rated employers and community-rated individuals; (5) provide for coordination with other purchasing cooperatives; (6) provide comparative information to the public and the participating State on standard health plans offered through the purchasing opperative; (7) have the capability of accepting data from standard health plans; (8) comply with such fiduciary responsibility, financial management, and administrative requirements as the Secretary may establish; and (9) carry out other functions provided for under this title. Prohibits a cooperative from: (1) performing any activity (including review, approval, or enforcement) relating to payment rates for providers; (2) performing any activity (including certification or enforcement) relating to compliance of standard health plans with the requirements of this Act; (3) assuming insurance risk; or (4) performing other activities identified by the State as being inconsistent with the performance of its duties under this Act. (Sec. 1322) Requires a purchasing cooperative to offer all community-rated individuals and community-rated employees residing within the community rating area served by the cooperative the opportunity to enroll in any standard health plan that has entered into an agreement with the cooperative. (Sec. 1324) Directs a purchasing cooperative to charge members a uniform membership fee to cover costs. (Sec. 1331) Requires a purchasing cooperative for a community rating area to offer to enter into an agreement with each community-rated employer that employs individuals in the community rating area and that desires to join the cooperative. (Sec. 1341) Sets forth requirements applicable to the Federal Employees Health Benefits Program. (Sec. 1351) Sets forth rules relating to multiple employer welfare arrangements. Subtitle E: Federal Responsibilities - Directs the Secretary of Health and Human Services to implement all provisions of this Act, subject to stated exceptions, and report annually to the President and the Congress concerning the health care system of this Act. Authorizes appropriations. (Sec. 1411) Requires the Secretary to approve a State health care system for which a plan has been submitted, unless it does not meet applicable requirements. (Sec. 1412) Provides sanctions for participating States not in compliance, including Federal assumption of responsibilities. (Sec. 1422) Provides for Federal assumption of responsibilities in non-participating States. (Sec. 1431) Directs the Secretary to establish premium class and age class factors. (Sec. 1435) Directs the Secretary to develop a risk adjustment and reinsurance methodology. (Sec. 1441) Directs the Secretary to establish minimum capital requirements for workers, as well as additional capital requirements to reflect factors likely to affect the financial stability of a carriers. (Sec. 1461) Directs the Secretary to certify as an essential community provider any health care provider meeting the standards for certification or that is within any of the following categories of providers: (1) covered entities as defined under the Public Health Service Act, school health centers, public or nonprofit hospitals, public and private nonprofit mental health and substance abuse providers, runaway homeless youth centers or transitional living programs for homeless youth, public or nonprofit maternal and child health providers, rural health clinics, and programs of the Indian Health Service shall all be considered category one entities; and (2) Medicare dependent small rural hospitals and children's hospitals shall both be considered category two entities. (Sec. 1463) Directs the Secretary to publish standards for the certification of additional categories of health care providers and organizations as essential community providers. (Sec. 1466) Provides that for essential community providers electing to apply to a health plan, the plan shall either: (1) enter into a provider participation agreement; or (2) enter into an agreement under which the plan makes payments to the provider. (Sec. 1467) Requires the Secretary, within five years of enactment, to submit to the Congress specific recommendations, based on studies, concerning whether, and to what extent, sec. 1466 provisions should continue to apply to some or all essential community providers. Requires the recommendations to be implemented unless a congressional joint resolution disapproving such recommendations is enacted. (Sec. 1481) Sets forth the responsibilities of the Secretary of Labor. (Sec. 1491) Provides that the Office of Rural Health Policy shall be headed by an Assistant Secretary, instead of a Director. Subtitle F: Participating State Responsibilities - Sets forth provisions concerning approval of State plans and certification of standard health plans and supplemental health benefits plans. Requires the Secretary to establish a program for the accreditation, certification, and enforcement (the ACE program) of health plan standards by States. (Sec. 1502) Requires each participating State to be divided into one or more community rating areas. (Sec. 1503) Provides for: (1) open enrollment periods; (2) a risk adjustment program; (3) guaranty funds; and (4) public access sites. (Sec. 1511) Prohibits, as a general rule, any State law from applying to any services provided under a health plan that is not a fee-for-service plan. (Sec. 1512) Provides for the override of restrictive State practice laws. (Sec. 1521) Provides for the continuance of existing Federal law waivers under Medicare, Medicaid, or the Employee Retirement Income Security Act. (Sec. 1522) Sets forth provisions concerning: (1) the Hawaii Prepaid Health Care Act; (2) alternative State provider payment systems; and (3) alternative State hospital services payment systems. (Sec. 1531) Sets forth requirements for State single-payer systems. (Sec. 1541) Provides for the early implementation of comprehensive State programs. Subtitle G: Miscallenous Provisions - Permits a health professional or health facility to deny the provision of an item or service if the professional or facility objects on the basis of religious belief or moral conviction. Prohibits discrimination on the basis of race, national origin, sex, religion, language, income, age, sexual orientation, disability, health status, or anticipated need for health services. Title II: New Benefits - Subtitle A: Coverage of Outpatient Prescription Drugs in Medicare - Amends title XVIII (Medicare) of the Social Security Act to provide for: (1) Medicare coverage of certain outpatient prescription drugs and biologicals as well as home infusion drug therapy services; (2) payment rules and related requirements, such as those pertaining to deductibles, for covered outpatient prescription drugs; (3) manufacturer rebates to the Secretary under Medicare part B (Supplementary Medical Insurance) for covered outpatient prescription drugs; (4) a Prescription Drug Payment Review Commission appointed by the Director of the Congressional Office of Technology Assessment for reporting annually to the Congress on Medicare coverage of outpatient prescription drugs; and (5) the provision of covered outpatient drugs through Medicare drug benefit plans under contract with the Secretary to individuals entitled to benefits under Medicare part A (Hospital Insurance) and enrolled under Medicare part B. Authorizes appropriations. (Sec. 2007) Allows the Secretary, in providing for payments for covered outpatient drugs under Medicare contracts with HMOs and competitive medical plans, to base such payments on classes of enrollees or geographic factors that are different from those otherwise utilized for determining payment. Subtitle B: Home and Community Based Services - Entitles each State with an approved plan for home and community-based services for individuals with disabilities to specified payments. Authorizes appropriations. (Sec. 2111) Amends the Public Health Service Act to direct the Secretary to compile, evaluate, and disseminate information to assist in the replication of successful long-term health care services programs that are aimed at offering care management to hospitalized individuals in need of long-term care so that services to meet individual needs and preferences can be arranged in home and community-based settings as an alternative to long-term nursing home placement. Establishes a related grant program. Authorizes appropriations. Subtitle C: Long-Term Care Insurance Improvement and Accountability - Long-Term Care Insurance Improvement and Accountability Act - Provides for the promulgation of standards and model benefits with respect to long-term care insurance. (Sec. 2211) Prohibits the sale of a long-term care policy unless it meets specified standards. (Sec. 2212) Regulates sales practices and renewal practices for long-term care policies. (Sec. 2215) Establishes benefit standards for long-term care policies. Subtitle D: Life Care - Life Care Act - Amends the Public Health Service Act to add a new title, Title XXVII - Life Care: Public Insurance Program for Nursing Home Care. Directs the Secretary to: (1) establish a voluntary insurance program for individuals 35 yers of age and over to cover the nursing home stays of such individuals; and the nursing home stays of such individuals; and (2) establish a process for enrollment in the Life Care Program. Prohibits the coverage amount from exceeding $90,000. Provides coverage under the title for: (1) nursing care; (2) specified therapy services; (3) medical social work; (4) drugs and appliances; (5) other nursing home facility services; and (6) with respect to the first six months of covered residence in a nursing facility, such room and board costs as are not covered by beneficiary copayment. Subtitle E: Study and Report - Provides for a study on issues relating to appropriate care at the end of life. Title III: Health Professions Workforce - Subtitle A: Workforce Priorities Under Federal Payments - Establishes within the Department of Health and Human Services the National Council on Graduate Medical Education. Directs the Council to ensure that the aggregate number of individuals entering graduate medical education programs does not exceed specified limits. Directs the Council to designate the number of individuals authorized to be enrolled in each specialty. (Sec. 3031) Sets forth provisions concerning Federal formula payments to: (1) qualified entities for the costs of operating approved physician training programs; and (2) academic health centers and other eligible institutions. (Sec. 3061) Sets forth provisions concerning Federal payments to: (1) medical schools; (2) graduate nurse training programs; (3) dental schools; and (4) schools of public health. (Sec. 3081) Authorizes appropriations through FY 2000 for workforce development. Subtitle B: Academic Health Centers - Authorizes grants to: (1) eligible centers for the establishment and operation of information and referral systems to provide the services of such centers to rural health plans; and (2) community-and provider-based health plans for the purpose of providing the services of eligible centers to residents of rural or urban communities who otherwise would not have adequate access to such services. Subtitle C: Health Research Initiatives - Requires 0.25 percent of all premium-related payments made by employers, individuals, and families for coverage under this Act to be used for biomedical and behavioral research and health services research as specified. (Sec. 3221) Authorizes appropriations for a medical technology impact study. Subtitle D: Core Functions of Public Health Programs; National Initiatives Regarding Preventive Health - Authorizes appropriatons for: (1) core functions of public health programs; and (2) national initiatives regarding health promotion and disease prevention. Provides for grants to states for core functions of public health programs. Provides grants for agencies of State or local government and nonprofit organizations for national prevention initiatives. Provides for grants and authorizes appropriations for the development of rural telemedicine. Subtitle E: Health Services for Medically Underserved Populations - Authorizes appropriations for: (1) the development of community health groups and health care sites and services; and (2) the capital costs of the development of community health groups. (Sec. 3402) Authorizes approprations for grants and contracts for enabling and supplemental services. (Sec. 3471) Authorizes appropriations for the National Health Service Corps Program. (Sec. 3481) Provides for payments to hospitals with a low-income utilization rate of not less than 25 percent. Subtitle F: Mental Health; Substance Abuse - Requires each State, as a condition of participation under title I, to integrate the mental illness and substance abuse services of the State and its political subdivisions with the mental illness and substance abuse services offered by health plans pursuant to title I. Authorizes appropriations to States for grants for the development and operation of comprehensive managed mental health and substance abuse programs that are integrated with the health delivery system established under this Act. Subtitle G: Comprehensive School Health Education; School-Related Health Services - Provides for grants to State educational agencies in eligible States to integrate comprehensive school health education in schools within the State, with priority given to those communities in greatest need. Authorizes appropriations. (Sec. 3603) Establishes a Healthy Students-Healthy Schools Interagency Task Force. (Sec. 3681) Authorizes appropriations for grants to State health agencies or local community partnerships for the development and operation of school-related health services. Subtitle H: Public Health Service Initiative - Authorizes appropriations through FY 2004 for specified programs under title III, as well as programs of the Indian Health Service under title VIII. Subtitle I: Additional Provisions Regarding Public Health - Authorizes grants for the purpose of implementing and developing for trainees a curriculum that includes training in identification, treatment, and referral of victims of domestic violence and women's health needs. Subtitle J: Occupational Safety and Health - Directs the Secretary of Health and Human Services and the Secretary of Labor to work together to develop and implement a comprehensive program to expand and coordinate initiatives to prevent occupational injuries and illnesses. Establishes a National Advisory Board for Occupational Injury and Illness Prevention to provide oversight. Authorizes appropriations. Subtitle K: Full Funding for WIC - Amends provisions of the Child Nutrition Act of 1966 concerning the special supplemental food program to authorize to be: (1) appropriated such amounts as are necessary through FY 2000; and (2) made available other specified amounts through FY 2000. Subtitle L: Border Health Improvement - Authorizes the President to conclude an agreement with Mexico to establish a binational commission to be known as the United States - Mexico Border Health Commission to: (1) conduct a needs assessment; (2) develop and implement a plan to carry out actions recommended by the needs assessment; and (3) formulate recommendations to United States and Mexico concerning reimbursement for health care costs. Title IV: Medicare and Medicaid - Subtitle A: Medicare - Amends SSA title XVIII (Medicare) to allow individuals to elect to remain in certain plans. (Sec. 4002) Makes specified changes with regard to eligible organization and Medicare supplemental policy enrollment. (Sec. 4101) Revises provisions relating to Medicare part A and concerned with: (1) various specified hospital and skilled nursing facility payment adjustments for, among other things, capital-related costs for inpatient hospital services and services for low-income patients; (2) the Medicare-dependent, small rural hospital program and the rural health transition grant program; (3) payments for certain multi-campus, rehabilitation, and long-term care hospitals; (4) long-term hospital designation; and (5) indirect medical education payment termination. (Sec. 4111) Replaces the essential access community hospital (EACH) program with a limited service hospital program, prohibiting EACH designations after July 1, 1994, while permitting payment to prior designated EACHs. Authorizes appropriations. Makes part A and B amendments relating to rural primary care hospitals and medical assistance facilities. Repeals provisions for prospective payment systems (PPSs) for rural primary care services. (Sec. 4112) Requires the Secretary to study and report to the Congress with regard to subacute care. (Sec. 4201) Makes specified changes with regard to Medicare part B provisions on: (1) payment for physicians' services, adding limitations on payments relating to inpatient stays in certain hospitals and making various other changes concerning, among other things, service updates, adjustments for volume and intensity, and the performance standard factor; (2) underserved area bonus payments; (3) payments for certain outpatient hospital services and durable medical equipment; (4) eye or eye and ear hospitals; and (5) the general Medicare part B premium. (Sec. 4206) Requires the Secretary to establish: (1) demonstration projects for Medicare State-based performance standard rates of increase; and (2) bidding areas for the competitive acquisition of specified items and services. Provides for a reduction in payment amounts if such competitive acquisition fails to achieve certain savings. (Sec. 4209) Imposes across-the-board co-payments for clinical diagnostic laboratory tests. (Sec. 4212) Provides for expanded coverage for physician assistants and nurse practitioners. Bases payments for physician assistants and certain nurse practitioners on the physician fee schedule. (Sec. 4213) Prohibits nonparticipating physicians and suppliers from receiving payment for items or services provided under Medicare. (Sec. 4214) Requires the Secretary to develop a methodology for implementing a resource-based system for determining practice expense relative value units for each physician's service. (Sec. 4301) Modifies provisions relating to Medicare parts A and B and concerned with: (1) medicare as secondary payer; (2) payments for home health services; and (3) Medicare supplemental policies. (Sec. 4303) Directs the Secretary to use a competitive process to contract with centers of excellence for certain appropriate services (including cataract surgery). (Sec. 4305) Imposes co-payments for home health services. (Sec. 4306) Terminates payments for direct graduate medical education costs attributable to an approved medical residency training program. (Sec. 4307) Amends the Omnibus Budget Reconciliation Act of 1990 to permit Medicare supplemental policies in all States. Subtitle B: Medicaid Program - Amends SSA title XIX (Medicaid) to