Immigration

Health Security Act

United States · United States Congress · 22 November 1993

TABLE OF CONTENTS: Title I: Health Care Security Subtitle A: Universal Coverage and Individual Responsibility Subtitle B: Benefits Subtitle C: State Responsibilities Subtitle D: Health Alliances Subtitle E: Health Plans Subtitle F: Federal Responsibilities Subtitle G: Employer Responsibilities Subtitle J (sic): General Definitions; Miscellaneous Provisions Title II: New Benefits Subtitle B (sic): Long-Term Care Title III: Public Health Initiatives Subtitle A: Workforce Priorities Under Federal Payments Subtitle B: Academic Health Centers Subtitle C: Health Research Initiatives Subtitle D: Core Functions of Public Health Programs; National Initiatives Regarding Preventive Health Subtitle E: Health Services for Medically Underserved Populations Subtitle F: Mental Health; Substance Abuse Subtitle G: Comprehensive School Health Education; School-Related Health Services Subtitle H: Public Health Service Initiative Subtitle I: Coordination With COBRA Continuation Coverage Title V (sic): Quality and Consumer Protection Subtitle A: Quality Management and Improvement Subtitle B: Information Systems, Privacy, and Administrative Simplification Subtitle C: Remedies and Enforcement Title VI: Premium Caps; Premium-Based Financing; and Plan Payments Subtitle A: Premium Caps Subtitle B: Premium-Related Financing Subtitle C: Payments to Regional Alliance Health Plans Title VIII (sic): Health and Health-Related Programs of the Federal Government Subtitle E (sic): Amendments to the Employee Retirement Income Security Act of 1974 Title IX: Aggregate Government Payments Subtitle B (sic): Aggregate Federal Alliance Payments Subtitle C: Borrowing Authority to Cover Cash-Flow Shortfalls Title X: Coordination of Medical Portion of Workers Compensation and Automobile Insurance Subtitle A: Workers Compensation Insurance Subtitle C (sic): Commission on Integration of Health Benefits Subtitle E (sic): Davis-Bacon Act and Service Contract Act Subtitle F: Effective Dates Title XI: Transitional Insurance Reform Health Security Act - Title I: Health Care Security - Subtitle A: Universal Coverage and Individual Responsibility - Entitles each eligible individual to: (1) the benefit provided under subtitle B through the applicable health plan in which the individual is enrolled; and (2) a health security card to be issued by the alliance or other entity that offers the applicable health plan in which the individual is enrolled. Defines an eligible individual as an individual who resides in the United States and is: (1) a citizen or national of the United States; (2) an alien permanently residing in the U.S. under color of law; or (3) a long-term nonimmigrant. Entitles a Medicare-eligible individual to benefits under Medicare instead of the above provisions of this Act. (Sec. 1002) Requires each eligible individual to enroll in an applicable health plan and pay any required premium. Prohibits disenrollment of an eligible individual until the individual is either enrolled in another plan or in Medicare. (Sec. 1003) States that nothing in this Act shall be construed as prohibiting: (1) an individual from purchasing any health services; (2) an individual from purchasing supplemental insurance; (3) an individual who is not an eligible individual from purchasing health insurance; or (4) employers from providing additional coverage. (Sec. 1004) States that a regional alliance health plan is the applicable plan for a family, unless a family member is eligible for a corporate alliance health plan. Allows military personnel, veterans, and Indians to enroll either with an alliance or with a military, veteran, or Indian plan, respectively. (Sec. 1005) Prohibits an undocumented alien from enrolling in a health plan under this Act. (Sec. 1011) Defines a family as an eligible individual's eligible spouse and children. Defines couple as meaning an individual and the individual's spouse. Defines a child as being under age 18, or under age 24 in the case of a full-time student. Subtitle B: Benefits - Includes the following terms and services in the comprehensive benefit package: (1) hospital services; (2) services of health professionals; (3) emergency and ambulatory medical and surgical services; (4) clinical preventive services; (5) mental illness and substance abuse services; (6) family planning services and services for pregnant women; (7) hospice care; (8) home health care; (9) extended care services; (10) ambulance services; (11) outpatient laboratory, radiology, and diagnostic services; (12) outpatient prescription drugs and biologicals; (13) outpatient rehabilitation services; (14) durable medical equipment and prosthetic and orthotic devices; (15) vision care; (16) dental care; (17) health education classes; and (18) investigational treatments. Describes such items and services. (Sec. 1131) Requires each health plan to offer to its enrollees only one of the following cost sharing schedules: (1) lower cost sharing; (2) higher cost sharing; or (3) combination cost sharing. Provides that the annual maximum out-of-pocket expenses for an individual in any of the plans shall be $1500 and for a family the annual maximum shall be $3000. (Sec. 1135) Sets forth a table of copayments and coinsurance. (Sec. 1141) Excludes the following items and services: (1) an item or service that is not medically necessary or appropriate; (2) an item or service that the National Health Board may determine is not medically necessary or appropriate; (3) custodial care, except hospice care; (4) surgery performed solely for cosmetic purposes, unless required to correct a congenital anomaly or performed to correct a part of the body injured by either disease or accident; (5) hearing aids; (6) eyeglasses and contact lenses for individuals at least 18 years of age; (7) in vitro fertilization; (8) sex change surgery and related services; (9) private duty nursing; (10) personal comfort items, except in the case of hospice care; and (11) any dental procedures involving orthodontic care, inlays, gold or platinum fillings, bridges, crowns, pin/post retention, dental implants, surgical periodontal procedures, or the preparation of the mouth for the fitting or continued use of dentures, except as specified. (Sec. 1151) Gives the National Health Board the authority to promulgate such regulations or establish such guidelines as necessary to assure uniformity in the application of the comprehensive benefit package across all health plans. Permits the Board to expand the benefit package. (Sec. 1162) Permits a health professional or facility to refuse to provide a benefit if the professional or facility objects on the basis of a religious belief or moral conviction. Subtitle C: State Responsibilities - Requires a State, in order to be approved as a participating State, to submit a document describing the State's health care system. (Sec. 1201) Requires a participating State to: (1) establish one or more regional alliances; (2) establish and publish the criteria used in the certification of its health plan; (3) meet minimum financial solvency requirements for health plans established by the National Health Board; (4) designate an agency or official to coordinate State responsibilities under this Act; (5) conform State laws to meet the requirements of title X of this Act with respect to workers' compensation and automobile insurance; and (6) carry out all the responsibilities of a participating State specified in this Act. (Sec. 1221) Permits a State, with the Board's approval, to operate a single-payer system if specified requirements are met. Subtitle D: Health Alliances - Provides for regional alliances and corporate alliances. (Sec. 1302) Requires a regional alliance to be governed by a Board of Directors consisting of: (1) employers, including self-employed individuals; and (2) members who represent individuals purchasing coverage. Requires each regional alliance to establish a provider advisory board consisting of health care providers and professionals. (Sec. 1311) Includes in a corporate alliance an eligible sponsor who is either a large employer (more than 5000 full-time employees) or a multiemployer plan (a plan with more than 5000 active participants). Excludes: (1) an employer whose primary business is employee leasing; (2) the Federal Government (other than the U.S. Postal Service); and (3) a State or local government. Excludes from corporate alliance eligibility the following classes of individuals: (1) AFDC recipients; (2) SSI recipients; (3) military personnel and families, veterans, and Indians who elect to enroll in specified plans specifically designed for them; and (4) seasonal or temporary employees. (Sec. 1321) Directs each regional alliance to negotiate with any State-certified health plan for a contract with the alliance for the enrollment under the plan of eligible individuals. (Sec. 1322) Requires each regional alliance to offer a choice of health plans, including at least one fee-for-service plan. (Sec. 1326) Requires each regional alliance to establish and maintain an office of an ombudsman to assist consumers in dealing with problems that arise with health plans and the alliance. (Sec. 1329) Permits a regional alliance to adjust payments to plans or use other financial incentives to encourage health plans to expand into areas that have inadequate health services. (Sec. 1341) Set forth provisions concerning the collection of funds by regional alliances from individuals, employers, and others. (Sec. 1351) Requires each regional alliance to compute a blended plan per capita payment amount for each regional alliance health plan for enrollment in the alliance. (Sec. 1361) Requires each regional alliance to comply with specified standards relating to the management of finances, maintenance of records, accounting practices, auditing procedures, financial reporting, and employer payments. (Sec. 1371) Provides for a reduction in cost sharing for low-income families. (Sec. 1373) Provides for premium discounts and reduction in liabilities for low-income families. (Sec. 1381) Permits each corporate alliance to: (1) offer coverage under either an appropriate self-insured health plan; or (2) negotiate with a State-certified plan to enter into a contract with the plan. (Sec. 1382) Requires each corporate alliance to provide a choice of health plans, including at least one fee-for-service plan and two health plans that are not fee-for-service plans. (Sec. 1385) Requires each corporate alliance to make an additional contribution towards the enrollment in health plans of the alliance by certain low-wage families. (Sec. 1386) Sets forth provisions relating to a corporate alliance concerning: (1) consumer information and marketing; (2) plan and information requirements; (3) management of funds; (4) cost control; (5) payments by corporate alliance employers to corporate alliances; (6) ERISA; and (7) disclosure and reserve requirements. Subtitle E: Health Plans - Requires a health plan to: (1) be either a self-insured plan (meaning a group health plan as defined by a the Employee Retirement Income Security Act of 1974) or a State-certified plan (meaning a plan certified by a State or the National Health Board); and (2) meet the applicable regulatory requirements. (Sec. 1402) Requires each health plan offered by either a regional or corporate alliance to accept for enrollment every alliance eligible individual, unless the plan has reached its enrollment limit. Prohibits the limit from being imposed on the basis of any personal characteristics of enrollees such as health status, need for health care, age, occupation, or affiliation with any person or entity. Prohibits a plan from: (1) restricting or terminating coverage for any reason, including nonpayment of premiums; (2) cancelling coverage for any eligible individual until that individual is enrolled in another plan; (3) excluding an eligible individual because of an existing medical condition; (4) imposing a waiting period before coverage begins; or (5) imposing a rider that excludes the coverage of particular eligible individuals. Prohibits discrimination by a health plan on the basis of race, national origin, sex, language, socioeconomic status, age, disability, health status, or anticipated need for health services. (Sec. 1405) Requires each plan to have a grievance procedure. (Sec. 1421) Permits an entity to offer a supplemental insurance policy if the policy and the entity meet specified requirements. (Sec. 1431) Requires each health plan, with respect to each electing essential community provider located within the plan's service area, to enter into either a written provider participation agreement or a written agreement under which the plan will make payment to the provider as specified. Provides a special rule for providers of school health services. Makes the provisions of the preceding sentence applicable only to health plans offered by a health alliance during the five-year period beginning with the first year in which any health plan is offered by the alliance. Directs the Secretary of Health and Human Services to study essential community providers and to make recommendations concerning such providers to the Congress. Provides that such recommendations shall apply unless a joint resolution of disapproval is enacted by the Congress. (Sec. 1441) Requires each health plan to meet specified requirements of title X of this Act with respect to workers' compensation and automobile medical liability services. Subtitle F: Federal Responsibilities - Establishes the National Health Board in the Executive Branch. Directs the President to appoint the Board's seven members. (Sec. 1503) Directs the Board to: (1) interpret the comprehensive benefit package; (2) adjust the delivery of preventive services; (3) take steps to assure that the comprehensive benefit package is available on a uniform national basis; (4) recommend to the President and the Congress appropriate revisions to the package; (5) oversee cost containment requirements; (6) develop and implement eligibility standards; (7) establish a performance based system of quality management; (8) develop and implement standards for a national health information system; (9) establish State requirements and monitor State compliance; (10) establish premium class factors; (11) develop a methodology for the risk-adjustment of premium payments; (12) establish financial requirements for guaranty funds; (13) establish standards for health plan grievance procedures; and (14) report annually to the President and the Congress. (Sec. 1506) Authorizes appropriations for the Board. (Sec. 1511) Requires the Board to approve a State health care system if the system meets the applicable requirements of this Act. Prohibits approval of a State health care system prior to 1996. (Sec. 1512) Imposes sanctions upon States failing to meet conditions for compliance. (Sec. 1515) Provides for planning grants to States for implementation assistance. (Sec. 1521) Provides for the Federal assumption of responsibilities in the absence of a State system. Provides for increased premiums of 15 percent during Federal operation of a State system to provide reimbursement for the Federal cost of operating the system. (Sec. 1541) Directs the Board to develop a risk adjustment and reinsurance methodology. Sets forth guideline for developing such methodology. (Sec. 1543) Directs the Board to establish an advisory committee to provide technical advice and recommendations regarding the risk adjustment and reinsurance methodology. (Sec. 1551) Directs the Board to establish minimum capital requirements for regional alliance health plans under which at least $500,000 of capital must be maintained for each plan in the area. Permits the Board to require additional capital. (Sec. 1552) Requires the Board to establish standards for guaranty funds established by the States. (Sec. 1571) Sets forth the responsibilities of the Secretary of Health and Human Services. Directs the Secretary to administer and implement all provisions of this Act, except those duties delegated to the Board, any other executive agency, or to any State. (Sec. 1572) Directs the Secretary to appoint an Advisory Council on Breakthrough Drugs that will examine the reasonableness of launch prices of new breakthrough drugs. (Sec. 1581) Provides for the certification of essential community providers. Sets forth the following categories of providers automatically certified (under provisions of the Public Health Service Act): (1) migrant health centers; (2) community health centers; (3) homeless program providers; (4) public housing providers; (5) family planning clinics; and (6) AIDS providers under the Ryan White Act. Includes as automatically certified (under other Acts) the following: (1) Indian health programs under the Indian Health Act; and (2) maternal and child health providers and a Federal qualified health center or rural health clinic under the Social Security Act. Includes as automatically certified (under provisions of this Act) the following: (1) providers of school health services; and (2) a qualified community practice network. Provides for the setting of standards for additional health providers. (Sec. 1591) Sets forth the responsibilities of the Secretary of Labor. Includes among those responsibilities the following: (1) enforcement requirements applicable to employers; (2) elections to become corporate alliances; (3) temporary assumption of insolvent self-insured corporate alliance health plans; (4) establishment and administration of the Corporate Alliance Health Plan Insolvency Fund; and (5) administering title I of ERISA as it relates to group health plans maintained by corporate alliances. Subtitle G: Employer Responsibilities - Requires employers to provide for the payments required under title VI of this Act. Sets forth other employer responsibilities including: (1) information reporting requirements; (2) requirements relating to new employees; (3) recordkeeping requirements; and (4) antidiscrimination requirements. (Sec. 1606) Prohibits self-funding of cost sharing benefits by regional alliance employers. (Sec. 1607) Requires an employer to make equal employer premium payments to all qualifying employees, if a voluntary premium payment is made. Places a limit on such voluntary employer premium payments. (Sec. 1608) Sets forth an employer's obligation to a qualifying retired beneficiary where the employer, as of October 1, 1993, was providing a threshold payment. (Sec. 1609) Authorizes the Secretary of Labor to impose a civil penalty of up to $10,000 for each violation of this subtitle with respect to each individual. Subtitle J (sic): General Definition; Miscellaneous Provisions - Sets forth the definitions and rules used in this Act. (Sec. 1911) Grants the National Health Board, the Secretary of Health and Human Services, and the Secretary of Labor authority to issue regulations as necessary to permit the timely implementation of this Act. Title II: New Benefits - Subtitle B (sic): Long-Term Care - Establishes requirements for State plans for home and community-based services to individuals with disabilities. Includes among those requirements the following: (1) a prohibition of limiting eligibility of individuals with disabilities based on income, age, geography, severity of disability, residential setting, or other grounds specified by the Secretary; (2) a requirement to serve low-income individuals; (3) a requirement to specify how Federal and State funds will be managed; (4) quality assurance requirements; and (5) reporting requirements. Requires a State to consult with individuals and groups of individuals with disabilities when developing the plan in order to have the plan approved. (Sec. 2103) Defines individuals with disabilities to mean any individual within one or more of the following four categories: (1) individuals requiring help with the activities of daily living; (2) individuals with severe cognitive or mental impairment; (3) individuals with severe or profound mental retardation; and (4) severely disabled children. (Sec. 2104) Requires a State plan to specify the services available. Requires each individualized plan to be developed in close consultation with the individual and the individual's family. Prohibits a State plan from covering: (1) room and board; (2) services furnished in a hospital, nursing facility, intermediate care facility for the mentally retarded, or other specified institutional setting; or (3) items or services to the extent coverage is provided for an individual under a health plan or Medicare. (Sec. 2105) Sets forth provisions relating to: (1) cost sharing; (2) quality assurance and safeguards; (3) advisory groups; (4) payments to States; and (5) the total Federal budget for State plans and allotments to States. (Sec. 2301) Directs the Secretary, with the advice and assistance of the National Long-Term Care Insurance Advisory Council to promulgate regulations as necessary to implement provisions concerning private long-term care insurance. Directs the Secretary to make appointments to such Council. Authorizes appropriations for such Council. (Sec. 2321) Directs the Secretary, after considering the Council's recommendations to promulgate regulations designed to: (1) standardize formats and terminology used in long-term care policies; (2) require insurers to provide customers on the range of public and private long-term care coverage available; and (3) establish other requirements promoting consumer understanding of benefits. (Sec. 2322) Directs the Secretary to promulgate regulations establishing requirements with respect to the terms of the benefits under long-term care policies, which shall include the following requirements that the policy may not: (1) limit coverage based on a preexisting condition, subject to an exception for a six-month period; (2) condition eligibility for benefits based on the need or receipt of any other service; (3) condition eligibility for any benefit on any particular diagnosis; (4) condition eligibility for benefits by providers on compliance with requirements not required by State or Federal law; and (5) condition coverage of any service by a provider on the provision of such service at a higher level of care than required by the insured individual. Prohibits discrimination by diagnosis in the treatment of: (1) Alzheimer's disease; (2) any organic or inorganic mental illness; (3) mental retardation or any other cognitive or mental impairment; or (4) HIV infection or AIDS. (Sec. 2323) Sets forth other requirements for such policies, including requirements related to: (1) premium; (2) sales practices; (3) continuation, renewal, replacement, conversion, and cancellation of policies; and (4) payment of benefits. (Sec. 2342) Provides for grants to States to enforce the Federal standards concerning long-term care policies. Sets forth requirements for receiving such grants. Authorizes appropriations. Prohibits the sale of a long-term care policy in a State without a regulatory program. (Sec. 2361) Authorizes the Secretary to make grants for the development and implementation of long-term care information, counseling, and other programs to: (1) States; (2) regional alliances (at the option of States within which such alliances are located; and (3) national organizations representing insurance consumers, long-term care providers, and insurers. Authorizes appropriations for such grants. Title III: Public Health Initiatives - Subtitle A: Workforce Priorities Under Federal Payments - Establishes within the Department of Health and Human Services the National Council on Graduate Medical Education. Directs the National Council to designate for each academic year the number of individuals nationwide who are authorized to be enrolled in each specified approved physician training program for each medical specialty. (Sec. 3061) Directs the Secretary to carry out a program with respect to graduate nurse training programs that is equivalent to the program for approved physician training programs. Establishes a National Council on Graduate Nurse Education. (Sec. 3071) Authorizes appropriations for the following programs: (1) primary care physician and physician assistant training; (2) training of underrepresented minorities and disadvantaged persons; and (3) nurse training. (Sec. 3072) Authorizes appropriations for the following programs: (1) a program of skill upgrading and occupational retraining for health care workers; (2) a demonstration program to assist workers in health care institutions in obtaining advanced career positions; (3) a program to develop and operate health-worker job banks in local employment services agencies, subject to certain conditions; (4) a program to provide joint labor-management decision-making in the health care sector on workplace matters related to the restructuring of the health care delivery system of this Act; and (5) a program to facilitate the comprehensive workforce adjustment initiative. (Sec. 3073) Directs the Secretary of Health and Human Services and the Secretary of Labor to jointly establish the National Institute for Health Care Workforce Development. States that the Director of the Institute shall make recommendations to the Secretaries regarding: (1) the supply of health care workers; (2) the impact of this Act; and (3) the development and implementation of high-performance, high-quality health care delivery systems. Directs the Secretaries to establish an advisory board to assist in the development of such recommendations. Subtitle B: Academic Health Centers - Provides for the access of regional and corporate alliance patients to qualified academic health centers. Subtitle C: Health Research Initiatives - Amends the Public Health Service Act to ensure that the National Institutes of Health conducts and supports biomedical and behavioral research on promoting health and preventing diseases, disorders, and other health conditions. Provides for health services research. Authorizes appropriations for such research. Subtitle D: Core Functions of Public Health Programs; National Initiatives Regarding Preventive Health - Authorizes appropriations for the core functions of public health programs and national initiatives regarding health promotion and disease prevention. (Sec. 3312) Authorizes the Secretary to make grants to States to carry out one or more of the following core functions: (1) data collection; (2) activities to protect the environment and to assure the safety of housing, workplaces, and food and water; (3) investigation and control of adverse health conditions; (4) public information and education programs to reduce risks to health such as use of tobacco, alcohol, and drugs, sexual activities that increase the risk of HIV transmission and other sexually transmitted diseases, poor diet, physical inactivity, and low childhood immunization levels; (5) accountability and quality assurance activities; (6) provision of public health laboratory services to complement private clinical laboratory services that screen for diseases and conditions; (7) training and education to assure provision of care by all health professionals; and (8) leadership policy development and administrative activities. (Sec. 3331) Authorizes the Secretary to make grants to agencies of State or local government, private nonprofit organizations, and coalitions that link two or more of these groups for the purpose of carrying out projects to develop and implement innovative community-based strategies to provide for health promotion and disease prevention activities for which there is a significant need. Subtitle E: Health Services for Medically Underserved Populations - Directs the Secretary to make grants to migrant health centers and community health centers, which shall be in addition to other funds available to such centers. Authorizes appropriations. (Sec. 3412) Authorizes appropriations for: (1) grants and contracts for the development of qualified community health plans and practice networks; and (2) loans and guaranteeing the principal and interest to Federal and non-Federal lenders on behalf of public and private entities for the capital costs of developing qualified community health plans and practice networks. (Sec. 3461) Authorizes the Secretary to make grants and enter into contracts with qualified community health groups to provide enabling services such as transportation, community and patient outreach, patient education, and translation services in order to increase the capacity of individuals to utilize the items and services under title I of this Act. Authorizes appropriations. (Sec. 3471) Authorizes appropriations for: (1) the National Health Service Corps; and (2) such amounts as are necessary to ensure that at least 20 percent of participants in the Scholarship Program or the Loan Repayment Program of the Corps are nurses. (Sec. 3481) Entitles a hospital with a low-income utilization rate in a base year of at least 25 percent to a payment as specified. Requires 75 percent of the total available to be allocated to hospitals for low-income assistance. Requires 25 percent of the total available to be allocated to hospitals for assistance in furnishing inpatient hospital services that are not covered services under title I of this Act. Subtitle F: Mental Health; Substance Abuse - Authorizes appropriations to carry out this part. Provides for grants to: (1) increase access to mental health and substance abuse services; (2) improve State and local capacity to coordinate and monitor such services; (3) provide incentives to integrate public and private service systems; and (4) supplement any activity under part B (Alcohol and Drug Abuse and Mental Services Block Grant) of title XIX of the Public Health Service Act. (Sec. 3503) Authorizes the Secretary to make loans for the capital costs incurred in the development of non-acute, residential treatment centers and community-based ambulatory clinics. (Sec. 3521) Requires the establishment of a pilot program demonstrating the integration of the mental illness and substance abuse services of the States with the services included under title I of this Act. Subtitle G: Comprehensive School Health Education; School-Related Health Services - Authorizes appropriations for the programs of this subtitle. States that the purposes of the programs shall be to: (1) support the provision in kindergarten through grade 12 of comprehensive health education programs; (2) establish a national framework within which States can create comprehensive school health education programs that target the health risk behaviors of youth, including tobacco use, alcohol and drug abuse, sexual behaviors resulting in infections, injury prevention, dietary patterns, and sedentary lifestyles; (3) pay the initial costs of planning and establishing such programs; (4) support related Federal demonstrations and training; (5) motivate youth to stay in school, avoid teen pregnancy, and strive for success; (6) improve the knowledge of health education among youth; and (7) further the National Education Goals set forth in title I of the Goals 2000: Educate America Act. Defines comprehensive school health education program. Requires such programs to be sensitive to cultural and ethnic issues, promote involvement by families, and promote personal responsibility. Sets forth requirements for applying for grants and selection of grantees. Subtitle H: Public Health Service Initiative - Establishes a Public Health Service Initiative consisting of specified amounts authorized to be appropriated for the Initiative. States that: (1) the Initiative includes the programs of subtitles C through G of this title and the programs of subtitle D of title VIII; and (2) amounts appropriated to carry out the Initiative, including subtitles A through F of this title, are available to carry out specific programs for which the amounts are appropriated. Subtitle I: Coordination with COBRA Continuation Coverage - Amends title XXII (Requirements for Certain Group Health Plans for Certain State and Local Employees) of the Public Health Service Act to provide for coordination with COBRA continuation coverage. Repeals such title XXII upon implementation of this Act. Title V (sic): Quality and Consumer Protection - Subtitle A: Quality Management and Improvement - Requires the National Health Board to establish and oversee a performance-based program of quality management and improvement designed to enhance the quality, appropriateness, and effectiveness of health care services and access to such services which will be called the National Quality Management Program. (Sec. 5002) Establishes the National Quality Management Council which shall: (1) administer the National Quality Management Program; (2) perform any other duty specified in this subtitle; and (3) advise the National Health Board with respect to its duties under this subtitle. Requires the Council to develop a set of national measures of quality performance to be used in the assessment of and the provision of access to health care services. Requires the Council, in addition, to: (1) recommend to the Board establishing goals for performance by health plans and health care providers on a subset of national measures of quality performance; (2) direct the Administrator for Health Care Policy and Research to develop, review, and disseminate practice guidelines to determine how diseases can most effectively be prevented, diagnosed, treated, and managed; and (3) direct the Administrator for Health Care Policy and Research to support research related to a five-year priority list of performance measures. (Sec. 5008) Directs the National Health Board to: (1) establish and oversee regional professional foundations to perform such duties as develop lifetime learning programs for health professionals and conduct research on health care quality; and (2) establish the National Quality Consortium to perform such duties as establishing continuing education for health professionals and provide advice on research priorities. (Sec. 5012) Requires each regional alliance and each corporate alliance to: (1) disseminate specified information to consumers; and (2) ensure that performance and quality standards are continually approved. Subtitle B: Information System, Privacy, and Administrative Simplification - Directs the National Health Board to develop and implement a health information system, in consultation with Federal agencies, States, employers, health plans, and others, by which the Board shall collect, report, and regulate the collection and dissemination of health care information which shall be used for: (1) health care planning by Federal, State, and local government; (2) establishing and monitoring payments for health services; (3) assessing and improving the quality of health care; (4) managing and containing costs at the alliance and plan levels; and (5) other specified purposes. Requires the establishment of an electronic data network to collect, compile, and transmit information. (Sec. 5120) Sets forth provisions providing for health information privacy standards. (Sec. 5130) Directs the National Health Board to develop the following standard health care benefit forms: (1) an enrollment and disenrollment form; (2) a clinical encounter record; and (3) a claim form. (Sec. 5140) Establishes the National Privacy and Health Data Advisory Council in order to advise the National Health Board with respect to its duties under this subtitle. (Sec. 5141) Sets forth monetary penalties for violating health information system standards. Subtitle C: Remedies and Enforcement - Sets forth provisions with respect to the review of benefit determinations for enrolled individuals, including provisions: (1) regulating the time limits for notice of disposition of a claim; (2) governing a plan's duty to review claim denials; (3) concerning urgent requests for preauthorization; and (4) concerning other time limits with respect to time limits and notice. (Sec. 5202) Requires each State to establish a complaint review office for each regional alliance established by a State. Permits aggrieved individuals to file complaints with the appropriate review office. (Sec. 5205) Provides for a Federal Health Plan Review Board to review the decisions of complaint review office hearing officers. (Sec. 5207) Sets monetary penalties for a plan which unreasonably denies or delays payment or provision of benefits. (Sec. 5211) Directs each State to establish and maintain an Early Resolution Program in each complaint review office. Requires a program to include: (1) forums for mediation of disputes; and (2) other forums of alternative dispute resolution as may be prescribed. Establishes guidelines for the eligibility of cases for submission to the Early Resolution Program. States that conclusions of the mediation proceedings shall be treated as nonbinding and shall not affect any rights to review. (Sec. 5231) Sets forth additional remedies and enforcement provisions. Title VI: Premium Caps; Premium-Based Financing; and Plan Payments - Subtitle A: Premium Caps - Sets forth provisions which provide for the computation of factors that limit the growth of premiums for the comprehensive benefit package in regional alliance health plans, including the computation of a: (1) regional alliance inflation factor; and (2) general health care inflation factor. (Sec. 6002) Directs the Board to determine: (1) a national per capita baseline premium target; (2) the national average per capita current coverage health expenditures; and (3) current health care expenditures. (Sec. 6003) Directs the Board to determine a regional alliance per capita premium. (Sec. 6004) Requires a regional alliance to annually obtain premium bids from each plan seeking to participate as a regional alliance health plan with respect to the alliance. (Sec. 6005) Permits any participating State to assume responsibility for containment of health care expenditures in the State consistent with this Act. (Sec. 6006) Directs the chair of the Board to establish an advisory commission on regional variations in health expenditures. Requires the commission to examine methods of eliminating variation in regional alliance per capital premium targets due to variation in practice patterns, not due to other factors. Requires the Board to submit its recommendations to the Congress. Requires such recommendations to apply unless a joint resolution of disapproval is passed. (Sec. 6011) Subjects each noncomplying regional alliance health plan for a year to a reduction in plan payment as specified, in order to assure that payments to regional alliance health plans by a regional alliance are consistent. Defines a noncomplying plan to include a plan in which the final accepted bid exceeds the maximum complying bid for the per capita target premium. Defines maximum complying bid. (Sec. 6021) Directs the Board to develop a methodology for calculating an annual per capita expenditure equivalent for amounts paid for coverage for the comprehensive benefit package within a corporate alliance. (Sec. 6022) Terminates a corporate alliance with two excess years in a three year period. Provides that employers that were corporate alliance employers with respect to a terminated alliance shall become regional alliance employers. Defines an excess year as one in which the rate of increase for the corporate alliance exceeds the national corporate inflation factor. Defines rate of increase and national corporate inflation factor. (Sec. 6031) Sets forth special rules for a single-payer State. (Sec. 6041) Directs the Secretary to establish a program to monitor prices and expenditures in the U.S. health care system. Subtitle B: Premium-Related Financings - Makes each family enrolled in a regional health alliance plan or in a corporate alliance health plan in a class of family enrollment responsible for payment of the family share of premium payable for enrollment. Provides for income-related discounts and specified credits. (Sec. 6102) Establishes the formula for determining the premiums. (Sec. 6111) Provides for the repayment of alliance credits by certain families. (Sec. 6114) Provides for the special treatment of certain retirees and qualified spouses and children. (Sec. 6121) Requires each regional alliance employer to pay a monthly premium to the regional alliance for a qualifying employee. Sets forth provisions for determining such premium. Varies the premium depending upon such factors as the employer's size and average wages paid. (Sec. 6126) Sets forth provisions applicable to self-employed individuals. (Sec. 6131) Sets forth provisions for determining the corporate employer premium. Subtitle C: Payments to Regional Alliance Health Plans - Sets forth provisions to determine the computation of: (1) the blended plan per capita payment amount; and (2) the plan bid, AFDC, and SSI proportions. Title VIII (sic): Health and Health-Related Programs of the Federal Government - Subtitle E (sic): Amendments to the Employee Retirement Income Security Act of 1974 - Amends the Employee Retirement Income Security Act of 1974 (ERISA) to revise and limit the coverage of group health plans ERISA. Makes certain ERISA provisions inapplicable with respect to State-certified health plans. Provides for an exception from ERISA civil action provisions where review is otherwise available under the Health Security Act (this Act, HSA). (Sec. 8402) Establishes ERISA requirements for expeditious reporting and disclosure applicable to group health plans, through special rules consistent with ERISA and HSA purposes. Excludes plans maintained by regional alliances from treatment as multiple employer welfare arrangements. (Sec. 8403) Revises certain ERISA provisions relating to continuation coverage under group health plans. Repeals such provisions upon implementation of HSA. (Sec. 8404) Makes ERISA standards for group health plans regarding: (1) cases of adoption applicable except to the extent otherwise provided in regulations of the National Health Board under HSA; and (2) coverage of pediatric vaccines inapplicable to a group health plan upon its becoming a corporate alliance health plan under HSA. (Sec. 8405) Requires group health plans under ERISA to comply with HSA requirements relating to health plan claims procedure. Title IX: Aggregate Government Payments - Subtitle B (sic): Aggregate Federal Alliance Payments - States that this section constitutes budget authority in advance of appropriation Acts and obligates the Federal Government to provide for the payment to regional alliances of a capped Federal alliance payment amount. Defines capped Federal alliance payment amount. Subtitle C: Borrowing Authority to Cover Cash-flow Shortfalls - Authorizes the Secretary to make available loans to regional alliances to cover any period of temporary cash-flow shortfall attributable to: (1) any estimation discrepancy; (2) a period of temporary cash-flow shortfall attributable to an administrative error; or (3) a period of temporary cash-flow shortfall relating to the relative timing during the year in which amounts are received and payments are required. Sets forth loan terms and conditions. Title X: Coordination of Medical Portion of Workers Compensation and Automobile Insurance - Subtitle A: Workers Compensation Insurance - Requires each health plan that provides services to enrollees through participating providers to make arrangements to provide workers' compensation to such enrollees. (Sec. 10002) Requires each workers compensation carrier that is liable for payment for workers compensation services furnished by or through a health plan, regardless of whether or not the services are included in the comprehensive benefit package, to make payment for such services. (Sec. 10011) Sets forth requirements for participating States. (Sec. 10031) Authorizes demonstration projects in one or more States with respect to the treatment of work-related injuries and illnesses. Subtitle C (sic): Commission on Integration of Health Benefits - Establishes the Commission on Integration of Health Benefits, which shall study and report on the feasibility and appropriateness of transferring financial responsibility for all medical benefits, including those currently covered by workers' compensation and automobile insurance, to health plans. Authorizes appropriations. Subtitle E (sic): Davis-Bacon Act and Service Contract Act - Amends the Davis-Bacon Act and the Service Contract Act of 1965 to require Health Security Act benefits. Subtitle F: Effective Dates - Sets forth effective date provisions. Title XI: Transitional Insurance Reform - Sets forth transitional provisions concerning: (1) enforcement; (2) preservation of current coverage; (3) restrictions on premium increases during transition; (4) portability requirements; (5) restrictions limiting benefit reductions; and (6) the establishment of the National Transitional Health Insurance Risk Pool.

Health Security Act

United States · United States Congress · 22 November 1993

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

For the relief of Mark A. Potts.

United States · United States Congress · 22 November 1993

Authorizes the classification of a named individual as a child within the meaning of the Immigration and Nationality Act.