prohibit a State Medicaid plan from paying for items and services in the standard benefit package described above in title I of this Act, with certain exceptions. (Sec. 4605) Limits State Medicaid expenditures to HMOs to HMOs that are certified as a standard health plan. Revises the 75/25 rule under Medicaid HMO provisions. (Sec. 4611) Modifies national DSH payment limit provisions. Creates a Medicaid part B (Payments to Hospitals Serving Vulnerable Populations). (Sec. 4615) Makes various specified changes with regard to Medicaid long-term care provisions (including provisions on frail elderly demonstration project waivers) as well as with regard to other provisions concerning: (1) Medicaid coverage of certified nurse practitioners and clinical nurse specialist services; and (2) relief from third party liability requirements. Title V: Quality and Consumer Protection - Subtitle A: Quality Management and Improvement - Directs the Secretary of Health and Human Services to establish the National Quality Council to oversee a program of quality management and improvement designed to enhance the quality, appropriateness, and effectiveness of health care services and access to such services. Authorizes appropriations. Subtitle B: Administrative Simplification - States that the purpose of this subtitle is to improve the efficiency and effectiveness of the health care system, including Medicare and Medicaid, by encouraging the development of a health information network through the establishment of standards and requirements for the electronic transmission of certain health information. Provides for standards for data elements and information transactions. Imposes penalties for violators of the standards. Requires standards relating to the form of health security cards issued by health plans and the information needed to be encoded electronically on such cards. Establishes the Health Care Information Advisory Committee. Provides for grants for demonstration projects to promote the development and use of electronically integrated community-based clinical information systems and computerized patient medical records. Repeals provisions of the Social Security Act that established the Medicare and Medicaid Coverage Data Bank. Subtitle C: Privacy of Health Information - States that the purpose of this subtitle is to establish effective mechanisms to protect the privacy of individuals with respect to individually identifiable health care information. Permits the disclosure of health information only in accordance with provisions of this subtitle. Specifies authorized disclosures. Subtitle D: Expanded Efforts to Combat Health Care Fraud and Abuse Affecting Federal Outlay Programs - Directs the Secretary and the Attorney General to establish a joint program to: (1) coordinate Federal, State, and local law enforcement programs to control fraud and abuse affecting Federal outlay programs; (2) conduct investigations and audits relating to the delivery of and payment of health care; and (3) facilitate the enforcement of this subtitle and other statutes applicable to health care fraud and abuse. (Sec. 5302) Establishes the Federal Outlay Program Fraud and Abuse Control Account to be available for carrying out such program. (Sec. 5303) Establishes the HHS Office of Inspector General Asset Forfeiture Proceeds Fund. (Sec. 5304) Authorizes monetary rewards for information relating to a possible prosecution of a Federal health care offfense. (Sec. 5311) Imposes civil penalties for certain violations, including fraud, with respect to certified standard health or long-term care plans or long-term care services. (Sec. 5313) Excludes an individual or entity from participating in any applicable health plan if the individual or entity: (1) is excluded from participation in a public program due to conviction for health care-related crimes or patient abuse; (2) has been convicted under Federal or State law of specified felonies in connection with the delivery of a health care item or service; or (3) has been convicted of a felony relating to the unlawful manufacture, distribution, prescription, or dispensing of a controlled substance. Waives mandatory exclusion if it would significantly harm or pose a risk to public health. Bars payments under a certified standard health plan for the delivery of or payment for any item or service furnished by an excluded individual. (Sec. 5321) Amends the Federal criminal code to provide criminal penalties for fraud, theft, embezzlement, false statements, bribery, and graft in connection with health care. (Sec. 5331) Imposes civil penalties for false claims regarding certified standard health plans or long-term care insurance policies. Subtitle E: Medical Liability Reform - Requires parties to any malpractice action, before the commencement of such action, to participate in a State-based alternative dispute resolution system. Limits attorney's contingency fees. Provides for demonstration projects concerning medical malpractice liability. Authorizes appropriations for such projects. Subtitle F: Remedies and Enforcement - Establishes procedures for the review of health claims, including the review of claims, proceedings in complaint review offices, civil money penalties, the establishment of early resolution programs, mediation proceedings, enforcement of settlement agreements, due process for health care providers, judicial review, civil enforcement, private enforcement rights, consumer protections, discrimination claims, and facial constitutional challenges to invalidate this Act or any provision of this Act. Subtitle G: Repeal of Exemption - Establishes the applicability of the following Acts to the health insurance business: (1) the Sherman Act; (2) the Clayton Act; (3) the Federal Trade Commission Act; and (4) the Robinson-Patman Antidiscrimination Act. Title VI: Individual and Employer Subsidies - Subtitle A: Individual Premium and Cost-Sharing Assistance - Requires a participating State to have in effect a program for furnishing premium assistance and cost-sharing assistance in accordance with the provisions of this subtitle. Sets forth eligibility standards for such assistance. Provides for payments to States furnishing premium assistance. Subtitle B: Employer Subsidies - States that it is the purpose of this subtitle to provide subsidies to eligible employers in providing, or expanding the provision of, health care coverage for the employer's employees. Sets forth provisions concerning the eligibility for and amount of such subsidy. Declares ineligible for such a subsidy: (1) the self-employed; (2) employee leasing firms; and (3) State or local governments. Title VII: Revenue Provisions - Subtitle A: Financing Provisions - Amends the Internal Revenue Code to increase the excise taxes on cigarettes and other tobacco products. Applies such increases to tobacco products manufactured and sold in Puerto Rico. (Sec. 7103) Imposes an excise tax on the manufacture or importation of roll-your-own tobacco. (Sec. 7111) Imposes a tax: (1) on a percentage of premiums received under taxable health insurance policies; and (2) on a percentage of amounts received for health-related administrative services. Imposes on self-insured plans a monthly tax on a percentage of the accident or health coverage expenditures and direct administrative expenditures. (Sec. 7112) Imposes a 25 percent tax on community-rated high cost health plans to be paid by the issuer. Requires the Secretary of Health and Human Services to establish a reference premium for each class of enrollment for community-rated plans within a community rating area. Imposes a 25 percent tax on the excess premium equivalents of an experience-related standard health plan. (Sec. 7121) Provides for the recapture of certain health care subsidies received by high-income individuals. Transfers such amounts to the Supplemental Medical Insurance Trust Fund. (Sec. 7131) Increases the excise tax on certain hollow point and large caliber handgun ammunition. (Sec. 7132) Requires certain shareholders of S corporations and limited partners who materially participate in corporate activities to include their share of income or loss from such corporation when determining net earnings from self-employment. (Sec. 7133) Provides for extending Medicare coverage and applying the hospital insurance tax to all State and local government employees. Subtitle B: Tax Treatment of Employer-Provided Health Care - Declares that on and after January 1, 2004, gross income of an employee includes employer-provided coverage under an accident or health plan which is not permitted coverage. (Sec. 7202) Prohibits health benefits from being provided under cafeteria plans. (Sec. 7203) Increases and makes permanent the deduction for health insurance costs of self-employed individuals. (Sec. 7211) Imposes a tax on employer-provided health benefits that do not meet the requirements for permitted coverage. Subtitle C: Exempt Health Care Organizations - Sets forth qualification and disclosure requirements for tax-exempt health care organizations. (Sec. 7302) Imposes an excise tax on the beneficiary of a taxable inurement and on the management of the participating tax-exempt health care organization. (Sec. 7303) Provides for the treatment of health maintenance organizations, parent organizations, and health insurance purchasing cooperatives as tax-exempt entities. (Sec. 7304) Provides for the taxation as an insurance company other than a life insurance company of certain organizations that provide health insurance and other prepaid health care services. (Sec. 7305) Repeals the special rules for Blue Cross and Blue Shield and similar organizations. (Sec. 7306) Provides a tax exemption for certain qualified high risk insurance pools. (Sec. 7308) Provides for the tax treatment of bonds of certain nonprofit tax-exempt organizations in a manner similar to governmental bonds. Subtitle D: Tax Treatment of Long-Term Care Insurance and Services - Treats qualified long-term care services as medical care for purposes of the medical expense deduction. (Sec. 7402) Provides for the treatment of long-term care insurance as accident and health insurance. (Sec. 7403) Allows accelerated death benefits under life insurance contracts to be paid to terminally ill individuals. Subtitle E: Other Revenue Provisions - Requires the Secretary of the Treasury to submit to specified congressional committees a legislative proposal providing statutory standards for the classification of workers as employees or independent contractors. (Sec. 7502) Increases the penalty for failure to file correct information for returns involving payments for services. (Sec. 7505) Allows a tax credit for certain primary health services providers that practice in health professional shortage areas. (Sec. 7506) Increases the amount allowed to be expensed as a depreciable business asset if such asset is medical equipment. (Sec. 7521) Requires additional reserves for post-retirement medical and life insurance benefits to cover not less than ten years of the working lives of covered employees and to be maintained as separate accounts. (Sec. 7522) Allows a tax credit for the cost of personal assistance services required by certain employed individuals. Limits the amount of such credit and provides a cost-of-living adjustment. Subtitle F: Graduate Medical Education and Academic Health Centers Trust Fund - Establishes the Graduate Medical Education and Academic Health Centers Trust Fund, consisting of the Graduate Medical Education Accountand the Academic Health Centers Account. Provides funding for such trust fund through tax and assessments on insured and self-insured plans and transfers from certain social security trust funds. Title VIII: Other Federal Programs - Subtitle A: Indian Health Service - Makes qualifying Indians eligible for health and supplemental benefits under the Indian Health Service (IHS). (Sec. 8105) Authorizes an IHS program to contract with a health plan to provide health care services to non-Indians. (Sec. 8107) Makes IHS programs eligible for Medicare payments. (Sec. 8109) Directs the Secretary of Health and Human Services to: (1) establish an advisory group to access budget aspects of IHS programs; (2) conduct health service transitional studies and establish a related advisory group; (3) develop a long-term care demonstration program; (4) survey health services available to Indian veterans; and (5) develop new funding methodologies. (Sec. 8118) Authorizes appropriations. Subtitle B: Department of Veterans Affairs - Veterans Health Care Reform Act of 1994 - Allows veterans, individuals currently enrolled in a health plan under the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), and their family members to be enrolled in a Department of Veterans Affairs health plan (VA plan). Requires the Secretary of Veterans Affairs to ensure that each VA plan provides to enrolled individuals the items and services in the standard benefit package under this Act. Allows such plans to offer supplemental health benefits and cost-sharing plans consistent with this Act. Provides a limitation with regard to veterans enrolled with health plans outside the VA. Prohibits the imposition of any plan enrollment charges upon service-connected disabled veterans, veterans receiving disability compensation from the VA, former prisoners of war, veterans of the Mexican border period or World War I, and veterans unable to defray the costs of such care. Allows the Secretary to establish plan charges for other veterans. Deems a VA facility to be a Medicare provider, and a VA health plan to be a Medicare HMO, for purposes of any program administered by the Secretary of Health and Human Services under Medicare (title XXVIII of the Social Security Act). Allows for the recovery of certain care and services provided under a VA plan in the case of an individual who has coverage under another plan. Establishes in the Treasury the Department of Veterans Affairs Health Plan Fund to be used for VA health plan payments and services. Preserves existing benefits for VA facilities not operating within a health plan certified under this Act. Directs the Secretary to organize health plans and operate VA facilities as, or within, health plans under this Act. Preempts conflicting State health plan standards or requirements. Directs the Secretary to designate a health plan director for each VA health plan organized and operated under this subtitle. Authorizes such directors to enter into contracts and agreements for the provision of care and services under the VA plan as well as related services (equipment, maintenance, and repair). Authorizes the Secretary to enter into resource-sharing agreements with other health care plans and providers, health industry organizations, individuals, and other Government departments and agencies. Provides certain administrative and personnel flexibility, as well as expenditure authority, for care and services under a VA plan. Establishes in the Treasury the Veterans Health Care Investment Fund. Authorizes appropriations. Provides specified credits to the Fund for FY 1995 through 1997 for operation of VA health plans. Requires a report from the Secretary to the Congress on the operation of such plans. Authorizes the Secretary to accept and use grants for health care services provided to special populations if used by the VA while operating under a VA health plan. Title IX: Workers Compensation Medical Services - Applies the provisions of subtitle B of title V of this Act to the provision of workers compensation medical services in the same manner as such provisions apply with respect to the provision of services included in the standard benefit package. Requires that, in cases where a workers compensation claim is challenged, a health plan must provide or pay for all medical care in the standard benefit package according to the applicable workers compensation for schedule, until the challenge is adjudicated. Provides for demonstration projects with respect to treatment of work-related injuries and illness. Establishes a Commission on Workers Compensation Medical Services. Title X: Premium Financing - Subtitle A: National Health Care Cost and Coverage Commission - Establishes the National health Care Cost and Coverage Commission to monitor and respond to: (1) trends in health care coverage; and (2) changes in per-capita premiums and other indicators of health care inflation. Provides for congressional consideration of Commission recommendations. Subtitle B: Employer and Indiandual Premium Requirements and Assistance - Requires, with respect to a participating State, each resident U.S. citizen or lawful alien to: (1) enroll in or be covered under a health plan; (2) pay any premium required, consistent with this Act. Excludes individuals covered under an equivalent health care program such as Medicare, Medicaid, a military or veterans health care program, CHAMPUS, the Indian Health Care Improvement Act, or an approved State single-payer system. Provides for a religious exemption. Excludes inmates. Requires employers of 25 or more and employers of less than 25 than make an election, to make health care coverage premium payments on behalf of the employer's qualifying employees. Permits other employers to elect to be treated as community-rated employers. Sets forth provisions for providing for the determination premium payments. Title XI: Ensuring Health Care Reform Financing - States that it is the purpose of this title to ensure that this Act does not result in unanticipated increases in the Federal deficit. States that any entitlement provided by this Act, including premium assistance, shall be subject to the operation of this Act. Requires the President, annually through FY 2004, to issue a health care baseline. Requires the President's budget to include a current health care baseline. Provides that if a baseline exceeds the initial (1995) baseline by more than a specified amount there is to be a proposed order that offsets the excess through a combination of: (1) reductions in premium assistance; (2) reductions in the Medicare deductible for drugs; and (3) reductions in each direct spending program of this Act by a uniform percentage. Requires the eligibility percentage for children and pregnant women to be reduced last. Sets forth provisions in the event of war or low growth. Provides for a Government Accounting Office audit and for additonal reporting requirements by the Office of Management and Budget and the National Health Care Commission.
Bill· SS. 2352 (103rd)referred
United States · United States Congress · 2 August 1994
Mental Health and Substance Abuse Programs Reauthorization Act of 1994 - Amends the Public Health Service Act to reauthorize appropriations for specified programs relating to the Substance Abuse and Mental Health Services Administration. Repeals the block grant program that provides funds to States with insufficient capacity for treatment facilities.
Bill· SS. 2351 (103rd)open
United States · United States Congress · 2 August 1994
TABLE OF CONTENTS: Title I: Health Insurance and Delivery Systems Reform Subtitle A: Federal Standards for State Regulatory Programs Subtitle B: Coordination With Other Provisions of Law Title II: Coverage Title III: Premium and Cost-Sharing Assistance Title IV: Administrative Simplification and Privacy Title V: Malpractice and Fraud Subtitle A: Federal Tort Reform Subtitle B: Expanded Efforts to Combat Health Care Fraud and Abuse Affecting Federal Outlay Programs Title VI: Medicare, Medical Education, and Medicaid Subtitle A: Medicare Subtitle B: Medical Education Subtitle C: Home and Community-Based Services Subtitle D: Medicaid Program Title VII: Revenue Provisions Subtitle A: Financing Provisions Subtitle B: Tax Treatment of Employer-Provided Health Care Subtitle C: Deduction for Individuals Purchasing Own Health Insurance Subtitle D: Exempt Organizations Subtitle E: Tax Treatment of Long-Term Care Insurance and Services Subtitle F: Health Care Trust Funds Subtitle G: Other Revenue Provisions Subtitle H: Ensuring Health Care Financing Health Security Act - States that it is the purpose of this Act to achieve universal health insurance coverage through: (1) subsidies for the purchase of health insurance; (2) affordable standardized health insurance; (3) elimination of exclusionary practices by health insurance companies; (4) a permanent National Health Commission for recommending periodically to the Congress how to increase the number of people covered by health insurance; (5) reduction of health costs through more open competitive markets and continued advances in medical education and research; and (6) health care provided under Medicare and Medicaid and health programs of the Departments of Defense and of Veterans Affairs, and the Indian Health Service. Title I: Health Insurance and Delivery Systems Reform - Subtitle A: Federal Standards for State Regulatory Programs - Amends the Social Security Act (SSA) to add a new title XXI under which States are required to establish accreditation, certification, enforcement, and information programs for certifying all health plans and long-term care policies (except multistate self-insured health plans which will be certified by the Secretary of Labor) issued, sold, offered for sale, or operated in the State that meet certain standards incorporating specified requirements, such as those pertaining to community rating, preexisting conditions, and a patient's right to self-determination in health care services, as certified standard, nonstandard, or supplemental health plans or certified long-term care policies in order to participate in Medicaid. (Sec. 101) Requires establishment of such programs also for: (1) enforcing applicable standards for such plans and policies; (2) providing consumers in the State with comparative value information on the performance of all health plans in each community rating area established in the State; (3) designating State health plan service areas for purposes of access to essential community providers, delivery of benefits, and improved access to underserved areas; (4) providing for reinsurance, risk adjustment, and cost-sharing adjustment programs; (5) specifying an annual general enrollment period; (6) providing for a premium approval process for long-term care policies; (7) providing for the certification of workplace wellness programs; (8) enforcing employer responsibilities with regard to employee access to standard plans; (9) oversight of purchasing cooperatives; (10) supporting quality assurances for measuring access to and appropriateness of health care services provided to consumers; (11) supporting development of community health networks and plans; (12) supporting development of community health networks and plans; (13) providing coordination between health plans and automobile medical liability policies; (14) developing remedy and enforcement mechanisms (including early resolution programs) as described for dealing with complaints involving health plans, collecting any civil monetary penalties assessed by the Secretary of Health and Human Services (HHS) under such program, and for handling civil actions brought to invalidate any provision of this Act; and (15) conforming State laws and procedures to the rules regarding fraud and medical malpractice under SSA title XI. Directs the Secretary to initially determine and approve the compliance of such State programs with the Federal guidelines under this new title and periodically review such State programs to determine if they continue to comply with such guidelines. Provides funding for such programs. Sets forth requirements relating to: (1) possessions of the United States; (2) State single-payer systems; and (3) treatment of certain State laws. Directs the Secretary to: (1) develop certification criteria for workplace wellness programs; and (2) certify certain private accreditation entities. Describes the various benefit packages and the categories of items and services included in them (such as mental illness and substance abuse services as well as family planning services and services for pregnant women). Prescribes general cost-sharing under the standard benefits package. Creates in HHS a National Health Benefits Board to: (1) establish cost-sharing schedules to be provided by standard packages; and (2) define the standards to be used by a health plan in determining whether an item or service under certain categories of health care items and services is medically necessary or appropriate for an enrollee in the plan. Outlines the process for congressional consideration of any Board recommendations to modify standard benefit packages and cost-sharing assistance. Authorizes appropriations. Sets forth special provisions relating to abortion and religious beliefs, providing that nothing under this new title shall be construed to require the creation or maintenance of abortion clinics or other abortion providers within a State or any region of a State. Details general employer responsibilities pertaining to payroll deductions and other specified matters in enrolling their employees in certified standard health plans. Lists specific duties of purchasing cooperatives, which include making enrollment information available, enrolling community-rated individuals in certified standard health plans, and collecting and forwarding plan premiums to the plan, as well as specific requirements governing the organization and operation of purchasing cooperatives. Provides for access to standard health benefit plan coverage through qualified association plans. Sets forth special rules for church and multiemployer plans. Requires the Secretary to direct the Agency for Health Care Policy and Research and the Health Care Financing Administration to support and conduct research on the effects of health care reform on health care delivery systems and methods for risk adjustment. Authorizes appropriations. Requires the Secretary to award grants to States or community-based, independent, not-for-profit organizations that have submitted applications to establish demonstration projects that provide certified standard health plans with the technical assistance to implement the results of quality improvement research into medical practice. Directs the Secretary to submit an annual report to the Congress which: (1) reviews the results of the quality improvement research grants; (2) evaluates consumer information programs established by participating States; (3) tracks the evolution of national performance measures and other research; and (4) evaluates State, regional, and national trends on quality of health care. Allows the Secretary to make grants to and enter into contracts with: (1) eligible public or private non-profit consortia for the development of community health groups (i.e. certified community health plans or community health networks); and (2) community health groups for their operation. Authorizes the Secretary to make certain types of financial assistance available to a community health group or isolated rural facility applying for capital assistance. Directs the Secretary to: (1) award grants to eligible entities to establish demonstration projects to promote telemedicine and other uses of the telecommunications network in rural areas; and (2) establish the Interagency Task Force on Rural Telemedicine to, among other things, identify specific uses for telemedicine that have proven to be effective and review the policy of the Health Care Financing Administration relating to reimbursement for telemedicine services. Subtitle B: Coordination With Other Provisions of Law - Eliminates immunity from antitrust suits under provisions commonly known as the McCarran-Ferguson Act with respect to health insurance. (Sec. 112) Elevates the position of the Director of the Office of Rural Health to the position of the Assistant Secretary for Rural Health and expands that official's duties. (Sec. 113) Permits the Secretary of Labor to issue special reporting and disclosure rules for employer group health plans and make other conforming amendments to the Employee Retirement Income Security Act of 1974 (ERISA). Repeals ERISA provisions on multiple employer welfare arrangements. Title II: Coverage - Amends SSA to add a new title XXII under which is established the National Health Care Commission to monitor and respond to: (1) trends in health insurance coverage; and (2) changes in per-capita premiums and other indicators of health care inflation. Requires the Commission to report to the Congress biennially on the status of health insurance coverage in the nation and the national goal of universal coverage. Authorizes appropriations. Provides that if 95 percent of the resident population is not covered by 2002, the Commission shall submit to the Congress an implementing bill which such statutory provisions as the Commission determines are necessary or appropriate to implement recommendations developed by it to achieve that target. Title III: Premium and Cost-Sharing Assistance - Amends SSA title XIX (Medicaid) to require State Medicaid plans to provide for a State program furnishing premium and cost-sharing assistance in accordance with a new Medicaid part B (State Programs for Premium and Cost-Sharing Assistance), which includes a grant program for providing cost-sharing assistance for certain individuals with incomes above 100 percent of the poverty line. Title IV: Administrative Simplification and Privacy - Amends SSA title XI to: (1) delay employer reporting requirements under Medicare and Medicaid Coverage Data Bank provisions; (2) terminate the Bank, effective January 1, 1996; (3) provide for administration simplification in the health care system, including Medicaid and Medicare, through an information network developed according to certain specified data element standards and requirements for electronic transmission and accessing of certain health information; (4) direct the Secretary to establish standards for certifying health information network services as qualified services and for establishing the form of health security cards issued by health plans and the information to be encoded electronically on such cards; (5) provide penalties for failure to comply with data element standards and requirements and for misuse of health security cards and personal health identifiers; (6) provide billing rules for clinical laboratory services; (7) establish the Health Care Information Advisory Committee for advising the Secretary and the Congress with respect to the health information network and network operations; (8) provide for demonstration projects to promote development and use of electronically integrated community-based clinical information systems and computerized patient medical records; (9) provide for privacy of health information; and (10) authorize appropriations. Amends SSA title XVIII (Medicare) to repeal provisions requiring the identification of secondary payer situations. Title V: Malpractice and Fraud - Subtitle A: Federal Tort Reform - Amends SSA title XI to provide for Federal medical malpractice provisions preempting inconsistent State laws (with specified exceptions) for governing malpractice actions brought in State or Federal courts (except with regard to actions arising from a vaccine-related injury or death covered under the Public Health Service Act) without establishing any new basis for bringing malpractice in Federal courts. Requires: (1) States participating under new SSA title XXI to establish alternative dispute resolution procedures for settling medical malpractice claims; and (2) any such claims to have gone through and reached final resolution under such procedures in order for any medical malpractice liability action to be brought with respect to such claim in a participating State. Authorizes the Secretary to provide funds to one or more eligible participating States to establish no-fault medical liability system demonstration projects to replace the common law tort liability system for medical injuries. Authorizes appropriations. Subtitle B: Expanded Efforts to Control Health Care Fraud and Abuse Affecting Federal Outlay Programs - Amends SSA title XI to provide for additional measures for controlling health care fraud and abuse affecting Federal outlay programs, among other means by: (1) mandating a joint program by the Secretary and the Attorney General to coordinate Federal, State, and local law enforcement programs to control fraud and abuse affecting Federal outlay programs; (2) providing qualified immunity to individuals providing information to such officials on health care fraud or abuse; (3) establishing the HHS Office of Inspector General Asset Forfeiture Proceeds Fund, consisting of all proceeds from forfeitures that have been transferred to the HHS Inspector General (IG) from the Department of Justice Asset Forfeiture Fund and available to the IG for investigation expenses; (4) allowing rewards for information leading to possible prosecution for a Federal health care offense; and (5) making revisions with regard to civil monetary penalties for health care fraud and abuse, including increasing such penalties, and with regard to private rights of action and mandatory exclusion from health care program participation. (Sec. 531) Amends Federal criminal code and (Civil False Claims Act) provisions, covering health care fraud as well as theft and embezzlement, false statements, and bribery and graft in connection with health care, and false claims for payments by health plans in order to conform to the changes made above under SSA. Title VI: Medicare, Medical Education, and Medicaid - Subtitle A: Medicare - Amends SSA title XVIII to replace provisions on payments to health maintenance organizations and competitive medical plans with provisions on payments to certain certified standard health plans, modifying provisions with regard to risk-contracting. (Sec. 611) Makes various specified changes in provisions related to Medicare part A (Hospital Insurance) and concerned with: (1) inpatient hospital services updates for prospective payment system hospitals; (2) payment reductions for capital-related costs for inpatient hospital services; (3) disproportionate share payment reductions; (4) payment methodology for rehabilitation and long-term care hospitals; (5) new designations of new long-term hospitals; (6) extension of the freeze on updates to routine service cost limits for skilled nursing facilities; (7) payments for sole community hospitals with teaching programs and multihospital campuses; (8) Medicare-dependent, small rural hospitals; (9) the rural health transition grant program; (10) a new limited service hospital program replacing the essential access community hospital program; (11) rural primary care hospitals and medical assistance facilities; and (12) termination of indirect medical education payments. (Sec. 622) Directs the Secretary to study and report to the Congress on subacute care. (Sec. 631) Makes various specified changes in provisions related to Medicare part B (Supplementary Medical Insurance) and concerned with: (1) updates for physicians' services; (2) volume performance standard rates of increase; (3) limitations on payment for physicians' services relating to inpatient stays in certain hospitals; (4) underserved area bonus payments; (5) development and implementation of resource-based methodology for practice expenses; (6) demonstration projects for Medicare State-based performance standard rate of increase; (7) elimination of formula-driven overpayments for certain outpatient hospital services; (8) eye or eye and ear hospitals; (9) imposition of coinsurance on laboratory services; (10) competition acquisition for items and services and laboratory services; (11) expanded coverage for physician assistants and nurse practitioners; and (12) general part B premiums. (Sec. 651) Makes various specified changes in provisions related to Medicare parts A and B and concerned with: (1) Medicare as secondary payer; (2) physician referral exceptions; (3) Medicare supplemental policies; (4) reductions in routine cost limits for home health services; (5) termination of graduate medical education payments; and (6) extension of social health maintenance organization demonstrations. (Sec. 653) Requires the Secretary to use a competitive process to contract with centers of excellence for cataract surgery and coronary artery by-pass surgery with payment under Medicare to be made for services subject to such contracts on the basis of specified negotiated or all-inclusive rates. (Sec. 659) Requires the Prospective Payment Assessment Commission and the Physician Payment Review Commission to each study and report to the Congress on Medicare spending. (Sec. 660) Directs the Secretary to develop a process to ensure that Medicare claims are submitted first by Medicare, Medicare supplemental policies, and other policies that provide supplemental benefits under Medicare before providers can submit claims to Medicare beneficiaries. Subtitle B: Medical Education - Amends SSA title XVIII to add a new part D (Medical Education) providing Federal payments to: (1) qualified applicants of approved physician and dental training programs and graduate nurse training programs; (2) medical schools for certain costs; and (3) academic health centers and other eligible institutions. Establishes the Graduate Medical Education and Academic Health Centers and Biomedical and Behavioral Research Trust Fund Advisory Committee to study and report to the Congress on operations of the Graduate Medical Education and Academic Health Centers Trust Fund, and the Biomedical and Behavioral Research Trust Fund. Authorizes appropriations. Subtitle C: Home and Community-Based Services - Amends SSA title XIX to add new parts: (1) C (State Programs for Home and Community-Based Services for Individuals with Disabilities) under which each State with an approved plan for home and community-based services for individuals with disabilities can receive Federal payments to provide such services to such individuals; and (2) D (Payments to Hospitals Serving Vulnerable Populations). Subtitle D: Medicaid Program - (Sec. 671) Limits: (1) coverage under Medicaid of items and services covered under the standard benefits package; and (2) State expenditures to certified health plans. Provides that no certified health plan with a Medicaid contract could have more than 50 percent of its enrollment composed of SSI-Medicaid recipients. (Sec. 673) Replaces disproportionate share hospital payment provisions with provisions relating to payments to hospitals serving vulnerable populations. (Sec. 674) Sets forth Medicaid long-term care provisions, including provisions for payments for personal care services and frail elderly services. (Sec. 675) Provides for an increased resource disregard for individuals receiving certain services. (Sec. 676) Increases the number of frail elderly demonstration project waivers. Amends the Omnibus Budget Reconciliation Act of 1986 to provide for the development of waiver protocols and model certification guidelines for an organization operating a demonstration project under such a waiver. (Sec. 677) Eliminates the: (1) requirement of prior institutionalization with respect to habilitation services furnished under a waiver for home or community-based services; and (2) rule regarding availability of beds in certain institutions. (Sec. 679) Provides for Medicaid coverage of all certified nurse practitioner and clinical nurse specialist services. Title VII: Revenue Provisions - Subtitle A: Financing Provisions - Amends the Internal Revenue Code to increase the excise taxes on cigarettes and other tobacco products. Applies such increase to tobacco products manufactured and sold in Puerto Rico. Increases such taxes for a temporary period for the funding of subsidies for children and pregnant women. (Sec. 703) Imposes an excise tax on the manufacture or importation of roll-your-own tobacco. (Sec. 705) Imposes a tax: (1) on a percentage of premiums received under taxable health insurance policies; and (2) on a percentage of amounts received for health-related administrative services. Imposes on self-insured plans a monthly tax on a percentage of the accident or health coverage expenditures and direct administrative expenditures. (Sec. 706) Imposes a 25 percent tax on high cost health plans to be paid by the issuer or the plan sponsor. Makes such tax non-deductible. (Sec. 711) Provides for the recapture of certain health care subsidies received by high-income individuals. Transfers such amounts to the Supplementary Medical Insurance Trust Fund. (Sec. 715) Increases the excise tax on certain hollow point and large caliber handgun ammunition. (Sec. 716) Requires certain shareholders of S corporations and limited partners who materially participate in corporate activities to include their share of income or loss from such corporation when determining net earnings from self-employment. (Sec. 717) Provides for extending Medicare coverage and applying the hospital insurance tax to all State and local government employees. Subtitle B: Tax Treatment of Employer-Provided Health Care - Imposes a tax on employer-provided health benefits that do not meet the requirements for permitted coverage. (Sec. 722) Includes in gross income health insurance coverage provided through flexible spending arrangements. (Sec. 723) Extends the deduction for health insurance costs of self-employed individuals until December 31, 1995. Subtitle C: Deduction for Individuals Purchasing Own Health Insurance - Allows a full deduction for the costs to individuals who purchase their own health insurance. Allows such deduction against the gross income of the individual. Subtitle D: Exempt Organizations - Sets forth qualification and disclosure requirements for tax-exempt health care organizations. (Sec. 742) Imposes an excise tax on the beneficiary of a taxable insurement and on the management of the participating tax-exempt health care organization. (Sec. 743) Provides for the treatment of health maintenance organizations, parent organizations, and health insurance purchasing cooperatives as tax-exempt entities. (Sec. 744) Provides for the taxation as an insurance company other than a life insurance company of certain organizations that provide health insurance and other prepaid health care services. (Sec. 746) Provides a tax exemption for certain qualified high risk insurance pools. (Sec. 748) Provides for the tax treatment of bonds of certain nonprofit tax-exempt organizations in a manner similar to governmental bonds. Subtitle E: Tax Treatment of Long-Term Care Insurance and Services - Treats qualified long-term care services as medical care for purposes of the medical expense deduction. (Sec. 752) Provides for the treatment of long-term care insurance as accident and health insurance. (Sec. 753) Allows accelerated death benefits under life insurance contracts to be paid to terminally ill individuals. Subtitle F: Health Care Trust Funds - Establishes the following trust funds to finance health-related programs: (1) the Health Security Trust Fund; (2) the Graduate Medical Education and Academic Health Centers Trust fund; and (3) the Biomedical and Behavioral Research Trust fund. Provides funding for such Trust Funds through tax and assessments made under this Act. Subtitle G: Other Revenue Provisions - Requires the Secretary of the Treasury to submit to specified congressional committees a legislative proposal providing statutory standards for the classification of workers as employees or independent contractors. (Sec. 772) Increases the penalty for failure to file correct information for returns involving payments for services. (Sec. 775) Allows a tax credit for certain primary health services providers that practice in health professional shortage areas. (Sec. 776) Increases the amount allowed to be expensed as a depreciable business asset if such asset is medical equipment. (Sec. 781) Requires additional reserves for post-retirement medical and life insurance benefits to cover not less than ten years of the working lives of covered employees and to be maintained as separate accounts. (Sec. 783) Allows a tax credit for the cost of personal assistance services required by certain employed individuals. Limits the amount of such credit and provides a cost-of-living adjustment. (Sec. 785) Makes the limit on annual deferrals inapplicable in the case of an individual covered under an excess benefit arrangement maintained by a tax-exempt group medical practice. Subtitle H: Ensuring Health Care Financing - Sets forth provision to ensure that programs under this Act and unanticipated increases in other Federal health spending do not increase the Federal deficit.