Consumer Choice Health Security Act of 1993

United States · United States Congress · 22 November 1993

TABLE OF CONTENTS: Title I: Tax and Insurance Provisions Subtitle A: Tax Treatment of Health Care Expenses Subtitle B: Insurance Provisions Subtitle C: Employer Provisions Subtitle D: State Plan Requirements Subtitle E: Federal Preemption Title II: Medicare and Medicaid Reforms Subtitle A: Medicare Subtitle B: Medicaid Title III: Health Care Liability Reform Title IV: Administrative Cost Savings Subtitle A: Standardization of Claims Processing Subtitle B: Electronic Medical Data Standards Subtitle C: Development and Distribution of Comparative Value Information Subtitle D: Preemption of State Quill Pen Laws Title V: Anti-Fraud Subtitle A: Criminal Prosecution of Health Care Fraud Subtitle B: Coordination of Health Care Anti-Fraud and Abuse Activities Title VI: Antitrust Provisions Title VII: Long-Term Care Title VIII: Welfare Restrictions for Aliens Title IX: Increase in Assistance to Community and Migrant Health Centers from Residual Savings Consumer Choice Health Security Act of 1993 - Title I: Tax and Insurance Provisions - Subtitle A: Tax Treatment of Health Care Expenses - Amends the Internal Revenue Code to allow a tax credit for health care expenses based upon percentages of qualified health insurance premiums and adjusted gross income. Provides for employers to make advance payments of such credit. (Sec. 102) Allows individuals a tax credit for a percentage of contributions made to a medical care savings account established for the benefit of an eligible individual. Exempts such accounts from taxation. Establishes an excise tax for excess contributions to medical care savings accounts and makes such accounts subject to the tax on prohibited transactions. (Sec. 103) Disallows the use of a personal exemption for an uninsured individual. Terminates the medical expense deduction, the deduction for health insurance costs of self-employed individuals, and the exclusion for employer-provided health insurance. Subtitle B: Insurance Provisions - Part I: Federally Qualified Health Insurance Plans - Sets forth requirements for federally qualified health insurance plans, including coverage for acute medical care, cost-sharing, premium rating practices, and guaranteed issuance and renewability. Part II: Certification of Federally Qualified Health Insurance Plans - Requires States to meet standards for regulatory programs for the certification of federally qualified health insurance plans. Subtitle C: Employer Provisions - Requires employers to: (1) withhold health insurance premiums from employee wages and remit such premiums to the employee's chosen insurer; and (2) notify each employee of their right to claim an advance refundable tax credit for such premiums. (Sec. 122) Provides for the conversion and continuation of existing insurance plans to required coverage under this Act. (Sec. 125) Establishes the Benefits Cash Out Commission to propose a procedure under which individuals may cash out Federal health benefits. Provides for congressional consideration of such proposal prior to its implementation. (Sec. 126) Imposes excise taxes on employers and health insurance carriers for noncompliance with this Act. Subtitle D: State Plan Requirements - Sets forth requirements for States to meet in order to receive Federal funds for health care programs. Subtitle E: Federal Preemption - Preempts specified State laws concerning health insurance. Title II: Medicare and Medicaid Reforms - Subtitle A: Medicare - Directs the Secretary to report to the Congress on the feasibility of allowing future Medicare beneficiaries to elect to receive certificates with which to purchase private health insurance coverage instead of receiving Medicare benefits. (Sec. 202) Eliminates disproportionate share hospital payments under Medicare. (Sec. 203) Provides for a reduction in the adjustment for indirect medical education costs under Medicare. (Sec. 204) Imposes copayments for skilled nursing facility services provided under Medicare. (Sec. 205) Moves payment updates to January for all payment rates under Medicare's hospital insurance program. (Sec. 206) Accelerates the transition to prospective rates for facility costs in hospital outpatient departments. Subtitle B: Medicaid - Places a cap on Federal payments for acute medical services furnished under a State's Medicaid program. (Sec. 212) Provides for waivers from Medicaid requirements in order to establish acute medical services programs. (Sec. 213) Terminates disproportionate share hospital payments under Medicaid. (Sec. 214) Directs the Secretary to provide grants to States for programs to provide health insurance coverage, acute medical services, preventive care, and disease prevention services to low-income individuals. Title III: Health Care Liability Reform - Health Care Liability Reform Act of 1993 - Limits payments, damages, and attorney's fees in health care malpractice actions and claims. (Sec. 304) Declares that a manufacturer or seller of a health care product shall not be strictly liable for injury from: (1) a defect in the design of the product; or (2) a failure to warn or instruct regarding a risk posed by the product that was not known or reasonably knowable. (Sec. 305) Limits the amount of noneconomic damages that may be awarded in a health care malpractice claim or a health care product liability claim. Allows several liability for noneconomic loss and for punitive damages. (Sec. 306) Allows punitive damages to be awarded only if the claimant establishes that the harm suffered was the result of conduct manifesting conscious, flagrant indifference to the health of those harmed by the product. Disallows punitive damges against a product approved by the Food and Drug Administration. Title IV: Administrative Cost Savings - Subtitle A: Standardization of Claims Processing - Directs the Secretary to adopt standards relating to: (1) data elements for use in paper and electronic claims processing under health benefit plans and in utilization review and mangement of care; (2) uniform claims forms; and (3) uniform electronic transmission of the data elements. (Sec. 402) Authorizes the Secretary, two years after standards are adopted for classes of services upon determining that a significant number of claims for benefits for such services under health benefit plans are not being submitted in accordance with such standards, to require that all providers of such services submit claims to health benefit plans in accordance with such standards. (Sec. 403) Directs the Secretary to: (1) provide for the ongoing receipt and review of comments and suggestions for changes in the standards adopted and promulgated; (2) establish a schedule for the periodic review of such standards; and (3) revise such standards. Subtitle B: Electronic Medical Data Standards - Directs the Secretary to promulgate standards for hospitals concerning electronic medical data, including standards for transmission of such data and confidentiality of patient-specific information. Authorizes the Secretary to periodically revise such standards. (Sec. 412) Sets forth requirements with respect to: (1) the sharing of hospital information under Medicare; (2) waiver of such requirements; and (3) application of such requirements to hospitals of the Department of Veterans Affairs. (Sec. 413) Authorizes the head of a Federal agency to require a provider to present and transmit a required data element electronically in accordance with applicable presentation or transmission standard. (Sec. 414) Sets forth limitations on data requirements where standards with respect to data elements are in effect. (Sec. 415) Directs the Secretary to establish an advisory commission on the standards established under this part and operational concerns about the implementation of such standards. Authorizes appropriations. Subtitle C: Development and Distribution of Comparative Value Information - Directs the Secretary to determine whether each State is developing and implementing a health care value information program that meets specified criteria and a specified schedule. Authorizes the Secretary to: (1) make grants to enable each State to plan development and initiate implementation of its health care value information program; and (2) recover the amount of such a grant by offset against any other amount payable to the State under the Social Security Act under specified circumstances. Authorizes appropriations. (Sec. 422) Directs the Secretary to take actions necessary to implement a comparable program in a State that fails to develop or implement a health care value information program in accordance with such criteria and schedule. Authorizes the Secretary to charge fees for the information materials provided pursuant to such a program. (Sec. 423) Directs the head of each Federal agency with responsibility for the provision of health insurance or health care services to individuals to develop health care value information relating to each program that such head administers and covering the same types of data that a State program meeting such criteria would provide. Subtitle D: Preemption of State Quill Pen Laws - Specifies that, effective January 1, 1996, no effect shall be given to any provision of State law that requires medical or health insurance records (including billing information) to be maintained in written, rather than electronic, form. Title V: Anti-Fraud - Subtitle A: Criminal Prosecution of Health Care Fraud - Amends the Federal criminal code to impose penalties upon a health care provider that knowingly engages in any scheme or artifice to defraud a person in connection with the provision of health care. (Sec. 502) Authorizes the Attorney General to pay a reward of up to $10,000 to a person who furnishes information unknown to the Government relating to a possible prosecution for health care fraud, with exceptions. Subtitle B: Coordination of Health Care Anti-Fraud and Abuse Activities - Amends the Social Security Act to provide for: (1) the application of Federal health anti-fraud and abuse sanctions to all fraud and abuse against any health insurance plan; and (2) treble damages for making or causing to be made false statements or representations involving Medicare or State health care programs, for illegal remuneration, and for false statements or representations with respect to the condition or operation of health care institutions. Directs the Secretary of Health and Human Services, in consultation with State and local health care officials, to: (1) identify opportunities for the satisfaction of community service obligations that a court may impose upon the conviction of a criminal offense involving Medicare or State health care programs; and (2) make information concerning such opportunities available to Federal and State law enforcement officers and State and local health care officials. Title VI: Antitrust Provisions - Exempts from the antitrust laws specified "safe harbor" activities related to the provision of health care services. Sets forth provision regarding the award of attorney fees and costs of suit to the prevailing party in an action based on a claim involving activity found to be exempt. (Sec. 602) Lists as safe harbors specified: (1) activities relating to health care services of combinations of health care providers with market share below a specified threshold; (2) activities of medical self-regulatory entities relating to standard setting or enforcement activities not conducted for purposes of financial gain; (3) participation of a health care provider in a written survey of the prices of services, reimbursement levels, or the compensation and benefits of employees and personnel; (4) activities relating to health care joint ventures for high technology and costly equipment and services; (5) activities relating to hospital mergers; (6) joint purchasing arrangements; and (7) negotiations. (Sec. 603) Directs the Attorney General to publish a notice in the Federal Register soliciting proposals for additional safe harbors and to review and report to the Congress on proposed safe harbors. Sets forth criteria in establishing safe harbors, including: (1) the extent to which a competitive or collaborative activity will accomplish an increase in health care access and quality, the establishment of cost efficiencies, and increased ability of health care facilities to provide services in medically underserved areas or to underserved populations; and (2) whether designation as a safe harbor will result in specified desirable outcomes. (Sec. 604) Directs the Attorney General to issue certificates of review for providers of health care services and to assist persons in applying for such certificates. Sets forth provisions regarding applications for, revocation of, and review of determinations regarding such certificates. Limits the disclosure of information. (Sec. 605) Sets forth provisions regarding notifications providing for a reduction in certain penalties under the antitrust laws for health care cooperative ventures. (Sec. 606) Directs the Attorney General to: (1) review the safe harbors and certificates of review periodically; and (2) promulgate such rules, regulations, and guidelines as necessary to carry out provisions of this title. Title VII: Long-Term Care - Amends the Internal Revenue Code to exclude from gross income certain amounts withdrawn from individual retirement accounts and certain employer cash or deferred arrangements to pay long-term care premiums. (Sec. 702) Provides for the nonrecognition of gain or loss on the exchange of any life insurance contract or an endowment or annuity contract for a long-term care insurance contract. (Sec. 703) Provides for the exclusion as a death benefit of any amount paid or advanced to an individual under a life insurance contract because such individual is terminally ill, or chronically ill and has been permanently confined to a qualified facility. Title VIII: Welfare Restrictions for Aliens - Makes aliens ineligible for programs of public welfare assistance, other than medical assistance with respect to emergency services. (Sec. 802) Amends the Social Security Act to require State agencies to provide the Immigration and Naturalization Service with identifying information on individuals unlawfully in the United States whose children are citizens for purposes of the Aid to Families with Dependent Children program. Title IX: Increase in Assistance to Community and Migrant Health Centers from Residual Savings - Directs the Secretary of Health and Human Services to provide for a program of grants to migrant and community health centers to promote primary health care services for underserved individuals. Authorizes appropriations with limitations. Requires a report to the Congress on such program.

Health Security Act

United States · United States Congress · 20 November 1993

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

Health Security Act

United States · United States Congress · 20 November 1993

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

To prohibit direct Federal financial benefits and unemployment benefits to illegal aliens.

United States · United States Congress · 20 November 1993

Prohibits the payment of: (1) direct Federal financial or social insurance benefits to illegal aliens; or (2) unemployment benefits to aliens without employment authorization. Requires the head of each Federal agency which provides such benefits to: (1) use immigration status verification systems; and (2) notify the Immigration and Naturalization Service regarding applications for such benefits by illegal aliens.

A bill to amend the Immigration Reform and Control Act of 1986 concerning interim assistance to States for legalization (SLIAG).

United States · United States Congress · 19 November 1993

Amends the Immigration Reform and Control Act of 1986 to extend: (1) the period of availability of State legalization impact-assistance grants; and (2) the period of State authority to use funds for educational and naturalization services. Makes specified other funds available to States for services provided to eligible legalized aliens.

Community Health Improvement Act of 1993

United States · United States Congress · 19 November 1993

Community Health Improvement Act of 1993 - Amends title XIX (Medicaid) of the Social Security Act to provide for State operated community health authorities demonstration projects for testing the effectiveness of various innovative health care approaches in providing access to cost-effective prevention and primary care and related services for low-income residents of medically underserved areas. Amends the Public Health Service Act to: (1) authorize grants for the development of health service networks in medically underserved areas; and (2) extend the authorization of appropriations for migrant and community health centers.

A bill to amend the Immigration and Nationality Act to provide that public ceremonies for the admission of new citizens shall be conducted solely in English.

United States · United States Congress · 18 November 1993

Amends the Immigration and Nationality Act to require that public ceremonies for the admission of new citizens be conducted solely in English.

For the relief of Wolfgang Dietrich Hofmann.

United States · United States Congress · 18 November 1993

Waives grounds for deportation or exclusion from the United States of a named individual by reason of his conviction of any crime that occurred before January 1, 1980, that is reflected in the records of the Immigration and Naturalization Service of the Department of Justice or the Visa Office of the Department of State. Directs the Attorney General to rescind any outstanding order of deportation or finding of deportability that has been entered against the individual by reason of such conviction.

For the relief of Rauof A. Khalil.

United States · United States Congress · 17 November 1993

Waives the two-year foreign residence requirement for a named individual and deems him eligible to apply for any benefit under the Immigration and Nationality Act for which he qualifies.

Concerning United States interdiction of Haitian vessels and individuals.

United States · United States Congress · 17 November 1993

Expresses the sense of the Congress that: (1) Haitians interdicted at sea should not be returned to Haiti without a determination of their fear of persecution in Haiti; and (2) any person with a credible fear of persecution should be paroled into the United States for the purpose of applying for political asylum.

To amend the Immigration Reform and Control Act of 1986 concerning interim assistance to States for legislation (SLIAG).

United States · United States Congress · 10 November 1993

Amends the Immigration Reform and Control Act of 1986 to extend: (1) the period of availability of State legalization impact-assistance grants; and (2) the period of State authority to use funds for educational and naturalization services. Makes specified other funds available to States for services provided to eligible legalized aliens.

Concerning the case of Joseph Occhipinti.

United States · United States Congress · 10 November 1993

Requires the Attorney General to appoint a special prosecutor to investigate all allegations of a drug cartel inspired conspiracy against a named individual and to determine whether or not such individual's conviction was justified or if there was perjured testimony, organized crime coercion of witnesses, and possible prosecutorial misconduct. States that the President should grant the individual a full and complete pardon and restore him to his position within the Immigration and Naturalization Service if the investigation finds that he was unjustly convicted.

North American Free Trade Agreement Implementation Act

United States · United States Congress · 4 November 1993

TABLE OF CONTENTS: Title I: Approval of, and General Provisions Relating to, the North American Free Trade Agreement Title II: Customs Provisions Title III: Application of Agreement to Sectors and Services Subtitle A: Safeguards Subtitle B: Agriculture Subtitle C: Intellectual Property Subtitle D: Temporary Entry of Business Persons Subtitle E: Standards Subtitle F: Corporate Average Fuel Economy Subtitle G: Government Procurement Title IV: Dispute Settlement in Antidumping and Countervailing Cases Subtitle A: Organizational, Administrative, and Procedural Provisions Regarding the Implementation of the Agreement Subtitle B: Conforming Amendments and Provisions Title V: NAFTA Transitional Adjustment Assistance and Other Provisions Subtitle A: NAFTA Transitional Adjustment Assistance Program Subtitle B: Provisions Relating to Performance Under the Agreement Subtitle C: Funding Subtitle D: Implementation of NAFTA Supplemental Agreements Title VI: Customs Modernization Subtitle A: Improvements in Customs Automation Program Subtitle B: National Customs Automation Program Subtitle C: Miscellaneous Amendments to the Tariff Act of 1930 Subtitle D: Miscellaneous Provisions and Consequential and Conforming Amendments to Other Laws North American Free Trade Agreement Implementation Act - Title I: Approval of, and General Provisions Relating to, the North American Free Trade Agreement - Declares that the Congress, pursuant to the Omnibus Trade and Competitiveness Act of 1988 and the Trade Act of 1974, approves: (1) the North American Free Trade Agreement (NAFTA) entered into on December 17, 1992, with Canada and Mexico and submitted to it on November 4, 1993; and (2) the statement of administrative action proposed to implement the Agreement that was submitted to it on November 4, 1993. Sets forth conditions for entry into force of NAFTA. (Sec. 102) Declares that U.S. laws shall prevail over provisions of NAFTA that conflict. Requires the President to consult with the States in order to achieve conformity of State laws with NAFTA. Requires the United States Trade Representative (USTR) to establish within the Office of the USTR a Federal-State consultation process to address issues relating to NAFTA that directly affect the States. Prohibits any person other than the United States from having a cause of action with respect to NAFTA. (Sec. 105) Authorizes the President to establish within any U.S. agency a U.S. Section of the Secretariat to facilitate the operation of NAFTA. Authorizes appropriations. (Sec. 106) Requires the United States to encourage the selection of individuals with expertise in environmental issues for service on the Chapter 20 panel to hear any challenge to a U.S. or State environmental law. (Sec. 107) Sets forth provisions governing the termination or suspension of NAFTA. (Sec. 108) Declares that the congressional approval of NAFTA may not be construed as applying to any countries other than Canada and Mexico. Sets forth provisions outlining future free trade area negotiations with other foreign countries. Title II: Customs Provisions - Authorizes the President to proclaim such modifications or continuation of any duty, continuation of duty-free or excise treatment, or additional duties as are necessary to carry out specified provisions of NAFTA. (Sec. 201) Requires the President to terminate Mexico's designation as a beneficiary developing country under the Trade Act of 1974 upon entry into force of NAFTA. Prohibits the President from considering a request to accelerate the staging of duty reductions for an article for which the United States tariff phaseout period is more than ten years if such request for such article has been denied in the preceding three years. Authorizes the President to convert the base rate of certain textiles imported from Mexico to an ad valorem rate. (Sec. 202) Sets forth, for purposes of implementing tariff treatment and quantitative restrictions provided in NAFTA, rules of origin with respect to goods from NAFTA countries. (Sec. 203) Defines the term "good subject to NAFTA drawback." Amends the Tariff Act of 1930 to prohibit an article manufactured in a bonded warehouse from materials that are goods subject to NAFTA drawback (refund) from being withdrawn from such warehouse for exportation to a NAFTA country without assessment of a duty on the materials in their condition and quantity, and at their weight, at the time of importation into the United States. Sets forth similar provisions with respect to articles from bonded smelting and refining warehouses. Authorizes merchandise, under specified conditions, to be cleaned, sorted, repacked, or otherwise changed in condition in bonded warehouses and be withdrawn: (1) for export to a NAFTA country if such merchandise consists of goods subject to NAFTA drawback (refund) and certain duties are assessed; and (2) without the payment of duties for export to NAFTA and, in certain cases, non-NAFTA countries. Amends the Foreign Trade Zones Act to provide that, if Canada ceases to be a NAFTA country and the U.S.-Canada Free-Trade Agreement terminates, no article manufactured or otherwise changed in condition (except a change by cleaning, testing, or repacking) shall be exported to Canada without the payment of a duty unless a certain privilege has been requested and no manipulation (change of condition) has occurred. Prohibits merchandise consisting of goods subject to NAFTA drawback that is manufactured or otherwise changed in condition from being exported to a NAFTA country without an assessment of a duty on it. Prohibits the Secretary of the Treasury (Secretary) from, on the condition of export, refunding or reducing fees imposed under the Agricultural Adjustment Act with respect to "goods subject to NAFTA drawback" that are exported to Canada after December 31, 1995, or Mexico after December 31, 2000, for so long as they are NAFTA countries. Declares that none of the amendments made under this Act shall be considered to authorize the refund, waiver, or reduction of countervailing duties or antidumping duties imposed on an imported good. (Sec. 204) Amends the Consolidated Omnibus Budget Reconciliation Act of 1985 to prohibit customs user fees with respect to goods qualifying under the rules of origin from being: (1) charged with respect to goods that qualify to be marked as Canadian goods; and (2) increased after December 31, 1993, and charged after June 29, 1999, with respect to goods that qualify to be marked as Mexican goods. (Sec. 205) Amends the Tariff Act of 1930 to require persons who sign a NAFTA Certificate of Origin for a good for which preferential treatment is claimed to keep and render for inspection all records relating to the origin of the good. Sets forth penalties for violation of such recordkeeping requirements. Sets forth provisions regarding incorrect and false Certificates of Origin. (Sec. 206) Authorizes the United States Customs Service to reliquidate an entry to refund excess duties paid on a good qualifying under the rules of origin under the NAFTA for which no claim for preferential tariff treatment was made or protest filed at the time of importation if the importer, within one year after the importation, files a claim that includes specified information. (Sec. 207) Revises country of origin marking requirements with respect to certain pipe and steel products and manhole rings or frames and covers from NAFTA countries to include continuous paint stenciling, or an equally permanent method of marking, as methods for satisfying such requirements. Sets forth provisions regarding: (1) adverse marking and origin determinations by the U.S. Customs Service; and (2) the judicial review of such determinations. (Sec. 209) Declares the Secretary of Commerce may authorize the U.S. Customs Service to exchange information with any government agency of a NAFTA country provided certain safeguards are met. (Sec. 210) Prohibits duties from being refunded (drawnback) on imported color cathode-ray television picture tubes, including video monitor cathode-ray tubes, when such items are nonoriginating goods and are: (1) exported to a NAFTA country; (2) used as a material in the production of other goods that are exported to a NAFTA country; or (3) substituted for by goods of the same kind and quality used as a material in the production of other goods that are exported to a NAFTA country. (Sec. 211) Requires the U.S. Customs Service to monitor television and picture tube imports for a five-year period. Directs the U.S. Customs Service to make the results of such monitoring, including verification of the rules of origin, available to the President and the USTR. Title III: Application of Agreement to Sectors and Services - Subtitle A: Safeguards - Part 1: Relief From Imports Benefitting From the Agreement - Authorizes an entity, trade association, firm, certified or recognized union, or group of workers that is representative of an industry to file with the International Trade Commission (ITC) a petition requesting the adjustment of U.S. obligations under NAFTA. Requires the ITC to investigate, and make a determination, whether as a result of the reduction or elimination of a duty under NAFTA, a Canadian or Mexican article is being imported in such increased quantities as to constitute a substantial case of serious injury, or except in the case of a Canadian article, a threat of serious injury to a domestic industry producing an article that is like, or directly competitive with, such article. (Sec. 303) Requires the ITC, if it makes an affirmative determination, to recommend to the President the amount of import relief that is necessary to remedy or prevent such injury. (Sec. 308) Amends the United States-Canada Free-Trade Agreement Implementation Act to require the Secretary to decide whether to recommend to the President the imposition of a temporary duty on Canadian fresh fruits and vegetables. (Sec. 309) Requires the Secretary of Agriculture to determine each period of five consecutive business days in which the daily price for frozen concentrated orange juice is less than the trigger price and the first period occurring thereafter of five consecutive business days in which the daily price for frozen concentrated orange juice is greater than the trigger price. Sets forth a formula for determining the rate of duty on certain quantities of imported Mexican articles of frozen concentrated orange juice. Part 2: Relief From Imports From All Countries - Requires the ITC, if it makes an affirmative determination for import relief under the Trade Act of 1974 (or a determination which the President may treat as an affirmative determination under the Tariff Act of 1930), to also find (and report to the President) whether: (1) imports from a NAFTA country, considered individually, account for a substantial share of total imports; and (2) imports from a NAFTA country, considered individually, or, in exceptional circumstances considered collectively, contribute importantly to the serious injury, or threat of serious injury, caused by imports. (Sec. 312) Requires the President, in determining whether to take import relief action under the Trade Act of 1974 with respect to imports from a NAFTA country, to determine whether: (1) imports from such country, considered individually, account for a substantial share of total imports; or (2) imports from such a country, considered individually, or in exceptional circumstances considered collectively, contribute importantly to the serious injury, or threat of serious injury, found by the ITC. Requires the President to take specified actions with respect to such imports. Part 3: General Provisions - Amends the Trade Act of 1974 to authorize an entity representing a domestic industry that produces a citrus product that is like or directly competitive with an imported citrus product to file a request with the USTR for monitoring of such imports. Requires the ITC, upon the filing of a petition alleging import injury and a request for provisional import relief, to make a determination whether increased imports of such citrus products are a substantial cause of serious injury, or threat of serious injury, to the domestic industry producing such product. Defines "citrus product" to mean any processed oranges or grapefruit, or any orange or grapefruit juice, including concentrate. (Sec. 316) Requires the ITC, with respect to expediting an investigation concerning provisional import relief, to monitor, until January 1, 2009, imports of fresh or chilled tomatoes and peppers (other than chili peppers) as if proper requests for such monitoring have been made. (Sec. 317) Requires the ITC to adopt certain rules and procedures with respect to the release of confidential business information under the Tariff Act of 1930 and apply them in import injury investigations under NAFTA. Subtitle B: Agriculture - Amends the Meat Import Act of 1979 to redefine the term "meat articles." Authorizes the President to exclude meat articles originating in a NAFTA country, Canada, or Mexico from quantitative import limitations. (Sec. 321) Requires the President to take such action as may be necessary to ensure that imports of agricultural goods do not disrupt the orderly marketing of commodities in the United States. Declares that nothing in NAFTA reduces or eliminates: (1) any penalty required under the Agricultural Adjustment Act of 1938; or (2) any requirement under Marketing Agreement No. 146, Regulating the Quality of Domestically Produced Peanuts, on peanuts in the domestic market, pursuant to the Agricultural Act of 1949. Amends the Agricultural Adjustment Act of 1938 to express the sense of the Congress that the United States should request consultations in the Working Group on Emergency Action if imports of peanuts exceed the in-quota quantity under a tariff rate quota set out in NAFTA concerning whether: (1) the increased imports of peanuts constitute a substantial cause of, or contribute importantly to, serious injury, or threat of serious injury, to the domestic peanut industry; and (2) recourse under NAFTA or the General Agreement on Tariffs and Trade (GATT). Requires the Secretary of Agriculture to designate an office within the United States Department of Agriculture to be responsible for maintaining and disseminating data accumulated for verifying citrus, fruit, vegetable, and cut flower trade between the United States and Mexico. Requires the Secretary of Agriculture to implement a program requiring that end-use certificates be included in the documentation covering the entry into, or withdrawal from a warehouse for consumption in, the U.S. customs territory of any wheat or barley from a foreign country that requires end-use certificates of U.S. wheat or U.S. barley. Authorizes the Secretary of Agriculture to suspend such requirements when making a determination that the program has resulted in: (1) the reduction of income to U.S. producers of agricultural products; or (2) the reduction of the competitiveness of such U.S. producers in the world export markets. Requires the Secretary of Agriculture to suspend such requirements if a foreign country that requires end-use certificates for U.S. wheat and U.S. barley eliminates the requirement. Amends the Food, Agriculture, Conservation, and Trade Act of 1990 to require the Secretary of Agriculture to grant fellowships to individuals from NAFTA countries to study agriculture in the United States, and individuals in the United States to study agriculture in other NAFTA countries. Authorizes appropriations. Authorizes the Secretary of Agriculture to make grants to public agencies or private organizations with tax-exempt status that have experience in providing emergency services to low-income migrant or seasonal farmworkers if it is determined that implementation of the NAFTA has caused such farmworkers to lose income. Authorizes appropriations. Requires the Secretary of Agriculture to prepare, and submit to specified congressional committees, a biennial report on the effects of the NAFTA on U.S. producers of agricultural commodities and on U.S. rural communities. Subtitle C: Intellectual Property - Amends Federal patent law to extend U.S. intellectual property protections to inventions that are made in other countries by persons who are domiciled in a NAFTA country and serving in any other country in connection with operations by or on behalf of the United States or a NAFTA country. (Sec. 332) Amends the Record Rental Amendment of 1984 to repeal a provision of such Act with respect to rental rights in sound recordings. (Sec. 333) Amends the Trademark Act of 1946 to provide that nothing in such Act shall prevent the registration before enactment of the NAFTA: (1) of a mark which, when used on or in connection with the goods of an applicant for a trademark, is primarily geographically deceptively misdescriptive of them, and which became distinctive of the applicant's goods in commerce; or (2) on the supplemental register of a mark, capable of distinguishing the applicant's goods or services and not registrable on the principal register under such Act, that is declared to be unregistrable, if such mark has been in lawful use in commerce by the owner, on or in connection with any goods or services. (Sec. 334) Amends Federal copyright law to grant copyright protection to motion pictures that are first fixed or published in a NAFTA country, including any work in such pictures, that enter the U.S. public domain and are first published on or after January 1, 1978, and before March 1, 1989, even though certain required notice has not been given. Subtitle D: Temporary Entry of Business Persons - Classifies as nonimmigrants, if otherwise eligible for a visa and admissible into the United States under the Immigration and Nationality Act, any alien trader or investor who is a citizen of Canada or Mexico, including any accompanying spouse and children of such alien. (Sec. 341) Amends the Immigration and Nationality Act to authorize the admittance of aliens who are citizens of Canada or Mexico, including any spouse and children of such alien, into the United States to engage in business activities as professionals. Requires the Attorney General to establish annual numerical limits on such admissions. Prohibits such aliens from being classified as nonimmigrants if there is a strike or lockout in the course of a labor dispute in the applicable occupational classification, unless such aliens establish that their entry will not adversely affect the settlement of such strike or lockout or the employment of any person involved in the strike or lockout. Subtitle E: Standards - Part 1: Standards and Measures - Amends the Trade Agreements Act of 1979 to provide that nothing under such Act shall be construed to: (1) prohibit a Federal or State agency from engaging in activity related to sanitary or phytosanitary measures to protect human, animal, or plant life or health; (2) limit the authority of such agencies to determine the level of protection of human, animal, or plant life or health the agency considers appropriate; (3) prohibit a Federal agency from engaging in activity related to standards-related measures, including any such measure relating to safety, the protection of human, animal, or plant life or health, the environment or consumers; or (4) limit the authority of a Federal agency to determine the level it considers appropriate of safety or the protection of human, animal, or plant life or health, the environment or consumers. Requires the standards information center of the Department of Commerce, among other things, to make available to the public documents and information regarding: (1) general application of sanitary or phytosanitary measures by Federal or State agencies; and (2) participation of Federal and State governments and nongovernmental bodies in international and regional standardizing bodies and conformity assessment systems, and in bilateral and multilateral arrangements regarding standards-related measures. Part 2: Agricultural Standards - Amends the Federal Seed Act to declare that provisions of such Act requiring certain seeds to be stained shall not apply to alfalfa or clover seed from Mexico. (Sec. 361) Amends Federal law to authorize the Secretary of Agriculture to permit the importation: (1) of cattle, sheep, or other ruminants, and swine, from Canada or Mexico; and (2) from the British Virgin Islands into the U.S. Virgin Islands, for slaughter only, of cattle that have been infested with or exposed to ticks on being freed from such ticks. Authorizes the Secretary of Agriculture to waive provisions requiring the inspection of imported animals for contagious diseases and infections with respect to shipments between the United States and Canada or Mexico. Amends the Tariff Act of 1930 to authorize the Secretary of Agriculture to permit the importation of cattle, sheep, other ruminants, or swine (including their embryos), or the fresh, chilled, or frozen meat of such animals, from a region that the Secretary of Agriculture has determined to be, and is likely to remain, free from rinderpest and foot-and-mouth disease. Amends the Honeybee Act to authorize the importation into the United States of honeybees from Canada or Mexico if the Secretary of Agriculture determines that the region from which such honeybee originated is, and is likely to remain, free of diseases or parasites harmful to honeybees, and undesirable species or subspecies of honeybees. Amends the Poultry Products Inspection Act to require all poultry, or parts or products of poultry, that are intended as human food and imported into the United States from Canada and Mexico to meet inspection, sanitary, and processing standards that are equivalent to those in the United States. Amends the Federal Meat Inspection Act to require the Secretary of Agriculture to submit to specified congressional committees a report that includes, among other things, a certification by the Secretary of Agriculture that foreign plants in Canada and Mexico that export carcasses or meat or meat products have complied with requirements that are equivalent to U.S. requirements with regard to inspection and building construction standards. Requires all domestic peanut butter and peanut paste to be processed from peanuts that meet the quality standards established for peanuts under Marketing Agreement No. 146. Requires the Secretary of Agriculture to make grants to a land grant college or university for the construction of a facility (to be known as the Southwest Regional Animal Health Biocontainment Facility) at such college or university to do research in animal health, disease-transmitting insects, and toxic chemicals that requires the use of biocontainment facilities and equipment. Authorizes appropriations. Requires the Secretary of Agriculture to prepare, and submit to specified congressional committees, annual reports on the impact of the NAFTA on the inspection of imported meat, poultry, other foods, animals, or plants. Subtitle F: Corporate Average Fuel Economy - Amends the Motor Vehicle Information and Cost Savings Act to provide that, for purposes of calculating the corporate average fuel economy of certain passenger automobiles, such automobiles shall be considered domestically manufactured in a model year if at least 75 percent of the manufacturer's cost is attributable to value added in the United States, Canada, or Mexico, unless the assembly of the automobile is completed in Canada or Mexico and such automobile is not imported into the United States prior to the expiration of 30 days following the end of that model year. Subtitle G: Government Procurement - Amends the Trade Agreements Act of 1979 to revise provisions regarding the waiver of discriminating purchasing requirements with respect to Government contracting to apply to countries that are parties to the NAFTA. Declares that the President's authority to waive such requirements does not authorize the waiver of any small business or minority preference. Title IV: Dispute Settlement in Antidumping and Countervailing Duty Cases - Subtitle A: Organizational, Administrative, and Procedural Provisions Regarding the Implementation of Chapter 19 of the Agreement - Sets forth organizational and administrative provisions regarding the selection of individuals to serve on binational panels and extraordinary challenge committees. (Sec. 402) Establishes within the interagency trade organization an interagency group, which shall be chaired by the USTR and consist of appropriate officers, to annually prepare, and submit to appropriate congressional committees, lists of individuals who are qualified to serve on such panels and committees. (Sec. 407) Authorizes an entity, including a trade association, firm, certified or recognized union, or group of workers, that is representative of a U.S. industry to file with the USTR a petition requesting that the industry be appropriately identified whenever it has reason to believe that: (1) as a result of implementation of NAFTA, the industry is likely to face increased competition from subsidized imports from a NAFTA country, or such industry is likely to face increased competition from subsidized imports from any other country designated by the President as benefitting from a reduction of tariffs or other trade barriers under a trade agreement that enters into force with the United States after January 1, 1994; and (2) the industry is likely to experience a deterioration of its competitive position before more rules relating to the use of government subsidies have been developed with respect to the subject country. Requires the USTR upon receipt of a petition to decide whether to identify the industry on the basis of both the subsidization and deterioration of its competitive position. Requires the USTR, if there is an identification, to take appropriate action, including: (1) compiling and making available to the industry certain trade information; and (2) recommending to the President that the ITC commence an investigation under the Tariff Act of 1930. Subtitle B: Conforming Amendments and Provisions - Amends the Tariff Act of 1930 to apply provisions of such Act regarding time limits for commencing judicial review in antidumping duty and countervailing duty actions to cases involving merchandise from a free trade area (NAFTA) country. Title V: NAFTA Transitional Adjustment Assistance and Other Provisions - Subtitle A: NAFTA Transitional Adjustment Assistance Program - NAFTA Worker Security Act - Amends the Trade Act of 1974 to require a group of workers, including workers in any agricultural firm or subdivision of an agricultural firm, to be certified as eligible for adjustment assistance if the Secretary of Labor determines that a significant number of workers in such firm or subdivision have become totally or partially separated, or are threatened to become totally or partially separated, and either that: (1) the sales or production, or both, of such firm or subdivision have decreased, imports from Mexico or Canada of articles like or directly competitive with the firm's articles have increased, and such increase in imports contributed to such workers' separation or threat of separation and to the decline in the firm's sales or production; or (2) there has been a shift in production by such workers' firm or subdivision to Mexico or Canada of articles like or directly competitive with the firm's articles. (Sec. 502) Sets forth provisions regarding: (1) the filing of petitions for worker adjustment assistance; (2) petition findings; and (3) review of petitions by the Secretary of Labor. (Sec. 503) Prohibits a worker from receiving duplicative assistance. (Sec. 504) Authorizes appropriations. (Sec. 507) Amends the Internal Revenue Code to provide for a self-employment assistance program which makes certain qualified individuals eligible to receive an allowance in lieu of regular unemployment compensation under State law in order to assist such an individual in establishing a business and becoming self-employed. Subtitle B: Provisions Relating to Performance Under the Agreement - Expresses the sense of the Congress that a State, province, or other governmental entity of a NAFTA country that discriminatorily enforces sales or other taxes so as to afford protection to its domestic production or domestic service providers shall be considered in violation of the NAFTA. Requires the USTR to pursue all appropriate remedies when such discriminatory enforcement adversely affects U.S. producers of goods or U.S. service providers. (Sec. 512) Requires the President, by not later than July 1, 1997, to provide the Congress a comprehensive study on the operation and effects of NAFTA. (Sec. 513) Amends the Trade Act of 1974 to require the USTR, no later than 30 days after a specified report is submitted to specified congressional committees, to identify any act, policy, or practice of Canada which: (1) affects cultural industries; (2) is adopted or expanded after December 17, 1992; and (3) is actionable under the NAFTA. (Sec. 514) Requires the USTR to annually submit to specified congressional committees a report on how effective the NAFTA is on increasing U.S. exports of motor vehicles and motor vehicle parts to Mexico. (Sec. 515) Amends the Caribbean Basin Economic Recovery Act to authorize and direct the Commissioner of Customs to make grants to an institution (or consortium of such institutions) to assist it in establishing in Texas a Center for the Study of Western Hemispheric Trade in order to promote and study trade between the Western Hemisphere countries. Subtitle C: Funding - Part 1: Customs User Fees - Amends the Consolidated Omnibus Budget Reconciliation Act of 1985 to increase for FY 1994 through 1997 the customs user fees for the arrival of each passenger aboard a commercial vessel or commercial aircraft from outside the U.S. customs territory. Maintains for FY 1998 and thereafter the current five dollar customs user fee for the arrival of each passenger aboard such vessel or aircraft from a place outside the United States. Part 2: Internal Revenue Code Amendments - Amends the Internal Revenue Code to authorize the Secretary to disclose to officers and employees of the Department of the Treasury (particularly the Customs Service) certain tax information. (Sec. 523) Directs the Secretary to prescribe regulations for the development of an electronic fund transfer system for the collection of depository taxes. Subtitle D: Implementation of NAFTA Supplemental Agreements - Part 1: Agreements Relating to Labor and Environment - Authorizes the United States to participate in: (1) the Commission for Labor Cooperation in accordance with the North American Agreement on Labor Cooperation; (2) the Commission for Environmental Cooperation in accordance with the North American Agreement on Environmental Cooperation; and (3) the Border Environment Cooperation Commission in accordance with the Border Environment Cooperation Agreement. Authorizes appropriations. Part 2: North American Development Bank and Related Provisions - Authorizes the President to accept membership for the United States in the North American Development Bank. (Sec. 541) Amends Federal banking law to exempt the Bank from the securities laws with respect to the issuance of certain securities by such Bank. (Sec. 543) Authorizes the President to enter into agreements with the Bank for implementation of a community adjustment and investment program pursuant to the Border Environment Cooperation Agreement. Requires the President to establish the Community Adjustment and Investment Program Advisory Committee to provide advice to the President with respect to the implementation of such program. Authorizes appropriations. Title VI: Customs Modernization - Subtitle A: Improvements in Customs Enforcement - Amends the Tariff Act of 1930 to revise customs procedures with respect to: (1) electronic transmission of forged, altered, or false data to the United States Customs Service with regard to the entry of imported merchandise; (2) penalties for failure to declare imported controlled substances; (3) examination and detention of imported merchandise; (4) certain recordkeeping requirements; (5) examination of books and witnesses; (6) review of protests by the Customs Service; (7) a repeal of a provision relating to the reliquidation on account of fraud; (8) penalties relating to manifests, false drawback or refund claims, and for fraud, gross negligence, and negligence; (9) unlawful unloading or transshipment; (10) public access to Customs Service interpretive rulings and decisions; and (11) seizure of imported merchandise. Subtitle B: National Customs Automation Program - Directs the Secretary to establish the National Customs Automation Program which shall be an automated and electronic system for the processing of commercial imports. (Sec. 631) Provides for electronic data transmission relating to: (1) remote location filing; (2) effective date of rates of duty on imported merchandise; (3) merchandise manifests; (4) imported merchandise invoices; (5) entry and release of imported merchandise; (6) admissibility in administrative and judicial proceedings of electronically transmitted information; (7) appraisement and liquidations of imported merchandise; (8) the payment of duties; (9) abandonment and damage to imported merchandise; (10) protests of Customs Service decisions; (11) refunds and errors; (12) bonds and other security; and (13) customhouse brokers. (Sec. 632) Requires a refund (drawback) of duties (less one per cent of such duties) on articles produced in the United States with imported merchandise that have been destroyed under Customs Service supervision, provided such articles have not been used prior to such destruction. (Sec. 644) Sets forth provisions with respect to customs officers' immunity in regard to the appraisement of or collection of duties on imported merchandise. Subtitle C: Miscellaneous Amendments to the Tariff Act of 1930 - Amends the Tariff Act of 1930 to authorize the Secretary to disregard the difference, but not less than $20 (currently ten dollars), between the total estimated duties deposited with respect to imported merchandise and the total amount actually due on such merchandise. Increases specified ceiling amounts of duty-free gifts and articles. (Sec. 652) Requires masters of vessels that have visited a hovering vessel or received merchandise while outside the U.S. territorial sea to report their arrival to the nearest customs facility. Provides for the electronic transmission of vessel documentation to the Customs Service. (Sec. 653) Requires specified kinds of vessels to report to the nearest Customs Service facility within 24 hours (or other period of time as provided) after arrival at a U.S. port. (Sec. 655) Exempts from entry and clearance requirements certain passenger vessels on excursion from the U.S. Virgin Islands to the British Virgin Islands and returning, U.S. documented vessels with recreational endorsement, or (as under current law) undocumented U.S. pleasure vessels not engaged in trade, except such vessels must comply upon arrival with specified customs reporting requirements and navigation laws and must not have visited any hovering vessel. (Sec. 656) Prohibits merchandise, passengers, or baggage from being unladen from any vessel required to make entry or vehicle required to report its arrival until such entry or report of arrival is made and a permit for unlading has been issued by the Customs Service. Authorizes the issuance of such permits through electronic data transmission. (Sec. 659) Reduces from one year to six months the length of time merchandise may remain in customs custody with fees unpaid before it may be treated as unclaimed. (Sec. 662) Authorizes the Secretary to prescribe regulations for the declaration and entry of merchandise whose value does not exceed a designated amount, but not more than $2,500 (currently not greater than $1,250), or when different commercial facilitation and risk considerations that may vary for different classes or kinds of merchandise or different classes of transactions may dictate. (Sec. 663) Reduces from one year to 90 days the minimum length of time after forfeiture the Secretary must wait before selling at public auction any seized imported merchandise with a counterfeit mark. (Sec. 664) Sets forth certain recordkeeping requirements for merchandise transported by pipeline. (Sec. 665) Authorizes the withdrawal from warehouse of turbine fuel without the payment of duties provided certain requirements are met. (Sec. 667) Authorizes the Customs Service to order the destruction or other appropriate disposition of vessels, vehicles, aircraft, merchandise, or baggage that has been seized under the customs laws if it determines that the expense of keeping such items is disproportionate to their value (currently applies only to items of less than $1,000 in value). (Sec. 668) Requires actions for fraud, gross negligence, and negligence, false drawback, or refund claims with respect to imported merchandise to be instituted within five years after the alleged violation or discovery of such fraud. (Sec. 669) Requires the Customs Service to be reimbursed for costs incurred in collecting fees on behalf of Government agencies. (Sec. 670) Authorizes the Secretary to settle, for no more than $50,000 in each case, claims for damage to, or loss of, privately owned property caused by an investigative or law enforcement officer of the Customs Service. (Sec. 671) Provides for the use of private collection agencies to recover money owed the United States under customs laws. Subtitle D: Miscellaneous Provisions and Consequential and Conforming Amendments to Other Laws - Amends the Harmonized Tariff Schedule of the United States to exempt from such Schedule articles which are returned within 45 days after being exported from the United States as undeliverable and which have not left the custody of the carrier or foreign customs service. (Sec. 681) Declares that certain railway locomotives and railway freight cars on which no duty is owed are not subject to the entry or release requirements for imported merchandise under the Tariff Act of 1930. States that instruments of international trade, such as containers, lift vans, rail cars and locomotives, truck cabs and trailers, etc., are exempt from formal entry procedures, but must be accounted for when imported to and exported from the United States through the manifesting procedures required for international carriers. (Sec. 683) Amends the Internal Revenue Code to authorize the payment from the Harbor Maintenance Trust Fund of administrative expenses incurred by the Army Corps of Engineers and the Department of Commerce, not to exceed $5 million for any fiscal year. (Sec. 684) Amends Federal law to grant the Court of International Trade exclusive jurisdiction of any civil action for review of decisions of the Customs Service that deny, suspend, or revoke accreditation of private customs laboratories. Bars the commencement of such actions unless brought within 60 days of such decisions. (Sec. 685) Authorizes the payment of certain claims against Customs Service employees out of the Department of the Treasury Forfeiture Fund. Authorizes (currently mandates) unobligated amounts in such Fund to be kept on deposit or invested in U.S. bonds. (Sec. 686) Requires U.S. and foreign vessels to obtain clearance from the Customs Service before proceeding from a U.S. port for: (1) a foreign port; (2) another U.S. port (for foreign vessels only), or (for U.S. vessels only) another U.S. port if the vessel has bonded or foreign merchandise for which entry has not been made; or (3) outside the U.S. territorial sea to visit a hovering vessel or to receive merchandise. (Sec. 687) Repeals specified provisions of Federal law. (Sec. 691) Requires the Commissioner of Customs to report to the Congress each fiscal year after FY 1994 on the collection of duties imposed under the antidumping and countervailing duty laws. Amends the Omnibus Budget Reconciliation Act of 1987 to authorize the Commissioner of Customs to obtain from the operators of centralized cargo examination stations information regarding fees paid to them for the provision of services at such stations. Amends the Customs and Trade Act of 1990 to require the Commissioner of Customs to: (1) devise a methodology for estimating the level of compliance with the U.S. customs laws; and (2) evaluate the extent to which such compliance was obtained during the 12-month period preceding the 60th day before each fiscal year 1994 through 1996.