Bill· SS. 2350 (103rd)referred
United States · United States Congress · 2 August 1994
TABLE OF CONTENTS: Title I: Meat, Poultry, and Eggs Inspection Agency Subtitle A: Establishment and Authorities of Agency Subtitle B: Transitional Provisions Subtitle C: Other Matters Title II: Expansion of Foods Covered By Inspection Laws Title III: Establishment and Enforcement of Safe Cooking Standards for Meat and Poultry Products Title IV: Epidemiological Activities Regarding Foodborne Diseases Title V: Research on Treatment of Foodborne Diseases Katie O'Connell Safe Food Act - Title I: Meat, Poultry, and Eggs Inspection Agency - Subtitle A: Establishment and Authority of Agency - Establishes the Meat, Poultry, and Eggs Inspection Agency (Agency) which shall implement and administer: (1) the Federal Meat Inspection Act; (2) the Poultry Products Inspection Act; (3) the Egg Products Inspection Act; (4) safe cooking standards for meat and poultry preparation at restaurants and other retail food establishments; and (5) related research, inspection, and oversight activities. Establishes within the Agency a Bureau for Improved Inspection Capabilities. Subtitle B: Transitional Provisions - Directs the Secretary of Agriculture to terminate the inspection activities of the Food Safety and Inspection Service of the Department of Agriculture. Transfers related assets, funds, and personnel to the Agency. Requires the Agency appointment of an Office of Inspector General. Subtitle C: Other Matters - Defines specified terms for purposes of this title. Title II: Expansion of Foods Covered by Inspection Laws - Amends the Federal Meat Inspection Act and the Poultry Products Inspection Act to authorize expanded coverage of meats and poultry. Title III: Establishment and Enforcement of Safe Cooking Standards for Meat and Poultry Products - Requires the Director of the Agency to establish and enforce safe cooking standards for meat and poultry preparation at restaurants and other retail food establishments. Establishes civil monetary penalties for standards violations. Title IV: Epidemiological Activities Regarding Foodborne Diseases - Amends the Public Health Service Act to authorize the Secretary of Health and Human Services, through the Centers for Disease Control and Prevention, to carry out foodborne disease prevention and control activities. Authorizes appropriations. Title V: Research on Treatment of Foodborne Diseases - Amends the Public Health Service Act to require the Director of the National Institute of Diabetes and Digestive and Kidney Diseases to carry out foodborne disease support activities, including research and data collection.
Bill· SS. 2346 (103rd)open
United States · United States Congress · 1 August 1994
Public Health Improvement Act of 1994 - Title I: Programs Under Public Health Improvement Trust Fund - Subtitle A: Programs of Public Health Service Act - Amends the Public Health Service Act to establish a new title regarding public health programs. Establishes the Public Health Improvement Trust Fund to carry out public health programs. Directs the Secretary of Health and Human Services (Secretary) to establish the National Public Health Advisory Commission for advice on carrying out this title and on other Federal policies regarding public health. Authorizes appropriations from the Fund for FY 1995 through 2002 for the activities of the Commission. Authorizes appropriations from the Fund for FY 1995 through 2002 for formula grants to States for core functions of public health programs. Declares the purpose of such grants to provide improvements in the health status of the public through attaining the Healthy People 2000 Objectives. Authorizes appropriations from the Fund for FY 1995 through 2000 for grants to eligible entities for comprehensive evaluations of disease prevention and health promotion programs. Authorizes appropriations from the Fund for FY 1995 through 2002 for: (1) scholarship and loan repayment programs regarding service in approved public health positions; (2) grants to relevant institutions to expand educational capacities; and (3) grants to States lacking public health training programs. Authorizes appropriations from the Fund for FY 1995 through 1997 for grants to public and nonprofit private entities for regional poison control centers. Authorizes appropriations from the Fund for FY 1996 through 2002 for grants to eligible entities for the development and operation of school health service sites. Authorizes the Secretary to make loans and loan guarantees regarding such projects. Authorizes appropriations from the Fund for FY 1995 through 2002 for a scholarship program and loan repayment program for school nurses. Authorizes appropriations from the Fund for FY 1995 through 2000 for: (1) grants to migrant health centers and community health centers; and (2) grants to public or private health care providers for the development of qualified community health plans and qualified community practice networks. Authorizes the Secretary to make and guarantee loans for the capital costs of developing qualified community health groups. Authorizes appropriations from the Fund for FY 1996 through 2000 for grants with relevant entities for enabling services, such as transportation, community and patient outreach, patient education, and translation services. Authorizes appropriations from the Fund for FY 1995 through 2000 for: (1) the National Health Service Corps program and to increase the participation of nurses in scholarship and loan repayment programs; (2) grants to States to assist outpatient health centers (satellite clinics) that are providers of comprehensive health services; and (3) formula grants for the development and operation of community health advisor programs to assist States in attaining the Healthy People 2000 Objectives. Authorizes appropriations from the Fund for FY 1995 through 2000 for formula grants to States for service activities with respect to mental health and substance abuse. Authorizes the Secretary to make loans to entities for the capital costs incurred in the development of non-acute, residential treatment centers and community-based ambulatory clinics. Subtitle B: Comprehensive School Health Education - Authorizes appropriations from the Fund for FY 1995 through 2000 for planning and implementation grants for State education agencies and local educational agencies for programs of comprehensive school health education.
Bill· SS. 2343 (103rd)open
United States · United States Congress · 1 August 1994
Expresses the sense of the Senate that: (1) the health care program of the Department of Defense (DOD) known as TRICARE reflects a commitment to cooperation between the military departments and integrates the provision of health care by mlitary medical facilities; (2) full implementation of the TRICARE program will enhance DOD readiness to provide health care in support of military operations, as well as routine military health care, and will result in improved access to health care and enhancement of DOD medical facilities; and (3) Medicare (title XVIII of the Social Security Act) reimbursement is essential if the TRICARE program is to compete effectively among nationwide providers of health care services. Provides that, in the case of a person who is a Medicare-eligible individual who receives services in a certified military medical facility, the Secretary of Health and Human Services (HHS) shall be responsible for making reimbursement payments to the certified facility providing such care. Requires the Secretary of Defense to certify to the HHS Secretary a list of all military facilities that meet or exceed Medicare requirements that apply to a public facility, as well as all DOD health plans that meet or exceed Medicare HMO requirements.
Bill· HRH.R. 4882 (103rd)referred
United States · United States Congress · 1 August 1994
TABLE OF CONTENTS: Title I: Lead Abatement Title II: Miscellaneous Title III: Authorization of Appropriations Lead Exposure Reduction Act of 1994 - Title I: Lead Abatement - Amends the Toxic Substances Control Act to prohibit the processing or distribution in commerce of certain products containing more than a specified percentage of lead. (Sec. 103) Prohibits the sale or distribution in commerce of packaging or products if they include any additive to which lead has been intentionally introduced. Exempts certain products from lead content requirements, including products used for medical purposes, radiation protection or shielding, or in the mining industry to determine the presence of noble metals. (Sec. 104) Requires the Administrator to promulgate a list of lead-containing products that may present a health or environmental risk, specify the maximum concentration of lead found in such products, and promulgate labeling requirements. (Sec. 106) Prohibits: (1) placing in a landfill or incinerating lead-acid batteries; and (2) the disposal of such batteries other than by recycling in accordance with this Act. Requires used batteries to be delivered to specified entities and establishes battery acceptance requirements. Makes it unlawful to sell a battery that does not bear a label setting forth lead content and recycling information. Prohibits any person from selling at retail for use in the United States a regulated battery or rechargeable consumer product introduced into interstate commerce on or after one year after this Act's enactment date unless: (1) the battery is easily removable from the product, is contained in a battery pack that is easily removable, or is sold separately; and (2) the rechargeable consumer product and the battery are labeled in accordance with this Act. Sets forth labeling requirements, including that the label contain a statement that the battery must be recycled or disposed of properly. Requires retail establishments that sell such batteries or products to post notices informing consumers that regulated batteries must be recycled or disposed of properly. Authorizes the Administrator, upon determining that other rechargeable batteries having electrode chemistries different from regulated batteries are toxic and may cause substantial harm if discarded for land disposal or incineration, to promulgate: (1) labeling requirements for such batteries and related products; and (2) easily-removable design requirements for rechargeable consumer products designed to contain such batteries or battery packs. Provides for exemptions from rechargeable battery requirements under certain conditions. Prohibits the introduction into commerce or offering for introduction or promotional purposes of: (1) alkaline-manganese batteries manufactured on or after January 1, 1996, with a mercury content that was intentionally introduced (limits the content in alkaline-manganese button cells to 25 milligrams of mercury per button cell); (2) zinc carbon batteries manufactured on or afer January 1, 1995, that contain mercury that was intentionally introduced; (3) button cell mercuric-oxide batteries on or after January 1, 1995; and (4) any mercuric-oxide battery on or after January 1, 1997. Sets forth enforcement provisions. Authorizes appropriations. (Sec. 107) Directs the Administrator to study and report to the Congress on the environmental and public health effects of burning used oil. Requires the Administrator to appoint a Coordinator for Lead Activities to coordinate activities relating to the prevention of lead poisoning, the reduction of lead exposure, and lead abatement. Title II: Miscellaneous - Expresses the sense of the Congress that the Administrator should finalize no rule or regulation that requires a nationwide prohibition of the manufacture, sale, or use of fishing sinkers, jigs, or lures containing lead, brass, or zinc until the Administrator gives priority consideration to alternative means of reducing the risk to waterfowl from lead fishing sinkers. Title III: Authorization of Appropriations - Authorizes appropriations.
Bill· HRH.R. 4864 (103rd)open
United States · United States Congress · 1 August 1994
Medical Device User Fee Act of 1994 - Amends the Federal Food, Drug, and Cosmetic Act to authorize the assessment and collection of fees from applicants for medical device approval. Provides for the use of such fees to defray cost increases in the resources allocated for the process of device application review and related activities. Authorizes appropriations for FY 1995 through 1999.
Bill· HRH.R. 4865 (103rd)open
United States · United States Congress · 1 August 1994
Orphan Drug Act Amendments of 1994 - Amends the Federal Food, Drug, and Cosmetic Act to change from seven to four years the period of market exclusivity guaranteed to any approved orphan drug. Specifies that orphan drugs of "limited commercial potential," as defined by regulations to be issued by the Department of Health and Human Services (HHS) (based on total sales revenue for such drug during the four-year exclusivity period or other factors identified by the Secretary of HHS), would qualify for an additional three years of exclusive marketing rights. Permits more than one company to put a particular orphan drug on the market in instances where both companies were working on the drug in roughly the same time frame. Provides for the withdrawal of exclusive marketing rights if the patient population for the approved treatment exceeds 200,000. Extends the authorization of the research grant program. Replaces the existing Orphan Products Board with an Office for Orphan Diseases and Conditions.
Bill· HRH.R. 4856 (103rd)referred
United States · United States Congress · 28 July 1994
TABLE OF CONTENTS: Title I: General Provisions Title II: Creation of Independent and Effective State Medical Boards Title III: Requirements for Health Care Professionals and Providers Title IV: Public Access to Practitioner Data Bank Patient Safety Act of 1994 - Title I: General Provisions - Declares that the purpose of this Act is to create a national program of medical malpractice prevention. Title II: Creation of Independent and Effective State Medical Boards - Requires each State medical board to create a consumer assistance unit to deal directly with complainants. Requires the board to disclose information received from complaints to the national practitioner data bank. Establishes guidelines for investigations, disciplinary hearings, and disciplinary actions. Provides for the Secretary of Health and Human Services to assume responsibilities of this Act in cases where a State medical board does not meet requirements. Title III: Requirements for Health Care Professionals and Providers - Requires health care professionals and health care providers to renew their medical licenses every two years. Sets forth reporting requirements for health care professionals and providers and medical examiners. Requires licensed health care professionals to be reexamined every six years as a condition of licensure. Requires State medical boards to perform audits of the office-based practices of licensees to assess performance and to improve practices. Requires an audit of pharmacies to detect illegal drug diversion and other misuse of controlled substances. Requires health care professionals and providers to maintain malpractice insurance. Directs the Secretary to conduct a national interdisciplinary study of medical negligence. Title IV: Public Access to Practitioner Data Bank - Amends the Health Care Quality Improvement Act of 1986 to require the Secretary to make specified information on health practitioners available to the public.
Bill· HRH.R. 4840 (103rd)referred
United States · United States Congress · 27 July 1994
TABLE OF CONTENTS: Title I: Insurance Reform Subtitle A: Reform of Insured Market for Employers and Individuals Subtitle B: ERISA and Internal Revenue Code Requirements Title II: Tax Fairness Title III: Medical Savings Accounts Title IV: Medical Malpractice Title V: Antitrust Reform Title VI: Consumer Information The Prescription for Health Act of 1994 - Title I: Insurance Reforms - Subtitle A: Reform of Insured Market for Employers and Individuals - Part 1: General Reforms - Prohibits an insurer from canceling coverage or denying renewal of coverage of health insurance with respect to an employer or an individual other than: (1) for nonpayment of premiums, fraud or other misrepresentations, or noncompliance with plan provisions; or (2) because the insurer is ceasing to provide any health insurance in the State or, in the case of a health maintenance organization, in a geographic area with respect to employer or individuals, respectively. Prohibits an insurer that terminates the offering of health insurance plans in an area with respect to the market for employers or individuals from offering such a plan to any employer or individual in the area for five years after such termination. (Sec. 102) Bars an insurer from providing for an increase in the premium charged an employer or an individual for health insurance by a percentage that exceeds the percentage change in the premium charged any other employer or individual with the same characteristics, for similar benefits, and for the same area. (Sec. 103) Prohibits an insurer from denying health insurance coverage to any employer or individual, and a sponsor of a group health plan (GHP) from denying coverage to an eligible individual, on the basis of health status or preexisting condition if the employer or individual was covered by health insurance or a GHP for the same condition by another insurer or GHP for a period of not less than 12 months within the 15-month period ending with the month in which the application for coverage is made, with exceptions. Requires an insurer or sponsor of a GHP to waive any period applicable to a preexisting condition under health insurance or a GHP if the employer or individual was covered by such insurance or GHP for the same condition by another insurer or sponsor of a GHP for a period of not less than 12 months within the 15-month period ending with the month in which the application for coverage is made. (Sec. 104) Prohibits the premium charged by an insurer with respect to an employer or an individual covered under health insurance by another insurer for a period of not less than 12 consecutive months from exceeding the greater of the amount charged during the previous rating period or the premium charged to any other employer or individual with the same characteristics, for similar benefits, and for the same area. (Sec. 105) Permits variations in health insurance premiums among employers or individuals based on differences in covered services, age, gender, family composition, geographic area, or group size. (Sec. 106) Requires an insurer, upon request, to fully disclose all actuarial assumptions and methods used in establishing its premiums for health insurance at the time it offers or renews coverage to any employer or individual. (Sec. 107) Subjects any insurer or sponsor of a GHP which fails to comply with the provisions of this part to a civil monetary penalty of $250,000 per individual for each violation. Part 2: State Preemptions - Specifies that no provision of State or local law shall apply: (1) that requires the coverage under health insurance of any insurer of any specific benefits, services, or categories of health care or services of any class or type of provider of health care; and (2) that prohibits two or more employers or groups from obtaining coverage under a multiple health insurance plan. Subtitle B: ERISA and Internal Revenue Code Requirements - Amends the Employee Retirement Income Security Act of 1974 to direct the Secretary of Labor to prescribe: (1) solvency standards for GHPs that are single-employer plans which will ensure that benefits under such plans will be provided in full when due; and (2) rules for monitoring and enforcing compliance with such standards. Requires: (1) the Secretary, in prescribing such solvency standards, to take into consideration the extent to which a plan's potential liabilities are covered by excess or stop-loss coverage; and (2) the plan sponsor of each GHP to take such steps as necessary to ensure that plan assets held for the purpose of complying with such standards are held in trust under the plan and are available solely for such purpose. (Sec. 133) Amends the Internal Revenue Code to provide that the account limit for any qualified asset account for a taxable year is the amount reasonably and actuarially necessary to fund compliance with Federal or State solvency requirements, in the case of an account providing medical benefits, as well as specified claims and administrative costs. Title II: Tax Fairness - Amends the Internal Revenue Code to allow individuals a deduction from gross income for medical expenses attributable to health plan coverage and contributions to a medical savings account. Revises the medical expense deduction to include amounts paid under a health plan or paid to a medical savings account. Makes such deduction inapplicable to participants in a health plan maintained by their employer. Excludes employer contributions to medical savings accounts from employment taxes. Allows an individual tax credit for amounts allocable to FICA taxes used to purchase health plan coverage and to make contributions to medical savings accounts. Makes such credit inapplicable to participants in a health plan maintained by their employer. Title III: Medical Savings Accounts - Establishes tax-exempt medical savings accounts as trusts created to pay the medical expenses of beneficiaries. Title IV: Medical Malpractice - Makes this title applicable to any medical malpractice liability claim (claim) and any medical malpractice liability action (action) brought in State or Federal court, except regarding a claim or action for damages arising from a vaccine-related injury or death to the extent that specified provisions of the Public Health Service Act apply. Sets forth provisions regarding: (1) preemption and negotiated liability; (2) effect on sovereign immunity and choice of law or venue; and (3) Federal court jurisdiction. (Sec. 402) Sets a two-year statute of limitations from the date the alleged injury was, or reasonably should have been, discovered for actions, with an exception for certain minors. (Sec. 403) Makes the liability of each defendant in an action, with respect to economic and noneconomic damages, several only and not joint. Specifies that such a defendant shall be liable only for the amount of such damages allocated to the defendant in direct proportion to such defendant's percentage of fault or responsibility for the claimant's injury. (Sec. 404) Limits to $250,000 the total amount of noneconomic damages that may be awarded to a claimant and the members of the claimant's family for losses resulting from the injury which is the subject of an action. (Sec. 405) Prohibits requiring a defendant, in an action in which the damages awarded for any economic losses to be incurred after the date on which the judgment is entered exceed $100,000, from paying such damages in a single, lump-sum payment. Authorizes the court to require that such a defendant purchase an annuity or fund a reversionary trust to make periodic payments under specified circumstances. Bars a court judgment awarding periodic payments from being reopened at any time to contest, amend, or modify the schedule or amount of payments in the absence of fraud or any other basis under which a party may obtain relief from a final judgment. (Sec. 406) Authorizes a court, as a condition of the initiation of an action, to require an undertaking for the payment of the costs associated with the action, including reasonable attorney fees. Directs the court to require the party against whom the judgment was rendered to pay to the prevailing party costs and fees incurred, with exceptions. (Sec. 407) Specifies that the total amount of damages received by a claimant in an action shall be reduced by any other payment that has been, or will be, made to such claimant to compensate such claimant for an injury that was part of the action. (Sec. 408) Prohibits the award of noneconomic damages regarding any medical product liability claim alleged against a medical product producer if: (1) the drug or device that is the subject of such claim was subject to approval or premarket approval by the Food and Drug Administration (FDA) with respect to the safety of the formulation or performance of the aspect, or the adequacy of the packaging or labeling, of the drug or device, and was approved by the FDA; or (2) the drug or device is generally recognized as safe and effective pursuant to conditions established by the FDA and applicable regulations. Makes an exception in the case of withheld information, misrepresentation, or illegal payment to an FDA official for purposes of securing approval. Title V: Antitrust Reform - Directs the Attorney General to: (1) provide for the development and publication of explicit guidelines on the application of antitrust laws to the activities of health plans; and (2) establish a review process under which the administrator or sponsor of a health plan may submit a request to the Attorney General to obtain a prompt opinion from the Department of Justice on the plan's conformity with the Federal antitrust laws. (Sec. 502) Requires the Attorney General to issue a certificate of public advantage to each eligible health care collaborative activity that complies with specified requirements in effect on or after the expiration of the one-year period that begins on the date of this Act's enactment (thus making such activity and the parties to such activity immune from liability under the antitrust laws for conduct described). Sets forth provisions regarding requirements applicable to the issuance of such certificates. Directs the Attorney General to issue a certificate to an eligible health care collaborative activity upon finding that the benefits are likely to outweigh any reduction in competition likely to result from the activity and that such reduction in competition is reasonably necessary to obtain such benefits. Sets forth provisions regarding: (1) the establishment of criteria and procedures; (2) eligible health care collaborative activity; (3) the review of applications for certificates; (4) revocation of certificates; and (5) judicial review. Title VI: Consumer Information - Requires each hospital, physician, or other health care provider to make available to an individual, before providing any health care item or service in the United States, a list of all applicable fees and charges (and where not readily determinable in advance, the provider may use such estimates as the Secretary of Health and Human Services may permit), with an exception for emergency treatment. Specifies that no individual shall be liable for payment for a health care item or service for which disclosure has not been substantially made in accordance with this title.
Bill· HRH.R. 4841 (103rd)referred
United States · United States Congress · 27 July 1994
TABLE OF CONTENTS: Title I: Programs Under Public Health Improvement Trust Fund Subtitle A: Programs of Public Health Service Act Subtitle B: Comprehensive School Health Education Title II: Amendments to Internal Revenue Code of 1986 Public Health Improvement Act of 1994 - Title I: Programs Under Public Health Improvement Trust Fund - Subtitle A: Programs of Public Health Service Act - Amends the Public Health Service Act to establish a new title regarding public health programs. Establishes the Public Health Improvement Trust Fund to carry out public health programs. Appropriates to such Fund revenues received by the disallowed deduction for certain advertising expenses for tobacco products or alcoholic beverages. Directs the Secretary of Health and Human Services (Secretary) to establish the National Public Health Advisory Commission for advice on carrying out this title and on other Federal policies regarding public health. Authorizes appropriations from the Fund for FY 1995 through 2002 for the activities of the Commission. Authorizes appropriations from the Fund for FY 1995 through 2002 for formula grants to States for core functions of public health programs. Declares the purpose of such grants to provide improvements in the health status of the public through attaining the Healthy People 2000 Objectives. Authorizes appropriations from the Fund for FY 1995 through 2000 for grants to eligible entities for comprehensive evaluations of disease prevention and health promotion programs. Authorizes appropriations from the Fund for FY 1995 through 2002 for: (1) scholarship loan repayment programs regarding service in approved public health positions; (2) grants to relevant institutions to expand educational capacities; and (3) grants to States lacking public health training programs. Authorizes appropriations from the Fund for FY 1995 through 1997 for grants to public and nonprofit private entities for regional poison control centers. Authorizes appropriations from the Fund for FY 1996 through 2002 for grants to eligible entities for the development and operation of school health service sites. Authorizes the Secretary to make loans and loan guarantees regarding such projects. Authorizes appropriations from the Fund for FY 1995 through 2002 for a scholarship program and loan repayment program for school nurses. Authorizes appropriations from the Fund for FY 1995 through 2000 for: (1) grants to migrant health centers and community health centers; and (2) grants to public or private health care providers for the development of qualified community health plans and qualified community practice networks. Authorizes the Secretary to make and guarantee loans for the capital costs of developing qualified community health groups. Authorizes appropriations from the Fund for FY 1996 through 2000 for grants with relevant entities for enabling services such as transporation, community and patient outreach, patient education, and translation services. Authorizes appropriations from the Fund for FY 1995 through 2000 for: (1) the National Health Service Corps program and to increase the participation of nurses in scholarship and loan repayment programs; (2) grants to States to assist outpatient health centers (satellite clinics) that are providers of comprehensive health services; and (3) formula grants for the development and operation of community health advisor programs to assist States in attaining the Health People 2000 Objectives. Authorizes appropriations from the Fund for FY 1995 through 2000 for formula grants to States for service activities with respect to mental health and substance abuse. Authorizes the Secretary to make loans to entities for the capital costs incurred in the development of non-acute, residential treatment centers and community-based ambulatory clinics. Subtitle B: Comprehensive School Health Education - Authorizes appropriations from the Fund for FY 1995 through 2000 for planning and implementation grants for State education agencies and local educational agencies for programs of comprehensive school health education. Title II: Amendments to Internal Revenue Code of 1986 - Amends the Internal Revenue Code to disallow the deduction for advertising expenses for tobacco products or alcoholic beverages.
Resolution· HRESH.Res. 493 (103rd)referred
United States · United States Congress · 27 July 1994
Declares that it is the sense of the House of Representatives that: (1) one of the principal purposes of health care reform should be to ensure that medically underserved populations are provided adequate access to health services; (2) the reform should require that each health plan make provider agreements with specified types of individuals, institutions, and entities; and (3) the reform should require that those individuals, institutions, and entities provide services in the most appropriate language and cultural context.
Bill· HRH.R. 4829 (103rd)referred
United States · United States Congress · 26 July 1994
Family Health Care Coverage Act - Requires health plans that provide a family class of enrollment to offer and provide equal coverage to any child of an eligible individual who is less than 27 years of age, has never been married, has no dependents, and has a parent-child relationship with such individual.
Resolution· HCONRESH.Con.Res. 273 (103rd)referred
United States · United States Congress · 26 July 1994
Declares that it is the sense of the Congress that comprehensive health care reform should make contemporaneous compounding available to provide allergen-free medications.