North American Free Trade Agreement Implementation Act

United States · United States Congress · 4 November 1993

TABLE OF CONTENTS: Title I: Approval of, and General Provisions Relating to, the North American Free Trade Agreement Title II: Customs Provisions Title III: Application of Agreement to Sectors and Services Subtitle A: Safeguards Subtitle B: Agriculture Subtitle C: Intellectual Property Subtitle D: Temporary Entry of Business Persons Subtitle E: Standards Subtitle F: Corporate Average Fuel Economy Subtitle G: Government Procurement Title IV: Dispute Settlement in Antidumping and Countervailing Cases Subtitle A: Organizational, Administrative, and Procedural Provisions Regarding the Implementation of the Agreement Subtitle B: Conforming Amendments and Provisions Title V: NAFTA Transitional Adjustment Assistance and Other Provisions Subtitle A: NAFTA Transitional Adjustment Assistance Program Subtitle B: Provisions Relating to Performance Under the Agreement Subtitle C: Funding Subtitle D: Implementation of NAFTA Supplemental Agreements Title VI: Customs Modernization Subtitle A: Improvements in Customs Enforcement Subtitle B: National Customs Automation Program Subtitle C: Miscellaneous Amendments to the Tariff Act of 1930 Subtitle D: Miscellaneous Provisions and Consequential and Conforming Amendments to Other Laws North American Free Trade Agreement Implementation Act - Title I: Approval of, and General Provisions Relating to, the North American Free Trade Agreement - Declares that the Congress, pursuant to the Omnibus Trade and Competitiveness Act of 1988 and the Trade Act of 1974, approves: (1) the North American Free Trade Agreement (NAFTA) entered into on December 17, 1992, with Canada and Mexico and submitted to it on November 4, 1993; and (2) the statement of administrative action proposed to implement the Agreement that was submitted to it on November 4, 1993. Sets forth conditions for entry into force of NAFTA. (Sec. 102) Declares that U.S. laws shall prevail over provisions of NAFTA that conflict. Requires the President to consult with the States in order to achieve conformity of State laws with NAFTA. Requires the United States Trade Representative (USTR) to establish within the Office of the USTR a Federal-State consultation process to address issues relating to NAFTA that directly affect the States. Prohibits any person other than the United States from having a cause of action with respect to NAFTA. (Sec. 105) Authorizes the President to establish within any U.S. agency a U.S. Section of the Secretariat to facilitate the operation of NAFTA. Authorizes appropriations. (Sec. 106) Requires the United States to encourage the selection of individuals with expertise in environmental issues for service on the Chapter 20 panel to hear any challenge to a U.S. or State environmental law. (Sec. 107) Sets forth provisions governing the termination or suspension of NAFTA. (Sec. 108) Declares that the congressional approval of NAFTA may not be construed as applying to any countries other than Canada and Mexico. Sets forth provisions outlining future free trade area negotiations with other foreign countries. Title II: Customs Provisions - Authorizes the President to proclaim such modifications or continuation of any duty, continuation of duty-free or excise treatment, or additional duties as are necessary to carry out specified provisions of NAFTA. (Sec. 201) Requires the President to terminate Mexico's designation as a beneficiary developing country under the Trade Act of 1974 upon entry into force of NAFTA. Prohibits the President from considering a request to accelerate the staging of duty reductions for an article for which the United States tariff phaseout period is more than ten years if such request for such article has been denied in the preceding three years. Authorizes the President to convert the base rate of certain textiles imported from Mexico to an ad valorem rate. (Sec. 202) Sets forth, for purposes of implementing tariff treatment and quantitative restrictions provided in NAFTA, rules of origin with respect to goods from NAFTA countries. (Sec. 203) Defines the term "good subject to NAFTA drawback." Amends the Tariff Act of 1930 to prohibit an article manufactured in a bonded warehouse from materials that are goods subject to NAFTA drawback (refund) from being withdrawn from such warehouse for exportation to a NAFTA country without assessment of a duty on the materials in their condition and quantity, and at their weight, at the time of importation into the United States. Sets forth similar provisions with respect to articles from bonded smelting and refining warehouses. Authorizes merchandise, under specified conditions, to be cleaned, sorted, repacked, or otherwise changed in condition in bonded warehouses and be withdrawn: (1) for export to a NAFTA country if such merchandise consists of goods subject to NAFTA drawback (refund) and certain duties are assessed; and (2) without the payment of duties for export to NAFTA and, in certain cases, non-NAFTA countries. Amends the Foreign Trade Zones Act to provide that, if Canada ceases to be a NAFTA country and the U.S.-Canada Free-Trade Agreement terminates, no article manufactured or otherwise changed in condition (except a change by cleaning, testing, or repacking) shall be exported to Canada without the payment of a duty unless a certain privilege has been requested and no manipulation (change of condition) has occurred. Prohibits merchandise consisting of goods subject to NAFTA drawback that is manufactured or otherwise changed in condition from being exported to a NAFTA country without an assessment of a duty on it. Prohibits the Secretary of the Treasury (Secretary) from, on the condition of export, refunding or reducing fees imposed under the Agricultural Adjustment Act with respect to "goods subject to NAFTA drawback" that are exported to Canada after December 31, 1995, or Mexico after December 31, 2000, for so long as they are NAFTA countries. Declares that none of the amendments made under this Act shall be considered to authorize the refund, waiver, or reduction of countervailing duties or antidumping duties imposed on an imported good. (Sec. 204) Amends the Consolidated Omnibus Budget Reconciliation Act of 1985 to prohibit customs user fees with respect to goods qualifying under the rules of origin from being: (1) charged with respect to goods that qualify to be marked as Canadian goods; and (2) increased after December 31, 1993, and charged after June 29, 1999, with respect to goods that qualify to be marked as Mexican goods. (Sec. 205) Amends the Tariff Act of 1930 to require persons who sign a NAFTA Certificate of Origin for a good for which preferential treatment is claimed to keep and render for inspection all records relating to the origin of the good. Sets forth penalties for violation of such recordkeeping requirements. Sets forth provisions regarding incorrect and false Certificates of Origin. (Sec. 206) Authorizes the United States Customs Service to reliquidate an entry to refund excess duties paid on a good qualifying under the rules of origin under the NAFTA for which no claim for preferential tariff treatment was made or protest filed at the time of importation if the importer, within one year after the importation, files a claim that includes specified information. (Sec. 207) Revises country of origin marking requirements with respect to certain pipe and steel products and manhole rings or frames and covers from NAFTA countries to include continuous paint stenciling, or an equally permanent method of marking, as methods for satisfying such requirements. Sets forth provisions regarding: (1) adverse marking and origin determinations by the U.S. Customs Service; and (2) the judicial review of such determinations. (Sec. 209) Declares the Secretary of Commerce may authorize the U.S. Customs Service to exchange information with any government agency of a NAFTA country provided certain safeguards are met. (Sec. 210) Prohibits duties from being refunded (drawnback) on imported color cathode-ray television picture tubes, including video monitor cathode-ray tubes, when such items are nonoriginating goods and are: (1) exported to a NAFTA country; (2) used as a material in the production of other goods that are exported to a NAFTA country; or (3) substituted for by goods of the same kind and quality used as a material in the production of other goods that are exported to a NAFTA country. (Sec. 211) Requires the U.S. Customs Service to monitor television and picture tube imports for a five-year period. Directs the U.S. Customs Service to make the results of such monitoring, including verification of the rules of origin, available to the President and the USTR. Title III: Application of Agreement to Sectors and Services - Subtitle A: Safeguards - Part 1: Relief From Imports Benefitting From the Agreement - Authorizes an entity, trade association, firm, certified or recognized union, or group of workers that is representative of an industry to file with the International Trade Commission (ITC) a petition requesting the adjustment of U.S. obligations under NAFTA. Requires the ITC to investigate, and make a determination, whether as a result of the reduction or elimination of a duty under NAFTA, a Canadian or Mexican article is being imported in such increased quantities as to constitute a substantial case of serious injury, or except in the case of a Canadian article, a threat of serious injury to a domestic industry producing an article that is like, or directly competitive with, such article. (Sec. 303) Requires the ITC, if it makes an affirmative determination, to recommend to the President the amount of import relief that is necessary to remedy or prevent such injury. (Sec. 308) Amends the United States-Canada Free-Trade Agreement Implementation Act to require the Secretary to decide whether to recommend to the President the imposition of a temporary duty on Canadian fresh fruits and vegetables. (Sec. 309) Requires the Secretary of Agriculture to determine each period of five consecutive business days in which the daily price for frozen concentrated orange juice is less than the trigger price and the first period occurring thereafter of five consecutive business days in which the daily price for frozen concentrated orange juice is greater than the trigger price. Sets forth a formula for determining the rate of duty on certain quantities of imported Mexican articles of frozen concentrated orange juice. Part 2: Relief From Imports From All Countries - Requires the ITC, if it makes an affirmative determination for import relief under the Trade Act of 1974 (or a determination which the President may treat as an affirmative determination under the Tariff Act of 1930), to also find (and report to the President) whether: (1) imports from a NAFTA country, considered individually, account for a substantial share of total imports; and (2) imports from a NAFTA country, considered individually, or, in exceptional circumstances considered collectively, contribute importantly to the serious injury, or threat of serious injury, caused by imports. (Sec. 312) Requires the President, in determining whether to take import relief action under the Trade Act of 1974 with respect to imports from a NAFTA country, to determine whether: (1) imports from such country, considered individually, account for a substantial share of total imports; or (2) imports from such a country, considered individually, or in exceptional circumstances considered collectively, contribute importantly to the serious injury, or threat of serious injury, found by the ITC. Requires the President to take specified actions with respect to such imports. Part 3: General Provisions - Amends the Trade Act of 1974 to authorize an entity representing a domestic industry that produces a citrus product that is like or directly competitive with an imported citrus product to file a request with the USTR for monitoring of such imports. Requires the ITC, upon the filing of a petition alleging import injury and a request for provisional import relief, to make a determination whether increased imports of such citrus products are a substantial cause of serious injury, or threat of serious injury, to the domestic industry producing such product. Defines "citrus product" to mean any processed oranges or grapefruit, or any orange or grapefruit juice, including concentrate. (Sec. 316) Requires the ITC, with respect to expediting an investigation concerning provisional import relief, to monitor, until January 1, 2009, imports of fresh or chilled tomatoes and peppers (other than chili peppers) as if proper requests for such monitoring have been made. (Sec. 317) Requires the ITC to adopt certain rules and procedures with respect to the release of confidential business information under the Tariff Act of 1930 and apply them in import injury investigations under NAFTA. Subtitle B: Agriculture - Amends the Meat Import Act of 1979 to redefine the term "meat articles." Authorizes the President to exclude meat articles originating in a NAFTA country, Canada, or Mexico from quantitative import limitations. (Sec. 321) Requires the President to take such action as may be necessary to ensure that imports of agricultural goods do not disrupt the orderly marketing of commodities in the United States. Declares that nothing in NAFTA reduces or eliminates: (1) any penalty required under the Agricultural Adjustment Act of 1938; or (2) any requirement under Marketing Agreement No. 146, Regulating the Quality of Domestically Produced Peanuts, on peanuts in the domestic market, pursuant to the Agricultural Act of 1949. Amends the Agricultural Adjustment Act of 1938 to express the sense of the Congress that the United States should request consultations in the Working Group on Emergency Action if imports of peanuts exceed the in-quota quantity under a tariff rate quota set out in NAFTA concerning whether: (1) the increased imports of peanuts constitute a substantial cause of, or contribute importantly to, serious injury, or threat of serious injury, to the domestic peanut industry; and (2) recourse under NAFTA or the General Agreement on Tariffs and Trade (GATT). Requires the Secretary of Agriculture to designate an office within the United States Department of Agriculture to be responsible for maintaining and disseminating data accumulated for verifying citrus, fruit, vegetable, and cut flower trade between the United States and Mexico. Requires the Secretary of Agriculture to implement a program requiring that end-use certificates be included in the documentation covering the entry into, or withdrawal from a warehouse for consumption in, the U.S. customs territory of any wheat or barley from a foreign country that requires end-use certificates of U.S. wheat or U.S. barley. Authorizes the Secretary of Agriculture to suspend such requirements when making a determination that the program has resulted in: (1) the reduction of income to U.S. producers of agricultural products; or (2) the reduction of the competitiveness of such U.S. producers in the world export markets. Requires the Secretary of Agriculture to suspend such requirements if a foreign country that requires end-use certificates for U.S. wheat and U.S. barley eliminates the requirement. Amends the Food, Agriculture, Conservation, and Trade Act of 1990 to require the Secretary of Agriculture to grant fellowships to individuals from NAFTA countries to study agriculture in the United States, and individuals in the United States to study agriculture in other NAFTA countries. Authorizes appropriations. Authorizes the Secretary of Agriculture to make grants to public agencies or private organizations with tax-exempt status that have experience in providing emergency services to low-income migrant or seasonal farmworkers if it is determined that implementation of the NAFTA has caused such farmworkers to lose income. Authorizes appropriations. Requires the Secretary of Agriculture to prepare, and submit to specified congressional committees, a biennial report on the effects of the NAFTA on U.S. producers of agricultural commodities and on U.S. rural communities. Subtitle C: Intellectual Property - Amends Federal patent law to extend U.S. intellectual property protections to inventions that are made in other countries by persons who are domiciled in a NAFTA country and serving in any other country in connection with operations by or on behalf of the United States or a NAFTA country. (Sec. 332) Amends the Record Rental Amendment of 1984 to repeal a provision of such Act with respect to rental rights in sound recordings. (Sec. 333) Amends the Trademark Act of 1946 to provide that nothing in such Act shall prevent the registration before enactment of the NAFTA: (1) of a mark which, when used on or in connection with the goods of an applicant for a trademark, is primarily geographically deceptively misdescriptive of them, and which became distinctive of the applicant's goods in commerce; or (2) on the supplemental register of a mark, capable of distinguishing the applicant's goods or services and not registrable on the principal register under such Act, that is declared to be unregistrable, if such mark has been in lawful use in commerce by the owner, on or in connection with any goods or services. (Sec. 334) Amends Federal copyright law to grant copyright protection to motion pictures that are first fixed or published in a NAFTA country, including any work in such pictures, that enter the U.S. public domain and are first published on or after January 1, 1978, and before March 1, 1989, even though certain required notice has not been given. Subtitle D: Temporary Entry of Business Persons - Classifies as nonimmigrants, if otherwise eligible for a visa and admissible into the United States under the Immigration and Nationality Act, any alien trader or investor who is a citizen of Canada or Mexico, including any accompanying spouse and children of such alien. (Sec. 341) Amends the Immigration and Nationality Act to authorize the admittance of aliens who are citizens of Canada or Mexico, including any spouse and children of such alien, into the United States to engage in business activities as professionals. Requires the Attorney General to establish annual numerical limits on such admissions. Prohibits such aliens from being classified as nonimmigrants if there is a strike or lockout in the course of a labor dispute in the applicable occupational classification, unless such aliens establish that their entry will not adversely affect the settlement of such strike or lockout or the employment of any person involved in the strike or lockout. Subtitle E: Standards - Part 1: Standards and Measures - Amends the Trade Agreements Act of 1979 to provide that nothing under such Act shall be construed to: (1) prohibit a Federal or State agency from engaging in activity related to sanitary or phytosanitary measures to protect human, animal, or plant life or health; (2) limit the authority of such agencies to determine the level of protection of human, animal, or plant life or health the agency considers appropriate; (3) prohibit a Federal agency from engaging in activity related to standards-related measures, including any such measure relating to safety, the protection of human, animal, or plant life or health, the environment or consumers; or (4) limit the authority of a Federal agency to determine the level it considers appropriate of safety or the protection of human, animal, or plant life or health, the environment or consumers. Requires the standards information center of the Department of Commerce, among other things, to make available to the public documents and information regarding: (1) general application of sanitary or phytosanitary measures by Federal or State agencies; and (2) participation of Federal and State governments and nongovernmental bodies in international and regional standardizing bodies and conformity assessment systems, and in bilateral and multilateral arrangements regarding standards-related measures. Part 2: Agricultural Standards - Amends the Federal Seed Act to declare that provisions of such Act requiring certain seeds to be stained shall not apply to alfalfa or clover seed from Mexico. (Sec. 361) Amends Federal law to authorize the Secretary of Agriculture to permit the importation: (1) of cattle, sheep, or other ruminants, and swine, from Canada or Mexico; and (2) from the British Virgin Islands into the U.S. Virgin Islands, for slaughter only, of cattle that have been infested with or exposed to ticks on being freed from such ticks. Authorizes the Secretary of Agriculture to waive provisions requiring the inspection of imported animals for contagious diseases and infections with respect to shipments between the United States and Canada or Mexico. Amends the Tariff Act of 1930 to authorize the Secretary of Agriculture to permit the importation of cattle, sheep, other ruminants, or swine (including their embryos), or the fresh, chilled, or frozen meat of such animals, from a region that the Secretary of Agriculture has determined to be, and is likely to remain, free from rinderpest and foot-and-mouth disease. Amends the Honeybee Act to authorize the importation into the United States of honeybees from Canada or Mexico if the Secretary of Agriculture determines that the region from which such honeybee originated is, and is likely to remain, free of diseases or parasites harmful to honeybees, and undesirable species or subspecies of honeybees. Amends the Poultry Products Inspection Act to require all poultry, or parts or products of poultry, that are intended as human food and imported into the United States from Canada and Mexico to meet inspection, sanitary, and processing standards that are equivalent to those in the United States. Amends the Federal Meat Inspection Act to require the Secretary of Agriculture to submit to specified congressional committees a report that includes, among other things, a certification by the Secretary of Agriculture that foreign plants in Canada and Mexico that export carcasses or meat or meat products have complied with requirements that are equivalent to U.S. requirements with regard to inspection and building construction standards. Requires all domestic peanut butter and peanut paste to be processed from peanuts that meet the quality standards established for peanuts under Marketing Agreement No. 146. Requires the Secretary of Agriculture to make grants to a land grant college or university for the construction of a facility (to be known as the Southwest Regional Animal Health Biocontainment Facility) at such college or university to do research in animal health, disease-transmitting insects, and toxic chemicals that requires the use of biocontainment facilities and equipment. Authorizes appropriations. Requires the Secretary of Agriculture to prepare, and submit to specified congressional committees, annual reports on the impact of the NAFTA on the inspection of imported meat, poultry, other foods, animals, or plants. Subtitle F: Corporate Average Fuel Economy - Amends the Motor Vehicle Information and Cost Savings Act to provide that, for purposes of calculating the corporate average fuel economy of certain passenger automobiles, such automobiles shall be considered domestically manufactured in a model year if at least 75 percent of the manufacturer's cost is attributable to value added in the United States, Canada, or Mexico, unless the assembly of the automobile is completed in Canada or Mexico and such automobile is not imported into the United States prior to the expiration of 30 days following the end of that model year. Subtitle G: Government Procurement - Amends the Trade Agreements Act of 1979 to revise provisions regarding the waiver of discriminating purchasing requirements with respect to Government contracting to apply to countries that are parties to the NAFTA. Declares that the President's authority to waive such requirements does not authorize the waiver of any small business or minority preference. Title IV: Dispute Settlement in Antidumping and Countervailing Duty Cases - Subtitle A: Organizational, Administrative, and Procedural Provisions Regarding the Implementation of Chapter 19 of the Agreement - Sets forth organizational and administrative provisions regarding the selection of individuals to serve on binational panels and extraordinary challenge committees. (Sec. 402) Establishes within the interagency trade organization an interagency group, which shall be chaired by the USTR and consist of appropriate officers, to annually prepare, and submit to appropriate congressional committees, lists of individuals who are qualified to serve on such panels and committees. (Sec. 407) Authorizes an entity, including a trade association, firm, certified or recognized union, or group of workers, that is representative of a U.S. industry to file with the USTR a petition requesting that the industry be appropriately identified whenever it has reason to believe that: (1) as a result of implementation of NAFTA, the industry is likely to face increased competition from subsidized imports from a NAFTA country, or such industry is likely to face increased competition from subsidized imports from any other country designated by the President as benefitting from a reduction of tariffs or other trade barriers under a trade agreement that enters into force with the United States after January 1, 1994; and (2) the industry is likely to experience a deterioration of its competitive position before more rules relating to the use of government subsidies have been developed with respect to the subject country. Requires the USTR upon receipt of a petition to decide whether to identify the industry on the basis of both the subsidization and deterioration of its competitive position. Requires the USTR, if there is an identification, to take appropriate action, including: (1) compiling and making available to the industry certain trade information; and (2) recommending to the President that the ITC commence an investigation under the Tariff Act of 1930. Subtitle B: Conforming Amendments and Provisions - Amends the Tariff Act of 1930 to apply provisions of such Act regarding time limits for commencing judicial review in antidumping duty and countervailing duty actions to cases involving merchandise from a free trade area (NAFTA) country. Title V: NAFTA Transitional Adjustment Assistance and Other Provisions - Subtitle A: NAFTA Transitional Adjustment Assistance Program - NAFTA Worker Security Act - Amends the Trade Act of 1974 to require a group of workers, including workers in any agricultural firm or subdivision of an agricultural firm, to be certified as eligible for adjustment assistance if the Secretary of Labor determines that a significant number of workers in such firm or subdivision have become totally or partially separated, or are threatened to become totally or partially separated, and either that: (1) the sales or production, or both, of such firm or subdivision have decreased, imports from Mexico or Canada of articles like or directly competitive with the firm's articles have increased, and such increase in imports contributed to such workers' separation or threat of separation and to the decline in the firm's sales or production; or (2) there has been a shift in production by such workers' firm or subdivision to Mexico or Canada of articles like or directly competitive with the firm's articles. (Sec. 502) Sets forth provisions regarding: (1) the filing of petitions for worker adjustment assistance; (2) petition findings; and (3) review of petitions by the Secretary of Labor. (Sec. 503) Prohibits a worker from receiving duplicative assistance. (Sec. 504) Authorizes appropriations. (Sec. 507) Amends the Internal Revenue Code to provide for a self-employment assistance program which makes certain qualified individuals eligible to receive an allowance in lieu of regular unemployment compensation under State law in order to assist such an individual in establishing a business and becoming self-employed. Subtitle B: Provisions Relating to Performance Under the Agreement - Expresses the sense of the Congress that a State, province, or other governmental entity of a NAFTA country that discriminatorily enforces sales or other taxes so as to afford protection to its domestic production or domestic service providers shall be considered in violation of the NAFTA. Requires the USTR to pursue all appropriate remedies when such discriminatory enforcement adversely affects U.S. producers of goods or U.S. service providers. (Sec. 512) Requires the President, by not later than July 1, 1997, to provide the Congress a comprehensive study on the operation and effects of NAFTA. (Sec. 513) Amends the Trade Act of 1974 to require the USTR, no later than 30 days after a specified report is submitted to specified congressional committees, to identify any act, policy, or practice of Canada which: (1) affects cultural industries; (2) is adopted or expanded after December 17, 1992; and (3) is actionable under the NAFTA. (Sec. 514) Requires the USTR to annually submit to specified congressional committees a report on how effective the NAFTA is on increasing U.S. exports of motor vehicles and motor vehicle parts to Mexico. (Sec. 515) Amends the Caribbean Basin Economic Recovery Act to authorize and direct the Commissioner of Customs to make grants to an institution (or consortium of such institutions) to assist it in establishing in Texas a Center for the Study of Western Hemispheric Trade in order to promote and study trade between the Western Hemisphere countries. Subtitle C: Funding - Part 1: Customs User Fees - Amends the Consolidated Omnibus Budget Reconciliation Act of 1985 to increase for FY 1994 through 1997 the customs user fees for the arrival of each passenger aboard a commercial vessel or commercial aircraft from outside the U.S. customs territory. Maintains for FY 1998 and thereafter the current five dollar customs user fee for the arrival of each passenger aboard such vessel or aircraft from a place outside the United States. Part 2: Internal Revenue Code Amendments - Amends the Internal Revenue Code to authorize the Secretary to disclose to officers and employees of the Department of the Treasury (particularly the Customs Service) certain tax information. (Sec. 523) Directs the Secretary to prescribe regulations for the development of an electronic fund transfer system for the collection of depository taxes. Subtitle D: Implementation of NAFTA Supplemental Agreements - Part 1: Agreements Relating to Labor and Environment - Authorizes the United States to participate in: (1) the Commission for Labor Cooperation in accordance with the North American Agreement on Labor Cooperation; (2) the Commission for Environmental Cooperation in accordance with the North American Agreement on Environmental Cooperation; and (3) the Border Environment Cooperation Commission in accordance with the Border Environment Cooperation Agreement. Authorizes appropriations. Part 2: North American Development Bank and Related Provisions - Authorizes the President to accept membership for the United States in the North American Development Bank. (Sec. 541) Amends Federal banking law to exempt the Bank from the securities laws with respect to the issuance of certain securities by such Bank. (Sec. 543) Authorizes the President to enter into agreements with the Bank for implementation of a community adjustment and investment program pursuant to the Border Environment Cooperation Agreement. Requires the President to establish the Community Adjustment and Investment Program Advisory Committee to provide advice to the President with respect to the implementation of such program. Authorizes appropriations. Title VI: Customs Modernization - Subtitle A: Improvements in Customs Enforcement - Amends the Tariff Act of 1930 to revise customs procedures with respect to: (1) electronic transmission of forged, altered, or false data to the United States Customs Service with regard to the entry of imported merchandise; (2) penalties for failure to declare imported controlled substances; (3) examination and detention of imported merchandise; (4) certain recordkeeping requirements; (5) examination of books and witnesses; (6) review of protests by the Customs Service; (7) a repeal of a provision relating to the reliquidation on account of fraud; (8) penalties relating to manifests, false drawback or refund claims, and for fraud, gross negligence, and negligence; (9) unlawful unloading or transshipment; (10) public access to Customs Service interpretive rulings and decisions; and (11) seizure of imported merchandise. Subtitle B: National Customs Automation Program - Directs the Secretary to establish the National Customs Automation Program which shall be an automated and electronic system for the processing of commercial imports. (Sec. 631) Provides for electronic data transmission relating to: (1) remote location filing; (2) effective date of rates of duty on imported merchandise; (3) merchandise manifests; (4) imported merchandise invoices; (5) entry and release of imported merchandise; (6) admissibility in administrative and judicial proceedings of electronically transmitted information; (7) appraisement and liquidations of imported merchandise; (8) the payment of duties; (9) abandonment and damage to imported merchandise; (10) protests of Customs Service decisions; (11) refunds and errors; (12) bonds and other security; and (13) customhouse brokers. (Sec. 632) Requires a refund (drawback) of duties (less one per cent of such duties) on articles produced in the United States with imported merchandise that have been destroyed under Customs Service supervision, provided such articles have not been used prior to such destruction. (Sec. 644) Sets forth provisions with respect to customs officers' immunity in regard to the appraisement of or collection of duties on imported merchandise. Subtitle C: Miscellaneous Amendments to the Tariff Act of 1930 - Amends the Tariff Act of 1930 to authorize the Secretary to disregard the difference, but not less than $20 (currently ten dollars), between the total estimated duties deposited with respect to imported merchandise and the total amount actually due on such merchandise. Increases specified ceiling amounts of duty-free gifts and articles. (Sec. 652) Requires masters of vessels that have visited a hovering vessel or received merchandise while outside the U.S. territorial sea to report their arrival to the nearest customs facility. Provides for the electronic transmission of vessel documentation to the Customs Service. (Sec. 653) Requires specified kinds of vessels to report to the nearest Customs Service facility within 24 hours (or other period of time as provided) after arrival at a U.S. port. (Sec. 655) Exempts from entry and clearance requirements certain passenger vessels on excursion from the U.S. Virgin Islands to the British Virgin Islands and returning, U.S. documented vessels with recreational endorsement, or (as under current law) undocumented U.S. pleasure vessels not engaged in trade, except such vessels must comply upon arrival with specified customs reporting requirements and navigation laws and must not have visited any hovering vessel. (Sec. 656) Prohibits merchandise, passengers, or baggage from being unladen from any vessel required to make entry or vehicle required to report its arrival until such entry or report of arrival is made and a permit for unlading has been issued by the Customs Service. Authorizes the issuance of such permits through electronic data transmission. (Sec. 659) Reduces from one year to six months the length of time merchandise may remain in customs custody with fees unpaid before it may be treated as unclaimed. (Sec. 662) Authorizes the Secretary to prescribe regulations for the declaration and entry of merchandise whose value does not exceed a designated amount, but not more than $2,500 (currently not greater than $1,250), or when different commercial facilitation and risk considerations that may vary for different classes or kinds of merchandise or different classes of transactions may dictate. (Sec. 663) Reduces from one year to 90 days the minimum length of time after forfeiture the Secretary must wait before selling at public auction any seized imported merchandise with a counterfeit mark. (Sec. 664) Sets forth certain recordkeeping requirements for merchandise transported by pipeline. (Sec. 665) Authorizes the withdrawal from warehouse of turbine fuel without the payment of duties provided certain requirements are met. (Sec. 667) Authorizes the Customs Service to order the destruction or other appropriate disposition of vessels, vehicles, aircraft, merchandise, or baggage that has been seized under the customs laws if it determines that the expense of keeping such items is disproportionate to their value (currently applies only to items of less than $1,000 in value). (Sec. 668) Requires actions for fraud, gross negligence, and negligence, false drawback, or refund claims with respect to imported merchandise to be instituted within five years after the alleged violation or discovery of such fraud. (Sec. 669) Requires the Customs Service to be reimbursed for costs incurred in collecting fees on behalf of Government agencies. (Sec. 670) Authorizes the Secretary to settle, for no more than $50,000 in each case, claims for damage to, or loss of, privately owned property caused by an investigative or law enforcement officer of the Customs Service. (Sec. 671) Provides for the use of private collection agencies to recover money owed the United States under customs laws. Subtitle D: Miscellaneous Provisions and Consequential and Conforming Amendments to Other Laws - Amends the Harmonized Tariff Schedule of the United States to exempt from such Schedule articles which are returned within 45 days after being exported from the United States as undeliverable and which have not left the custody of the carrier or foreign customs service. (Sec. 681) Declares that certain railway locomotives and railway freight cars on which no duty is owed are not subject to the entry or release requirements for imported merchandise under the Tariff Act of 1930. States that instruments of international trade, such as containers, lift vans, rail cars and locomotives, truck cabs and trailers, etc., are exempt from formal entry procedures, but must be accounted for when imported to and exported from the United States through the manifesting procedures required for international carriers. (Sec. 683) Amends the Internal Revenue Code to authorize the payment from the Harbor Maintenance Trust Fund of administrative expenses incurred by the Army Corps of Engineers and the Department of Commerce, not to exceed $5 million for any fiscal year. (Sec. 684) Amends Federal law to grant the Court of International Trade exclusive jurisdiction of any civil action for review of decisions of the Customs Service that deny, suspend, or revoke accreditation of private customs laboratories. Bars the commencement of such actions unless brought within 60 days of such decisions. (Sec. 685) Authorizes the payment of certain claims against Customs Service employees out of the Department of the Treasury Forfeiture Fund. Authorizes (currently mandates) unobligated amounts in such Fund to be kept on deposit or invested in U.S. bonds. (Sec. 686) Requires U.S. and foreign vessels to obtain clearance from the Customs Service before proceeding from a U.S. port for: (1) a foreign port; (2) another U.S. port (for foreign vessels only), or (for U.S. vessels only) another U.S. port if the vessel has bonded or foreign merchandise for which entry has not been made; or (3) outside the U.S. territorial sea to visit a hovering vessel or to receive merchandise. (Sec. 687) Repeals specified provisions of Federal law. (Sec. 691) Requires the Commissioner of Customs to report to the Congress each fiscal year after FY 1994 on the collection of duties imposed under the antidumping and countervailing duty laws. Amends the Omnibus Budget Reconciliation Act of 1987 to authorize the Commissioner of Customs to obtain from the operators of centralized cargo examination stations information regarding fees paid to them for the provision of services at such stations. Amends the Customs and Trade Act of 1990 to require the Commissioner of Customs to: (1) devise a methodology for estimating the level of compliance with the U.S. customs laws; and (2) evaluate the extent to which such compliance was obtained during the 12-month period preceding the 60th day before each fiscal year 1994 through 1996.