Bill· HRH.R. 4816 (103rd)referred
United States · United States Congress · 22 July 1994
TABLE OF CONTENTS: Title I: Prospective Payment System for Nursing Facilities Title II: Subacute Care Continuum Amendments of 1994 Title III: Long-Term Care Tax Clarification Title IV: Long-Term Care Insurance Standards Title V: Financial Eligibility Standards Title VI: Establishment of Program for Home and Community-Based Services for Certain Individuals with Disabilities Title VII: Asset Transfers Quality Care for Life Act of 1994 - Title I: Prospective Payment System for Nursing Facilities - Prospective Payment System for Nursing Facilities Amendments of 1994 - Mandates that payment rates under the Prospective Payment System for Nursing Facilities reflect enumerated objectives. Declares that this Act does not affect the skilled nursing facility benefit under title XVIII (Medicare) of the Social Security Act (SSA). (Sec. 105) Instructs the Secretary of Health and Human Services to: (1) establish a resident classification system which groups residents into classes according to similarity of their assessed condition and required services; and (2) determine payment rates for nursing facilities according to prescribed guidelines. (Sec. 107) Prescribes guidelines for: (1) resident assessment; (2) per diem rate for nursing service costs, administrative and general costs; (3) payment for fee-for-service ancillary services; (4) reimbursement of selected ancillary services including drugs and medical supplies; (5) the per diem rate for property costs; (6) mid-year adjustments; and (7) payment methods for new and low-volume nursing facilities. Title II: Subacute Care Continuum Amendments of 1994 - Subacute Care Continuum Act of 1994 - Provides that SSA shall not be construed as limiting a skilled nursing facility (SNF) from offering subacute care services. Prohibits the Secretary or the States from imposing conditions for such services which restrict SNFs from qualifying based upon their status. (Sec. 203) Instructs the Secretary, regardless of the issuance of final regulations, to: (1) grant an interim exception within 90 days of submission of a request by a SNF providing subacute care services; and (2) establish identical fee schedules for physician visits to a subacute care patient in a SNF or in a hospital. (Sec. 205) Provides coverage under the Medicare program for respiratory therapy services in an SNF. Requires the Secretary to determine and subsequently publish a list of hospital DRGs appropriate for SNFs and the appropriate hospitalizations and copayments and rebase Medicare payments which reflect the lower cost of such care provided in SNFs. (Sec. 207) Expresses the sense of the Congress that: (1) the States are encouraged to develop payment methodologies for nursing facilities which provide subacute care for Medicaid patients; and (2) Federal funding should be available for nursing facilities which provide subacute care to Medicaid patients. Title III: Long-Term Care Tax Clarification - Private Long-Term Care Insurance Incentive Amendments of 1994 - Amends the Internal Revenue Code to: (1) set forth definitions concerning the treatment of long-term care insurance or plans; (2) treat qualified long-term services as medical care; (3) exclude from taxable income policy benefits pertaining to long-term care; (4) permit the offer of certain long-term care insurance contracts in certain employer (cafeteria) plans; (5) include in gross income excessive long-term care benefits; and (6) mandate that qualified long-term care insurance tax reserves be determined by the National Association of Insurance Commissioners. Title IV: Long-Term Care Insurance Standards - Long-Term Care Insurance Standards Amendments of 1994 - Directs the Congress to appoint the National Long-Term Care Insurance Advisory Council to advise it and monitor development of the long-term care insurance market. Authorizes appropriations. (Sec. 402) Amends the Internal Revenue Code to set forth consumer protection provisions regarding long-term care insurance policies. Sets forth tax penalties for non-complying issuers of such policies. (Sec. 404) Declares that insurance policies deemed by a State Insurance Commissioner to be in compliance with this Act and the Internal Revenue Code shall be deemed approved for sale in any other State. Title V: Financial Eligibility Standards - Amends title XIX (Medicaid) of the Social Security Act to delineate the criteria for financial eligibility for nursing facility services. Directs the Secretary to provide grants for State demonstration projects to investigate the coordination of private long-term care insurance benefits and financial eligibility requirements. Title VI: Establishment of Program for Home and Community-Based Services for Certain Individuals with Disabilities - Home and Community-Based Services for Individuals with Disabilities Program Amendments of 1994 - Establishes a program which mandates that States having an approved State plan provide for home and community-based services for eligible individuals with disabilities. (Sec. 602) Increases the amount of an individual's resources which shall be disregarded when determining eligibility for inpatient nursing or intermediate care facilities for the mentally retarded. Title VII: Asset Transfers - Extends from 36 to 60 months the look-back period for asset transfers. Modifies the guidelines for such transfers with respect to the treatment of certain trusts.
Bill· SS. 2310 (103rd)referred
United States · United States Congress · 21 July 1994
Instructs the Secretary of Health and Human Services to revise Medicare regulations governing payment for anesthesia services to compensate: (1) certified registered nurse anesthetists (CRNAs) for their services; and (2) physicians for supervision of CRNAs. Amends title XVIII (Medicare) of the Social Security Act to provide guidelines for proportionally split payments for anesthesia services furnished jointly by a physician and a CRNA.
Bill· SS. 2309 (103rd)open
United States · United States Congress · 21 July 1994
Veterans Health Care Reform Act of 1994 - Allows each veteran who is an eligible individual under provisions of the Health Security Act (the Act), individuals currently enrolled in a health plan under the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), and their family members to be enrolled in a Department of Veterans Affairs health plan (VA plan). Requires the Secretary of Veterans Affairs to ensure that each VA plan provides to enrolled individuals the items and services in the comprehensive benefit package under the Act. Allows such plans to offer supplemental health benefits and cost-sharing policies consistent with the Act. Provides a limitation with regard to veterans enrolled with health plans outside the VA. Prohibits the imposition of any plan enrollment charges upon service-connected disabled veterans, veterans receiving disability compensation from the VA, former prisoners of war veterans of the Mexican border period or World War I, and veterans unable to defray the costs of such care. Allows the Secretary to establish plan charges for other veterans. Deems a VA facility to be a Medicare provider, and a VA health plan to be a Medicare HMO, for purposes of any program administered by the Secretary of Health and Human Services under Medicare (title XVIII of the Social Security Act). Allows for the recovery of certain care and services provided under a VA plan in the case of an individual who has coverage under another plan. Establishes in the Treasury the Department of Veterans Affairs Health Plan Fund to be used for VA health plan payments and services. Preserves existing benefits for VA facilities not operating within a health plan certified under the Act. Directs the Secretary to organize health plans and operate VA facilities as, or within, health plans under the Act. Preempts conflicting State health plan standards or requirements. Directs the Secretary to designate a health plan director for each VA health plan organized and operated under this Act. Authorizes such directors to enter into contracts and agreements for the provision of care and services under the VA plan as well as related services (equipment, maintenance, and repair). Authorizes the Secretary to enter into resource-sharing agreements with other health care plans and providers, health industry organizations, individuals, and other Government departments and agencies. Provides certain administrative and personnel flexibility, as well as expenditure authority, for care and services under a VA plan. Establishes in the Treasury the Veterans Health Care Investment Fund. Provides specified credits to the Fund for FY 1995 through 1997 for operation of VA health plans. Requires a report from the Secretary to the Congress on the operation of such plans. Authorizes the Secretary to accept and use grants for health care services provided to special populations if used by the VA while operating under a VA health plan.
Bill· HRH.R. 4809 (103rd)referred
United States · United States Congress · 21 July 1994
Prostate Cancer Diagnosis and Treatment Act of 1994 - Amends title XVIII (Medicare) of the Social Security Act to provide for coverage of specified prostate cancer screening services and certain drug treatments for such cancer. Requires the Secretary of Health and Human Services to establish fee schedules for such services. Amends Federal law to cover such screening and treatment services for veterans as a preventive health service. Amends the Public Health Service Act to authorize appropriations for certain public health programs related to prostate cancer research and education. Directs the Administrator of the Agency for Health Care Policy and Research to: (1) conduct and support prostate cancer health services and screening and treatment procedures; and (2) provide for the development, periodic review, and updating of clinically relevant guidelines, standards of quality, performance measures, and medical review criteria.
Bill· HRH.R. 4810 (103rd)referred
United States · United States Congress · 21 July 1994
Integrated Child Health Care Network Act of 1994 - Amends title XIX (Medicaid) of the Social Security Act to prohibit the Secretary of Health and Human Services from granting a waiver under the Medicaid program to permit a State to require children enrolled in the program to receive medical assistance through managed care plans, unless such assistance is provided through an integrated child health care network. Directs the Secretary to make grants to eligible entities over a three-year period for the establishment and operation of such networks using different payment models, including grants to demonstrate the operation of networks (including State-initiated networks) applying a separate capitated payment rate with respect to children enrolled with the network.
Resolution· HRESH.Res. 485 (103rd)referred
United States · United States Congress · 20 July 1994
Expresses the sense of the Congress that any legislation enacted to reform health care delivery should not include price controls and limits on national health care expenditures that would restrict access to medical technology or hinder its development.
Bill· SS. 2294 (103rd)referred
United States · United States Congress · 19 July 1994
Morris K. Udall Parkinson's Research, Education, and Assistance Act of 1994 - Amends the Public Health Service Act to require the Director of the National Institutes of Health to establish a council to coordinate Parkinson's research activities. Directs: (1) the council to convene a National Consensus Conference on Parkinson's Disease and Related Neuro-degenerative Disorders to aid in the development of a broad-based strategy for identifying the cause of and treating such disorders; and (2) the Secretary of Health and Human Services to develop and annually submit to specified congressional committees a coordinated research agenda and to provide for the establishment of ten Parkinson's Research Centers. Authorizes the Secretary to: (1) award feasibility study grants to support the development of preliminary data sufficient to provide the basis for the submission of applications for independent research support grants or establishment of a Center; and (2) award grants to appropriate institutions for the provision of training and continuing education concerning health and long-term care of individuals with Parkinson's. Directs the Secretary to establish: (1) a grant program to support scientists who have distinguished themselves in the field of Parkinson's research; (2) a registry for screening and collecting patient and family data that may be useful in determining incidence and possible risk factors concerning Parkinson's; and (3) a national education program designed to foster a national focus on Parkinson's and the care of those with Parkinson's. Sets forth application requirements. Authorizes appropriations.
Bill· SS. 2296 (103rd)open
United States · United States Congress · 19 July 1994
TABLE OF CONTENTS: Title I: Health Care Security Subtitle A: Universal Coverage and Individual Responsibility Subtitle B: Benefits Subtitle C: State Responsibilities Subtitle D: Consumer Purchasing Cooperatives Subtitle E: Employer Purchasers Subtitle F: Health Plans Subtitle G: Federal Responsibilities Subtitle H: Miscellaneous Employer Responsibilities Subtitle I: General Definitions; Miscellaneous Provisions Title II: Long-Term Care Title III: Public Health Initiatives Subtitle A: Workforce Priorities Under Federal Payments Subtitle B: Academic Health Centers Subtitle C: Health Research Initiatives Subtitle D: Core Functions of Public Health Programs; National Initiatives Regarding Preventive Health Subtitle E: Health Services for Medically Underserved Populations Subtitle F: Mental Health; Substance Abuse Subtitle G: Comprehensive School Health Education; School-Related Health Services Subtitle H: Public Health Service Initiative Subtitle I: Additional Provisions Regarding Public Health Subtitle J: Occupational Safety and Health Subtitle K: Full Funding for WIC Subtitle L: Border Health Improvement Title V (sic): Quality and Consumer Protection Subtitle A: Quality Management and Improvement Subtitle B: Information Systems, Privacy, and Administrative Simplification Subtitle C: Remedies and Enforcement Subtitle D: Medical Malpractice Subtitle E: Expanded Efforts to Combat Health Care Fraud and Abuse Subtitle F: Repeal of Exemption Title VI: Premium Caps; Premium-Based Financing; and Plan Payments Subtitle A: Premium Caps Subtitle B: Premium-Related Financings Subtitle C: Payments to Health Plans and Miscellaneous Provisions Title VIII (sic): Health and Health-Related Programs of the Federal Government Subtitle E (sic): Amendments to the Employee Retirement Income Security Act of 1974 Title IX: Aggregate Government Payments Subtitle B (sic): Aggregate Federal Payments to Participating State Subtitle C: Borrowing Authority to Cover Cash-Flow Shortfalls Title X: Workers Compensation Medical Services Title XI: Transitional Insurance Reform Health Security Act - Title I: Health Care Security - Subtitle A: Universal Coverage and Individual Responsibility - Entitles each eligible individual to: (1) the benefit provided under subtitle B through the applicable health plan in which the individual is enrolled; and (2) a health security card to be issued by the alliance or other entity that offers the applicable health plan in which the individual is enrolled. Entitles a Medicare-eligible individual to benefits under Medicare instead of the provisions of this Act. (Sec. 1002) Requires each eligible individual to enroll in an applicable health plan and pay any required premium. Prohibits disenrollment of an eligible individual until the individual is either enrolled in another plan or becomes Medicare-eligible. (Sec. 1003) States that nothing in this Act shall be construed as prohibiting: (1) an individual from purchasing any health services; (2) an individual from purchasing supplemental insurance; (3) an individual who is not an eligible individual from purchasing health insurance; or (4) employers from providing additional coverage. (Sec. 1004) Prescribes principles applicable to all health plans, including: (1) nondiscrimination based on medical history, pre- existing medical conditions, or genetic predisposition to medical conditions; (2) open enrollment periods; and (3) the provision of services as defined in the benefits package. (Sec. 1005) States that a community-rated health plan is the applicable plan for a family, unless a family member is eligible for an experienced-rated health plan. (Sec. 1006) Prohibits an ineligible alien from enrolling in a health plan under this Act. Subtitle B: Benefits - Includes the following terms and services in the comprehensive benefit package: (1) hospital services; (2) services of health professionals; (3) emergency and ambulatory medical and surgical services; (4) clinical preventive services; (5) mental illness and substance abuse services; (6) family planning services and services for pregnant women; (7) hospice care; (8) home health care; (9) extended care services; (10) ambulance services; (11) outpatient laboratory, radiology, and diagnostic services; (12) outpatient prescription drugs and biologicals; (13) outpatient rehabilitation services; (14) durable medical equipment and prosthetic and orthotic devices; (15) vision care; (16) hearing aids for children; (17) dental care; (18) investigational treatments; and (19) optional services. (Sec. 1131) Requires each health plan to offer to its enrollees only one of the following cost sharing schedules: (1) lower cost sharing; (2) higher cost sharing; or (3) combination cost sharing. Provides that the annual maximum out-of-pocket expenses for an individual in any of the plans shall be $2500 and for a family the annual maximum shall be $3000. (Sec. 1141) Excludes the following items and services: (1) an item or service that is not medically necessary or appropriate; (2) an item or service that the National Health Board may determine is not medically necessary or appropriate; (3) custodial care, except hospice care; (4) surgery performed solely for cosmetic purposes, unless required to correct a congenital anomaly or performed to correct a part of the body altered by either disease or accident; (5) hearing aids; (6) eyeglasses and contact lenses for individuals at least 18 years of age; (7) in vitro fertilization; (8) sex change surgery and related services; (9) private duty nursing; (10) personal comfort items, except in the case of hospice care; and (11) any dental procedures involving orthodontic care, inlays, gold or platinum fillings, bridges, crowns, pin-post retention, dental implants, surgical periodontal procedures, or the preparation of the mouth for the fitting or continued use of dentures, except as specified. (Sec. 1151) Gives the National Health Board the authority to promulgate such regulations or establish such guidelines as necessary to assure uniformity in the application of the comprehensive benefit package across all health plans. Permits the Board to expand the benefit package. (Sec. 1162) Permits a health professional or facility to refuse to provide a benefit if the professional or facility objects on the basis of a religious belief or moral conviction. (Sec. 1163) Requires facilities to promptly report incorrect test results to the provider who ordered the test. Subtitle C: State Responsibilities - Requires a State, in order to be approved as a participating State, to submit a document describing the State's health care system. (Sec. 1201) Sets forth general responsibilities for participating States. (Sec. 1207) Requires the establishment of a National Center of Consumer Advocacy to provide technical assistance, adequate training, and support to States and Offices of Consumer Advocacy in each State. (Sec. 1209) Requires a State to designate an agency to coordinate the delivery of medical and social services to children with special health care needs. (Sec. 1221) Permits a State, with the Board's approval, to operate a single-payer system if specified requirements are met. (Sec. 1281) Provides for reductions in cost sharing for certain low-income families enrolled in community-rated health plans. Subtitle D: Consumer Purchasing Cooperatives - Requires a State to certify consumer purchasing cooperatives to: (1) enter into agreements with health plans; (2) enter into agreements with community-rated employers; (3) enroll eligible individuals in health plans; (4) make payments to health plans on behalf of community-rated employers and eligible individuals; (5) provide for coordination with other cooperatives; (6) provide information on health plans; and (7) carry out other functions as provided in this title. (Sec. 1321) Provides for the Federal Employees Health Benefits Program (FEHBP) to serve as a consumer purchasing cooperative in each health care coverage area designated by a State. Subtitle E: Employer Purchasers - Sets forth the