A bill for the relief of Reza A. Maleki.

United States · United States Congress · 2 November 1993

Declares a named individual to have been lawfully admitted to the United States for permanent residence under the Immigration and Nationality Act.

Violent Crime Control and Law Enforcement Act of 1993

United States · United States Congress · 1 November 1993

TABLE OF CONTENTS: Title I: Public Safety and Policing Title II: Death Penalty Title III: Habeas Corpus Reform Title IV: Gun Crime Penalties Title V: Obstruction of Justice Title VI: Youth Violence Subtitle A: Increased Penalties for Drug Trafficking and Criminal Street Gangs Subtitle B: Juvenile Drug Trafficking and Gang Prevention Grants Subtitle C: Bindover System for Certain Violent Juveniles Title VII: Terrorism Subtitle A: Maritime Navigation and Fixed Platforms Subtitle B: General Provisions Title VIII: Sexual Violence and Child Abuse Subtitle A: Sexual Abuse Subtitle B: Child Protection Subtitle C: Crimes Against Children Title IX: Crime Victims Subtitle A: Victims' Rights Subtitle B: Crime Victims' Fund Title X: State and Local Law Enforcement Subtitle A: DNA Identification Subtitle B: Department of Justice Community Substance Abuse Prevention Subtitle C: Racial and Ethnic Bias Study Grants Title XI: Provisions Relating to Police Officers Subtitle A: Law Enforcement Family Support Subtitle B: Police Pattern or Practice Subtitle C: Police Corps and Law Enforcement Officers Training and Education Title XII: Drug Court Programs Title XIII: Prisons Subtitle A: Federal Prisons Subtitle B: State Prisons Title XIV: Rural Crime Subtitle A: Fighting Drug Trafficking in Rural Areas Subtitle B: Drug Free Truck Stops and Safety Rest Areas Title XV: Drug Control Subtitle A: Increased Penalties Subtitle B: Precursor Chemicals Act Subtitle C: General Provisions Title XVI: Drunk Driving Provisions Title XVII: Commissions Subtitle A: Commission on Crime and Violence Subtitle B: National Commission to Study the Causes of the Demand for Drugs in the United States Subtitle C: National Commission to Support Law Enforcement Title XVIII: Bail Posting Reporting Title XIX: Motor Vehicle Theft Prevention Title XX: Protection for the Elderly Title XXI: Consumer Protection Title XXII: Financial Institution Fraud Prosecutions THIS Title XXIII: Savings and Loan Prosecution Task Force Title XXIV: Sentencing Provisions Title XXV: Sentencing and Magistrates Amendments Title XXVI: Computer Crime Title XXVII: International Parental Kidnapping Title XXVIII: Safe Schools Title XXIX: Miscellaneous Subtitle A: Increases in Penalties Subtitle B: Extension of Protection of Civil Rights Statutes Subtitle C: Audit and Report Subtitle D: Gambling Subtitle E: White Collar Crime Amendments Subtitle F: Safer Streets and Neighborhoods Subtitle G: Other Provisions Title XXX: Technical Corrections Violent Crime Control and Law Enforcement Act of 1993 - Title I: Public Safety and Policing - Public Safety Partnership and Community Policing Act of 1993 - Amends the Omnibus Crime Control and Safe Streets Act of 1968 (Omnibus Act) to authorize the Attorney General to make grants and provide technical assistance to units of State and local government, and to other public and private entities, to increase police presence (including the rehiring of law enforcement officers laid off as a result of State and local budget reductions, as well as the hiring of new, additional career law enforcement officers, for deployment in community-oriented policing), expand and improve cooperative efforts between law enforcement agencies (LEAs) and members of the community, and otherwise enhance public safety. Sets forth matching fund, application, and related requirements. Authorizes appropriations. Title II: Death Penalty - Federal Death Penalty Act of 1993 - Amends the Federal criminal code to provide for imposition of the death penalty for various offenses, including: (1) murder by a Federal prisoner; (2) civil rights murders; (3) drive-by shootings and carjackings resulting in death; (4) foreign murder of U.S. nationals; (5) rape and child molestation murders; (6) gun murders during Federal crimes of violence and drug trafficking crimes; and (7) murder in the course of alien smuggling. (Sec. 202) Sets forth procedures for the imposition, implementation, and review of such sentence. Limits mitigating factors (such as impaired capacity, duress, minor participation, and victim's consent) and aggravating factors (such as involvement of a firearm or previous conviction of a violent felony involving a firearm, previous conviction of other serious offenses, vulnerability of victim, and continuing criminal enterprise involving drug sales to minors). Requires a special hearing to determine whether a death sentence is justified. Directs the court to instruct the jury not to consider the race, color, religious beliefs, national origin, or sex of the defendant or of any victim. Prohibits the execution of a woman while she is pregnant and of a person who is mentally retarded. Title III: Habeas Corpus Reform - An Act to enforce the fourteenth amendment and to reform habeas corpus - Amends the Federal judicial code to impose a 180-day limitations period for the filing of Federal habeas corpus petitions, applicable in both capital and non-capital cases in which the State has offered the petitioner counsel for State post-conviction review, which begins from the time the petitioner's conviction becomes final on State direct review. Tolls such period while the petitioner pursues State post-conviction remedies, unless the petitioner fails to initiate post-conviction review within 270 days in capital cases or 180 days in non-capital cases. Provides for a one-time 60-day extension of the period upon a showing of good cause. (Sec. 303) Provides an automatic stay of execution in capital cases through the consideration of the first Federal habeas corpus petition. Permits a stay of execution to be granted thereafter only if the petition on its face satisfies the requirements for successive petitions. (Sec. 304) Prohibits a Federal court from announcing or applying a new rule to grant relief to a habeas corpus petitioner, except where the new rule places a class of individual conduct beyond the power of the criminal lawmaking authority to proscribe or prohibits the imposition of a certain type of punishment for a class of persons because of their status or offense, or constitutes a watershed rule of criminal procedure implicating the fundamental fairness and accuracy of the criminal proceeding. Codifies caselaw providing for an independent Federal habeas corpus review of claims under Federal law, except for fourth amendment exclusionary rule claims. Specifies that the State bears the burden of proving harmless error in Federal habeas corpus review of State criminal convictions. (Sec. 305) Sets forth provisions regarding: (1) limits on successive petitions (allows a prisoner to bring a second or subsequent petition only upon a showing of cause for not having brought the claim before and prejudice if the claim is not heard); and (2) new evidence (allows prisoners in capital cases to present claims of actual innocence based on newly discovered evidence that the petitioner did not previously know about). (Sec. 308) Sets standards and procedures for the provision of counsel for indigent defendants at all stages of State capital litigation. Requires each State in which a sentence of death may be imposed to establish a State counsel certification authority, comprised of members of the State's criminal defense bar, to create a roster of qualified lawyers eligible for court appointment and monitor the performance of attorneys so certified. (Sec. 309) Amends the Omnibus Act to require the Director of the Bureau of Justice Assistance (BJA) to make grants to States to help fund the provision of defense counsel. Authorizes: (1) Federal grants of up to 75 percent of the additional costs imposed by the new counsel requirements during the first three years following enactment of this title and 50 percent thereafter; and (2) grants for the prosecution of Federal habeas corpus cases in an amount equal to that allocated to capital resource centers. (Sec. 310) Abrogates State sovereign immunity from suit in Federal court for a violation of specified provisions regarding the establishment of a State certification authority and attorney compensation. Title IV: Gun Crime Penalties - Directs the U.S. Sentencing Commission to amend its sentencing guidelines to enhance the penalty for: (1) use of a semiautomatic firearm during a crime of violence or a drug trafficking crime; (2) a second offense of using an explosive to commit a Federal felony; (3) use of a firearm in the commission of counterfeiting or forgery; and (4) firearms possession by violent felons and serious drug offenders. (Sec. 403) Prohibits and sets penalties for: (1) smuggling firearms in aid of drug trafficking; (2) theft of firearms and explosives; (3) the transfer of firearms to a nonresident of a State, except for lawful sporting purposes; (4) conspiracies to commit firearms and explosives crimes; and (5) the distribution of explosives to a person who is legally disqualified from having the explosives. (Sec. 405) Mandates the revocation of: (1) supervised release and the institution of a prison term for a defendant who possesses a controlled substance or firearm in violation of a condition of such release, or who refuses to cooperate with drug testing; and (2) probation for possession of a controlled substance or firearms in violation of a condition of probation, or who refuses to cooperate with drug testing. (Sec. 407) Increases the penalty for: (1) knowingly making a false, material statement in connection with the acquisition of a firearm from a licensed dealer; and (2) interstate gun trafficking. Title V: Obstruction of Justice - Increases the penalties for threats and intimidation of jurors and court officers, obstruction of justice, and attempted retaliatory killings of witnesses, victims, and informants. (Sec. 501) Provides the death penalty for: (1) the murder of jurors and court officers; (2) retaliatory killings of witnesses, victims, and informants; (3) the murder of State officials working with Federal law enforcement officials in connection with Federal criminal investigations; and (4) the murder of Federal witnesses. (Sec. 503) Creates an exception to current law requiring that persons charged with capital offenses be furnished with a list (with addresses) of veniremen and witnesses, if the court finds by a preponderance of the evidence that providing such list may jeopardize the life or safety of any person. Title VI: Youth Violence - Subtitle A: Increased Penalties for Drug Trafficking and Criminal Street Gangs - Amends: (1) the Controlled Substances Act (CSA) to increase penalties for employing children to distribute drugs or avoid apprehension for a drug offense; and (2) the Federal criminal code to provide for imprisonment of up to ten years for a gang member or person acting on behalf of a criminal street gang who commits a Federal drug or violent crime offense and who has had a prior drug or crime of violence conviction, with the penalty to run consecutively to any other sentence imposed. Subtitle B: Juvenile Drug Trafficking and Gang Prevention Grants - Amends the Juvenile Justice and Delinquency Prevention Act of 1974 to authorize the Administrator of the Office of Juvenile Justice and Delinquency Prevention to make grants for: (1) programs to reduce the formation or continuation of juvenile gangs and the use and sale of illegal drugs by juveniles; (2) public or non-profit private organizations or individuals to identify promising new juvenile drug reduction and enforcement programs; and (3) public or non-profit private organizations or individuals to support promising new programs that specifically address the unique crime, drug, and alcohol related challenges faced by juveniles living at or near international ports of entry and in other international border communities. Authorizes appropriations. Subtitle C: Bindover System for Certain Violent Juveniles - Amends the Omnibus Act to authorize grants for bindover systems for the prosecution of 16- and 17-year-olds as adults for certain violent crimes (first- and second-degree murder, attempted murder, armed robbery with a firearm, aggravated battery or assault with a firearm, criminal sexual penetration when armed with a firearm, and drive-by shooting). Title VII: Terrorism - Subtitle A: Maritime Navigation and Fixed Platforms - Amends the Federal criminal code to prohibit and set penalties for the seizure of a ship or fixed platform by force, an act of violence against a person aboard, damage or destruction, or the injuring or killing of a person in connection with such activities. Provides the death penalty where death results. Subtitle B: General Provisions - Provides the death penalty where death results from the use of a weapon of mass destruction. (Sec. 714) Extends: (1) the application of State, territory, or district law for offenses committed in territorial waters not otherwise committed within a State's territory or district; (2) special maritime and territorial jurisdiction to offenses committed by or against a U.S. national during a voyage on a foreign vessel scheduled to depart from or arrive in the United States; and (3) the statute of limitations to ten years for certain terrorist offenses. (Sec. 716) Provides: (1) the death penalty for the commission of torture outside the United States and for the killing of a U.S. national outside the country; (2) the Federal Bureau of Investigation (FBI) with access to telephone subscriber information if the Director or Deputy Assistant Director certifies that such information is relevant to a foreign counterintelligence investigation and that it pertains to an agent of a foreign power; and (3) criminal penalties for willful violations of airport or airline security regulations. (Sec. 719) Prohibits: (1) acts of terrorism at U.S. international airports (and provides the death penalty where death results), subject to certain limitations; and (2) counterfeiting U.S. currency abroad (and sets penalties). Enhances penalties for any felony that involves or is intended to promote international terrorism. Sets penalties for those who provide material support to terrorists. (Sec. 722) Creates an Economic Terrorism Task Force. (Sec. 725) Amends the Immigration and Nationality Act to authorize the Attorney General to grant a nonimmigrant visa to an alien who possesses critical information about a criminal organization and whose presence in the United States is essential to an investigation or prosecution of such organization. Title VIII: Sexual Violence and Child Abuse - Subtitle A: Sexual Abuse - Amends the Federal criminal code to include within the definition of "sexual act" the intentional touching, not through the clothing, of the genitalia of another person who has not attained age 16 with intent to abuse, humiliate, harass, degrade, or arouse or gratify the sexual desire of any person. Subtitle B: Child Protection - National Child Protection Act of 1993 - Provides for the establishment of a national background check system whereby child care organizations can determine whether prospective employees have histories of child abuse or other serious crimes. Requires States to have at least 80 percent currency of crime cases in their systems within three years. Directs the Administrator of the Office of Juvenile Justice and Delinquency Prevention to begin a study of child abusers' criminal records. (Sec. 816) Amends the Omnibus Act to provide for the use of drug control and system improvement grants for the improvement of State record systems and the sharing of records of child abuse crime information to implement this subtitle. Subtitle C: Crimes Against Children - Jacob Wetterling Crimes Against Children Registration Act - Directs the Attorney General to establish guidelines for State programs requiring any person convicted of a criminal offense against a victim who is a minor to register a current address with a designated State LEA for ten years after release from prison or being placed on parole or supervised release. Subjects to criminal penalties a person required to register under a State program who knowingly fails to register and keep such registration current. (Sec. 823) Specifies that the allocation of BJA grant funds (under the Omnibus Act) received by a State not complying with provisions of this Act three years after its enactment shall be reduced by ten percent, with the unallocated funds to be reallocated to the States in compliance with this Act. Title IX: Crime Victims - Subtitle A: Victims' Rights - Amends Rule 32 of the Federal Rules of Criminal Procedure to give victims of violent crimes and sexual abuse the right to address the court concerning the sentence to be imposed on convicted offenders. Permits such right to be exercised by a parent or guardian if the victim is under 18, or by one or more family members if the victim is deceased or incapacitated. (Sec. 902) Requires courts to order criminal defendants who are convicted to pay restitution to victims. Specifies that a restitution order shall constitute a lien against real or personal property. Subtitle B: Crime Victims' Fund - Amends the Victims of Crime Act of 1984 to provide that if the compensation paid by an eligible crime victim compensation program would cover costs that a Federal, or a federally financed State or local, program would otherwise pay: (1) such victim compensation program shall not pay such compensation; and (2) the other program shall make its payments without regard to the existence of the crime victim compensation program. (Sec. 913) Allows: (1) up to five percent of a victim compensation or assistance program grant to be used for administrative costs; and (2) the Director of the Office for Victims of Crime to use unspent compensation funds for assistance programs in either the year such funds are not spent or in the following year. (Sec. 917) Requires grantees to certify that no grant funds will be used to supplant State and local funds, but rather will supplement those otherwise available funds. Title X: State and Local Law Enforcement - Subtitle A: DNA Identification - DNA Identification Act of 1993 - Amends the Omnibus Act to authorize the use of drug control and system improvement grants to develop or improve in a forensic laboratory a capability to analyze deoxyribonucleic acid (DNA) for specified identification purposes. Sets forth provisions regarding: (1) restrictions on the use of funds; and (2) reporting and recordkeeping (including access to records) requirements. Authorizes appropriations. (Sec. 1003) Requires the Director of: (1) the FBI to appoint a distinct advisory board on DNA quality assurance methods from among nominations proposed by the National Academy of Sciences and professional societies of crime laboratory officials and issue standards for quality assurance; and (2) the National Institute of Justice (NIJ) to make specified certifications to the House and Senate Judiciary Committees regarding the establishment of a proficiency testing program for DNA analyses. (Sec. 1004) Authorizes the Director to establish an index of DNA identification records of persons convicted of crimes, and of analyses of DNA samples recovered from crime scenes and from unidentified human remains. (Sec. 1005) Sets forth proficiency testing and privacy protection requirements, and penalties for violations. (Sec. 1006) Authorizes appropriations. Subtitle B: Department of Justice Community Substance Abuse Prevention - Department of Justice Community Substance Abuse Prevention Act of 1993 - Amends the Omnibus Act to authorize the Attorney General to make grants to eligible coalitions to develop and implement substance abuse prevention programs, with the efforts of such coalitions involving substantial community participation. Grants priority to communities providing evidence of significant abuse. Authorizes appropriations. Subtitle C: Racial and Ethnic Bias Study Grants - Authorizes the Attorney General to make grants to States that have established, by State law or the court of last resort, plans for analyzing the role of race in their criminal justice systems. Requires State plans to include recommendations designed to correct any findings of racial and ethnic bias. Authorizes appropriations. Title XI: Provisions Relating to Police Officers - Subtitle A: Law Enforcement Family Support - Amends the Omnibus Act to: (1) require the Director of the BJA to establish guidelines and oversee the implementation of family-friendly policies in law enforcement divisions of the Department of Justice (DOJ), identify model programs that provide support to law enforcement families, and provide technical assistance for stress reduction and family support efforts by State and local LEAs; and (2) authorize the Director to make grants to States and local LEAs and organizations representing State or local law enforcement personnel to provide family support services to law enforcement personnel. Authorizes appropriations. Subtitle B: Police Pattern or Practice - Prohibits any governmental authority, or any agent or person acting on behalf of such authority, from engaging in a pattern or practice of conduct by law enforcement officers that deprives persons of their constitutional or Federal rights. Authorizes the Attorney General to bring a civil action against such officers to eliminate such practices. (Sec. 1112) Directs the Attorney General to acquire data about the use of excessive force by law enforcement officers. Subtitle C: Police Corps and Law Enforcement Officers Training and Education - Chapter 1: Police Corps - Police Corps Act - Establishes in DOJ an Office of the Police Corps and Law Enforcement Education, headed by a Director. Authorizes the Director to award college and graduate school scholarships (of up to $30,000 per student) in exchange for four years work with a State or local police force upon graduation. Requires participants who do not follow through on their commitment to pay back all the scholarship money plus ten percent interest. (Sec. 1127) Sets forth provisions regarding: (1) selection and training of participants; (2) swearing in, discipline, and layoffs; (3) State plan requirements; and (4) assistance to States and localities employing police corps officers. Authorizes appropriations. Chapter 2: Law Enforcement Scholarship Program - Law Enforcement Scholarships and Recruitment Act - Requires the Director to provide scholarships for in-service law enforcement personnel who seek further education, allotting 80 percent of funds based on the relative number of law enforcement officers per State and 20 percent based on the relative shortage of officers. Provides grants for summer jobs or part-time jobs during the year for high school students interested in law enforcement careers. Authorizes appropriations. Title XII: Drug Court Programs - Amends the Omnibus Act to authorize the BJA to make grants to States: (1) for drug testing upon arrest, during the pretrial period, or during participation in any pre- or post-conviction diversion program; (2) to develop alternative methods of punishment for young nonviolent offenders to traditional forms of incarceration and probation; and (3) for residential substance abuse treatment programs in State prisons. Authorizes appropriations. Title XIII: Prisons - Subtitle A: Federal Prisons - Amends the Federal criminal code to: (1) prohibit the Bureau of Prisons from showing favoritism to prisoners of high social or economic status in designating their place of imprisonment; and (2) require that any submission of legislation by the judicial or executive branch that might affect prison populations be accompanied by an impact statement (and requires the Attorney General to prepare and transmit to the Congress annual prison impact assessments). (Sec. 1303) Federal Prisoner Drug Testing Act of 1993 - Requires the Director of the Administrative Office of the U.S. Courts to establish a program of drug testing of Federal offenders on post-conviction release. (Sec. 1304) Drug Treatment in Federal Prisons Act of 1993 - Establishes a schedule for the Bureau of Prisons to place all eligible prisoners into residential substance abuse treatment programs for between nine and 12 months, in facilities separate from the general prison population. Specifies that prisoners who successfully complete such programs could be released up to a year early. Authorizes appropriations. (Sec. 1305) Directs the court, in imposing sentence, to consider the expected costs to the Government of any imprisonment, supervised release, or probation. Authorizes the Sentencing Commission, in promulgating guidelines, to include as a component of a fine the expected costs to the Government of any imprisonment, supervised release, or probation sentence that is ordered. Subtitle B: State Prisons - Authorizes the Attorney General to make grants to States and to multi-State compact associations for the development and operation of boot camp prisons (for prisoners not convicted of violent felonies, providing a highly regimented schedule of strict discipline, physical training, and work, as well as remedial education and treatment for substance abuse) and regional prisons (for violent offenders with serious substance abuse problems). Specifies that grants may support the activation of boot camp and regional prison facilities already constructed by State or local governments, and shall support aftercare services (to reduce the likelihood of repeat criminality following release). Authorizes appropriations. (Sec. 1323) Requires the Director of NIJ to study: (1) the feasibility of establishing an information clearinghouse to facilitate the interstate transfer of prisoners to facilities near their families; (2) the recidivism rates of persons who were under the influence of alcohol at the time they committed their crimes, comparing recidivism rates of those who participated in a residential treatment program while in custody with those who did not; and (3) the use of alcohol, alone or in combination with other drugs, as a factor in criminal activity. (Sec. 1324) Requires the Bureau of Prisons to notify State and local law enforcement authorities concerning the release or relocation to their areas of Federal offenders under post-release supervision, with respect to prisoners convicted of drug trafficking and violent crimes. Title XIV: Rural Crime - Subtitle A: Fighting Drug Trafficking in Rural Areas - Amends the Omnibus Act to authorize appropriations, and increase the base allocation, for rural drug enforcement assistance. (Sec. 1402) Directs the Attorney General, subject to the availability of appropriations, to establish a Rural Drug Enforcement Task Force in each of the Federal judicial districts which encompass significant rural lands. (Sec. 1403) Authorizes the Attorney General to cross-designate up to 100 Federal officers with jurisdiction to enforce CSA provisions on non-Federal lands to the extent necessary to effect the purposes of this title. (Sec. 1404) Requires the Director of the Federal Law Enforcement Training Center to develop a specialized course of instruction devoted to training law enforcement officers from rural agencies in the investigation of drug trafficking and related crimes. Authorizes appropriations. Subtitle B: Drug Free Truck Stops and Safety Rest Areas - Amends the CSA to enhance penalties for drug distribution at or near truck stops and safety rest areas. Title XV: Drug Control - Subtitle A: Increased Penalties - Amends: (1) the Federal criminal code to enhance penalties for drug trafficking and illegal drug use in prisons; (2) the Tariff Act of 1930 to make the penalty for failure to declare a controlled substance 1,000 percent of the value of the article (as under current law) or $500, whichever is greater; and (3) the CSA to enhance penalties for drug dealing in or near public housing authority facilities, and to set penalties for any physical trainer or adviser who endeavors to persuade or induce an individual to possess or use anabolic steroids in violation of such Act. (Sec. 1505) Directs the Sentencing Commission to amend the sentencing guidelines to increase penalties for drug-dealing in "drug-free" zones. Subtitle B: Precursor Chemicals Act - Chemical Control Amendments Act of 1993 - Amends the CSA to impose registration requirements for precursor chemicals. (Sec. 1514) Requires manufacturers to submit annual reports concerning listed chemicals manufactured during the year. (Sec. 1515) Amends the Controlled Substances Import and Export Act to: (1) subject brokers and traders to the same recordkeeping and reporting requirements for international transactions, and the same criminal penalties, as exporters; and (2) authorize the Attorney General to require that the 15-day advance notice requirement with respect to the importation and exportation of listed chemicals apply to all exports of specific listed chemicals to specified countries, regardless of the status of certain customers in such countries as regular customers, if necessary to support effective diversion control programs or as required by treaty; and (3) establish criminal penalties for attempting to evade reporting requirements and for smuggling listed drugs. (Sec. 1519) Grants the Attorney General the same inspection authority for listed chemicals as presently exists with respect to controlled substances. (Sec. 1521) Makes it a felony to violate the Solid Waste Disposal Act in the handling of chemicals used to illegally manufacture a controlled substance. Requires that violators be assessed costs of the initial cleanup an disposal of the listed chemical and contaminated property and the costs of restoring property damaged by exposure to such chemical. Subtitle C: General Provisions - Prohibits advertising which aims to illegally solicit or sell drugs. (Sec. 1535) Includes among the long-term goals of the National Drug Control Strategy making drug treatment available to all who need it. (Sec. 1536) Amends the Federal Aviation Act of 1958 to require the Administrator of the Federal Aviation Administration to issue regulations requiring employees to report to law enforcement authorities the discovery of illegal drugs or amounts of cash over $10,000 in airport security screenings. Title XVI: Drunk Driving Provisions - Drunk Driving Child Protection Act of 1993 - Amends the Federal criminal code to provide supplementary prison terms and fine authorizations in cases where drunk driving endangers or injures a person under 18 years of age. (Sec. 1603) Expresses the sense of the Congress that in determining child custody and visitation rights the courts should consider the history of drunk driving of anyone involved in the determination. Title XVII: Commissions - Subtitle A: Commission on Crime and Violence - Establishes the National Commission on Crime and Violence in America to develop a comprehensive crime control plan for the 1990's. Subtitle B: National Commission to Study the Causes of the Demand for Drugs in the United States - National Commission to Study the Causes of the Demand for Drugs in the United States - Establishes a National Commission to Study the Causes of the Demand for Drugs in the United States. Subtitle C: National Commission to Support Law Enforcement - National Commission to Support Law Enforcement Act - Establishes a National Commission to Support Law Enforcement. Title XVIII: Bail Posting Reporting - Illegal Drug Profits Act of 1993 - Requires State and Federal criminal court clerks to report to the Internal Revenue Service (IRS) and prosecutors the name and taxpayer identification number of anyone accused of a drug, money laundering, or racketeering crime who posts cash bail exceeding $10,000. Title XIX: Motor Vehicle Theft Prevention - Motor Vehicle Theft Prevention Act - Directs the Attorney General to develop a national voluntary motor vehicle theft prevention program which would involve placing identifiable decals on the vehicles of consenting owners, whereby such vehicles could then be stopped by law enforcement officers upon a reasonable suspicion that the vehicles were not being operated by or with the consent of their owners. (Sec. 1903) Prohibits and sets penalties for tampering with the decals, with exceptions. Title XX: Protections for the Elderly - Directs the Attorney General, subject to the availability of appropriations, to make grants in support of programs to protect and locate missing patients with Alzheimer's disease and related dementias. Authorizes appropriations. (Sec. 2002) Directs the Sentencing Commission to ensure that the sentences for those convicted of crimes of violence against elderly victims be sufficiently stringent to deter such crimes, protect the public from additional crimes of such a defendant, and provide enhanced penalties under specified criteria. Title XXI: Consumer Protection - Amends the Federal criminal code to set penalties for insurance industry crimes, including embezzling from insurance companies, making false entries in insurance company books with intent to deceive, and corruptly influencing or obstructing proceedings before State insurance regulatory agencies or insurance examiners. Prohibits persons convicted of criminal felonies involving dishonesty or breach of trust from engaging in the insurance business without the written consent of an insurance regulatory official authorized to regulate the insurer. (Sec. 2102) Consumer Protection Against Credit Card Fraud Act of 1993 - Prohibits the sale of credit cards without credit card company authorization, fraudulent receipt of payments via credit card for goods never received or inferior to those promised, and laundering to credit card receipts. (Sec. 2103) Extends the mail fraud statute to include mail sent by private interstate carriers. Title XXII: Financial Institution Fraud Prosecutions - Financial Institutions Fraud Prosecution Act of 1991 (sic) - Amends the Federal Deposit Insurance Act and the Federal Credit Union Act to disqualify certain persons with criminal records from participating in the affairs of insured depository institutions and credit unions. (Sec. 2204) Amends the Crime Control Act of 1990 to encourage the Attorney General to report to the Congress on the collapse of private insurance deposit corporations. Title XXIII: Savings and Loan Prosecution Task Force - Directs the Attorney General to establish within DOJ a savings and loan criminal fraud task force to prosecute those criminal cases involving savings and loan institutions. Title XXIV: Sentencing Provisions - Amends the Federal criminal code to allow the court, in determining the sentence to be imposed in the case of a violation of probation or supervised release, to consider guidelines or policy statements issued by the Sentencing Commission. (Sec. 2403) Directs the court to revoke a term of supervised release and require the defendant to serve in prison all or part of the term of release authorized by statute for the offense that resulted in such term, without credit for time previously served on post-release supervision, if the court finds that the defendant violated a condition of supervised release, subject to specified limitations. Authorizes the court to include a requirement that the defendant be placed on supervised release after imprisonment when a term of supervised release is revoked and the defendant is required to serve a term of imprisonment less than the maximum authorized. Specifies that the power of the court to revoke a term of supervised release for violation of a condition of such release extends beyond the expiration of the term of release for a period reasonably necessary for the adjudication of matters arising before its expiration if, prior to such expiration, a warrant or summons ha been issued on the basis of an allegation of such a violation. (Sec. 2404) Provides for the application of the sentencing guidelines (and any pertinent policy statement issued by the U.S. Sentencing Commission) for certain nonviolent drug offenses in which a mandatory minimum term of imprisonment would otherwise be required. Directs the Sentencing Commission to: (1) review the consideration of defendants' criminal histories under the guidelines; and (2) monitor the operation of this Act. Title XXV: Sentencing and Magistrates Amendments - Permits concurrent sentencing of a defendant to imprisonment and probation for petty offenses. (Sec. 2502) Authorizes the trial of petty offenses by magistrate judges. Title XXVI: Computer Crime - Computer Abuse Amendments Act of 1993 - Amends the Computer Fraud and Abuse Act to make it a felony to knowingly transmit an unauthorized program or code that alters the information stored in a computer with the intent to damage the system or information contained within the affected computer or system, or to withhold or deny the use of such system or information, if the transmission: (1) occurred without the authorization of the person responsible for the computer system receiving the program; and (2) causes damage exceeding $1,000 in any one-year period or modifies or impairs the medical care of one or more individuals. Makes it a misdemeanor to recklessly transmit a destructive computer program or code. Creates a civil cause of action for persons suffering damage or loss by virtue of a violation of this Act. Modifies the prohibition against accessing a Government computer where such conduct affects the use of the Government's operation of such computer to cover only actions that "adversely" affect such use. Title XXVII: International Parental Kidnapping - International Parental Kidnapping Crime Act of 1993 - Amends the Federal criminal code to establish penalties for removing a child from, or retaining a child outside, the United States with intent to obstruct the lawful exercise of parental rights. (Sec. 2703) Authorizes appropriations to carry out under the State Justice Institute Act of 1984 national, regional, and in-State training and educational programs dealing with criminal and civil aspects of interstate and international parental child abduction. Title XXVIII: Safe Schools - Safe Schools Act of 1993 - Amends the Omnibus Act to: (1) authorize the Director of the BJA to make grants to local educational agencies for the purpose of providing assistance to such agencies most directly affected by crime and violence; and (2) require the Director to develop a written safe schools model in English and in Spanish and make such model available to any such agency that requests it. Authorizes appropriations. Title XXIX: Miscellaneous - Subtitle A: Increases in Penalties - Increases penalties for assault: (1) of Federal officers, foreign officials, and official guests and internationally protected persons; (2) within a maritime and territorial jurisdiction; and (3) of the President, presidential staff, congressional leaders, cabinet officials, and Supreme Court justices. (Sec. 2902) Increases the maximum penalties for voluntary and involuntary manslaughter. (Sec. 2903) Broadens the scope and increases the penalties for conspiracies to deprive persons of their civil rights. (Sec. 2904) Increases penalties for: (1) trafficking in counterfeit goods and services; (2) conspiracy to commit murder for hire; and (3) Travel Act violations. Subtitle B: Extension of Protection of Civil Rights Statutes - Extends the protections of the criminal civil rights statute to any person in a State. (Currently, the statute only covers State "inhabitants.") Subtitle C: Audit and Report - Directs the Attorney General to: (1) require State and local LEAs to annually audit and detail the uses and expenses to which forfeiture funds were dedicated and the amount used for each use or expense; and (2) report to the Congress on the administrative and contracting expenses paid from the DOJ Assets Forfeiture Fund. Subtitle D: Gambling - Grants a State gaming enforcement office located within a State Attorney General's office access to FBI criminal history record information for licensing purposes. Subtitle E: White Collar Crime Amendments - Establishes penalties for knowingly receiving the proceeds of: (1) extortion; (2) a kidnapping; and (3) a postal robbery. (Sec. 2943) Extends the prohibition against obstructing civil investigative demands to include obstruction in racketeering and false claims investigations. Subtitle F: Safer Streets and Neighborhoods - Safer Streets and Neighborhoods Act of 1993 - Amends the Omnibus Act to authorize the Director of the BJA to make grants to, or enter into contracts with, non-Federal public or private agencies, institutions, or organizations to carry out specified purposes of such Act (current law does not specify "non-Federal"), effective October 1, 1993. Subtitle G: Other Provisions - Authorizes the venue for espionage and related offenses to be in the District of Columbia or in any other district authorized by law. (Sec. 2963) Amends the Anti-Drug Abuse Act to make amendments with respect to certain IRS undercover operations effective from the date of this Act's enactment through December 31, 1994. (Sec. 2964) Directs the Attorney General and the Secretary of Health and Human Services to report to the Congress on the medical and psychological basis of "battered women's syndrome" and the extent to which evidence of the syndrome has been held to be admissible as evidence of guilt or as a defense in a criminal trial. (Sec. 2966) Amends the Federal criminal code to set penalties for: (1) the theft of major art works from museums; (2) misuse of the words "Drug Enforcement Administration" or the initials "DEA"; and (3) attempted robbery, kidnapping, smuggling, and property damage offenses. (Sec. 2971) Extends the statute of limitations of arson. Title XXX: Technical Corrections - Makes technical corrections to various criminal law provisions.