responsibilities of employer purchasers of health plans. (Sec. 1411) Directs the Secretary of Labor to develop and publish standards applicable to employer sponsored plans offered by large group purchasers. Subtitle F: Health Plans - Sets forth requirements for the certification of health plans by a State. (Sec. 1531) Sets forth requirements relating to essential community providers. Subtitle G: Federal Responsibilities - Establishes the National Health Board in the Executive Branch. (Sec. 1603) Sets forth the general duties and responsibilities of the Board, including an annual report to the President and the Congress. (Sec. 1611) Requires the Board to approve a State health care system if the system meets the applicable requirements of this Act. Prohibits approval of a State health care system prior to 1996. (Sec. 1621) Provides for the Federal assumption of responsibilities in the absence of a State system. (Sec. 1641) Directs the Board to develop a risk adjustment and reinsurance methodology. Sets forth guidelines for developing such methodology. (Sec. 1651) Directs the Board to establish minimum capital requirements for community-rated health plans. (Sec. 1660) Requires the Board to establish a national annual open enrollment period. (Sec. 1671) Sets forth the responsibilities of the Secretary of Health and Human Services. Directs the Secretary to administer and implement all provisions of this Act, except those duties delegated to the Board, any other executive agency, or to any State. (Sec. 1672) Directs the Secretary to undertake an interdisciplinary medical technology impact study to assess the overall effect on patient outcomes of medical technologies used in treating a list of target diseases and conditions. (Sec. 1681) Provides for the certification of essential community providers. Sets forth the categories of providers automatically certified. (Sec. 1687) Directs the Secretary to perform responsibilities with respect to the development of workplace wellness programs. (Sec. 1691) Sets forth the responsibilities of the Secretary of Labor in administering provisions of this Act and related Acts. (Sec. 1695) Provides for collective bargaining dispute resolution for the transition period to a restructured health care delivery system. Subtitle H: Miscellaneous Employer Responsibilities - Sets forth employer responsibilities including: (1) auditing of records; (2) prohibitions on discrimination based on family status; (3) evasion of obligations; (4) prohibitions on self-funding of cost sharing benefits; and (5) obligations to retirees. Subtitle I: General Definitions; Miscellaneous Provisions - Sets forth the definitions and rules used in this Act. (Sec. 1911) Grants the National Health Board, the Secretary of Health and Human Services, and the Secretary of Labor authority to issue regulations as necessary to permit the timely implementation of this Act. (Sec. 1917) Expresses the sense of the Senate Committee on Labor and Human Resources that when the Health Security Act is enacted it should include specified sources of financing not within the jurisdiction of the Committee. Expresses the sense of such Committee that when health reform legislation is enacted it should include the permanent extension of the research and development tax credit. (Sec. 1918) Expresses the sense of such Committee that provisions encouraging the establishment of medical savings accounts be included in any health reform bill passed by the Senate, in conjunction with a comprehensive benefit package described in subtitle B of this title. Title II: Long-Term Care - Establishes requirements for State programs for home and community-based services to individuals with disabilities. Requires a State to consult with individuals and groups of individuals with disabilities when developing the plan in order to have the plan approved. (Sec. 2103) Defines individuals with disabilities to mean any individual within one or more of the following four categories: (1) individuals requiring help with the activities of daily living; (2) individuals with severe cognitive or mental impairment; (3) individuals with severe or profound mental retardation; and (4) severely disabled children. (Sec. 2107) Directs the Secretary to establish an advisory group to advise on all aspects of such State programs. (Sec. 2111) Provides financial assistance to States to assist in developing and implementing, or expanding and enhancing, a family- centered, culturally competent, community-centered, comprehensive statewide system of extended services and benefits for children with special health care needs. (Sec. 2201) Long-Term Care Insurance Improvement and Accountability Act - Amends the Public Health Service Act to mandate the establishment of model Federal standards for long-term care insurance. (Sec. 2301) Life Care Act - Amends the Public Health Service Act to establish a voluntary long-term care insurance program for individuals 35 years of age and over to cover the nursing home stays of such individuals. (Sec. 2303) Expresses the sense of the Senate Committee on Labor and Human Services concerning the success of PACE (Program of All- inclusive Care for the Elderly) in providing integrated service delivery. Title III: Public Health Initiatives - Subtitle A: Workforce Priorities Under Federal Payments - Establishes within the Department of Health and Human Services the National Council on Graduate Medical Education. Directs the National Council to designate for each academic year the number of individuals nationwide who are authorized to be enrolled in each specified approved physician training program for each medical specialty. (Sec. 3031) Makes funds available for: (1) qualified entities for the operation of approved physician training programs; (2) eligible medical schools for the direct costs of academic programs; and (3) qualified academic health centers or teaching hospitals. (Sec. 3071) Directs the Secretary to carry out a program with respect to graduate nurse training programs that is equivalent to the program for approved physician training programs. Establishes a National Council on Graduate Nurse Education. (Sec. 3081) Authorizes appropriations to the Secretary of Health and Human Services for the following programs: (1) primary care physician and physician assistant training; (2) training of underrepresented minorities and disadvantaged persons; (3) expanding rural health career opportunities and retention efforts; and (4) nurse training. Directs the Secretary to establish a National Advisory Board on Health Care Workforce Development to make recommendations on health care worker matters. Amends the Public Health Service Act to authorize appropriations for grants to improve the training of health care workers in assisting the needs of mentally retarded individuals and others with developmental disabilities. (Sec. 3082) Authorizes appropriations to the Secretary of Labor for a retraining program, a demonstration program for advanced career positions, and a workforce adjustment program. Subtitle B: Academic Health Centers - Authorizes appropriations for grants for: (1) rural information and referral systems; and (2) community- and provider-based health plans to provide services of eligible centers to residents of rural or urban communities. Subtitle C: Health Research Initiatives - Amends the Public Health Service Act to ensure that the National Institutes of Health conducts and supports biomedical and behavioral research on promoting health and preventing diseases, disorders, and other health conditions. Provides for health services research. Authorizes appropriations for such research. Subtitle D: Core Functions of Public Health Programs; National Initiatives Regarding Preventive Health - Authorizes appropriations for the core functions of public health programs and national initiatives regarding health promotion and disease prevention. Subtitle E: Health Services for Medically Underserved Populations - Authorizes appropriations for: (1) grants and contracts for the development of qualified community health plans and networks; (2) loans and grants for the capital costs of developing qualified community health groups; and (3) grants and contracts for enabling and supplemental services. (Sec. 3471) Authorizes appropriations for: (1) the National Health Service Corps; and (2) such amounts as are necessary to ensure that a specified percentage of participants in the Scholarship Program or the Loan Repayment Program of the Corps are nurses. (Sec. 3481) Entitles a hospital with a low-income utilization rate to specified payments. (Sec. 3491) Expresses the sense of the Senate Committee on Labor and Human Resources on the appropriate recognition of the success of community and migrant health centers. Subtitle F: Mental Health; Substance Abuse - Authorizes appropriations for grants to States for the development and operation of comprehensive managed mental health and substance abuse programs that are integrated with the health delivery system established under this Act. Subtitle G: Comprehensive School Health Education; School- Related Health Services - Authorizes appropriations for: (1) the development and implementation of comprehensive age appropriate health education programs in public schools for children and youth kindergarten through grade 12; and (2) increase access to preventive and primary health care services for children and youth through school-based or school-linked health service sites. Subtitle H: Public Health Service Initiative - Specifies the initiatives under this Act to be funded through funds not otherwise appropriated. Subtitle I: Additional Provisions Regarding Public Health - Requires the Secretary to reserve allocated appropriations for curriculum development and implementation regarding domestic violence and women's health needs. Subtitle J: Occupational Safety and Health - Directs the Secretary of Health and Human Services and the Secretary of Labor to work together to develop and implement a comprehensive program to expand and coordinate initiatives to prevent occupational injuries and illnesses. Subtitle K: Full Funding for WIC - Amends the Child Nutrition Act of 1966 to authorize appropriations for the special supplemental food program. Subtitle L: Border Health Improvement - Authorizes the President to conclude an agreement with Mexico to establish a binational commission to be known as the United States-Mexico Border Health Commission. Title V (sic): Quality and Consumer Protection - Subtitle A: Quality Management and Improvement - Requires the National Health Board to establish and oversee a performance-based program of quality management and improvement designed to enhance the quality, appropriateness, and effectiveness of health care services and access to such services which will be called the National Quality Council. (Sec. 5002) Specifies the duties of such Council. Subtitle B: Information Systems, Privacy, and Administrative Simplification - Directs the National Health Board to develop standards under which health care providers and health plans collect information for a national health care data network. (Sec. 5135) Authorizes the Board to make grants for demonstration projects to promote the development and use of electronically integrated community-based clinical information systems and computerized patient medical records. (Sec. 5160) Health Care Privacy Protection Act - Amends Federal criminal law to prescribe penalties for the wrongful disclosure of protected health information and the misuse of health security cards. (Sec. 5163) Provides limitations on the disclosure of protected health information. (Sec. 5195) Requires the Board to publish standard benefit forms. Subtitle C: Remedies and Enforcement - Sets forth provisions with respect to the review of benefit determinations for enrolled individuals, including provisions: (1) regulating the time limits for notice of disposition of a claim; (2) governing a plan's duty to review claim denials; (3) concerning urgent requests for preauthorization; and (4) concerning other time limits with respect to time limits and notice. (Sec. 5202) Requires each State to establish a complaint review office to permit aggrieved individuals to file complaints. (Sec. 5205) Provides for a Federal Health Plan Review Board to review the decisions of complaint review office hearing officers. (Sec. 5206) Sets monetary penalties for a plan which unreasonably denies or delays payment or provision of benefits. (Sec. 5211) Directs each State to establish and maintain an Early Resolution Program in each complaint review office. Requires a program to include: (1) forums for mediation of disputes; and (2) other forums of alternative dispute resolution as may be prescribed. (Sec. 5231) Sets forth additional remedies and enforcement provisions. Subtitle D: Medical Malpractice - Requires States to adopt an alternative dispute resolution system mechanism under which the parties must participate prior to the commencement of a medical malpractice action. Subtitle E: Expanded Efforts to Combat Health Care Fraud and Abuse - Requires the Secretary of Health and Human Services and the Attorney General to establish a joint program for health care fraud and abuse control. (Sec. 5421) Amends Federal criminal law to impose penalties for health care fraud, theft or embezzlement in connection with health care, false statements relating to health care matters, and bribery and graft relating to health care. Subtitle F: Repeal of Exemption - Amends specified Acts to repeal the exemption for health insurance. Title VI: Premium Caps; Premium-Based Financing; and Plan Payments - Subtitle A: Premium Caps - Sets forth provisions which provide for the computation of factors that limit the growth of premiums for the comprehensive benefit package in community-rated health plans. (Sec. 6002) Directs the Board to determine: (1) a national per capita baseline premium target; and (2) the health care coverage area per capita premium target. (Sec. 6006) Directs the chair of the Board to establish an advisory commission on regional variations in health expenditures. Requires the commission to examine methods of eliminating variation in health care coverage area per capita premium targets due to variation in practice patterns. (Sec. 6011) Subjects each noncomplying community-rated health plan for a year to a reduction in plan payment as specified, in order to assure that payments to community-rated health plans are consistent. (Sec. 6021) Directs the Board to develop a methodology for calculating an annual per capita expenditure equivalent for amounts paid for coverage for the comprehensive benefit package within a large group purchaser. (Sec. 6031) Sets forth special rules for a single-payer State. (Sec. 6041) Directs the Secretary to establish a program to monitor prices and expenditures in the U.S. health care system. Subtitle B: Premium-Related Financings - Makes each family enrolled in a community-rated health plan or an experienced-rated health plan in a class of family enrollment responsible for payment of the family share of premium. Provides for income-related discounts and specified credits. (Sec. 6116) Exempts certain employers from coverage obligations. (Sec. 6121) Specifies premium payments for community-rated employers, including premium discounts. (Sec. 6131) Specifies premium payments for large group purchasers. Subtitle C: Payments to Health Plans and Miscellaneous Provisions - Makes States responsible for assisting health plans and cooperatives in the collection of premium payments. Sets forth other duties and responsibilities of States and health plans with respect to payments and other administrative matters. Title VIII (sic): Health and Health-Related Programs of the Federal Government - Subtitle E (sic): Amendments to the Employee Retirement Income Security Act of 1974 - Amends the Employee Retirement Income Security Act of 1974 (ERISA) to define group health plan. (Sec. 8402) Sets limitations on coverage of group health plans under title I (Protection of Employee Benefit Rights) of ERISA. Authorizes the Secretary of Labor to provide special rules for group health plan reporting and disclosure. Makes provisions relating to interference with protected rights and coercive interference applicable to enrollees in large group purchaser health plans. (Sec. 8403) Revises certain continuation coverage requirements (from COBRA - the Consolidated Omnibus Budget Reconciliation Act) under ERISA with respect to group health plans. Repeals ERISA provisions for continuation coverage under group health plans upon full implementation of universal coverage under this Act. Amends the Public Health Service Act with respect to period of coverage under a qualified health plan. Repeals such coverage provisions upon full implementation of universal coverage under this Act. (Sec. 8404) Ends certain ERISA provisions' applicability with respect to: (1) cases of adoption, to the extent otherwise provided in regulations of the National Health Board under this Act; and (2) coverage of pediatric vaccines under group health plans, upon the plan's becoming a large group purchaser health plan under this Act. (Sec. 8405) Requires group health plans covered by specified ERISA provisions to comply with the requirements of this Act for health plan claims procedures. (Sec. 8406) Exempts the Hawaii Prepaid Health care Act from certain ERISA preemption provisions, under specified conditions. Title IX: Aggregate Government Payments - Subtitle B (sic): Aggregate Federal Payments to Participating State - Directs the Secretary of Health and Human Services (HHS) to pay a capped Federal entitlement payment amount to each participating State in each calendar quarter. Sets forth formulas and rules for capped entitlement payments. Subtitle C: Borrowing Authority to Cover Cash-Flow Shortfalls - Directs the Secretary of HHS to make available loans to States to cover any period of temporary cash-flow shortfall attributable to an estimation discrepancy, an administrative error, or relative timing during the year in which amounts are received and payments are required to be made. (Sec. 9201) Requires each State to provide that any surplus of funds resulting from an estimation discrepancy, up to a reasonable amount specified by the Secretary of HHS, shall be held in a State contingency fund for any future shortfalls from such a discrepancy. Title X: Workers Compensation Medical Services - Makes specified provisions under this Act (HSA) relating to use of standard forms and health care information applicable to a health plan or health care provider's provision of workers compensation medical services. Requires plans and providers that render such services to: (1) provide relevant health care information necessary to assist the worker in the safe and timely return to work; and (2) comply with legal duties and reporting requirements under State workers compensation laws and other Federal and State laws, including those regarding reporting of occupational injuries and diseases. Directs the Secretary of Labor to promulgate rules to clarify such plan and provider information responsibilities. (Sec. 10001) Requires health plans to provide care in disputed workers compensation cases, until an adjudicated determination is made that the claim is compensable as workers compensation. Requires the workers compensation carrier (or the self-insured employer) to reimburse the health plan and the worker if such determination is made. (Sec. 10002) Directs the Secretaries of HHS and Labor to conduct demonstration projects in one or more States with respect to treatment of work-related injuries and illnesses. Requires project development of: (1) protocols for treatment of work-related conditions; and (2) model methods of workers compensation carriers capitated payment on a per case basis to health plans for treatment of specified work-related injuries and illnesses. (Sec. 10003) Establishes a Commission on Workers Compensation Medical Services. Directs the Commission to study the relationship of workers compensation medical services to the new health system under this Act in terms of impact on the cost of such services, access to appropriate care for injured workers, and quality of medical care and its impact on functional and vocational outcomes for injured workers, considering specified issues. Requires the Commission's final report to the President and specified congressional committees to include a recommendation as to whether a transfer of financial responsibility for some or all medical benefits to health plans should be effected, along with a detailed implementation plan if such transfer is recommended. Title XI: Transitional Insurance Reform - Sets forth transitional provisions concerning: (1) enforcement; (2) preservation of current coverage; (3) restrictions on premium increases during transition; (4)portability requirements; (5) restrictions limiting benefit reductions; and (6) the establishment of the National Transitional Health Insurance Risk Pool.