Employer Sanctions Improvement Act of 1993

United States · United States Congress · 26 October 1993

TABLE OF CONTENTS: Title I: Promoting Enforcement Title II: Improving the Employment Verification System Title III: Additional Penalties and Increases in Penalties Employer Sanctions Improvement Act of 1993 - Title I: Promoting Enforcement - Amends Federal immigration law to repeal the Federal preemption of State law regarding sanctions against the employment of unauthorized aliens. Creates a private right of action for violation of Federal law prohibiting employment of unauthorized aliens. Directs the Attorney General to provide grants to the States for immigration assistance and enforcement. Authorizes appropriations. Amends the Omnibus Crime Control and Safe Streets Act of 1968 to condition Federal assistance upon assurances that the recipient State actively enforces sanctions against the employment of unauthorized aliens. Amends Federal immigration law to permit complaints alleging employment of unauthorized aliens to be registered in person or by toll-free telephone number. Authorizes the Attorney General to seek judicial review if adversely affected by a final order regarding an assessment for employment of unauthorized aliens. Title II: Improving the Employment Verification System - Restricts the authority of the Attorney General to expand the list of acceptable employment verification documents. Transfers from the President to the Attorney General responsibility for monitoring and evaluating the employment verification system. Directs the Attorney General to report to the Congress on the consolidation into a single tamper-resistant document of documentation evidencing temporary work authorization. Title III: Additional Penalties and Increases in Penalties - Declares alien employment without authorization unlawful and establishes civil penalties. Precludes aliens engaged in unlawful employment from eligibility for adjustment of immigration status. Increases the civil and criminal penalties for: (1) employment of unauthorized aliens; and (2) document fraud.

Immigration Enforcement and Asylum Reform Act of 1993

United States · United States Congress · 26 October 1993

TABLE OF CONTENTS: Title I: Smuggling and Fraud Title II: Asylum Title III: Inspections Title IV: Authorization of Appropriations for the Immigration and Naturalization Service Immigration Enforcement and Asylum Reform Act of 1993 - Title I: Smuggling and Fraud - Amends the Immigration and Nationality Act to provide procedures for expedited exclusion of aliens who arrive without proper documentation or who are determined by a special asylum officer not to have a proper claim of asylum (based upon a credible fear of prosecution). Limits judicial review to habeas corpus. Creates a separate offense and penalty for an alien smuggler who seriously injures or jeopardizes the life of an alien. Extends penalties to persons who contract to bring illegal labor. Treats smuggling as an aggravated felony. Expands Immigration and Naturalization Service (INS) forfeiture authority to include any real or personal property used or intended to be used to smuggle aliens, or that constitutes, is derived from, or traceable to such activities. Exempts property used without the owner's consent or knowledge, or not to his or her benefit. Amends Federal law to authorize INS wiretaps for alien smuggling investigations. Brings alien smuggling operations under the purview of the Racketeer Influenced and Corrupt Organizations (RICO) provisions. Title II: Asylum - Revises asylum procedures. Sets forth mandatory and discretionary conditions for granting provisional asylum. States that asylum applications shall be determined by specially trained asylum officers. Terminates an alien's claim for failure to appear at the application provisional asylum hearing. Title III: Inspections - Directs the Attorney General to: (1) establish specified numbers of preinspection stations at foreign airports identified as last departure points for the greatest numbers of U.S.-arriving passengers and at those with the greatest numbers of U.S.-arriving undocumented aliens (and to assign additional immigration officers at such airports without preinspection stations); and (2) establish an expedited inspection process for U.S. citizens returning by air from abroad. Revises the pilot visa waiver program to: (1) make it permanent; (2) repeal certain paperwork requirements; (3) subject participants to exclusion or deportation without appeal (except for an asylum claim); and (4) require carriers to distribute program information to passengers. Provides for the training of airline personnel in detection of fraudulent documents. Authorizes the Attorney General to reduce, refund, or waive the fine for bringing illegal aliens into the United States if: (1) a carrier followed prescribed screening procedures; or (2) other justifiable circumstances exist. Title IV: Authorization of Appropriations for the Immigration and Naturalization Service - Authorizes appropriations for the Border Patrol.

To provide for adjustment of immigration status for certain Haitian children.

United States · United States Congress · 26 October 1993

Cites conditions for the adjustment of immigration status for Haitian nationals who are the unmarried children of a citizen or permanent resident of the United States.

Authorizing the designation of Portugal, Ireland, and Greece under the visa waiver program under certain conditions.

United States · United States Congress · 22 October 1993

Authorizes the Attorney General and the Secretary of State to jointly designate Portugal, Ireland, and Greece as pilot program countries if the rate of refusals of nonimmigrant visitor visas for such countries meets specified criteria.

Managed Competition Act of 1993

United States · United States Congress · 21 October 1993

TABLE OF CONTENTS: Title I: Managed Competition in Employer-Based Health Plans: Incentives to Control Costs Subtitle A: Use of Tax Incentives to Purchase Cost-Effective Plans Subtitle B: Health Plan Purchasing Cooperatives (HPPCs) Subtitle C: Accountable Health Plans (AHPs) Subtitle D: National Health Board Subtitle E: Managed Competition in Rural and Urban Underserved Areas Subtitle F: Treatment of Chronically Underserved Areas Subtitle G: Repeal of COBRA Continuation Requirements Subtitle H: Definitions Title II: Low-Income Assistance for Health Coverage Subtitle A: Low-Income Assistance Subtitle B: Long-Term Care Phase-Down Assistance to States Subtitle C: Financing Subtitle D: Repeal of Medicaid Program Title III: Training and Education of Health Care Professionals Subtitle A: Reform of Federal Funding for Medical Residency Training Subtitle B: Other Medical Education Grants and Programs Title IV: Preventive Health and Individual Responsibility Subtitle A: Expansion of Public Health Programs Subtitle B: Medicare Title V: Malpractice Reform Subtitle A: Findings; Purpose; Definitions Subtitle B: Grants to States for Alternative Dispute Resolution Systems Subtitle C: Uniform Standards for Malpractice Claims Subtitle D: Grants to States for Development of Practice Guidelines Title VI: Paperwork Reduction and Administrative Simplification Managed Competition Act of 1993 - Title I: Managed Competition in Employer-Based Health Plans: Incentives to Control Costs - Subtitle A: Use of Tax Incentives to Purchase Cost-Effective Plans - Amends the Internal Revenue Code to impose a tax on the excess health plan expenses of any employer which are health plan expenses exceeding specific limits under an accountable health plan for a defined geographical area. (Sec. 1002) Increases to 100 percent and makes permanent the deduction for health plan premium expenses of self-employed individuals. (Sec. 1003) Permits the deduction for medical, dental, etc. expenses without regard to the limitation on such deduction with respect to amounts paid for premiums under an accountable health plan. (Sec. 1004) Provides for the exclusion from gross income of contributions by a partnership or S corporation to a health plan covering partners or shareholders. Subtitle B: Health Plan Purchasing Cooperatives (HPPCs) - Provides for the establishment of Health Plan Purchasing Cooperatives (HPPCs). Considers each State to be a HPPC, except that a State may subdivide into HPPC areas, and that there may be interstate HPPCs, as specified. Requires HPPCs to enter into agreements with accountable health plans and small employers, offer enrollment in accountable health plans, and charge premiums. Subtitle C: Accountable Health Plans (AHPs) - Directs the National Health Board to provide a process whereby a health plan may be registered with the Board by its sponsor as an accountable health plan. Sets forth requirements for a plan to be registered, including: (1) coverage for a specified uniform set of benefits, including cost-sharing for low-income individuals; (2) standard premiums for the uniform benefits; (3) grievance procedures; (4) collecting and providing specified information; (5) prohibiting discrimination in enrollment or benefits; and (6) financial solvency. (Sec. 1208) Sets forth additional requirements for open AHPs, which is any plan which is not closed. Defines a closed plan as one limited by structure or law to one or more large employers. (Sec. 1211) Requires each AHP to provide for payment of one percent of gross premium receipts to the National Medical Education Fund. (Sec. 1221) Sets forth provisions concerning the preemption of State laws for AHPs. (Sec. 1231) Directs the President to provide for the development and publication of guidelines on the application of Federal antitrust laws to AHPs. Subtitle D: National Health Board - Establishes, as an independent agency in the Executive Branch, a National Health Board (the Board). Requires the Board to transmit annually to the Congress recommendations for the uniform set of effective benefits. States that such recommendations shall apply unless the Congress passes a joint resolution of disapproval. (Sec. 1303) Directs the Board to provide for the initial organization, as a nonprofit corporation in the District of Columbia, of the Benefits, Evaluations, and Data Standards Board in order to make recommendations to the Board concerning the uniform set of effective benefits and matters related to the evaluation of health care services. (Sec. 1304) Directs the Board to provide for the initial organization, as a nonprofit organization, of the Health Plan Standards Board in order to make recommendations to the Board concerning the standards for AHPs and concerning its assessment of risk-adjustment factors. (Sec. 1305) Sets forth provisions concerning the registration of AHPs. (Sec. 1306) Directs the Board to establish rules for the process of risk-adjustment of premiums among AHPs by HPPCs. (Sec. 1307) Directs the Board to establish standards for the periodic provision by AHPs of standardized information. (Sec. 1309) Establishes, within the Department of Health and Human Services, the Agency for Clinical Evaluations which shall assume the responsibilities of the Director of the Office of Medical Applications of Research at the National Institutes of Health, the Director of the Office of Research and Demonstrations of the Health Care Financing Administration (insofar as such responsibilities relate to clinical evaluations), the Administrator for Health Care Policy and Research under title IX of the Public Health Service Act and specified provisions of the Social Security Act, and the Director of the National Center for Health Statistics, as well as other specified responsibilities. Authorizes appropriations. (Sec. 1312) Authorizes appropriations for the Board through FY 2000. Terminates the Board on December 31, 1999. Subtitle E: Managed Competition in Rural and Urban Underserved Areas - Authorizes the Governor of any State to designate rural and urban areas of a State as underserved areas. Permits a HPPC serving such an area to require AHPs offered by the HPPC and with a service area adjoining such area to include the area as part of their service area. (Sec. 1411) Authorizes appropriations for: (1) technical assistance for entities seeking to establish a network plan in an underserved area; (2) financial assistance to eligible entities in order to provide for the development and implementation of AHPs in rural areas; and (3) under the Public Health Service Act, migrant health centers and community health centers. (Sec. 1422) Provides coverage under part B of title XVIII (Medicare) of the Social Security Act for rural emergency access care hospital services. (Sec. 1431) Directs the Secretary of Health and Human Services to make payments for transitional assistance to eligible hospitals. Requires any hospital accepting such assistance to provide a significant volume of services to persons unable to pay for services. Authorizes appropriations. Subtitle F: Treatment of Chronically Underserved Areas - Directs the National Health Board to develop standards for the identification of chronically underserved areas. Makes provisions for addressing health care delivery in such areas. Subtitle G: Repeal of COBRA Continuation Requirements - Repeals the COBRA continuation requirements for group health plans and title XXII of the Public Health Service Act. Subtitle H: Definitions - Sets forth definitions for this title and title II. Title II: Low-Income Assistance for Health Coverage - Subtitle A: Low-Income Assistance - Provides premium assistance for very-low income individuals and moderately low-income individuals. Provides for nominal cost-sharing for such individuals and special assistance for certain items and services. Subtitle B: Long-Term Care Phase-Down Assistance to States - Provides for long-term care phase-down assistance to eligible States for each calendar quarter in 1995 through 1998. Subtitle C: Financing - Amends title XVIII (Medicare) of the Social Security Act to achieve savings under such program by: (1) reducing the update for inpatient hospital services; (2) reducing the conversion factor for the physician fee schedule for non-primary care services; and (3) reducing hospital outpatient services through establishing a prospective payment system. (Sec. 2204) Amends the Internal Revenue Code to impose a Medicare part B premium tax on higher-income individuals. (Sec. 2205) Achieves additional Medicare savings through the: (1) phased-in elimination of Medicare disproportionate share adjustment payments; (2) reduction of routine cost limits for home health services; (3) reduction in routine cost limits for extended care services; and (4) reductions in payments for hospice services. Subtitle D: Repeal of Medicaid Program - Repeals title XIX (Medicaid) of the Social Security Act. Title III: Training and Education of Health Care Professionals - Subtitle A: Reform of Federal Funding for Medical Residency Training - Directs the National Health Board to approve a resident training position in a medical residency program for purposes of funding approved medical residency training programs under this title. Provides funding, in addition, for physician retraining. Sets forth provisions concerning: (1) the allocation of entry positions among programs; and (2) the general distribution of positions among specialties. (Sec. 3004) Requires payment by AHPs of one percent of gross premium receipts to the National Medical Education Fund. Requires payments from the Medicare trust funds to the National Medical Education Fund. (Sec. 3005) Establishes the National Medical Education Fund. Subtitle B: Other Medical Education Grants and Programs - Authorizes appropriations under the Public Health Service Act for medical education programs, including: (1) the scholarship and loan repayment programs of the National Health Service Corps; (2) area education centers; (3) public health and preventive medicine; (4) family medicine; (5) general internal medicine and pediatrics; (6) physician assistants; (7) allied health projects grants and contracts; and (8) nurse practitioner and nurse midwife programs. Title IV: Preventive Health and Individual Responsibility - Subtitle A: Expansion of Public Health Programs - Authorizes appropriations under the Public Health Service Act for the following public health programs: (1) immunizations against vaccine-preventable diseases; (2) prevention, control, and elimination of tuberculosis; (3) lead poisoning prevention; (4) preventive health measures with respect to breast and cervical cancers; (5) the Office of Disease Prevention and Health Promotion; (6) the Office of Minority Health; (7) preventive health and health services block grant; (8) categorical grants for early intervention regarding acquired immune deficiency syndrome; and (9) programs of the Centers for Disease Control regarding the smoking of tobacco products. Directs the Office of Disease Prevention and Health Promotion to promote individual responsibility in personal health care and in the use of valuable health care resources. Subtitle B: Medicare - Provides Medicare coverage for: (1) screening fecal-occult blood tests and screening flexible sigmoidoscopies for the purpose of the early detection of cancer; (2) tetanus-diphtheria boosters; (3) well-child services; and (4) an annual screening mammography for women over age 64. Title V: Malpractice Reform - Subtitle A: Findings; Purpose; Definitions - Sets forth the findings, purpose, and definitions for this title. Subtitle B: Grants to States for Alternative Dispute Resolution Systems - Provides for grants for a two year period to States for the implementation and evaluation of alternative dispute resolution systems. Subtitle C: Uniform Standards for Malpractice Claims - Makes the provisions of this subtitle applicable to any medical malpractice liability action brought in a Federal or State court, and to any malpractice claim subject to alternative dispute resolution. (Sec. 5202) Establishes the United States Commission on Malpractice Awards which shall promulgate guidelines relating to limits on noneconomic and punitive damages. (Sec. 5205) Makes special provision for obstetric services. (Sec. 5206) Permits a finding of malpractice only if the defendant's conduct was unreasonable. Subtitle D: Grants to States for Development of Practice Guidelines - Directs the Secretary to make grants to States for the development of medical practice guidelines for health care professionals that may be applied to resolve medical malpractice liability claims. Title VI: Paperwork Reduction and Administrative Simplification - Preempts State quill pen laws. Ensures the confidential treatment of electronic health care information. Sets forth provisions which provide for: (1) the standardization of electronic health information; (2) uniform claims forms; (3) the liability of insurers when benefits are payable under two or more plans; and (4) the uniformity of the availability of information among health plans when benefits are payable under two or more plans. (Sec. 6007) Amends the Internal Revenue Code to impose a tax on a health plan not in compliance with specified requirements of this title.

Immigration Law Enforcement Act of 1993

United States · United States Congress · 20 October 1993

TABLE OF CONTENTS: Title I: Border Personnel, Training and Infrastructure Enhancement Title II: Asylum Reform Title III: Criminal Alien Deportation and Enhanced Prisoner Transfer Immigration Law Enforcement Act of 1993 - Title I: Border Personnel, Training and Infrastructure Enhancement - Improved Border Control and Narcotics Abatement Act - Authorizes appropriations and increases personnel levels for: (1) the Border Patrol; and (2) land border inspectors. Provides for: (1) primary deployment of such personnel on the Southwest border of the United States; (2) hiring preference for bilingual Border Patrol agents; and (3) improved training and improvement of border crossing infrastructure. Authorizes appropriations for Immigration and Naturalization Service technology and equipment acquisition. Establishes in the Treasury the Immigration Law Enforcement Fund. Creates a border crossing user fee. Title II: Asylum Reform - Executive Order Enhanced Consideration Revocation Act - Amends a specified Executive Order to partially revoke a provision with respect to asylum claims based upon birth control policies. Title III: Criminal Alien Deportation and Enhanced Prisoner Transfer - Criminal Alien Deportation and Enhanced Transfer Act of 1993 - Amends Federal criminal law to provide for a judicial order of deportation in the sentencing of an alien convicted of certain aggravated felonies. Authorizes the Secretary of State with the Attorney General to negotiate agreements with foreign countries for home-country incarceration of aliens subject to U.S. deportation. Authorizes appropriations. Amends the Immigration and Nationality Act to: (1) make an alien convicted of an aggravated felony ineligible for suspension of deportation and status of adjustment; and (2) prohibit the waiver of exclusion for an alien convicted of an aggravated felony.

Immigration Stabilization Act of 1993

United States · United States Congress · 20 October 1993

TABLE OF CONTENTS: Title I: Admission of Immigrants Title II: Admission of Refugees Title III: Asylum Reform Title IV: Criminal Aliens Title V: Financial Responsibility Title VI: Employer Sanctions Title VII: Border Security Title VIII: Alien Smuggling Title IX: Local Cooperation Title X: Citizenship Immigration Stabilization Act of 1993 - Title I: Admission of Immigrants - Amends the Immigration and Nationality Act (Act) with respect to: (1) immigration levels; (2) visa allotment; and (3) petition approval. Title II: Admission of Refugees - Limits nonemergency refugee admissions in any fiscal year to 50,000. Title III: Asylum Reform - Amends provisions with respect to: (1) alien inspection and exclusion by immigration officers; (2) asylum; and (3) judicial review. Title IV: Criminal Aliens - Expands the definition of "aggravated felony." (Sec. 402) Provides for the expedited deportation of certain nonpermanent resident aliens convicted of an aggravated felony. (Sec. 403) Authorizes judicial deportation for an alien convicted of a felony. (Sec. 404) Increases penalties for reentry or failure to depart. (Sec. 406) Authorizes the deportation of an alien prisoner prior to sentence completion under specified circumstances. (Sec. 407) Amends Federal criminal law to require the issuance of a judicial order of deportation in the case of an alien being sentenced for an aggravated felony. (Sec. 408) Authorizes Federal incarceration and deportation of certain State-convicted aliens. (Sec. 409) Amends Federal criminal law to increase penalties for specified visa and passport related crimes. (Sec. 410) Requires State or local law enforcement agencies to notify the district Immigration and Naturalization Service Office upon the felony arrest of an alien. Title V: Financial Responsibility - Authorizes the admission of an alien otherwise excludable as a public charge (as defined by this Act) if such alien has a sponsor guarantee of financial responsibility. (Sec. 503) Limits benefits, including unemployment benefits, for illegal aliens Title VI: Employer Sanctions - Revises employer sanction provisions, including: (1) work eligibility documents; and (2) social security telephone verification. Title VII: Border Security - Increases Border Patrol personnel levels. Establishes: (1) a border crossing fee; and (2) a Border Control Trust Fund. (Sec. 704) Amends the Act to establish increased penalties or a required pilot program for international carriers that bring in more than specified numbers of undocumented aliens. Title VIII: Alien Smuggling - Directs the Secretary of State to enter into cooperative foreign arrangements to prevent the unlawful entry of aliens into the United States. (Sec. 802) Directs the Secretary of Defense to instruct the Coast Guard with respect to preventing the illegal entry of aliens into the United States by sea. (Sec. 803) Amends Federal criminal law to bring specified alien related activities under the purview of the Racketeer Influenced and Corrupt Organizations (RICO) provisions. (Sec. 804) Increases alien smuggling penalties. (Sec. 805) Expands forfeiture provisions for smuggling or harboring aliens. (Sec. 806) Amends Federal criminal law to authorize wiretaps for alien smuggling investigations. Title IX: Local Cooperation - Prohibits specified Federal program assistance to States or local entities that do not use the SAVE system to verify an alien applicant's immigration status. Title X: Citizenship - Makes it unlawful (and establishes penalties) for a noncitizen to vote in a Federal or State election.

Consular Review Act of 1993

United States · United States Congress · 19 October 1993

Consular Review Act of 1993 - Amends the Immigration and Nationality Act to establish within the Department of State a Board of Visa Appeals to review, and revise if appropriate, consular determinations of alien excludability and visa denial or revocation. Authorizes specified interested parties to act on behalf of an alien seeking Board review.

Entitled the "Asylum Abuse Prevention Act of 1993".

United States · United States Congress · 14 October 1993

Amends the Immigration and Nationality Act to prohibit the United States from granting asylum to an alien who prior to U.S. arrival passes through another country which provides asylum or safe haven.

Concerning the responsibility of the Federal Government for providing social services for undocumented aliens.

United States · United States Congress · 12 October 1993

Expresses the sense of the Congress that: (1) immigration is a Federal matter and that the Federal Government should assume responsibility for financing the provision of social services to undocumented aliens living in this country; and (2) the Federal Government should support efforts by State and local governments to assemble reliable data on the costs of providing such services to undocumented aliens.

Affordable Health Care Now Act of 1993

United States · United States Congress · 7 October 1993

TABLE OF CONTENTS: Title I: Improved Access to Affordable Health Care Subtitle A: Increased Availability and Continuity of Health Coverage for Employees and Their Families Subtitle B: Reform of Health Insurance Marketplace for Small Business Subtitle C: Preemption Subtitle D: Health Deduction Fairness Subtitle E: Improved Access to Community Health Services Subtitle F: Improved Access to Rural Health Services Subtitle G: State Flexibility in the Medicaid Program: The Medical Health Allowance Program Subtitle H: Medicaid Program Flexibility Title II: Health Care Cost Containment and Quality Enhancement Subtitle A: Medical Malpractice Liability Reform Subtitle B: Administrative Cost Savings Subtitle C: Deduction for Cost of Catastrophic Health Plan; Medical Savings Accounts Subtitle D: Anti-Fraud Subtitle E: Medicare Payment Changes; Part B Premium Tax for High-Income Individuals Subtitle F: Removing Anti-Trust Impediments Subtitle G: Encouraging Enforcement Activities of Medical Self-Regulatory Entities Subtitle H: Prefunding Government Health Benefits for Certain Annuitants Subtitle I: Miscellaneous Provisions Title III: Long-Term Care Subtitle A: Tax Treatment of Long-Term Care Insurance Subtitle B: Protection of Assets Under Medicaid Through Use of Qualified Long-Term Care Insurance Subtitle C: Studies Subtitle D: Volunteer Service Credit Demonstration Projects Affordable Health Care Now Act of 1993 - Title I: Improved Access to Affordable Health Care - Subtitle A: Increased Availability and Continuity of Health Coverage for Employees and Their Families - Part 1: Required Coverage Options for Eligible Employees, Spouses, and Dependents - Requires each employer to make available to each eligible employee a group health plan under which: (1) coverage of each eligible individual with respect to such employee may be elected on an annual basis; (2) coverage is provided for at least the required coverage specified; and (3) employees may elect to have premiums collected through payroll deduction. Does not require employer contributions to the cost of coverage under such a plan. Provides for the exclusion of: (1) employers who have been employers for less than two years or who have no more than two eligible employees or no more than two eligible employees not covered under any group health plan; and (2) family members under specified circumstances. Specifies that a group health plan shall not be treated as failing to meet the requirements of this Act solely because a period of service by an eligible employee of not more than 60 days is required for coverage. Specifies that the required coverage is standard coverage, except that in the case of a small employer that has not contributed during the previous plan year to the cost of coverage for any eligible employee under any group health plan, the required coverage for the plan year is coverage under a MedAccess standard, MedAccess catastrophic, and MedAccess medisave plan. Provides for a five-year transition for existing group health plans. (Sec. 1002) Sets forth provisions regarding: (1) compliance with applicable requirements through multiple employer health arrangements; and (2) coverage options under a State medical health allowance program. Part 2: Preexisting Conditions and Continuity of Coverage; Renewability - Prohibits a group health plan from imposing (and an insurer from requiring an employer from imposing through a waiting period for coverage under a plan or similar requirement) a limitation or exclusion of benefits relating to treatment of a preexisting condition if: (1) the condition relates to a condition that was not diagnosed or treated within three months before the date of coverage under the plan; or (2) the limitation or exclusion extends over more than six month after the date of coverage, applies to an individual who, as of the date of birth, was covered under the plan, or relates to pregnancy. Specifies that, in the case of an individual who is eligible for coverage under a plan but for a waiting period imposed by the employer, the individual shall be treated as having been covered under the plan as of the earliest date of the beginning of the waiting period. (Sec. 1012) Requires each group health plan to waive any period applicable to a preexisting condition for similar benefits with respect to an individual to the extent that the individual, prior to enrollment in such plan, was covered for the condition under any other health plan. (Sec. 1013) Prohibits: (1) a multiemployer plan and an exempted multiple employer health plan from canceling or denying renewal of coverage under such a plan for an employer other than for nonpayment of contributions, fraud or other misrepresentation, noncompliance with plan provisions, or misuse of a provider network provision, or because the plan is ceasing to provide any coverage in a geographic area; (2) an insurer from canceling a health insurance plan or denying renewal of coverage other than as prescribed above; and (3) an insurer who terminates the offering of health insurance plans in an area from offering such a plan to any employer in the area until five years after the date of the termination. Part 3: Enforcement; Effective Dates; Definitions - Makes provisions of the Employee Retirement Income Security Act of 1974 applicable with respect to enforcement of this Act (by the Department of Labor). Amends the Internal Revenue Code (Code) to impose a tax ($100 per day for each individual involved, subject to specified limitations) on the failure of an insurer to comply with the requirements under part 2 unless the Secretary of Health and Human Services (Secretary) determines that the State has in effect a regulatory enforcement mechanism that provides adequate sanctions. Subtitle B: Reform of Health Insurance Marketplace for Small Business - Requires each insurer that makes available a health insurance plan to a small employer in a State to make available to each small employer in the State a MedAccess standard, MedAccess catastrophic, and MedAccess medisave plan, with exceptions for health maintenance organizations (HMOs) and if a State provides for guaranteed availability (rather than guaranteed issue). Requires each insurer that offers a MedAccess plan to a small employer in a State to accept: (1) every small employer in the State that applies for coverage; and (2) every eligible individual who applies for enrollment on a timely basis. Sets forth provision regarding: (1) special rules for HMOs; (2) timely enrollment requirements; and (3) enrollment of spouses and dependents. Makes such requirements inapplicable in a State that has provided (in accordance with specified standards) a mechanism under which each insurer offering a health insurance plan to a small employer in the State must participate in a program for assigning high-risk small employer groups (or individuals within such a group) among some or all such insurers, if the insurers comply. (Sec. 1102) Defines "MedAccess plan" as a health insurance plan that: (1) is designed to provide standard coverage with substantial cost-sharing, only catastrophic coverage, or medisave coverage; (2) includes only essential and medically necessary services; (3) meets applicable requirements relating to guaranteed issue; and (4) meets specifies consumer protection standards. Defines "MedAccess standard plan," "MedAccess catastrophic plan," and "MedAccess medisave plan" to mean a MedAccess plan that provides for at least standard coverage, for only catastrophic coverage, or medisave coverage, respectively. Requests the National Association of Insurance Commissioners (NAIC) to submit to the Secretary a set of rules which NAIC determines is sufficient for determining, in the case of any health insurance plan and for purposes of this subtitle, the actuarial value of the coverage offered by the plan. Directs the Secretary to certify such set of rules for use under this subtitle if they meet such requirements or establish such a set of rules. Specifies that a health insurance plan is considered to provide: (1) standard coverage if the benefits are determined, in accordance with certified rules of actuarial equivalence, to have a value that is within five percentage points of an established target actuarial value for standard coverage; (2) catastrophic coverage if benefits are available under the plan for a year only to the extent that expenses for covered services in a year exceed a deductible amount that is consistent with a specified requirement for a catastrophic health plan under the Code, and are determined, in accordance with certified actuarial equivalence rules, to have a value that is within five percentage points of an established target actuarial value for catastrophic coverage; and (3) medisave coverage if such plan consists of a catastrophic health plan within the meaning of the Code and a medical savings account. Requests NAIC to submit to the Secretary target actuarial values for standard and catastrophic coverage. Permits NAIC to submit periodic revisions of, and permits the Secretary to revise, the set of rules of actuarial equivalence and target actuarial values where necessary to take into account changes in the relevant types of health benefits provisions, in deductible levels for catastrophic coverage, or in relevant demographic conditions. (Sec. 1103) Directs the Secretary to request NAIC to develop model regulations that specify standards with respect to requirements: (1) that insurers make available MedAccess plans; (2) of guaranteed availability of MedAccess plans to small employers; (3) relating to limits on premiums and certain consumer protections; and (4) relating to limitation of annual premium increases. Requires the Secretary to review such standards and, if NAIC fails to specify standards meeting such requirements, to promulgate standards. Sets forth provisions regarding: (1) the application of MedAccess standards and consumer protection standards by the States; and (2) the Federal role. (Sec. 1104) Sets forth provisions: (1) regarding limits on premiums and annual premium increases; and (2) requiring an insurer, at the time of offering a health insurance plan to a small employer, to fully disclose rating practices for health insurance plans, including rating practices for different populations and benefit designs. (Sec. 1106) Directs the Secretary to: (1) request NAIC to develop models for reinsurance or allocation of risk mechanisms for health insurance plans made available to small employers for whom an insurer is at risk of incurring high costs under the plan; and (2) review such models or specify models. Sets forth provisions regarding implementation of reinsurance or allocation of risk mechanisms by the States and the Federal role. Amends the Code to provide for the imposition of a tax on any health insurance plan which covers any employee in a Federal reinsurance State. (Sec. 1108) Directs the Secretary to establish an Office of Private Health Care Coverage. Requires the Office Director to submit to the Congress annual reports evaluating health care coverage reform. (Sec. 1109) Authorizes the Director to conduct: (1) research on the impact of this subtitle on the availability of affordable health coverage for employees and dependents in the small employers group health care coverage market and other specified topics; and (2) demonstration projects relating to such topics. Requires the Director to develop: (1) methods for measuring the relative health risks of eligible individuals in terms of the expected costs of providing benefits under health insurance plans and, in particular, MedAccess plans; and (2) a model for equitably distributing health risks among insurers in the small employer health care coverage market. Authorizes appropriations. Subtitle C: Preemption - Part 1: Scope of State Regulation - Prohibits: (1) State benefit mandates for group health plans; and (2) State or local law prohibitions against two or more employers obtaining coverage under an insured multiple employer health plan. (Sec. 1203) Preempts State restrictions concerning: (1) reimbursement rates or selective contracting; (2) differential financial incentives; and (3) utilization review methods. Directs the Comptroller General to conduct a study of the benefits and cost effectiveness of the use of managed care in the delivery of health services. Part 2: Multiple Employer Health Benefits Protections - Amends the Employee Retirement Income Security Act of 1974 (ERISA) to allow a limited exemption under preemption rules for multiple employer plans providing health benefits subject to certain Federal standards. (Sec. 1212) Relieves exempted multiple employer plans providing medical care benefits of certain restrictions on preemption of State law. Treats such plans as employee welfare benefit plans. Allows commencement of new arrangements only if such exemption is in effect or an application is pending and the Secretary of Labor determines that provisional protection is appropriate. Sets forth exemption procedures, eligibility requirements, and additional requirements applicable to exempted arrangements. Requires certain disclosures to participating employers, maintenance of reserves, and corrective actions. Provides for expiration, suspension, and revocation of exemptions, and for review of actions by the Secretary. (Sec. 1213) Revises provisions relating to scope of preemption rules, and to treatment of single employer arrangements and of certain collectively bargained arrangements. (Sec. 1215) Establishes special rules for employee leasing healthcare arrangements. Treats such arrangements as multiple employer welfare arrangements except when they are multiple employer health plans. (Sec. 1216) Sets forth enforcement provisions relating to multiple employer welfare arrangements and employee leasing health care arrangements. (Sec. 1217) Sets forth filing requirements for multiple employer welfare arrangements. (Sec. 1218) Provides for cooperation between Federal and State authorities in enforcing ERISA requirements for multiple employer welfare arrangements with the limited exemption. Part 3: Encouragement of Multiple Employer Arrangements Providing Basic Health Benefits - Amends the Internal Revenue Code to eliminate the commonality of interest or geographic location requirement for tax exempt trust status for multiple employer health plans and insured multiple employer health plans if they meet certain requirements under ERISA and this Act. Part 4: Simplifying Filing of Reports for Employers Covered under Insured Multiple Employer Health Plans - Amends ERISA to direct the Secretary of Labor to prescribe an alternative method providing for a single annual report with respect to all employers who are covered under the same insured multiple employer health plan. Part 5: Compliance with Coverage Option Requirements - Provides for compliance with applicable coverage requirements through multiemployer plans and other multiple employer health arrangements. Subtitle D: Health Deduction Fairness - Amends the Internal Revenue Code to provide: (1) for a permanent extension and increase in the health insurance tax deduction for self-employed individuals; and (2) that the deduction for certain health insurance costs be determined without regard to an adjusted gross income threshold. Disallows the deduction to individuals eligible for employer-subsidized coverage. Allows the deduction whether or not the individual itemizes other deductions. Subtitle E: Improved Access to Community Health Services - Part 1: Increased Authorization for Community and Migrant Health Centers - Directs the Secretary to provide for grants to migrant and community health centers to promote primary health care services for underserved individuals. Allows grants to be used to promote the provision of off-site services, to improve birth outcomes in areas with high infant mortality and morbidity, to establish primary care clinics in areas in need, and for recruitment and training costs of necessary providers and operating costs for unreimbursed services. Authorizes appropriations. Directs the Secretary to conduct a study of the impact of such grants on access to health care, birth outcomes, and the use of emergency room services. Part 2: Grants for Projects for Coordinating Delivery of Services - Amends the Public Health Service Act to authorize the Secretary to make grants to public and nonprofit private entities: (1) to carry out demonstration projects to increase access to outpatient primary health services in specified geographic areas (i.e., areas that are rational areas for the delivery of health services, have a population of not more than 500,000 individuals, and have been designated by the Secretary as areas with a shortage of personal health services or that have a significant number of individuals with low incomes or insufficient health care insurance through coordinating the delivery of such services under Federal, State, local, and private programs; and (2) for developing plans to carry out such projects. Authorizes appropriations. Subtitle F: Improved Access to Rural Health Services - Part 1: Establishment of Rural Emergency Access Care Hospitals Under Medicare - Amends title XVIII (Medicare) of the Social Security Act (SSA) to provide for: (1) establishment of rural emergency access care hospitals under Medicare; and (2) coverage of and payment for rural emergency access care hospital services under Medicare part B (Supplementary Medical Insurance). Part 2: Rural Medical Emergencies Air Transport - Amends the Public Health Service Act to direct the Secretary to make grants to States to assist in the creation or enhancement of air medical transport systems that provide victims of medical emergencies in rural areas with access to treatments. Sets forth provisions regarding: (1) application and State plan requirements; (2) considerations in awarding grants; (3) State administration and use of grants; (4) the number of grants; and (5) reporting requirements. Authorizes appropriations. Part 3: Emergency Medical Services Amendments - Amends the Public Health Service Act to direct the Secretary to: (1) establish an Office of Emergency Medical Services, headed by a Director; (2) engage in specified emergency medical services activities, including disseminating information obtained in carrying out specified activities to public and private entities, providing technical assistance to State and local agencies, coordinating Department of Health and Human Services (DHHS) activities with those of other Federal agencies; and (3) ensure that such activities are carried out consistent with certain requirements regarding maintaining an adequate number of health professionals with expertise in the provision of services, developing, periodically reviewing, and revising as appropriate guidelines for the provision of such services, appropriately using available technologies, and serving the unique needs of underserved inner-city and rural areas. (Sec. 1522) Authorizes the Secretary to make grants to States for the purpose of improving the availability and quality of emergency medical services through the operation of State offices of emergency medical services, subject to specified matching fund, budgetary, and other requirements. (Sec. 1523) Provides for demonstration projects to establish telecommunications between rural medical facilities and medical facilities with expertise or equipment. Directs the Secretary to ensure that the telecommunications technologies demonstrated include interactive video telecommunications, static video imaging transmitted through the telephone system, and facsimiles transmitted through such system. (Sec. 1524) Authorizes appropriations for: (1) emergency medical services (including for State offices of Emergency Medical Services and for telecommunications demonstrations); and (2) trauma care and certain other activities. Subtitle G: State Flexibility in the Medicaid Program: The Medical Health Allowance Program - Amends SSA title XIX (Medicaid) to provide for the establishment of State health allowance programs under which the State makes payments to a group health plan which provides coverage to an eligible individual as an allowance towards the costs of providing the individual with benefits under the plan. Subtitle H: Medicaid Program Flexibility - Amends SSA title XIX Medicaid) to modify: (1) Federal requirements to allow States more flexibility in contracting for coordinated care services under Medicaid; and (2) provisions regarding the extension of certain waivers. Title II: Health Care Cost Containment and Quality Enhancement - Subtitle A: Medical Malpractice Liability Reform - Part 1: General Provisions - Makes this subtitle applicable with respect to any medical malpractice liability claim and to any medical malpractice liability action brought in State or Federal court, except a claim or action for damages arising from a vaccine-related injury or death to the extent that title XXI of the Public Health Service Act applies. Sets forth provisions regarding: (1) preemption of State law; (2) effect on sovereign immunity and choice of law or venue; (3) jurisdiction; and (4) effective dates. Part 2: Medical Malpractice and Product Liability Reform - Prohibits a medical malpractice liability action from being brought in any State court during a calendar year unless the relevant claim has been initially resolved (i.e., a decision has been reached on whether the defendant is liable to the plaintiff for damages and on the amount of damages) under a certified alternative dispute resolution (ADR) system or an alternative Federal system. Prohibits a medical malpractice liability action from being brought in Federal court based on diversity of citizenship during a calendar year unless the relevant claim has been initially resolved under such a system in the State whose law applies. Directs the Attorney General to establish an ADR process for tort claims consisting of medical malpractice liability claims brought against the United States under chapter 171 of the Federal judicial code (U.S. Court of Federal Claims). Prohibits a medical malpractice liability action based on such a claim from being brought in any Federal court unless the claim has been initially resolved under such process. Sets forth procedures for filing actions. (Sec. 2012) Limits to $250,000 the amount of noneconomic damages that may be awarded to a claimant and family members in a medical malpractice liability action. Sets limits on punitive damages and on periodic payments for future losses. (Sec. 2013) Set forth provisions regarding: (1) limits on attorney fees and other costs; (2) joint and several liability (generally, liability may be found only for those damages directly attributable to the person's proportionate share of fault or responsibility for the injury); (3) a statute of limitations of seven years; and (4) a uniform standard for determining negligence (the defendant's conduct at the time of providing the health care services was not reasonable). (Sec. 2017) Specifies that in the case of a medical malpractice liability claim relating to services provided during labor or the delivery of a baby, if the health care professional did not previously treat the injured individual for the pregnancy, the trier of fact may not find that the defendant committed malpractice nor assess damages unless the malpractice is proven by clear and convincing evidence. Part 3: Requirements for State Alternative Dispute Resolution Systems - Lists requirements for State ADR systems, including that such a system: (1) applies to all medical malpractice liability claims under the jurisdiction of the courts of that State; (2) requires that a written opinion resolving the dispute be issued within six months after each party against whom the claim is filed has received notice of the claim; (3) is approved by the State or local governments; (4) provides for the transmittal to the State agency responsible for monitoring or disciplining health care professionals and providers of any findings of malpractice; and (5) provides for the regular transmittal of information on disputes resolved under the system to the Administrator for Health Care Policy and Research in a manner that protects the identity of the parties involved. (Sec. 2032) Directs the Secretary, by October 1 of each year, to certify State ADR systems that meet such requirements. Directs the Secretary to establish an alternative Federal ADR system for the resolution of medical malpractice liability claims in States that do not have in effect a certified ADR system. (Sec. 2033) Directs the Secretary, within five years, to submit to the Congress a report describing and evaluating State ADR systems and the alternative Federal system, including: (1) information on the effect of the ADR systems on health care costs, access to health care, and quality of care provided within the State; and (2) to the extent that such report does not provide information on no-fault systems operated by States as ADR systems, an analysis of the feasibility and desirability of establishing a system for resolving medical malpractice liability claims on a no-fault basis. Part 4: Other Provisions Relating to Medical Malpractice Liability - Authorizes a State agency responsible for disciplinary actions for a type of health care practitioner to enter into agreements with State or county professional societies to permit their participation in the licensing of such practitioner and to review any health care malpractice action, claims, or allegation, or other information concerning the practice patterns of any such practitioner. Sets forth agreement requirements. (Sec. 2042) Directs the Secretary to study incentives adopted by State and local governments, insurers, medical societies, and other entities to encourage physicians to volunteer to provide health care services in medically underserved areas. (Sec. 2043) Directs each State to require: (1) each health care professional and health care provider to participate in a risk management program to prevent, and provide early warning of, practices which may result in injuries to patients or endanger patient safety; and (2) each provider of health care professional and provider liability insurance in the State to establish risk management programs or sanction programs of risk management for health care professionals and providers provided by other entities, and require each such professional or provider, as a condition of maintaining insurance, to participate in one such program at least once in each three-year period. (Sec. 2044) Directs the Secretary to make grants: (1) for basic research in the prevention of, and compensation for, injuries resulting from health care professional or provider malpractice and for research of the outcomes of health care procedures; (2) to the States to assist in improving their ability to license and discipline health care professionals; and (3) to States and local governments, private nonprofit organizations, and health professional schools for educating the general public about the appropriate use of health care, realistic expectations of medical intervention, and the resources and role of health care professional licensing and disciplinary boards in investigating claims of incompetence or health care malpractice, and for developing programs of faculty training and curricula for educating health care professionals in quality assurance, risk management, and medical injury prevention. Authorizes appropriations. Subtitle B: Administrative Cost Savings - Part 1: Standardization of Claims Processing - Directs the Secretary to adopt standards relating to: (1) data elements for use in paper and electronic claims processing under health benefit plans and in utilization review and management of care; (2) uniform claims forms; and (3) uniform electronic transmission of the data elements. (Sec. 2102) Authorizes the Secretary, two years after standards are adopted for classes of services upon determining that a significant number of claims for benefits for such services under health benefit plans are not being submitted in accordance with such standards, to require that all providers of such services submit claims to health benefit plans in accordance with such standards. (Sec. 2103) Directs the Secretary to: (1) provide for the ongoing receipt and review of comments and suggestions for changes in the standards adopted and promulgated; (2) establish a schedule for the periodic review of such standards; and (3) revise such standards. Part 2: Electronic Medical Data Standards - Directs the Secretary to promulgate standards for hospitals concerning electronic medical data, including standards for transmission of such data and confidentiality of patient-specific information. Authorizes the Secretary to periodically revise such standards. (Sec. 2112) Sets forth requirements with respect to: (1) the sharing of hospital information under Medicare; (2) waiver of such requirements; and (3) application of such requirements to hospitals of the Department of Veterans Affairs. (Sec. 2113) Authorizes the head of a Federal agency to require a provider to present and transmit a required data element electronically in accordance with applicable presentation or transmission standard. (Sec. 2114) Sets forth limitations on data requirements where standards with respect to data elements are in effect. (Sec. 2115) Directs the Secretary to establish an advisory commission on the standards established under this part and operational concerns about the implementation of such standards. Authorizes appropriations. Part 3: Development and Distribution of Comparative Value Information - Directs the Secretary to determine whether each State is developing and implementing a health care value information program that meets specified criteria and a specified schedule. Authorizes the Secretary to: (1) make grants to enable each State to plan development and initiate implementation of its health care value information program; and (2) recover the amount of such a grant by offset against any other amount payable to the State under the Social Security Act under specified circumstances. Authorizes appropriations. (Sec. 2122) Directs the Secretary to take actions necessary to implement a comparable program in a State that fails to develop or implement a health care value information program in accordance with such criteria and schedule. Authorizes the Secretary to charge fees for the information materials provided pursuant to such a program. (Sec. 2123) Directs the head of each Federal agency with responsibility for the provision of health insurance or health care services to individuals to develop health care value information relating to each program that such head administers and covering the same types of data that a State program meeting such criteria would provide. (Sec. 2124) Directs the Secretary to: (1) develop model systems to facilitate the gathering of data on health care cost, quality, and outcome and the analysis of such data in a manner that will permit the valid comparison of such data among providers and among health plans; (2) support experimentation with different approaches to achieve such objectives in the most cost effective manner; and (3) evaluate the various methods to determine their relative success. Authorizes the Secretary to establish standards for the collective and reporting of data on health care cost, quality, and outcomes. Authorizes appropriations. Part 4: Additional Standards and Requirements; Research and Demonstrations - Directs the Secretary to: (1) adopt standards relating to the design and use of magnetized Medicare identification cards to assist health care providers in determining whether individuals are eligible for benefits for provided services under the Medicare program and in billing the Medicare program for covered services; (2) take steps to encourage and assist States in the design and use of magnetized Medicaid identification cards under their Medicaid plans; and (3) establish a Medicare and Medicaid information system to provide information on group health and other health benefit plans that are primary payors to the Medicare and Medicaid programs. Authorizes appropriations. (Sec. 2132) Specifies that, effective January 1, 1994, no effect shall be given to any provision of State law that requires medical or health insurance records (including billing information) to be maintained in written, rather than electronic, form. (Sec. 2133) Requires, effective January 1, 1995, each health benefit plan: (1) to use a beneficiary's social security number as the personal identifier for claims processing and related purposes (authorizes the Secretary to impose a civil money penalty on any plan that fails to do so); and (2) to use the unique identifier under title XVIII of the Social Security Act (Medicare) for a provider that furnishes health care items or services to a beneficiary under the plan as the identifier of that provider for claims processing and related purposes. (Sec. 2134) Directs the Secretary to: (1) determine, where benefits are payable under two or more health benefit plans, whether problems relating to the rules for determining the liability of plans or the availability of information among plans causes significant administrative costs; and (2) promulgate standards, if the implementation of standards would significantly reduce such administrative costs. Authorizes the Secretary to impose a civil money penalty on plans that fail to comply with such standards. (Sec. 2135) Directs the Secretary to provide grants to qualified entities for research on the application of comprehensive information systems in continuously monitoring and improving patient care. Authorizes the Secretary to make grants to: (1) two to five community organizations or coalitions of health care providers, health benefit plans, and purchasers to establish and document the efficacy of communication links between the information systems of health benefit plans and of health care providers; (2) two to five public or private nonprofit entities for the development of regional or community-based clinical information systems; and (3) public or private nonprofit entities to develop and test the definition of a comprehensive set of data elements and the specification and manner of presentation of the individual data elements of the set, for electronic medical data generated by physicians and other entities (other than hospitals) that provide health care services. Authorizes appropriations. Subtitle C: Deduction for Cost of Catastrophic Health Plan; Medical Savings Account - Amends the Internal Revenue Code to include under the medical expense deduction the portion of such expense attributable to coverage under a catastrophic health plan. (Sec. 2202) Allows individuals a tax deduction for percentage of contributions made to a medical care savings account established for the benefit of an eligible individual. Allows such deduction whether or not an individual itemizes deductions. Disallows distributions from such accounts as medical expense deductions. Excludes employer contributions to such accounts from employment taxes. Establishes an excise tax for excess contributions to medical care savings accounts. Subtitle D: Anti-Fraud - Part 1: Criminal Prosecution of Health Care Fraud - Amends the Federal criminal code to: (1) set penalties for health care providers who knowingly engage in any scheme or artifice to defraud any person in connection with the provision of health care; and (2) make activity which, if engaged in by the U.S. Postal Service, would be a violation of mail fraud provisions punishable to the same extent with respect to private or commercial interstate carriers. (Sec. 2303) Authorizes appropriations to hire, equip, and train no fewer than: (1) 225 special agents of the Federal Bureau of Investigation and support staff to investigate health care fraud cases; (2) 50 assistant United States Attorneys and support staff to prosecute such cases; and (3) 25 investigators in the Office of Inspector General, DHHS, to be devoted exclusively to health care fraud cases. (Sec. 2304) Amends the Federal criminal code to authorize the Attorney General to make payments of up to $10,000 to a person who furnishes information unknown to the Government relating to a possible prosecution of health care fraud, subject to specified requirements and exceptions. Part 2: Coordination of Health Care Anti-Fraud and Abuse Activities - Directs the Secretary to establish in the Office of the Inspector General of DHHS a program (all-payer fraud and abuse control program) to: (1) coordinate Federal, State, and local law enforcement programs to control fraud and abuse with respect to the delivery of, and payment for, health care in the United States; (2) conduct investigations, audits, evaluations, and inspections relating to such delivery and payment; and (3) facilitate the enforcement of provisions of the Social Security Act and other statutes applicable to health care fraud and abuse. Directs the Secretary to establish standards to carry out such program, including standards relating to the furnishing of information by health insurers, providers, and other to enable the Secretary to carry out the program and procedures to assure that such information is provided and utilized in a manner that protects the confidentiality of the information and the privacy of individuals receiving health care services. Sets forth provisions regarding: (1) qualified immunity for providing information; (2) ensuring access to documentation; and (3) failure to comply as grounds for exclusion from the Medicare and Medicaid programs. (Sec. 2312) Authorizes additional appropriations to enable the Secretary to conduct investigations of allegations of health care fraud and to carry out the all-payor fraud and abuse control program. (Sec. 2313) Establishes in the Treasury an Anti-Fraud and Abuse Trust Fund to be used to assist the Inspector General of DHHS in carrying out the all-payor fraud and abuse control program in the fiscal year involved. Sets forth provisions regarding: (1) the deposit into the Fund of Federal health anti-fraud and abuse penalties; and (2) the use of such penalties to repay beneficiaries for cost-sharing. (Sec. 2314) Amends SSA title XI to provide for the application of Federal health anti-fraud and abuse sanctions to all fraud and abuse against private health benefit plans. Subtitle E: Medicare Payment Changes; Part B Premium Tax for High-Income Individuals: Part 1 - Medicare Payment Changes - Amends SSA title XVIII to: (1) eliminate the membership limitation for Medicare health maintenance organizations; and (2) revise the Medicare select policy program and provide for a civil money penalty for misrepresentations made in connection with a Medicare select policy. (Sec. 2402) Amends the Omnibus Budget Reconciliation Act of 1990 to: (1) make permanent the Medicare select policy program; and (2) allow access to Medicare select policies in all States. (Sec. 2403) Directs the Secretary of Health and Human Services to take such steps as may be necessary to consolidate the administration of Medicare parts A and B. Part 2: Part B Premium Tax for High-Income Individuals - (Sec. 2411) Amends the Internal Revenue Code to impose a tax on the Medicare part B premiums of high income individuals. Subtitle F: Removing Anti-Trust Impediments - Directs the Attorney General to promulgate guidelines under which a health care joint venture may submit an application requesting that the Attorney General provide the entities participating in the venture with an exemption under which: (1) monetary recovery on an antitrust claim brought against the entity shall be limited to actual damages if specified conditions are met; and (2) the conduct of the entity in making or performing a contract to carry out the venture shall not be deemed illegal per se. Requires the Attorney General to approve or disapprove the application within a specified time frame and to provide a statement explaining the reasons for any disapproval. Directs the Attorney General to approve the application if an entity participating in the venture submits to the Attorney General an application that contains the identities of the parties to the venture; the nature, objectives, and planned activities of the venture; and specified assurances and information. Sets forth provisions regarding: (1) revocation and renewal of exemptions and withdrawal of an application; (2) requirements relating to notice and publication of exemptions; and (3) issuance of health care certificates of public advantage to each eligible health care joint venture that complies with specified requirements. Establishes the Interagency Advisory Committee on Competition, Antitrust Policy, and Health Care to: (1) discuss and evaluate competition and antitrust policy and their implications regarding the performance of health care markets; (2) analyze the effectiveness of health care joint ventures receiving exemptions in reducing costs and expanding access; and (3) make recommendations to the Congress. Subtitle G: Encouraging Enforcement Activities of Medical Self-Regulatory Entities - Part 1: Application of the Clayton Act to Medical Self-Regulatory Entities - Provides that no damages, cost of suit, or attorney fee may be recovered under section 4, 4A, or 4C of the Clayton Act, or under any similar State law, except by a State or the United States, from any medical self-regulatory entity as a result of engaging in standard setting or enforcement activities that are: (1) designed to promote the quality of health care provided to patients; and (2) not conducted for purposes of financial gain. Directs the court to award the cost of such a suit, including a reasonable attorney fee, to a substantially prevailing defendant. Part 2: Consultation by Federal Agencies - Requires any Federal agency engaged in the establishment of medical profession standards to consult with appropriate medical societies or associations, specialty boards, or recognized accrediting agencies, if available, in carrying out medical professional standard setting and guidelines or standards relating to the practice of medicine. Subtitle H: Prefunding Government Health Benefit for Certain Annuitants - Requires that certain agencies prefund Government health benefits contributions for their annuitants. Subtitle I: Miscellaneous Provisions - Amends Civil Service and Federal Employees' Retirement Systems law to increase the minimum age required to be eligible for an immediate retirement annuity. Provides for the conformance of other Federal retirement systems with the minimum age increase made above. Title III: Long-Term Care - Subtitle A: Tax Treatment of Long-Term Care Insurance - Amends the Internal Revenue Code to provide for the treatment of qualified long-term care insurance as accident and health insurance for purposes of insurance company taxation. (Sec. 3002) Excludes from gross income benefits provided under a long-term care insurance contract. Includes in gross income employer-provided coverage for long-term care services. (Sec. 3003) Includes amounts paid for qualified long-term care services as medical expenses for individual itemized deductions. Includes any parent or grandparent as a dependent for purposes of such expenses. (Sec. 3004) Provides for the nonrecognition of gain or loss on the exchange of any life insurance contract or an endowment or annuity contract for a long-term care insurance contract. (Sec. 3005) Excludes from gross income certain amounts withdrawn from individual retirement accounts and certain employer cash or deferred arrangement to pay long-term care premiums. (Sec. 3006) Allows insurance companies to issue accelerated death benefit riders on life insurance contracts. Subtitle B: Protection of Assets Under Medicaid Through Use of Qualified Long-Term Care Insurance - Amends SSA title XIX to require State Medicaid plans to disregard some or all of the individual's assets attributable to coverage under a qualified long-term care insurance contract in determining the individual's eligibility for long-term care services. Subtitle C: Studies - Requires the Comptroller General to study the feasibility of: (1) encouraging health care providers to donate their services to homebound patients; and (2) providing heads of households who care for elderly family members in their home with an income tax credit. (Sec. 3203) Requires the Secretary of Health and Human Services to study and report to the Congress on the feasibility of encouraging or requiring the use of a single designate public or nonprofit agency to coordinate, through case management, the provision of long-term care benefits under current Federal, State, and local programs in a geographic area. Subtitle D: Volunteer Service Credit Demonstration Projects - (Sec. 3301) Amends the Older Americans Act of 1965 to require the Commissioner of the Administration on Aging to establish and operate a volunteer service credit demonstration project in each State.

Managed Competition Act of 1993

United States · United States Congress · 6 October 1993

TABLE OF CONTENTS: Title I: Managed Competition in Employer-Based Health Plans: Incentives to Control Costs Subtitle A: Use of Tax Incentives to Purchase Cost-Effective Plans Subtitle B: Health Plan Purchasing Cooperatives (HPPCs) Subtitle C: Accountable Health Plans (AHPs) Subtitle D: Health Care Standards Commission Subtitle E: Managed Competition in Rural and Urban Underserved Areas Subtitle F: Treatment of Chronically Underserved Areas Subtitle G: Repeal of COBRA Continuation Requirements Subtitle H: Definitions Title II: Low-Income Assistance for Health Coverage Subtitle A: Low-Income Assistance Subtitle B: Long-Term Care Phase-Down Assistance to States Subtitle C: Financing Subtitle D: Repeal of Medicaid Program Title III: Training and Education of Health Care Professionals Subtitle A: Reform of Federal Funding for Medical Residency Training Subtitle B: Other Medical Education Grants and Programs Title IV: Preventive Health and Individual Responsibility Subtitle A: Expansion of Public Health Programs Subtitle B: Medicare Title V: Malpractice Reform Subtitle A: Findings; Purpose; Definitions Subtitle B: Uniform Standards for Malpractice Claims Subtitle C: Requirements for State Alternative Dispute Resolution Systems (ADR) Subtitle D: Grants to States for Development of Practice Guidelines Title VI: Paperwork Reduction and Administrative Simplification Title VII: Additional Benefits On a Pay-As-You-Go Basis Managed Competition Act of 1993 - Title I: Managed Competition in Employer-Based Health Plans: Incentives to Control Costs - Subtitle A: Use of Tax Incentives to Purchase Cost-Effective Plans - Amends the Internal Revenue Code to impose a tax on the excess health plan expenses of any employer which are health plan expenses exceeding specific limits under an accountable health plan for a defined geographical area. (Sec. 1002) Increases to 100 percent and makes permanent the deduction for health plan premium expenses of self-employed individuals. (Sec. 1003) Permits the deduction for medical, dental, etc. expenses without regard to the limitation on such deduction with respect to amounts paid for premiums under an accountable health plan. (Sec. 1004) Provides for the exclusion from gross income of contributions by a partnership or S corporation to a health plan covering partners or shareholders. (Sec. 1006) Eliminates the commonality of interest and geographic location requirements with respect to group purchasing by large tax-exempt organizations. Subtitle B: Health Plan Purchasing Cooperatives (HPPCs) - Provides for the establishment of Health Plan Purchasing Cooperatives (HPPCs). Considers each State to be a HPPC, except that a State may subdivide into HPPC areas, and that there may be interstate HPPCs, as specified. Requires HPPCs to enter into agreements with accountable health plans and small employers, offer enrollment in accountable health plans, and charge premiums. Subtitle C: Accountable Health Plans (AHPs) - Directs the Health Care Standards Commission to provide a process whereby a health plan may be registered with the Commission by its sponsor as an accountable health plan. Sets forth requirements for a plan to be registered, including: (1) coverage for a specified uniform set of benefits, including cost-sharing for low-income individuals; (2) standard premiums for the uniform benefits; (3) grievance procedures; (4) collecting and providing specified information; (5) prohibiting discrimination in enrollment or benefits; and (6) financial solvency. (Sec. 1208) Sets forth additional requirements for open AHPs, which is any plan which is not closed. Defines a closed plan as one limited by structure or law to one or more large employers. (Sec. 1211) Requires each AHP to provide for payment of one percent of gross premium receipts to the National Medical Education Fund. (Sec. 1221) Sets forth provisions concerning the preemption of State laws for AHPs. (Sec. 1231) Directs the President to provide for the development and publication of guidelines on the application of Federal antitrust laws to AHPs. (Sec. 1232) Provides for the issuance of certificates of public advantage by the Attorney General to eligible health care joint ventures which, if followed, exempt such ventures from antitrust liability. Subtitle D: Health Care Standards Commission - Establishes, as an independent agency in the Executive Branch, a Health Care Standards Commission. Requires the Commission to transmit annually to the Congress recommendations for the uniform set of effective benefits. States that such recommendations shall apply unless the Congress passes a joint resolution of disapproval. (Sec. 1303) Directs the Commission to provide for the initial organization, as a nonprofit corporation, of the Benefits, Evaluations, and Data Standards Board in order to make recommendations to the Commission concerning the uniform set of effective benefits and matters related to the evaluation of health care services. (Sec. 1304) Directs the Commission to provide for the initial organization, as a nonprofit organization of the Health Plan Standards Board in order to make recommendations to the Commission concerning the standards for AHPs and concerning its assessment of risk-adjustment factors. (Sec. 1305) Sets forth provisions concerning the registration of AHPs. (Sec. 1306) Directs the Commission to establish rules for the process of risk-adjustment of premiums among AHPs by HPPCs. (Sec. 1307) Directs the Commission to publish information concerning procedures, their prices, and their quality. (Sec. 1309) Establishes, within the Department of Health and Human Services, the Agency for Clinical Evaluations which shall assume the responsibilities of the Director of the Office of Medical Applications of Research at the National Institutes of Health, the Director of the Office of Research and Demonstrations of the Health Care Financing Administration (insofar as such responsibilities relate to clinical evaluations), the Administrator for Health Care Policy and Research under title IX of the Public Health Service Act, as well as other specified responsibilities. Authorizes appropriations. (Sec. 1311) Prohibits the Commission from establishing or enforcing any controls on health care spending. (Sec. 1313) Authorizes appropriations for the Commission through FY 2000. Terminates the Commission on December 31, 1999. Subtitle E: Managed Competition in Rural and Urban Underserved Areas - Authorizes the Governor of any State to designate rural and urban areas of a State as underserved areas. Permits a HPPC serving such an area to require AHPs offered by the HPPC and with a service area adjoining such area to include the area as part of their service area. (Sec. 1411) Authorizes appropriations for: (1) technical assistance for entities seeking to establish a network plan in an underserved area; (2) financial assistance to eligible entities in order to provide for the development and implementation of AHPs in rural areas; and (3) under the Public Health Service Act, migrant health centers and community health centers. (Sec. 1422) Provides coverage under part B of title XVIII (Medicare) of the Social Security Act for rural emergency access care hospital services. (Sec. 1431) Directs the Secretary of Health and Human Services to make payments for transitional assistance to eligible hospitals. Requires any hospital accepting such assistance to provide a significant volume of services to persons unable to pay for services. Authorizes appropriations. Subtitle F: Treatment of Chronically Underserved Areas - Directs the Health Care Standards Commission to develop standards for the identification of chronically underserved areas. Makes provisions for addressing health care delivery in such areas. Subtitle G: Repeal of COBRA Continuation Requirements - Repeals the COBRA continuation requirements for group health plans and title XXII of the Public Health Service Act. Subtitle H: Definitions - Sets forth definitions for this title and title II. Title II: Low-Income Assistance for Health Coverage - Subtitle A: Low-Income Assistance - Provides premium assistance for very-low income individuals and moderately low-income individuals. Provides for nominal cost-sharing for such individuals and special assistance for certain items and services. Subtitle B: Long-Term Care Phase-Down Assistance to States - Provides for long-term care phase-down assistance to eligible States for each calendar quarter in 1995 through 1998. Subtitle C: Financing - Amends title XVIII (Medicare) of the Social Security Act to achieve savings under such program by: (1) reducing the update for inpatient hospital services; (2) reducing the conversion factor for the physician fee schedule for non-primary care services; and (3) reducing hospital outpatient services through establishing a prospective payment system. (Sec. 2204) Amends the Internal Revenue Code to impose a Medicare part B premium tax on higher-income individuals. (Sec. 2205) Achieves additional Medicare savings through the: (1) phased-in elimination of Medicare disproportionate share adjustment payments; (2) reduction of routine cost limits for home health services; (3) reduction in routine cost limits for extended care services; and (4) reductions in payments for hospice services. Subtitle D: Repeal of Medicaid Program - Repeals title XIX (Medicaid) of the Social Security Act. Title III: Training and Education of Health Care Professionals - Subtitle A: Reform of Federal Funding for Medical Residency Training - Directs the Health Care Standards Commission to approve a resident training position in medical residency program for purposes of funding approved medical residency training programs under this title. Provides funding, in addition, for physician retraining. Sets forth provisions concerning: (1) the allocation of entry positions among programs; and (2) the general distribution of positions among specialties. (Sec. 3004) Requires payment by AHPs of one percent of gross premium receipts to the National Medical Education Fund. Requires payments from the Medicare trust funds to the National Medical Education Fund. (Sec. 3005) Establishes the National Medical Education Fund. Subtitle B: Other Medical Education Grants and Programs - Authorizes appropriations under the Public Health Service Act for medical education programs, including: (1) the scholarship and loan repayment programs of the National Health Service Corps; (2) area education centers; (3) public health and preventive medicine; (4) family medicine; (5) general internal medicine and pediatrics; (6) physician assistants; (7) allied health projects grants and contracts; and (8) nurse practitioner and nurse midwife programs. Title IV: Preventive Health and Individual Responsibility - Subtitle A: Expansion of Public Health Programs - Authorizes appropriations under the Public Health Service Act for the following public health programs: (1) immunizations against vaccine-preventable diseases; (2) prevention, control, and elimination of tuberculosis; (3) lead poisoning prevention; (4) preventive health measures with respect to breast and cervical cancers; (5) the Office of Disease Prevention and Health Promotion; (6) the Office of Minority Health; (7) preventive health and health services block grant; (8) categorical grants for early intervention regarding acquired immune deficiency syndrome; and (9) programs of the Centers for Disease Control regarding the smoking of tobacco products. Directs the Office of Disease Prevention and Health Promotion to promote individual responsibility in personal health care and in the use of valuable health care resources. Subtitle B: Medicare - Provides Medicare coverage for: (1) screening fecal-occult blood tests and screening flexible sigmoidoscopies for the purpose of the early detection of cancer; (2) tetanus-diphtheria boosters; (3) well-child services; and (4) an annual screening mammography for women over age 64. Title V: Malpractice Reform - Subtitle A: Findings; Purpose; Definitions - Sets forth the findings, purpose, and definitions for this title. Subtitle B: Uniform Standards for Malpractice Claims - Prohibits bringing a medical malpractice liability action in a State court unless there has been an initial resolution under an alternative dispute resolution system. Limits the total noneconomic damages in such actions to $250,000. Sets limits on attorney's fees. Makes special provision for obstetric services. Subtitle C: Requirements for State Alternative Dispute Resolution Systems (ADR) - Establishes requirements for State alternative dispute resolution systems. Provides for grants to States to assist in implementation of such systems. Subtitle D: Grants to States for Development of Practice Guidelines - Directs the Secretary to make grants to States for the development of medical practice guidelines for health care professionals that may be applied to resolve medical malpractice liability claims. Title VI: Paperwork Reduction and Administrative Simplification - Preempts State quill pen laws. Ensures the confidential treatment of electronic health care information. Sets forth provisions which provide for: (1) the standardization of electronic health information; (2) uniform claims forms; (3) the liability of insurers when benefits are payable under two or more plans; and (4) the uniformity of the availability of information among health plans when benefits are payable under two or more plans. (Sec. 6007) Amends the Internal Revenue Code to impose a tax on a health plan not in compliance with specified requirements of this title. Title VII: Additional Benefits On a Pay-As-You-Go Basis - Expresses the sense of the Congress that additional benefits should be provided by the Federal Government to the extent that additional financing is made available on a pay-as-you-go basis.

Minority Health Opportunity Enhancement Act of 1993

United States · United States Congress · 6 October 1993

Minority Health Opportunity Enhancement Act of 1993 - Amends the Public Health Service Act to direct the Office of Minority Health to establish a center to carry out programs to improve access to health care services for individuals lacking proficiency in speaking English. Establishes an Office of Minority Health in specified agencies of the Public Health Service. Provides for equitable allocation of appropriations for certain health programs. Revises the factors to be considered in designating medically underserved populations and health professional shortage areas to include the percentage of members of racial or ethnic minority groups and the extent of cultural and language barriers. Authorizes appropriations for grants to migrant health centers and community health centers for programs to reduce the extent to which a lack of proficiency in English or other cultural factors constitutes a significant barrier to obtaining health services. Provides funding for the Centers of Excellence, activities of the Agency for Health Care Policy and Research, and certain activities of the National Center for Health Statistics. Requires such entities to spend a portion of such funding on ethnic and racial minorities. Authorizes appropriations for a demonstration project relating to Hispanics, African Americans, and other populations that are at significant risk of contracting diabetes mellitus.

Asylum Abuse Prevention and System Improvements Act of 1993

United States · United States Congress · 6 October 1993

Asylum Abuse Prevention and System Improvements Act of 1993 - Amends the Immigration and Nationality Act to impose criminal penalties upon any person who knowingly assists in fraudulent asylum applications for commercial advantage or private financial gain. Sets forth procedures for: (1) adjudicating political asylum claims; and (2) detention and release of asylum applicants. Directs the Attorney General to ensure that specified amounts are made available each fiscal year to the Central Asylum Office in the Executive Office of Immigration Review for adjudication implementation. Authorizes appropriations for additional Department of Justice asylum adjudication staff. Directs the Attorney General to report to certain congressional committees on the backlog in adjudicating asylum claims. Authorizes the Attorney General to use specified amounts from the Immigration Emergency Fund to manage large and sudden numbers of asylum applicants.