Bill· HRH.R. 4788 (103rd)referred
United States · United States Congress · 19 July 1994
Veterans' Health Care Eligibility Reform Act of 1994 - Defines "continuum of health care" and "noninstitutional long-term care" under veterans' health care provisions. Directs the Secretary of Veterans Affairs to provide a continuum of health care to veterans eligible for veterans' benefits. (Sec. 2) Directs the Secretary to provide institutional nursing home care to certain disabled veterans or those in receipt of a veterans' pension. Allows for recovery of nursing home care costs by the Secretary if the veteran is also eligible for such care through a State plan under title XIX (Medicaid) of the Social Security Act. Designates a Department of Veterans Affairs facility as a Medicare provider for purposes of any program administered by the Secretary of Health and Human Services (HHS) under title XVIII (Medicare) of the Social Security Act. Declares a Department medical center as a Medicare HMO. Directs the HHS Secretary to reimburse a Department facility or medical center for providing services as a Medicare provider in the case of care for a non-service-connected disability of a veteran eligible for Medicare benefits. (Sec. 3) Directs the Secretary to develop a plan to implement the provision of institutional long-term care for veterans who: (1) have a service-connected disability of less than 50 percent; (2) have an annual income below a formulated amount; (3) have a catastrophic nonservice-connected disability; or (4) require such care as a follow-up to inpatient care. Outlines, with respect to such care, provisions concerning: (1) premiums and copayments for covered veterans; (2) the issuance of a long-term care insurance contract; and (3) a report from the Secretary to the Congress on the costs of the plan and the insurance contract and legislation required for plan implementation. (Sec. 4) Directs the Secretary to administer a program of health insurance known as the VA Group Health Plan as a managed-care plan meeting specified requirements. Allows any eligible veteran and his or her spouse or child to be enrolled in the Plan. Provides Plan enrollment requirements. Prohibits the Plan from imposing a limitation or exclusion of benefits relating to treatment for certain preexisting conditions. Directs the Secretary to administer the Plan so that no appropriated funds are required for Plan operation. Requires an annual report to the Congress by the Secretary on Plan operation, as well as an initial report. (Sec. 5) Directs the Secretary to administer the health programs of the Veterans Health Administration (VHA) through use of a managed care medical practice model, with limitations. Directs the Secretary to organize the VHA health care delivery and resources into geographic regions known as veterans service areas. (Sec. 6) Authorizes appropriations to the Secretary for FY 1995 through 1999 for: (1) acquiring medical equipment to relieve existing medical equipment backlogs in Department facilities; and (2) infrastructure improvement, patient care amenities, primary care services and personnel, and medical facility construction projects.
Bill· HRH.R. 4791 (103rd)referred
United States · United States Congress · 19 July 1994
TABLE OF CONTENTS: Title I: General Provisions Title II: Federal Reform of Health Care Malpractice Title III: Requirements for ADR Medical Malpractice Fairness Act of 1994 - Title I: General Provisions - Sets forth provisions regarding definitions and the period of applicability of this Act. Title II: Federal Reform of Health Care Malpractice - Prohibits a health care malpractice action from being brought in any: (1) State court unless the claim that is the subject of the action has been initially resolved under an alternative dispute resolution (ADR) system certified by the Secretary of Health and Human Services (or, in the case of a State in which such a system is not in effect, under the alternative Federal system established under this Act); and (2) Federal court based on diversity of citizenship unless the claim has been initially resolved under the system that applied in the State whose law applies. Directs the Attorney General to establish an ADR process for the resolution of tort claims consisting of such claims brought against the United States. Prohibits an action based on such a claim from being brought in any Federal court unless the claim has been initially resolved under such process. Sets forth procedures for filing actions. Makes each defendant in such an action severally but not jointly liable. Directs that each defendant's fault be determined on the basis of the defendant's percentage of responsibility. Limits to $250,000 the total of noneconomic damages that may be awarded to a claimant and the claimant's family for losses resulting from the injury, regardless of the number of parties or actions brought with respect to the injury. Prohibits the award of punitive damages except in cases of gross or criminal negligence. Limits such awards against the manufacturer or seller of a medical product causing injury. Directs that any punitive damages awarded be: (1) paid to the State in which the action is brought or, in a case brought in Federal court, the State in which the health care services that caused the injury were provided; and (2) used for activities to assure the safety and quality of health care services. Sets forth provisions regarding: (1) reductions for contributions from collateral sources; (2) periodic payment of damages for future expenses; (3) a uniform statute of limitations; (4) attorney's fees and costs; (5) expert witness qualifications; (6) preemption; and (7) sovereign immunity and choice of law or venue. Title III: Requirements for ADR - Sets requirements for State ADR systems. Provides for the certification of State systems and the applicability of the alternative Federal system, as well as the treatment of States with an alternative system already in effect.
Bill· HRH.R. 4789 (103rd)referred
United States · United States Congress · 19 July 1994
Morris K. Udall Parkinson's Research, Education, and Assistance Act of 1994 - Amends the Public Health Service Act to require the Director of the National Institutes of Health to establish a council to coordinate Parkinson's research activities. Directs: (1) the council to convene a National Consensus Conference on Parkinson's Disease and Related Neuro-degenerative Disorders to aid in the development of a broad-based strategy for identifying the cause of and treating such disorders; and (2) the Secretary of Health and Human Services to develop and annually submit to specified congressional committees a coordinated research agenda and to provide for the establishment of ten Parkinson's Research Centers. Authorizes the Secretary to: (1) award feasibility study grants to support the development of preliminary data sufficient to provide the basis for the submission of applications for independent research support grants or establishment of a Center; and (2) award grants to appropriate institutions for the provision of training and continuing education concerning health and long-term care of individuals with Parkinson's. Directs the Secretary to establish: (1) a grant program to support scientists who have distinguished themselves in the field of Parkinson's research; (2) a registry for screening and collecting patient and family data that may be useful in determining incidence and possible risk factors concerning Parkinson's; and (3) a national education program designed to foster a national focus on Parkinson's and the care of those with Parkinson's. Sets forth application requirements. Authorizes appropriations.
Bill· SS. 2283 (103rd)referred
United States · United States Congress · 14 July 1994
Prostate Cancer Diagnosis and Treatment Act of 1994 - Amends title XVIII (Medicare) of the Social Security Act to provide for coverage of specified prostate cancer screening services and certain drug treatments for such cancer. Requires the Secretary of Health and Human Services to establish fee schedules for such services. Amends Federal law to cover such screening and treatment services for veterans as a preventive health service. Amends the Public Health Service Act to authorize appropriations for certain public health programs related to prostate cancer research and education. Directs the Administrator of the Agency for Health Care Policy and Research to: (1) conduct and support prostate cancer health services and screening and treatment procedures; and (2) provide for the development, periodic review, and updating of clinically relevant guidelines, standards of quality, performance measures, and medical review criteria.
Bill· HRH.R. 4769 (103rd)referred
United States · United States Congress · 14 July 1994
TABLE OF CONTENTS: Title I: Tax Treatment of Long-Term Care Insurance Title II: Establishment of Federal Standards for Long-Term Care Insurance Title III: Deduction for Certain Expenses for Dependents with Alzheimer's Disease or Related Organic Brain Disorders Title IV: Dependent Care Credit Expanded and Made Refundable Title I: Tax Treatment of Long-Term Care Insurance - Amends the Internal Revenue Code to provide for the treatment of qualified long-term care insurance or plans as accident and health insurance or plans for purposes of insurance company taxation. (Sec. 102) Excludes from gross income benefits provided under a long-term care insurance contract. Includes in gross income employer-provided coverage for long-term care services. (Sec. 103) Allows a tax credit for a percentage of eligible long-term care premiums. (Sec. 104) Includes amounts paid for qualified long-term care services as medical expenses for individual itemized deductions. Includes any parent or grandparent as a dependent for purposes of such expenses. (Sec. 105) Requires long-term care insurance contracts to use a one-year full preliminary term tax reserve method. (Sec. 106) Excludes from gross income certain amounts withdrawn from individual retirement accounts and certain employer cash or deferred arrangements to pay long-term care premiums. (Sec. 107) 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, chronically ill, or has been permanently confined to a qualified facility. (Sec. 108) Allows insurance companies to issue accelerated death benefit riders on life insurance contracts. (Sec. 109) Permits long-term care insurance contracts to be offered in cafeteria plans. Title II: Establishment of Federal Standards for Long-term Care Insurance - Amends the Public Health Service Act to mandate the establishment of model Federal standards for long-term care insurance. Prohibits the offering of a long-term care insurance policy in a State unless the State has a regulatory program meeting the requirements of this Act or the policy has been certified by the Secretary of Health and Human Services. Authorizes grants to States for demonstration programs to improve enforcement of the standards. Authorizes appropriations. Imposes on agents selling long-term policies a duty of good faith and fair dealing. Prohibits twisting, high pressure tactics, and cold lead advertising. Mandates minimum financial standards, including income and asset criteria, for advising individuals considering the purchase of a long-term policy. Prohibits sales: (1) to an individual eligible for assistance under title XIX (Medicaid) of the Social Security Act; (2) of duplicate service policies; and (3) of policies that reduce, limit, or coordinate benefits on the basis of eligibility for other coverage or benefits. Provides for: (1) criminal and civil penalties; and (2) agent training and certification. Sets forth additional carrier responsibilities relating to refunding of premiums, mailing of policies, providing information on denials of claims, and reporting of information. Prohibits cancellation or nonrenewal of a long-term care policy except for nonpayment of premium or material misrepresentation. Sets forth continuation and conversion rights for group policies, regulating premiums for converted policies. Requires guaranteed issuance to an individual if the individual meets the minimum medical requirements of the policy. Mandates standards regarding upgraded benefits. Limits cancellation for nonpayment by an incapacitated individual. Requires: (1) subject to exceptions, uniform language and definitions, a uniform format, and at least one standard benefit package; and (2) disclosure of certain matters, including an outline of coverage. Mandates recommendations by the National Association of Insurance Commissioners (NAIC) regarding informing consumers on the long-term economic viability of long-term care insurance carriers. Limits certain conditions on benefits. Requires, if benefits are provided for home health care or community-based services, that certain minimum benefits be provided. Prohibits treating cognitive or mental impairments (including Alzheimer's disease and mental illness) differently from other medical conditions. Limits preexisting condition requirements. Requires: (1) each claimant to have a functional assessment by an individual or entity meeting NAIC qualifications and unconnected to the policy issuer; (2) inflation protection, unless rejected in writing by a policyholder; (3) disclosure of certain premium increases; and (4) nonforfeiture benefits. Prohibits a carrier from contesting a policy or claim based on fraud or misrepresentation unless notice is provided within a time period set by NAIC. Establishes the right of a purchaser to return a policy within a specified period. Defines "long-term care insurance policy," excluding: (1) any basic Medicare supplemental policies; (2) other insurance offered primarily to provide specified types of coverage; and (3) certain life insurance policies. Authorizes grants for programs to provide information, counseling, and assistance regarding the procurement of long-term insurance. Authorizes appropriations. Title III: Deduction for Certain Expenses for Dependents with Alzheimer's Disease or Related Organic Brain Disorders - Amends the Internal Revenue Code to allow an individual an income tax deduction for qualified home health care and adult day and respite care expenses with respect to a dependent who: (1) resides with the taxpayer; (2) suffers from Alzheimer's disease or a related organic brain disorder; and (3) is physically or mentally incapable of self- care. Title IV: Dependent Care Credit Expanded and Made Refundable - Repeals the Internal Revenue Code's nonrefundable income tax credit for employment- related dependent care expenses, replacing it with a corresponding refundable 50 percent credit, reduced (but not below 20 percent) as the taxpayer's adjusted gross income exceeds $15,000 (adjusted for inflation). Includes within the scope of the new credit up to $1,200 ($2,400 in the case of more than one qualifying individual) of respite care expenses incurred in the care of: (1) a dependent of the taxpayer who is at least 13 years old; or (2) a spouse or other dependent who is physically or mentally incapable of self-care.