Improving America's Schools Act of 1994

United States · United States Congress · 4 October 1993

TABLE OF CONTENTS: Title I: Amendments to the Elementary and Secondary Education Act of 1965 Title II: Amendments to the General Education Provisions Act Title III: Amendments to Other Acts Improving America's Schools Act of 1993 - Title I: Amendments to the Elementary and Secondary Education Act of 1965 - Amends the Elementary and Secondary Education Act of 1965 (ESEA) to revise and reauthorize ESEA. (Sec. 101) Establishes a title I program for Helping Children in Need Meet High Standards, which revises and reauthorizes some of the current title I chapter 1 programs of Financial Assistance to Meet the Special Educational Needs of Children. Authorizes appropriations for: (1) grants under the basic program; (2) Even Start; (3) education of migratory children; (4) education for neglected or delinquent youth; (5) capital expenses; (6) school improvement; and (7) Federal activities. Requires any State desiring to receive a grant (under the basic program for making high-poverty schools work) to submit State plans that are integrated with that State's plan under the Goals 2000: Educate America Act or with other State plans under this Act. Requires each State plan to describe high-quality standards for all children that will be used by the State, it local educational agencies (LEAs), and its schools to carry out this Act, including challenging content standards in the core academic subjects and challenging performance standards, as well as assessment provisions and other teaching and learning support provisions. Directs the Secretary of Education to establish a process for peer review and Secretarial approval. Requires LEAs receiving subgrants to have plans with standards and assessments provisions and other teaching and learning support provisions. Provides for State approval and shared program responsibility of schools and the LEA in deciding on schoolwide programs and targeted assistance schools. Allows an LEA to only use basic program funds in eligible school attendance areas in which the percentage of children from low-income families is at least as high as that in the LEA as a whole. Sets forth formulas for ranking eligible school attendance areas for purposes of such funding in various cases where there are insufficient funds. Sets forth criteria which a school must meet in order for the LEA to use basic program funds to upgrade the entire educational program at an eligible school (schoolwide programs). Provides that in participating schools that are ineligible for a schoolwide program or that choose not to operate a schoolwide program, an LEA may use basic program funds only for targeted assistance programs that provide services to eligible children identified as having the greatest need for special assistance (targeted assistance schools). Sets forth criteria for eligible children at such schools. Sets forth requirements for parental involvement and for participation of children enrolled in private schools. Provides for assessment and school and district improvement, including local review, designation of Distinguished Schools, school improvement identification, State review and LEA improvement, State establishment of a corps of Distinguished Educators, and State allocations for school improvement. Revises formulas for allocations of funds. Revises Even Start Family Literacy Programs to increase program services and high-poverty-area targeting and include teenage parents. Revises Education of Migratory Children to restrict eligibility to children who have moved within the previous two years. Revises Education of Neglected and Delinquent Youth to require a 20-hour instructional week. Eliminates title I provisions for the National Commission on Migrant Education, rural technical assistance centers, current chapter 2 State block grants under the partnership for educational improvement, national diffusion network, and law-related education. Eliminates under title I, but provides elsewhere for, evaluation and technical assistance and blue ribbon schools. Provides, later in this Act, for programs for handicapped children to be combined with programs under the Individuals with Disabilities Education Act. Establishes a new ESEA title II, Improving Teaching and Learning, with a new part A, Dwight D. Eisenhower Professional Development Program, to support professional development of elementary and secondary school teachers in core academic subjects. (This replaces the current Dwight D. Eisenhower Mathematics and Science Education Act programs.) Gives priority for professional development in mathematics and science. Authorizes appropriations. Establishes a new title II part B, Support and Assistance for ESEA Programs. (This replaces the current Foreign Languages Assistance Act programs.) Includes under such technical assistance program comprehensive regional centers and technology-based technical assistance. Provides for information collection, evaluation, and transition. Authorizes appropriations. Establishes a new ESEA title III, Expanding Opportunities for Learning. (The current title III, Magnet Schools Assistance, is transferred to a new title V, Promoting Equity.) Authorizes appropriations for the following title III parts: (A) Putting Technology to Work for All Students, including educational technology research, development, and demonstration, an Office of Educational Technology, a national long-range plan, and Federal leadership, as well as a revised Star Schools Program; (B) a revised and renamed Fund for the Improvement of Education (currently under title IV as the Secretary's Fund for Innovation in Education); (C) a revised Jacob K. Javits Gifted and Talented Education Program (currently under title IV); (D) a new Charter Schools program to increase public school choice through grants for innovative programs and exemptions from regulations that limit school operational and management flexibility; (E) an expanded Arts in Education program; and (F) the Inexpensive Book Distribution Program. Establishes as ESEA title IV a Safe and Drug-Free Schools and Communities program, which replaces and revises the current title V Drug-Free Schools and Communities Act program. (The current title IV Special Programs are replaced as follows: (1) Women's Educational Equity, Gifted and Talented Children, Immigrant Education, and the Secretary's Fund for Innovation are transferred to other titles; and (2) Ellender Fellowships and certain Territorial Assistance are eliminated.) The new program includes: (1) State Grants for Drug and Violence Prevention Programs at State and local levels, including coordinating councils; (2) Postsecondary Drug and Violence Prevention Programs, including higher education institution grants and a national center; and (3) national programs. Establishes as ESEA title V, Promoting Equity, which authorizes appropriations for parts: (A) a revised Magnet Schools Assistance program; (B) a new Equalization Assistance program which provides technical and other assistance, including research, regarding school finance equity; and (C) a revised Women's Educational Equity program. Establishes a new ESEA title VI, Indian Education, which adds revised Indian Education Act programs to ESEA. (Eliminates the current title VI provisions for Projects and Programs Designed to Address School Dropout Problems and to Strengthen Basic Education.) Authorizes appropriations for the following title VI programs: (1) formula grants to LEAs; (2) discretionary programs to improve achievement of Indian children, through grants to Indian-controlled schools and demonstration grants; (3) professional development and adult education programs; (4) national activities and grants to States; and (5) Federal administration through the Office of Indian Education and the National Advisory Council on Indian Education. Revises ESEA title VII, Bilingual Education Programs, while transferring the Emergency Immigrant Education Program to title VII from title IV. Authorizes appropriations for: (1) financial assistance for bilingual education, including enhancement grants and comprehensive district grants; (2) research and evaluation, including academic excellence awards, State grants, and the National Clearinghouse for Bilingual Education; (3) professional development, including grants to higher education institutions, State educational agencies, and LEAs, and academic fellowships; and (4) the Emergency Immigrant Education Program. Establishes a new ESEA title VIII, Impact Aid. (The current impact aid laws are repealed later in this Act.) Revises the impact aid to LEAs by: (1) terminating payments for children whose parents either live on Federal land or work for the Federal Government; and (2) changing the payment formula for those children whose parents work for the Federal Government and live on Federal property, and those who live on Indian lands. Authorizes appropriations. Revises ESEA General Provisions, transferring them from title X to title IX. Provides for: (1) flexibility in the use of administrative and other funds, through consolidation of State administrative funds for elementary and secondary education programs and consolidation of funds for local administration; (2) coordination of programs, including consolidated State and local applications; (3) waivers of statutory and regulatory requirements; and (4) certain uniform provisions. Title II: Amendments to the General Education Provisions Act - Part A: Applicability of the General Education Provisions Act - Amends the General Education Provisions Act (GEPA) to revise applicability and other aspects. Part B: The Department of Education - Revises GEPA with respect to functions of the Department of Education, including an Office of Private Education. Part C: Appropriations and Evaluations - Revises GEPA with respect to availability of appropriations, contingent extension of programs, and biennial evaluation report. Part D: Administration of Education Program - Revises GEPA with respect to joint funding of programs, information collection and dissemination, review of application, use of withheld funds, applications, regulations, reduction of record retention requirements, and equity for students, teachers, and other program beneficiaries. Part E: Advisory Committees - Repeals specified GEPA provisions relating to Advisory Councils. Part F: Enforcement - Repeal specified GEPA provisions relating to use of recovered funds. Part G: Related Amendments to Other Acts - Makes related amendments to the Department of Education Organization Act and the Higher Education Act of 1965 (HEA). Part H: Conforming Amendments - Makes conforming amendments to the Rehabilitation Act of 1973 and to HEA. Title III: Amendments to Other Acts - Part A: Amendments to the Individuals with Disabilities Education Act - Amends the Individuals with Disabilities Education Act (IDEA) to revise provisions for allocations. Combines the current ESEA title I chapter I State agency program for the handicapped with the IDEA programs of grants to States and for infants and toddlers with disabilities. Part B: Amendments to the Stewart B. McKinney Homeless Assistance Act - Amends the Stewart B. McKinney Homeless Assistance Act to revise provisions with respect to grants for State literacy initiatives and grants for State and local activities for the education of homeless children and youth. Authorizes appropriations. Part C: Repeal of Impact Aid Statutes - Repeals certain Federal laws for impact aid. (Impact aid provisions are added to ESEA earlier in this Act.)

To amend the Immigration and Nationality Act to permit the admission to the United States of nonimmigrant students and visitors who are the spouses and children of United States permanent resident aliens, and for other purposes.

United States · United States Congress · 29 September 1993

Amends the Immigration and Nationality Act to authorize the nonimmigrant admission into the United States of certain alien students and visitors who are the spouses and children of U.S. permanent resident aliens.

To prohibit the admission to the United States as refugees of individuals who served in the armed forces of Iraq during the Persian Gulf conflict.

United States · United States Congress · 29 September 1993

Prohibits, with exceptions, the refugee admission into the United States of persons who served in the Iraqi armed forces during the Persian Gulf conflict.

Asylum at Ports of Entry System Improvements Act of 1993

United States · United States Congress · 28 September 1993

Asylum at Ports of Entry System Improvements Act of 1993 - Amends the Immigration and Nationality Act to create grounds for exclusion of an alien who: (1) uses or attempts to use a fraudulent document to enter the United States or to board a common carrier for such purpose; or (2) uses a document to board a common carrier and then fails to present such document to an immigration official upon arrival at a U.S. port of entry. Directs the Attorney General to designate a class of senior asylum officers who shall perform specified expedited asylum examinations at U.S. airports or other ports of entry. Authorizes such officers, upon a finding of frivolous claim or resettlement in another country, to exclude the alien from the United States. Sets forth limited petition and review provisions. Increases penalties for certain alien smuggling offenses. Creates a separate offense and penalty for an alien smuggler who seriously injures or jeopardizes an alien's life.

Violent Crime Control and Law Enforcement Act of 1993

United States · United States Congress · 23 September 1993

TABLE OF CONTENTS: Title I: Public Safety and Policing Title II: Death Penalty Title III: Habeas Corpus Reform Title IV: Gun Crime Penalties Title V: Obstruction of Justice Title VI: Youth Violence Subtitle A: Increased Penalties for Drug Trafficking and Criminal Street Gangs Subtitle B: Juvenile Drug Trafficking and Gang Prevention Grants Subtitle C: Bindover System for Certain Violent Juveniles Title VII: Terrorism Subtitle A: Maritime Navigation and Fixed Platforms Subtitle B: General Provisions Title VIII: Sexual Violence and Child Abuse Subtitle A: Sexual Abuse Subtitle B: Child Protection Subtitle C: Crimes Against Children Title IX: Crime Victims Subtitle A: Victims' Rights Subtitle B: Crime Victims' Fund Title X: State and Local Law Enforcement Subtitle A: DNA Identification Subtitle B: Department of Justice Community Substance Abuse Prevention Subtitle C: Racial and Ethnic Bias Study Grants Title XI: Provisions Relating to Police Officers Subtitle A: Law Enforcement Family Support Subtitle B: Police Pattern or Practice Subtitle C: Police Corps and Law Enforcement Officers Training and Education Subtitle D: Study Rights of Police Officers Title XII: Drug Court Programs Title XIII: Prisons Subtitle A: Federal Prisons Subtitle B: State Prisons Title XIV: Rural Crime Subtitle A: Fighting Drug Trafficking in Rural Areas Subtitle B: Drug Free Truck Stops and Safety Rest Areas Title XV: Drug Control Subtitle A: Increased Penalties Subtitle B: Precursor Chemicals Act Subtitle C: General Provisions Title XVI: Drunk Driving Provisions Title XVII: Commissions Subtitle A: Commission on Crime and Violence Subtitle B: National Commission to Study the Causes of the Demand for Drugs in the United States Subtitle C: National Commission to Support Law Enforcement Title XVIII: Bail Posting Reporting Title XIX: Motor Vehicle Theft Prevention Title XX: Protections for the Elderly Title XXI: Consumer Protection Title XXII: Financial Institution Fraud Prosecution Title XXIII: Savings and Loan Prosecution Task Force Title XXIV: Sentencing Provisions Title XXV: Sentencing and Magistrates Amendments Title XXVI: Computer Crime Title XXVII: International Parental Kidnapping Title XXVIII: Safe Schools Title XXIX: Miscellaneous Subtitle A: Increases in Penalties Subtitle B: Extension of Protection of Civil Rights Statutes Subtitle C: Audit and Report Subtitle D: Gambling Subtitle E: White Collar Crime Amendments Subtitle F: Safer Streets and Neighborhoods Subtitle G: Other Provisions Title XXX: Technical Corrections Violent Crime Control and Law Enforcement Act of 1993 - Title I: Public Safety and Policing - Public Safety Partnership and Community Policing Act of 1993 - Amends the Omnibus Crime Control and Safe Streets Act of 1968 (Omnibus Act) to authorize the Attorney General to make grants and provide technical assistance to units of State and local government, and to other public and private entities, to increase police presence (including the rehiring of law enforcement officers laid off as a result of State and local budget reductions, as well as the hiring of new, additional career law enforcement officers, for deployment in community-oriented policing), expand and improve cooperative efforts between law enforcement agencies (LEAs) and members of the community, and otherwise enhance public safety. Sets forth matching fund, application, and related requirements. Authorizes appropriations. Title II: Death Penalty - Federal Death Penalty Act of 1993 - Amends the Federal criminal code to provide for imposition of the death penalty for various offenses, including: (1) murder by a Federal prisoner; (2) civil rights murders; (3) drive-by shootings and carjackings resulting in death; (4) foreign murder of U.S. nationals; (5) rape and child molestation murders; (6) gun murders during Federal crimes of violence and drug trafficking crimes; and (7) murder in the course of alien smuggling. (Sec. 202) Sets forth procedures for the imposition, implementation, and review of such sentence. Limits mitigating factors (such as impaired capacity, duress, minor participation, and victim's consent) and aggravating factors (such as involvement of a firearm or previous conviction of a violent felony involving a firearm, previous conviction of other serious offenses, vulnerability of victim, and continuing criminal enterprise involving drug sales to minors). Requires a special hearing to determine whether a death sentence is justified. Directs the court to instruct the jury not to consider the race, color, religious beliefs, national origin, or sex of the defendant or of any victim. Prohibits the execution of a woman while she is pregnant and of a person who is mentally retarded. Title III: Habeas Corpus Reform - Habeas Corpus Reform Act of 1993 - Amends the Federal judicial code to impose a 180-day limitations period for the filing of Federal habeas corpus petitions, applicable in both capital and non-capital cases in which the State has offered the petitioner counsel for State post-conviction review, which begins from the time the petitioner's conviction becomes final on State direct review. Tolls such period while the petitioner pursues State post-conviction remedies, unless the petitioner fails to initiate post-conviction review within 270 days in capital cases or 180 days in non-capital cases. Provides for a one-time 60-day extension of the period upon a showing of good cause. (Sec. 303) Provides an automatic stay of execution in capital cases through the consideration of the first Federal habeas corpus petition. Permits a stay of execution to be granted thereafter only if the petition on its face satisfies the requirements for successive petitions. (Sec. 304) Prohibits a Federal court from announcing or applying a new rule to grant relief to a habeas corpus petitioner, except where the new rule places a class of individual conduct beyond the power of the criminal lawmaking authority to proscribe or prohibits the imposition of a certain type of punishment for a class of persons because of their status or offense, or constitutes a watershed rule of criminal procedure implicating the fundamental fairness and accuracy of the criminal proceeding. Codifies case law providing for an independent Federal habeas corpus review of claims under Federal law, except for fourth amendment exclusionary rule claims. Specifies that the State bears the burden of proving harmless error in Federal habeas corpus review of State criminal convictions. (Sec. 305) Sets forth provisions regarding: (1) limits on successive petitions (allows a prisoner to bring a second or subsequent petition only upon a showing of cause for not having brought the claim before and prejudice if the claim is not heard); and (2) new evidence (allows prisoners in capital cases to present claims of actual innocence based on newly discovered evidence that the petitioner did not previously know about). (Sec. 308) Sets standards and procedures for the provision of counsel for indigent defendants at all stages of State capital litigation. Requires each State in which a sentence of death may be imposed to establish a State counsel certification authority, comprised of members of the State's criminal defense bar, to create a roster of qualified lawyers eligible for court appointment and monitor the performance of attorneys so certified. (Sec. 309) Amends the Omnibus Act to require the Director of the Bureau of Justice Assistance (BJA) to make grants to States to help fund the provision of defense counsel. Authorizes: (1) Federal grants of up to 75 percent of the additional costs imposed by the new counsel requirements during the first three years following enactment of this title and 50 percent thereafter; and (2) grants for the prosecution of Federal habeas corpus cases in an amount equal to that allocated to capital resource centers. Title IV: Gun Crime Penalties - Directs the U.S. Sentencing Commission to amend its sentencing guidelines to enhance the penalty for: (1) use of a semiautomatic firearm during a crime of violence or a drug trafficking crime; (2) a second offense of using an explosive to commit a Federal felony; (3) use of a firearm in the commission of counterfeiting or forgery; and (4) firearms possession by violent felons and serious drug offenders. (Sec. 403) Prohibits and sets penalties for: (1) smuggling firearms in aid of drug trafficking; (2) theft of firearms and explosives; (3) the transfer of firearms to a nonresident of a State, except for lawful sporting purposes; (4) conspiracies to commit firearms and explosives crimes; and (5) the distribution of explosives to a person who is legally disqualified from having the explosives. (Sec. 405) Mandates the revocation of: (1) supervised release and the institution of a prison term for a defendant who possesses a controlled substance or firearm in violation of a condition of such release, or who refuses to cooperate with drug testing; and (2) probation for possession of a controlled substance or firearms in violation of a condition of probation, or who refuses to cooperate with drug testing. (Sec. 407) Increases the penalty for: (1) knowingly making a false, material statement in connection with the acquisition of a firearms from a licensed dealer; and (2) interstate gun trafficking. Title V: Obstruction of Justice - Increases the penalties for threats and intimidation of jurors and court officers, obstruction of justice, and attempted retaliatory killings of witnesses, victims, and informants. (Sec. 501) Provides the death penalty for: (1) the murder of jurors and court officers; (2) retaliatory killings of witnesses, victims, and informants; (3) the murder of State officials working with Federal law enforcement officials in connection with Federal criminal investigations; and (4) the murder of Federal witnesses. (Sec. 503) Creates an exception to current law requiring that persons charged with capital offenses be furnished with a list (with addresses) of veniremen and witnesses, if the court finds by a preponderance of the evidence that providing such list may jeopardize the life or safety of any person. Title VI: Youth Violence - Subtitle A: Increased Penalties for Drug Trafficking and Criminal Street Gangs - Amends: (1) the Controlled Substances Act (CSA) to increase penalties for employing children to distribute drugs or avoid apprehension for a drug offense; and (2) the Federal criminal code to provide for imprisonment of up to ten years for a gang member or person acting on behalf of a criminal street gang who commits a Federal drug or violent crime offense and who has had a prior drug or crime of violence conviction, with the penalty to run consecutively to any other sentence imposed. Subtitle B: Juvenile Drug Trafficking and Gang Prevention Grants - Amends the Juvenile Justice and Delinquency Prevention Act of 1974 to authorize the Administrator of the Office of Juvenile Justice and Delinquency Prevention to make grants for: (1) programs to reduce the formation or continuation of juvenile gangs and the use and sale of illegal drugs by juveniles; (2) public or non-profit private organizations or individuals to identify promising new juvenile drug reduction and enforcement programs; and (3) public or non-profit private organizations or individuals to support promising new programs that specifically address the unique crime, drug, and alcohol related challenges faced by juveniles living at or near international ports of entry and in other international border communities. Authorizes appropriations. Subtitle C: Bindover System for Certain Violent Juveniles - Amends the Omnibus Act to authorize grants for bindover systems for the prosecution of 16- and 17-year-olds as adults for certain violent crimes (first- and second-degree murder, attempted murder, armed robbery with a firearm, aggravated battery or assault with a firearm, criminal sexual penetration when armed with a firearm, and drive-by shooting). Title VII: Terrorism - Subtitle A: Maritime Navigation and Fixed Platforms - Amends the Federal criminal code to prohibit and set penalties for the seizure of a ship or fixed platform by force, an act of violence against a person aboard, damage or destruction, or the injuring or killing of a person in connection with such activities. Provides the death penalty where death results. Subtitle B: General Provisions - Provides the death penalty where death results from the use of a weapon of mass destruction. (Sec. 714) Extends: (1) the application of State, territory, or district law for offenses committed in territorial waters not otherwise committed within a State's territory or district; (2) special maritime and territorial jurisdiction to offenses committed by or against a U.S. national during a voyage on a foreign vessel scheduled to depart from or arrive in the United States; and (3) the statute of limitations to ten years for certain terrorist offenses. (Sec. 716) Provides: (1) the death penalty for the commission of torture outside the United States and for the killing of a U.S. national outside the country; (2) the Federal Bureau of Investigation (FBI) with access to telephone subscriber information if the Director or Deputy Assistant Director certifies that such information is relevant to a foreign counterintelligence investigation and that it pertains to an agent of a foreign power; and (3) criminal penalties for willful violations of airport or airline security regulations. (Sec. 719) Prohibits: (1) acts of terrorism at U.S. international airports (and provides the death penalty where death results); and (2) counterfeiting U.S. currency abroad (and sets penalties). Enhances penalties for any felony that involves or is intended to promote international terrorism. Sets penalties for those who provide material support to terrorists. (Sec. 722) Creates an Economic Terrorism Task Force. (Sec. 725) Amends the Immigration and Nationality Act to authorize the Attorney General to grant a nonimmigrant visa to an alien who possesses critical information about a criminal organization and whose presence in the United States is essential to an investigation or prosecution of such organization. Title VIII: Sexual Violence and Child Abuse - Subtitle A: Sexual Abuse - Amends the Federal criminal code to include within the definition of "sexual act" the intentional touching, not through the clothing, of the genitalia of another person who has not attained age 16 with intent to abuse, humiliate, harass, degrade, or arouse or gratify the sexual desire of any person. Subtitle B: Child Protection - National Child Protection Act of 1993 - Provides for the establishment of a national background check system whereby child care organizations can determine whether prospective employees have histories of child abuse or other serious crimes. Requires State to have at least 80 percent currency of crime cases in their systems within three years. Directs the Administrator of the Office of Juvenile Justice and Delinquency Prevention to begin a study of child abusers' criminal records. (Sec. 816) Amends the Omnibus Act to provide for the use of drug control and system improvement grants for the improvement of State record systems and the sharing of records of child abuse crime information to implement this subtitle. Subtitle C: Crimes Against Children - Jacob Wetterling Crimes Against Children Registration Act - Directs the Attorney General to establish guidelines for State programs requiring any person convicted of a criminal offense against a victim who is a minor to register a current address with a designated State LEA for ten years after release from prison or being placed on parole or supervised release. Subjects to criminal penalties a person required to register under a State program who knowingly fails to register and keep such registration current. (Sec. 823) Specifies that the allocation of BJA grant funds (under the Omnibus Act) received by a State not complying with provisions of this Act three years after its enactment shall be reduced by ten percent, with the unallocated funds to be reallocated to the States in compliance with this Act. Title IX: Crime Victims - Subtitle A: Victims' Rights - Amends Rule 32 of the Federal Rules of Criminal Procedure to give victims of violent crimes and sexual abuse the right to address the court concerning the sentence to be imposed on convicted offenders. Permits such right to be exercised by a parent or guardian if the victim is under 18, or by one or more family members if the victim is deceased or incapacitated. (Sec. 902) Requires courts to order criminal defendants who are convicted to pay restitution to victims. Specifies that a restitution order shall constitute a lien against real or personal property. Subtitle B: Crime Victims' Fund - Amends the Victims of Crime Act of 1984 to provide that if the compensation paid by an eligible crime victim compensation program would cover costs that a Federal, or a federally financed State or local, program would otherwise pay: (1) such victim compensation program shall not pay such compensation; and (2) the other program shall make its payments without regard to the existence of the crime victim compensation program. (Sec. 913) Allows: (1) up to five percent of a victim compensation or assistance program grant to be used for administrative costs; and (2) the Director of the Office for Victims of Crime to use unspent compensation funds for assistance programs in either the year such funds are not spent or in the following year. (Sec. 917) Requires grantees to certify that no grant funds will be used to supplant State and local funds, but rather will supplement those otherwise available funds. Title X: State and Local Law Enforcement - Subtitle A: DNA Identification - DNA Identification Act of 1993 - Amends the Omnibus Act to authorize the use of drug control and system improvement grants to develop or improve in a forensic laboratory a capability to analyze deoxyribonucleic acid (DNA) for identification purposes. Authorizes appropriations. (Sec. 1003) Requires the Director of the FBI to appoint an advisory board on DNA quality assurance methods and issue standards for quality assurance. (Sec. 1004) Authorizes the Director to establish an index of DNA identification records of persons convicted of crimes, and of analyses of DNA samples recovered from crime scenes and from unidentified human remains. (Sec. 1005) Sets forth proficiency testing and privacy protection requirements, and penalties for violations. (Sec. 1006) Authorizes appropriations. Subtitle B: Department of Justice Community Substance Abuse Prevention - Department of Justice Community Substance Abuse Prevention Act of 1993 - Amends the Omnibus Act to authorize the Attorney General to make grants to eligible coalitions to develop and implement substance abuse prevention programs, with the efforts of such coalitions involving substantial community participation. Grants priority to communities providing evidence of significant abuse. Authorizes appropriations. Subtitle C: Racial and Ethnic Bias Study Grants - Authorizes the Attorney General to make grants to States that have established, by State law or the court of last resort, plans for analyzing the role of race in their criminal justice systems. Requires State plans to include recommendations designed to correct any findings of racial and ethnic bias. Authorizes appropriations. Title XI: Provisions Relating to Police Officers - Subtitle A: Law Enforcement Family Support - Amends the Omnibus Act to: (1) require the Director of the BJA to establish guidelines and oversee the implementation of family-friendly policies in law enforcement divisions of the Department of Justice (DOJ), identify model programs that provide support to law enforcement families, and provide technical assistance for stress reduction and family support efforts by State and local LEAs; and (2) authorize the Director to make grants to States and local LEAs and organizations representing State or local law enforcement personnel to provide family support services to law enforcement personnel. Authorizes appropriations. Subtitle B: Police Pattern or Practice - Prohibits any governmental authority, or any agent or person acting on behalf of such authority, from engaging in a pattern or practice of conduct by law enforcement officers that deprives persons of their constitutional or Federal rights. Authorizes the Attorney General to bring a civil action against such officers to eliminate such practices. (Sec. 1112) Directs the Attorney General to acquire data about the use of excessive force by law enforcement officers. Subtitle C: Police Corps and Law Enforcement Officers Training and Education - Chapter 1: Police Corps - Police Corps Act - Establishes in DOJ an Office of the Police Corps and Law Enforcement Education, headed by a Director. Authorizes the Director to award college and graduate school scholarships (of up to $30,000 per student) in exchange for four years work with a State or local police force upon graduation. Requires participants who do not follow through on their commitment to pay back all the scholarship money plus ten percent interest. (Sec. 1127) Sets forth provisions regarding: (1) selection and training of participants; (2) swearing in, discipline, and layoffs; (3) State plan requirements; and (4) assistance to States and localities employing police corps officers. Authorizes appropriations. Chapter 2: Law Enforcement Scholarship Program - Law Enforcement Scholarships and Recruitment Act - Requires the Director to provide scholarships for in-service law enforcement personnel who seek further education, allotting 80 percent of funds based on the relative number of law enforcement officers per State and 20 percent based on the relative shortage of officers. Provides grants for summer jobs or part-time jobs during the year for high school students interested in law enforcement careers. Authorizes appropriations. Subtitle D: Study Rights of Police Officers - Directs the Attorney General to conduct a study of the procedures followed in internal, noncriminal investigations of State and local law enforcement officers to determine if such investigations are conducted fairly and effectively. Title XII: Drug Court Programs - Amends the Omnibus Act to authorize the BJA to make grants to States: (1) for drug testing upon arrest and on a regular basis pending trial for the purpose of making pretrial detention decisions; (2) to develop alternative methods of punishment for young offenders to traditional forms of incarceration and probation; and (3) for residential substance abuse treatment programs in State prisons. Authorizes appropriations. Title XIII: Prisons - Subtitle A: Federal Prisons - Amends the Federal criminal code to: (1) prohibit the Bureau of Prisons from showing favoritism to prisoners of high social or economic status in designating their place of imprisonment; and (2) require that any submission of legislation by the judicial or executive branch that might affect prison populations be accompanied by an impact statement (and requires the Attorney General to prepare and transmit to the Congress annual prison impact assessments). (Sec. 1303) Federal Prisoner Drug Testing Act of 1993 - Requires the Director of the Administrative Office of the U.S. Courts to establish a program of drug testing of Federal offenders on post-conviction release. (Sec. 1304) Drug Treatment in Federal Prisons Act of 1993 - Establishes a schedule for the Bureau of Prisons to place all eligible prisoners into residential substance abuse treatment programs for between nine and 12 months, in facilities separate from the general prison population. Specifies that prisoners who successfully complete such programs could be released up to a year early. Authorizes appropriations. Subtitle B: State Prisons - Authorizes the Attorney General to make grants to States and to multi-State compact associations for the development and operation of boot camp prisons (for prisoners not convicted of violent felonies, providing a highly regimented schedule of strict discipline, physical training, and work, as well as remedial education and treatment for substance abuse) and regional prisons (for violent offenders with serious substance abuse problems). Specifies that grants may support the activation of boot camp and regional prison facilities already constructed by State or local governments, and shall support aftercare services (to reduce the likelihood of repeat criminality following release). Authorizes appropriations. (Sec. 1323) Requires the Director of the National Institute of Justice to study: (1) the feasibility of establishing an information clearinghouse to facilitate the interstate transfer of prisoners to facilities near their families; (2) the recidivism rates of persons who were under the influence of alcohol at the time they committed their crimes, comparing recidivism rates of those who participated in a residential treatment program while in custody with those who did not; and (3) the use of alcohol, alone or in combination with other drugs, as a factor in criminal activity. (Sec. 1324) Requires the Bureau of Prisons to notify State and local law enforcement authorities concerning the release or relocation to their areas of Federal offenders under post-release supervision, with respect to prisoners convicted of drug trafficking and violent crimes. Title XIV: Rural Crime - Subtitle A: Fighting Drug Trafficking in Rural Areas - Amends the Omnibus Act to authorize appropriations, and increase the base allocation, for rural drug enforcement assistance. (Sec. 1402) Directs the Attorney General to establish a Rural Drug Enforcement Task Force in each of the Federal judicial districts which encompass significant rural lands. (Sec. 1403) Authorizes the Attorney General to cross-designate up to 100 Federal officers with jurisdiction to enforce CSA provisions on non-Federal lands to the extent necessary to effect the purposes of this title. (Sec. 1404) Requires the Director of the Federal Law Enforcement Training Center to develop a specialized course of instruction devoted to training law enforcement officers from rural agencies in the investigation of drug trafficking and related crimes. Authorizes appropriations. Subtitle B: Drug Free Truck Stops and Safety Rest Areas - Drug Free Truck Stop Act - Amends the CSA to enhance penalties for drug distribution at or near truck stops and safety rest areas. Title XV: Drug Control - Subtitle A: Increased Penalties - Amends: (1) the Federal criminal code to enhance penalties for drug trafficking and illegal drug use in prisons; (2) the Tariff Act of 1930 to make the penalty for failure to declare a controlled substance 1,000 percent of the value of the article (as under current law) or $500, whichever is greater; and (3) the CSA to enhance penalties for drug dealing in or near public housing authority facilities, and to set penalties for any physical trainer or adviser who endeavors to persuade or induce an individual to possess or use anabolic steroids in violation of such Act. (Sec. 1505) Directs the Sentencing Commission to amend the sentencing guidelines to increase penalties for drug-dealing in "drug-free" zones. Subtitle B: Precursor Chemicals Act - Chemical Control Amendments Act of 1993 - Amends the CSA to impose registration requirements for precursor chemicals. (Sec. 1514) Requires manufacturers to submit annual reports concerning listed chemicals manufactured during the year. (Sec. 1515) Amends the Controlled Substances Import and Export Act to: (1) subject brokers and traders to the same recordkeeping and reporting requirements for international transactions, and the same criminal penalties, as exporters; (2) authorize the Attorney General to require that the 15-day advance notice requirement with respect to the importation and exportation of listed chemicals apply to all exports of specific listed chemicals to specified countries, regardless of the status of certain customers in such countries as regular customers, if necessary to support effective diversion control programs or as required by treaty; and (3) establish criminal penalties for attempting to evade reporting requirements and for smuggling listed drugs. (Sec. 1519) Grants the Attorney General the same inspection authority for listed chemicals as presently exists with respect to controlled substances. (Sec. 1521) Makes it a felony to violate the Solid Waste Disposal Act in the handling of chemicals used to illegally manufacture a controlled substance. Requires that violators be assessed costs of the initial cleanup an disposal of the listed chemical and contaminated property and the costs of restoring property damaged by exposure to such chemical. Subtitle C: General Provisions - Prohibits advertising which aims to illegally solicit or sell drugs. (Sec. 1535) Includes among the long-term goals of the National Drug Control Strategy making drug treatment available to all who need it. (Sec. 1536) Amends the Federal Aviation Act of 1958 to require the Administrator of the Federal Aviation Administration to issue regulations requiring employees to report to law enforcement authorities the discovery of illegal drugs or amounts of cash over $10,000 in airport security screenings. Title XVI: Drunk Driving Provisions - Drunk Driving Child Protection Act of 1993 - Amends the Federal criminal code to provide supplementary prison terms and fine authorizations in cases where drunk driving endangers or injures a person under 18 years of age. (Sec. 1603) Expresses the sense of the Congress that in determining child custody and visitation rights the courts should consider the history of drunk driving of anyone involved in the determination. Title XVII: Commissions - Subtitle A: Commission on Crime and Violence - Establishes the National Commission on Crime and Violence in America to develop a comprehensive crime control plan for the 1990's. Subtitle B: National Commission to Study the Causes of the Demand for Drugs in the United States - National Commission to Study the Causes of the Demand for Drugs in the United States - Establishes a National Commission to Study the Causes of the Demand for Drugs in the United States. Subtitle C: National Commission to Support Law Enforcement - National Commission to Support Law Enforcement Act - Establishes a National Commission to Support Law Enforcement. Title XVIII: Bail Posting Reporting - Illegal Drug Profits Act of 1993 - Requires State and Federal criminal court clerks to report to the Internal Revenue Service (IRS) and prosecutors the name and taxpayer identification number of anyone accused of a drug, money laundering, or racketeering crime who posts cash bail exceeding $10,000. Title XIX: Motor Vehicle Theft Prevention - Motor Vehicle Theft Prevention Act - Directs the Attorney General to develop a national voluntary motor vehicle theft prevention program which would involve placing identifiable decals on the vehicles of consenting owners, whereby such vehicles could then be stopped by law enforcement officers upon a reasonable suspicion that the vehicles were not being operated by or with the consent of their owners. (Sec. 1903) Prohibits and sets penalties for tampering with the decals, with exceptions. Title XX: Protections for the Elderly - Directs the Attorney General to make grants in support of programs to protect and locate missing patients with Alzheimer's disease and related dementias. Authorizes appropriations. (Sec. 2002) Directs the Sentencing Commission to ensure that the sentences for those convicted of crimes of violence against elderly victims be sufficiently stringent to deter such crimes, protect the public from additional crimes of such a defendant, and provide enhanced penalties under specified criteria. Title XXI: Consumer Protection - Amends the Federal criminal code to set penalties for insurance industry crimes, including embezzling from insurance companies, making false entries in insurance company books with intent to deceive, and corruptly influencing or obstructing proceedings before State insurance regulatory agencies or insurance examiners. Prohibits persons convicted of criminal felonies involving dishonesty or breach of trust from engaging in the insurance business without the written consent of an insurance regulatory official authorized to regulate the insurer. (Sec. 2102) Consumer Protection Against Credit Card Fraud Act of 1993 - Prohibits the sale of credit cards without credit card company authorization, fraudulent receipt of payments via credit card for goods never received or inferior to those promised, and laundering of credit card receipts. (Sec. 2103) Extends the mail fraud statute to include mail sent by private interstate carriers. Title XXII: Financial Institution Fraud Prosecutions - Financial Institutions Fraud Prosecution Act of 1991 (sic) - Amends the Federal Deposit Insurance Act and the Federal Credit Union Act to disqualify certain persons with criminal records from participating in the affairs of insured depository institutions and credit unions. (Sec. 2204) Amends the Crime Control Act of 1990 to encourage the Attorney General to report to the Congress on the collapse of private insurance deposit corporations. Title XXIII: Savings and Loan Prosecution Task Force - Directs the Attorney General to establish within DOJ a savings and loan criminal fraud task force to prosecute those criminal cases involving savings and loan institutions. Title XXIV: Sentencing Provisions - Amends the Federal criminal code to allow the court, in determining the sentence to be imposed in the case of a violation of probation or supervised release, to consider guidelines or policy statements issued by the Sentencing Commission. (Sec. 2403) Directs the court to revoke a term of supervised release and require the defendant to serve in prison all or part of the term of release authorized by statute for the offense that resulted in such term, without credit for time previously served on post-release supervision, if the court finds that the defendant violated a condition of supervised release, subject to specified limitations. Authorizes the court to include a requirement that the defendant be placed on supervised release after imprisonment when a term of supervised release is revoked and the defendant is required to serve a term of imprisonment less than the maximum authorized. Specifies that the power of the court to revoke a term of supervised release for violation of a condition of such release extends beyond the expiration of the term of release for a period reasonably necessary for the adjudication of matters arising before its expiration if, prior to such expiration, a warrant or summons has been issued on the basis of an allegation of such a violation. Title XXV: Sentencing and Magistrates Amendments - Permits concurrent sentencing of a defendant to imprisonment and probation for petty offenses. (Sec. 2502) Authorizes the trial of petty offenses by magistrate judges. Title XXVI: Computer Crime - Computer Abuse Amendments Act of 1993 - Amends the Computer Fraud and Abuse Act to make it a felony to knowingly transmit an unauthorized program or code that alters the information stored in a computer with the intent to damage the system or information contained within the affected computer or system, or to withhold or deny the use of such system or information, if the transmission: (1) occurred without the authorization of the person responsible for the computer system receiving the program; and (2) causes damage exceeding $1,000 in any one-year period or modifies or impairs the medical care of one or more individuals. Makes it a misdemeanor to recklessly transmit a destructive computer program or code. Creates a civil cause of action for persons suffering damage or loss by virtue of a violation of this Act. Modifies the prohibition against accessing a Government computer where such conduct affects the use of the Government's operation of such computer to cover only actions that "adversely" affect such use. Title XXVII: International Parental Kidnapping - International Parental Kidnapping Crime Act of 1993 - Amends the Federal criminal code to establish penalties for removing a child from, or retaining a child outside, the United States with intent to obstruct the lawful exercise of parental rights. (Sec. 2703) Authorizes appropriations to carry out under the State Justice Institute Act of 1984 national, regional, and in-State training and educational programs dealing with criminal and civil aspects of interstate and international parental child abduction. Title XXVIII: Safe Schools - Safe Schools Act of 1993 - Amends the Omnibus Act to: (1) authorize the Director of the BJA to make grants to local educational agencies for the purpose of providing assistance to such agencies most directly affected by crime and violence; and (2) require the Director to develop a written safe schools model in English and in Spanish and make such model available to any such agency that requests it. Authorizes appropriations. Title XXIX: Miscellaneous - Subtitle A: Increases in Penalties - Increases penalties for assault: (1) of Federal officers, foreign officials, and official guests and internationally protected persons; (2) within a maritime and territorial jurisdiction; and (3) of the President, presidential staff, congressional leaders, cabinet officials, and Supreme Court justices. (Sec. 2902) Increases the maximum penalties for voluntary and involuntary manslaughter. (Sec. 2903) Broadens the scope and increases the penalties for conspiracies to deprive persons of their civil rights. (Sec. 2904) Increases penalties for: (1) trafficking in counterfeit goods and services; (2) conspiracy to commit murder for hire; and (3) Travel Act violations. Subtitle B: Extension of Protection of Civil Rights Statutes - Extends the protections of the criminal civil rights statute to any person in a State. (Currently, the statute only covers State "inhabitants.") Subtitle C: Audit and Report - Directs the Attorney General to: (1) require State and local LEAs to annually audit and detail the uses and expenses to which forfeiture funds were dedicated and the amount used for each use or expense; and (2) report to the Congress on the administrative and contracting expenses paid from the DOJ Assets Forfeiture Fund. Subtitle D: Gambling - Grants a State gaming enforcement office located within a State Attorney General's office access to FBI criminal history record information for licensing purposes. Subtitle E: White Collar Crime Amendments - Establishes penalties for knowingly receiving the proceeds of: (1) extortion; (2) a kidnapping; and (3) a postal robbery. (Sec. 2943) Extends the prohibition against obstructing civil investigative demands to include obstruction in racketeering and false claims investigations. Subtitle F: Safer Streets and Neighborhoods - Safer Streets and Neighborhoods Act of 1993 - Amends the Omnibus Act to authorize the Director of the BJA to make grants to, or enter into contracts with, non-Federal public or private agencies, institutions, or organizations to carry out specified purposes of such Act (current law does not specify "non-Federal"), effective October 1, 1993. Subtitle G: Other Provisions - Authorizes the venue for espionage and related offenses to be in the District of Columbia or in any other district authorized by law. (Sec. 2963) Amends the Anti-Drug Abuse Act to make amendments with respect to certain IRS undercover operations effective from the date of this Act's enactment through December 31, 1994. (Sec. 2964) Directs the Attorney General and the Secretary of Health and Human Services to report to the Congress on the medical and psychological basis of "battered women's syndrome" and the extent to which evidence of the syndrome has been held to be admissible as evidence of guilt or as a defense in a criminal trial. (Sec. 2966) Amends the Federal criminal code to set penalties for: (1) the theft of major art works from museums; (2) misuse of the words "Drug Enforcement Administration" or the initials "DEA"; and (3) attempted robbery, kidnapping, smuggling, and property damage offenses. (Sec. 2971) Extends the statute of limitations for arson. Title XXX: Technical Corrections - Makes technical corrections to various criminal law provisions.

Violent Crime Control and Law Enforcement Act of 1993

United States · United States Congress · 23 September 1993

TABLE OF CONTENTS: Title I: Public Safety and Policing Title II: Death Penalty Title III: Habeas Corpus Reform Title IV: Coerced Confessions Title V: Firearms Subtitle A: Brady Handgun Violence Prevention Act Subtitle B: Gun Crime Penalties Title VI: Youth Violence Subtitle A: General Subtitle B: Criminal Street Gangs Subtitle C: Certainty of Punishment for Young Offenders Subtitle D: Juvenile Drug Trafficking and Gang Prevention Grants Title VII: Terrorism Subtitle A: Maritime Navigation and Fixed Platforms Subtitle B: General Provisions Title VIII: Sexual Violence and Child Abuse Subtitle A: Sexual Abuse Subtitle B: Child Protection Subtitle C: Crimes Against Children Title IX: Crime Victims Title X: State and Local Law Enforcement Subtitle A: Safer Streets and Neighborhoods Subtitle B: DNA Identification Subtitle C: Department of Justice Community Substances Abuse Prevention Subtitle D: Drug Testing of Arrested Individuals Subtitle E: Racial and Ethnic Bias Study Grants Title XI: Provisions Relating to Police Officers Subtitle A: Law Enforcement Relating to Police Officers Subtitle B: Police Pattern or Practice Subtitle C: Police Corps and Law Enforcement Officers Subtitle D: Study Rights of Police Officers Title XII: Grant Program for State Prisons Title XIII: Federal Prisons Subtitle A: General Subtitle B: Drug Testing Subtitle C: Enhanced Penalties for Drugs in Federal Prisons Subtitle D: Drug Treatment in Federal Prisons Subtitle E: Studies Title XIV: Rural Crime Subtitle A: Fighting Drug Trafficking in Rural Areas Subtitle B: Drug Free Truck Stops and Safety Rest Areas Title XV: Drug Control Subtitle A: Drug Emergency Areas Subtitle B: Precursor Chemicals Subtitle C: General Provisions Title XVI: Drunk Driving Provisions Title XVII: Commissions Subtitle A: Commission on Crime and Violence Subtitle B: National Commission to Study the Causes of the Demand for Drugs in the United States Subtitle C: National Commission to Support Law Enforcement Title XVIII: Motor Vehicle Theft Prevention Title XIX: Protections for the Elderly Title XX: Consumer Protection Title XXI: Sentencing Provisions Title XXII: Computer Cime Title XXIII: International Parental Kidnapping Title XXIV: Safe Schools Title XXV: Financial Institutions Fraud Prosecutions Title XXVI: White Collar Crime Amendments Title XXVII: Gambling Title XXVIII: Bail Posting Reporting Title XXIX: General Increased Penalty Provisions Title XXX: Miscellaneous Title XXXI: Technical Corrections Violent Crime Control and Law Enforcement Act of 1993 - Title I: Public Safety and Policing - Amends the Omnibus Crime Control and Safe Streets Act of 1968 (Omnibus Act) to authorize the Attorney General to make grants and provide technical assistance to units of State and local government, and to other public and private entities, to increase police presence (including the rehiring of law enforcement officers laid off as a result of State and local budget reductions, as well as the hiring of new, additional career law enforcement officers, for deployment in community-oriented policing), expand and improve cooperative efforts between law enforcement agencies (LEAs) and members of the community, and otherwise enhance public safety. Sets forth matching fund, application, and related requirements. Authorizes appropriations. Title II: Death Penalty - Amends the Federal criminal code to provide for imposition of the death penalty for various offenses, including: (1) murder by a Federal prisoner; (2) civil rights murders; (3) drive-by shootings and carjackings resulting in death; (4) foreign murder of U.S. nationals; (5) rape and child molestation murders; (6) gun murders during Federal crimes of violence and drug trafficking crimes; and (7) murder of Federal witnesses. (Sec. 201) Sets forth procedures for the imposition, implementation, and review of such sentence. Limits mitigating factors (such as impaired capacity, duress, minor participation, and victim's consent) and aggravating factors (such as previous conviction of a violent felony involving a firearm, previous conviction of other serious offenses, vulnerability of victim, and continuing criminal enterprise involving drug sales to minors, and previous conviction of sexual assault or child molestation). Requires a special hearing to determine whether a death sentence is justified. Directs the court to instruct the jury not to consider the race, color, religious beliefs, national origin, or sex of the defendant or of any victim. Prohibits the execution of a woman while she is pregnant and of a person who is mentally retarded. Title III: Habeas Corpus Reform - Amends the Federal judicial code to impose a 180-day limitations period for the filing of Federal habeas corpus petitions, applicable in both capital and non-capital cases in which the State has offered the petitioner counsel for State post-conviction review, which begins from the time the petitioner's conviction becomes final on State direct review. Tolls such period while the petitioner pursues State post-conviction remedies, unless the petitioner fails to initiate post-conviction review within 270 days in capital cases or 180 days in non-capital cases. Provides for a one-time 60-day extension of the period upon a showing of good cause. (Sec. 302) Provides an automatic stay of execution in capital cases through the consideration of the first Federal habeas corpus petition. Permits a stay of execution to be granted thereafter only if the petition on its face satisfies the requirements for successive petitions. (Sec. 303) Prohibits a Federal court from announcing or applying a new rule to grant relief to a habeas corpus petitioner, except where the new rule places a class of individual conduct beyond the power of the criminal lawmaking authority to proscribe or prohibits the imposition of a certain type of punishment for a class of persons because of their status or offense, or constitutes a watershed rule of criminal procedure implicating the fundamental fairness and accuracy of the criminal proceeding. Codifies case law providing for an independent Federal habeas corpus review of claims under Federal law, except for fourth amendment exclusionary rule claims. Specifies that the State bears the burden of proving harmless error in Federal habeas corpus review of State criminal convictions. (Sec. 304) Allows a prisoner to bring a second or subsequent petition only upon a showing of cause for not having brought the claim before and prejudice if the claim is not heard. (Sec. 306) Sets standards and procedures for the provision of counsel for indigent defendants. Requires each State in which a sentence of death may be imposed to establish a State counsel certification authority, comprised of members of the State's criminal defense bar, to recruit, train, monitor, and support attorneys involved at all stages of capital litigation. (Sec. 307) Amends the Omnibus Act to require the Director of the Bureau of Justice Assistance (BJA) to make grants to States to help fund the provision of defense counsel. Authorizes: (1) Federal grants of up to 75 percent of the additional costs imposed by the new counsel requirements during the first three years following enactment of this title and 50 percent thereafter; and (2) grants for the prosecution of Federal habeas corpus cases in an amount equal to that allocated to capital resource centers. Title IV: Coerced Confessions - Specifies that the admission into evidence of a coerced confession (i.e., one elicited in violation of the fifth or fourteenth amendments to the Constitution) shall not be considered harmless error. Title V: Firearms - Subtitle A: Brady Handgun Violence Prevention Act - Amends the Federal criminal code to provide for a five (business) day waiting period for the purchase of a handgun. Sets forth: (1) interim procedures (pending the establishment of a national instant criminal background check system) for checking with the chief law enforcement officer of the place of residence of the purchaser as to whether the purchaser has a criminal record or whether there is any other legal impediment to such individual's receiving a handgun; and (2) permanent procedures for conducting criminal background checks. Sets penalties for violations. (Sec. 502) Directs the Attorney General to establish a national instant criminal background check system that any licensee may contact for information on whether receipt of a firearm by a prospective purchaser would violate specified legal provisions. Provides for the correction of erroneous information in the system. (Sec. 503) Permits the use of formula grants under the Omnibus Act for improvements in State criminal records. Authorizes appropriations. Sets forth provisions with respect to the withholding of State and Department of Justice (DOJ) funds for failure to meet set deadlines. Subtitle B: Gun Crime Penalties - Directs the U.S. Sentencing Commission to amend its sentencing guidelines to enhance the penalty for: (1) use of a semiautomatic firearm during a crime of violence or a drug trafficking crime; (2) a second offense of using an explosive to commit a Federal felony; (3) use of a firearm in the commission of counterfeiting or forgery; and (4) firearms possession by violent felons and serious drug offenders. (Sec. 506) Prohibits and sets penalties for: (1) smuggling firearms in aid of drug trafficking; (2) theft of firearms and explosives; (3) the transfer of firearms to a nonresident of a State, except for lawful sporting purposes; (4) conspiracies to commit firearms and explosives crimes; and (5) the distribution of explosives to a person who is legally disqualified from having the explosives. (Sec. 508) Increases the penalty for: (1) knowingly making a false, material statement in connection with the acquisition of a firearm from a licensed dealer; and (2) interstate gun trafficking. Title VI: Youth Violence - Subtitle A: General - Amends the Controlled Substances Act (CSA) to increase the penalty for employing, using, inducing, or coercing individuals under age 18 to violate provisions of such Act, or to assist in avoiding detection or apprehension for certain offenses under such Act by Federal, State, or local law enforcement officials. (Sec. 602) Amends the Federal criminal code to prohibit a juvenile from being transferred to adult prosecution or a hearing from being held under section 5037 (disposition after a finding of juvenile delinquency) until any prior juvenile records have been received by the court or other specified conditions are met. (Sec. 603) Amends the Omnibus Act to authorize grants for bindover systems for the prosecution of 16- and 17-year-olds as adults for certain violent crimes (first- and second-degree murder, attempted murder, armed robbery with a firearm, aggravated battery or assault with a firearm, criminal sexual penetration when armed with a firearm, and drive-by shooting). Subtitle B: Criminal Street Gangs - Amends the Federal criminal code to provide for imprisonment of up to ten years for a gang member or person acting on behalf of a criminal street gang who commits a Federal drug or violent crime offense and who has had a prior drug or violent crime conviction, with the penalty to run consecutively to any other sentence imposed Subtitle C: Certainty of Punishment for Young Offenders - Amends the Omnibus Act to authorize the Director of the BJA to make grants to States for the purpose of developing alternative methods of punishment for young offenders to traditional forms of incarceration and probation. Authorizes appropriations. Subtitle D: Juvenile Drug Trafficking and Gang Prevention Grants - Amends the Omnibus Act to authorize the Director of the BJA to make grants for programs to reduce the formation or continuation of juvenile gangs and the use and sale of illegal drugs by juveniles. Authorizes appropriations. Title VII: Terrorism - Subtitle A: Maritime Navigation and Fixed Platforms - Amends the Federal criminal code to prohibit and set penalties for the seizure of a ship or fixed platform by force, an act of violence against a person aboard, damage or destruction, or the injuring or killing of a person in connection with such activities. Provides the death penalty where death results. Subtitle B: General Provisions - Provides the death penalty where death results from the use of a weapon of mass destruction. (Sec. 705) Extends: (1) special maritime and territorial jurisdiction to offenses committed by or against a U.S. national during a voyage on a foreign vessel scheduled to depart from or arrive in the United States; and (2) the statute of limitations to ten years for certain terrorist offenses. (Sec. 706) Provides: (1) the death penalty for the commission of torture outside the United States and for the killing of a U.S. national outside the country; (2) the Federal Bureau of Investigation (FBI) with access to telephone subscriber information if the Director or Deputy Assistant Director certifies that such information is relevant to a foreign counterintelligence investigation and that it pertains to an agent of a foreign power; and (3) criminal penalties for willful violations of airport or airline security regulations. (Sec. 709) Prohibits: (1) acts of terrorism at U.S. international airports (and provides the death penalty where death results); and (2) counterfeiting U.S. currency abroad. Enhances penalties for any felony that involves or is intended to promote international terrorism. (Sec. 713) Amends the Immigration and Nationality Act to authorize the Attorney General to grant a nonimmigrant visa to an alien who possesses critical information about a criminal organization and whose presence in the United States is essential to an investigation or prosecution of such organization; and (2) the Federal criminal code to set penalties for those who provide material support to terrorists. Title VIII: Sexual Violence and Child Abuse - Subtitle A: Sexual Abuse - Amends the Federal criminal code to include within the definition of "sexual act" the intentional touching, not through the clothing, of the genitalia of another person who has not attained age 16 with intent to abuse, humiliate, harass, degrade, or arouse or gratify the sexual desire of any person. Subtitle B: Child Protection - Provides for the establishment of a national background check system whereby child care organizations can determine whether prospective employees have histories of child abuse or other serious crimes. Requires State to have at least 80 percent currency of crime cases in their systems within three years. Directs the Administrator of the Office of Juvenile Justice and Delinquency Prevention to begin a study of child abusers' criminal records. (Sec. 806) Amends the Omnibus Act to provide for the use of drug control and system improvement grants for the improvement of State record systems and the sharing of records of child abuse crime information to implement this subtitle. Subtitle C: Crimes Against Children Registration - Directs the Attorney General to establish guidelines for State programs requiring any person convicted of a criminal offense against a victim who is a minor to register a current address with a designated State LEA for ten yeas after release from prison, or being placed on parole or supervised release. Subjects to criminal penalties a person required to register under a State program who knowingly fails to register and keep such registration current. (Sec. 808) Specifies that the allocation of BJA grant funds (under the Omnibus Act) received by a State not complying with provisions of this Act three years after its enactment shall be reduced by ten percent, with the unallocated funds to be reallocated to the States in compliance with this Act. Title IX: Crime Victims - Amends the Victims of Crime Act of 1984 to: (1) specify the amounts available for grants under certain sections of the Act; and (2) provide that if the compensation paid by an eligible crime victim compensation program would cover costs that a Federal, or federally financed State or local, program would otherwise pay, such victim compensation program shall not pay such compensation and the other program shall make its payments without regard to the existence of the crime victim compensation program. (Sec. 903) Amends Rule 32 of the Federal Rules of Criminal Procedure to give victims of violent crimes and sexual abuse the right to address the court concerning the sentence to be imposed on convicted offenders. Permits such right to be exercised by a parent or guardian if the victim is under 18, or by one or more family members if the victim is deceased or incapacitated. (Sec. 904) Directs the Attorney General and the Secretary of Health and Human Services to report to specified congressional committees on the medical and psychological basis of "battered women's syndrome" and the extent to which evidence of the syndrome has been admitted as evidence of guilt or as a defense in criminal trials. Title X: State and Local Law Enforcement - Subtitle A: Safer Streets and Neighborhoods - Continues the current Federal-State funding formula for grants under title I of the Omnibus Act. (Sec. 1002) Amends such Act to authorize the Director of the BJA to make grants to, or enter into contracts with, non-Federal public or private agencies, institutions, or organizations to carry out specified purposes of the Act (current law does not specify "non-Federal"), effective October 1, 1994. Subtitle B: DNA Identification - Amends the Omnibus Act to authorize the use of drug control and system improvement grants to develop or improve in a forensic laboratory a capability to analyze deoxyribonucleic acid (DNA) for identification purposes. Authorizes appropriations. (Sec. 1004) Requires the Director of the FBI to appoint an advisory board on DNA quality assurance methods and issue standards for quality assurance. Authorizes the Director to establish an index of DNA identification records of persons convicted of crimes, and of analyses of DNA samples recovered from crime scenes and from unidentified human remains. (Sec. 1006) Sets forth proficiency testing and privacy protection requirements, and penalties for violations. (Sec. 1007) Authorizes appropriations. Subtitle C: Department of Justice Community Substances Abuse Prevention - Amends the Omnibus Act to authorize the Attorney General to make grants to eligible coalitions to develop and implement substance abuse prevention programs, with the efforts of such coalitions involving substantial community participation. Grants priority to communities providing evidence of significant abuse. Authorizes appropriations. Subtitle D: Drug Testing of Arrested Individuals - Amends the Omnibus Act to authorize the Director of the BJA to make grants to States for the purpose of developing, implementing, or continuing a drug testing project when individuals are arrested and during the pretrial period. Authorizes appropriations. Subtitle E: Racial and Ethnic Bias Study Grants - Authorizes the Attorney General to make grants to States that have established, by State law or the court of last resort, plans for analyzing the role of race in their criminal justice systems. Requires State plans to include recommendations designed to correct any findings of racial and ethnic bias. Authorizes appropriations. Title XI: Provisions Relating to Police Officers - Subtitle A: Law Enforcement Family Support - Amends the Omnibus Act to: (1) require the Director of the BJA to establish guidelines and oversee the implementation of family-friendly policies in law enforcement divisions of DOJ, identify model programs that provide support to law enforcement families, and provide technical assistance for stress reduction and family support efforts by State and local LEAs; and (2) authorize the Director to make grants to States and local LEAs and organizations representing State or local law enforcement personnel to provide family support services to law enforcement personnel. Authorizes appropriations. Subtitle B: Police Pattern or Practice - Prohibits any governmental authority, or any agent or person acting on behalf of such authority, from engaging in a pattern or practice of conduct by law enforcement officers that deprives persons of their constitutional or Federal rights. Authorizes the Attorney General to bring a civil action against such officers to eliminate such practices. (Sec. 1104) Directs the Attorney General to acquire data about the use of excessive force by law enforcement officers. Subtitle C: Police Corps and Law Enforcement Officers Scholarship Programs - Chapter 1: Community Police Corps Initiatives - Authorizes the Attorney General to make grants for up to ten Community Police Corps Programs in which participants can receive scholarships of not more than $5,000 annually times the number of years in the educational institution's regular program in exchange for a commensurate period of work with a State or local police force upon graduation. Authorizes appropriations. Permits up to ten percent of grant funds to be awarded to law enforcement officers currently employed by the jurisdiction, and who are assigned to community-oriented policing or who exercise supervisory or training roles in relation to such officers, for college or post-graduate work. Chapter 2: Law Enforcement Scholarship Program - Requires the Director of the BJA to provide scholarships for in-service law enforcement personnel who seek further education, allotting 80 percent of funds based on the relative number of law enforcement officers per State and 20 percent based on the relative shortage of officers. Provides grants for summer jobs or part-time jobs during the year for high school students interested in law enforcement careers. Authorizes appropriations. Subtitle D: Study Rights of Police Officers - Directs the Attorney General to conduct a study of the procedures followed in internal, noncriminal investigations of State and local law enforcement officers to determine if such investigations are conducted fairly and effectively. Title XII: Grant Programs for State Prisons - Amends the Omnibus Act to authorize the Director of the BJA to make grants to States for residential substance abuse treatment programs in State correctional facilities, as well as those in which inmates are incarcerated for a time sufficient to permit substance abuse treatment. Authorizes appropriations. Title XIII: Federal Prisons - Subtitle A: General - Amends the Federal criminal code to: (1) prohibit the Bureau of Prisons from considering the social or economic status of a prisoner in designating such prisoner's place of imprisonment; and (2) require that any submission of legislation by the judicial or executive branch that might affect prison populations be accompanied by an impact statement (and requires the Attorney General to prepare and transmit to the Congress annual prison impact assessments). (Sec. 1303) Requires notice to State and local law enforcement authorities concerning the release or relocation to their areas of Federal offenders under post-release supervision at least five days prior to such release or relocation, with respect to prisoners convicted of drug trafficking and violent crimes. (Sec. 1304) Deems references to supervised release, in the case of prisoners convicted of offenses committed prior to November 1, 1987, to be references to probation or parole. Subtitle B: Drug Testing - Requires the Director of the Administrative Office of the U.S. Courts to establish a program of drug testing of Federal offenders on post-conviction release. Subtitle C: Enhanced Penalties for Drugs in Federal Prisons - Provides for enhanced penalties for drug trafficking and illegal drug use in Federal prisons. Subtitle D: Drug Treatment in Federal Prisons - Establishes a schedule for the Bureau of Prisons to place all eligible prisoners into residential substance abuse treatment programs for between nine and 12 months, in facilities separate from the general prison population. Specifies that prisoners who successfully complete such programs could be released up to a year early. Authorizes appropriations. Subtitle E: Studies - Requires the National Institute of Justice to study: (1) the feasibility of establishing an information clearinghouse to facilitate the interstate transfer of prisoners to facilities near their families; (2) the recidivism rates of persons who were under the influence of alcohol at the time they committed their crimes, comparing recividism rates of those who participated in a residential treatment program while in custody with those who did not; and (3) the use of alcohol, alone or in combination with other drugs, as a factor in criminal activity. Title XIV: Rural Crime - Subtitle A: Fighting Drug Trafficking in Rural Areas - Amends the Omnibus Act to authorize appropriations, and increase the base allocation, for rural drug enforcement assistance. (Sec. 1402) Directs the Attorney General to establish a Rural Drug Enforcement Task Force in each of the Federal judicial districts which encompass significant rural lands. (Sec. 1403) Authorizes the Attorney General to cross-designate up to 100 Federal officers with jurisdiction to enforce CSA provisions on non-Federal lands to the extent necessary to effect the purposes of this title. (Sec. 1404) Requires the Director of the Federal Law Enforcement Training Center to develop a specialized course of instruction devoted to training law enforcement officers from rural agencies in the investigation of drug trafficking and related crimes. Authorizes appropriations. Subtitle B: Drug Free Truck Stops and Safety Rest Areas - Amends the CSA to enhance penalties for drug distribution at or near truck stops and safety rest areas. Title XV: Drug Control - Subtitle A: Drug Emergency Areas - Amends the National Narcotics Leadership Act of 1988 to authorize the President to declare a State, or part thereof, a drug emergency area, to take all necessary actions to save lives and protect property, public health, and safety, and to make grants aggregating $25 million for any single major drug-related emergency. Requires grant money to be divided equally between drug supply and demand reduction efforts, unless State or local conditions dictate otherwise. Permits the President to direct any Federal agency to utilize its resources to assist State anti-drug efforts. Authorizes appropriations. Subtitle B: Precursor Chemicals - Amends the CSA to impose registration requirements for precursor chemicals. (Sec. 1504) Requires manufacturers to submit annual reports concerning listed chemicals manufactured during the year. (Sec. 1505) Amends the Controlled Substances Import and Export Act to: (1) subject brokers and traders to the same recordkeeping and reporting requirements for international transactions, and the same criminal penalties, as exporters; and (2) authorize the Attorney General to require that the 15-day advance notice requirement with respect to the importation and exportation of listed chemicals apply to all exports of specific listed chemicals to specified countries, regardless of the status of certain customers in such countries as regular customers, if necessary to support effective diversion control programs or as required by treaty; and (3) establish criminal penalties for attempting to evade reporting requirements and for smuggling listed drugs. (Sec. 1509) Grants the Attorney General the same inspection authority for listed chemicals as presently exists with respect to controlled substances. (Sec. 1511) Makes it a felony to violate the Solid Waste Disposal Act in the handling of chemicals used to illegally manufacture a controlled substance. Requires that violators be assessed costs of the initial cleanup and disposal of the listed chemical and contaminated property and the costs of restoring property damaged by exposure to such chemical. Subtitle C: General Provisions - Prohibits and sets penalties for: (1) drug dealing in or near public housing authority facilities; (2) a physical trainer or adviser who tries to persuade an individual to use anabolic steroids; and (3) advertising which aims to illegally solicit or sell drugs. (Sec. 1518) Enhances penalties for drug dealing in "drug-free zones." (Sec. 1519) Includes among the long-term goals of the National Drug Control Strategy making drug treatment available to all who need it. Title XVI: Drunk Driving Provisions - Amends the Federal criminal code to provide supplementary prison terms and fine authorizations in cases where drunk driving endangers or injures a person under age 18. (Sec. 1602) Expresses the sense of the Congress that in determining child custody and visitation rights the courts should consider the history of drunk driving of anyone involved in the determination. Title XVII: Commissions - Subtitle A: Commission on Crime and Violence - Establishes the National Commission on Crime and Violence in America to develop a comprehensive crime control plan for the 1990's. Subtitle B: National Commission to Study the Causes of the Demand for Drugs in the United States - Establishes a National Commission to Study the Causes of the Demand for Drugs in the United States. Subtitle C: National Commission to Support Law Enforcement - Establishes a National Commission to Support Law Enforcement. Title XVIII: Motor Vehicle Theft Prevention - Directs the Attorney General to develop a national voluntary motor vehicle theft prevention program which would involve placing identifiable decals on the vehicles of consenting owners, whereby such vehicles could then be stopped by law enforcement officers upon a reasonable suspicion that the vehicles were not being operated by or with the consent of their owners. (Sec. 1802) Prohibits and sets penalties for tampering with the decals, with exceptions. Title XIX: Protections for the Elderly - Directs the Attorney General to make grants in support of programs to protect and locate missing patients with Alzheimer's disease and related dementias. Authorizes appropriations. (Sec. 1902) Directs the Sentencing Commission to ensure that the sentences for those convicted of crimes of violence against elderly victims be sufficiently stringent to deter such crimes, protect the public from additional crimes of such a defendant, and provide enhanced penalties under specified criteria. Title XX: Consumer Protection - Amends the Federal criminal code to set penalties for insurance industry crimes, including embezzling from insurance companies, making false entries in insurance company books with intent to deceive, and corruptly influencing or obstructing proceedings before State insurance regulatory agencies or insurance examiners. Prohibits persons convicted of criminal felonies involving dishonesty or breach of trust from engaging in the insurance business without the written consent of an insurance regulatory official authorized to regulate the insurer. (Sec. 2002) Consumer Protection Against Credit Card Fraud Act of 1993 - Prohibits the sale of credit cards without credit card company authorization, fraudulent receipt of payments via credit card for goods never received or inferior to those promised, and laundering to credit card receipts. (Sec. 2003) Extends the mail fraud statute to include mail sent by private interstate carriers. Title XXI: Sentencing Provisions - Amends the Federal criminal code to allow the court, in determining the sentence to be imposed in the case of a violation of probation or supervised release, to consider guidelines or policy statements issued by the Sentencing Commission. (Sec. 2103) Sets forth provisions regarding mandatory revocation of probation and of supervised release after imprisonment for possession of a controlled substance or firearm, or for refusal to comply with drug testing. (Sec. 2105) Permits concurrent sentencing of a defendant to imprisonment and probation for petty offenses. Title XXII: Computer Crime - Amends the Computer Fraud and Abuse Act to make it a felony to knowingly transmit an unauthorized program or code that alters the information stored in a computer with the intent to damage the system or information contained within the affected computer or system, or to withhold or deny the use of such system or information, if the transmission: (1) occurred without the authorization of the person responsible for the computer system receiving the program; and (2) causes damage exceeding $1,000 in any one-year period or modifies or impairs the medical care of any individual. Makes it a misdemeanor to recklessly transmit a destructive computer program or code. Creates a civil cause of action for persons suffering damage or loss by virtue of a violation of this title. Modifies the prohibition against accessing a Government computer where such conduct affects the use of the Government's operation of such computer to cover only actions that "adversely" affect such use. Title XXIII: International Parental Kidnapping - Amends the Federal criminal code to establish penalties for removing a child from, or retaining a child outside, the United States with intent to obstruct the lawful exercise of parental rights. (Sec. 2302) Authorizes appropriations to carry out under the State Justice Institute Act of 1984 national, regional, and in-State training and educational programs dealing with criminal and civil aspects of interstate and international parental child abduction. Title XXIV: Safe Schools - Amends the Omnibus Act to: (1) authorize the Director of the BJA to make grants to local educational agencies for the purpose of providing assistance to such agencies most directly affected by crime and violence; and (2) require the Director to develop a written safe schools model in English and in Spanish and make such model available to any such agency that requests it. Authorizes appropriations. Title XXV: Financial Institutions Fraud Prosecutions - Amends the Federal Deposit Insurance Act and the Federal Credit Union Act to disqualify certain persons with criminal records from participating in the affairs of insured depository institutions and credit unions. Title XXVI: White Collar Crime Amendments - Establishes penalties for knowingly receiving the proceeds of: (1) extortion; (2) a kidnapping; and (3) a postal robbery. (Sec. 2603) Extends the prohibition against obstructing civil investigative demands to include obstruction in racketeering and false claims investigations. Title XXVII: Gambling - Sets forth provisions regarding the scope of the prohibition on gambling on ships in international waters. Grants a State gaming enforcement office located within a State Attorney General's office access to FBI criminal history record information for licensing purposes. Title XXVIII: Bail Posting Reporting - Illegal Drug Profits Act of 1991 (sic) - Requires State and Federal criminal court clerks to report to the Internal Revenue Service and prosecutors the name and taxpayer identification number of anyone accused of a drug, money laundering, or racketeering crime who posts cash bail exceeding $10,000. Title XXIX: General Increased Penalty Provision - Increases penalties for assault: (1) of Federal officers, foreign officials, and official guests and internationally protected persons; (2) within a maritime and territorial jurisdiction; and (3) of the President, presidential staff, congressional leaders, cabinet officials, and Supreme Court justices. (Sec. 2902) Increases the maximum penalties for voluntary and involuntary manslaughter. (Sec. 2903) Increases penalties for: (1) conspiracy to commit murder for hire; (2) trafficking in counterfeit goods and services; and (3) Travel Act violations. (Sec. 2906) Broadens the scope and increases the penalties for conspiracies to deprive persons of their civil rights. Title XXX: Miscellaneous - Extends the protection of the criminal civil rights statute to any person in a State. (Currently, the statute only covers a State "inhabitants.") (Sec. 3003) Directs the Attorney General to: (1) require State and local LEAs to annually audit and detail the uses and expenses to which forfeiture funds were dedicated and the amount used for each use or expense; and (2) report to the Congress on the administrative and contracting expense paid from the DOJ Assets Forfeiture Fund. (Sec. 3005) Creates an optional venue in the District of Columbia for espionage and related offenses regarding the gathering, transmitting, losing, or delivering of defense information. (Sec. 3007) Prohibits: (1) the disclosure of information obtained through wiretapping or electronic surveillance with the intent to obstruct a criminal investigation; (2) the theft of major art works from museums; (3) misuse of the words "Drug Enforcement Administration" or the initials "DEA"; and (4) attempted robbery, kidnapping, smuggling, and property damage offenses. (Sec. 3010) Permits trials by a magistrate judge in petty offense cases involving juveniles. Title XXXI: Technical Corrections - Makes technical corrections to various criminal law provisions.

Improving America's Schools Act of 1993

United States · United States Congress · 23 September 1993

TABLE OF CONTENTS: Title I: Amendments to the Elementary and Secondary Education Act of 1965 Title II: Amendments to the General Education Provisions Act Title III: Amendments to Other Acts Improving America's Schools Act of 1993 - Title I: Amendments to the Elementary and Secondary Education Act of 1965 - Amends the Elementary and Secondary Education Act of 1965 (ESEA) to revise and reauthorize ESEA. (Sec. 101) Establishes a title I program for Helping Children in Need Meet High Standards, which revises and reauthorizes some of the current title I chapter 1 programs of Financial Assistance to Meet the Special Educational Needs of Children. Authorizes appropriations for: (1) grants under the basic program; (2) Even Start; (3) education of migratory children; (4) education for neglected or delinquent youth; (5) capital expenses; (6) school improvement; and (7) Federal activities. Requires any State desiring to receive a grant (under the basic program for making high-poverty schools work) to submit State plans that are integrated with that State's plan under the Goals 2000: Educate America Act or with other State plans under this Act. Requires each State plan to describe high-quality standards for all children that will be used by the State, it local educational agencies (LEAs), and its schools to carry out this Act, including challenging content standards in the core academic subjects and challenging performance standards, as well as assessment provisions and other teaching and learning support provisions. Directs the Secretary of Education to establish a process for peer review and Secretarial approval. Requires LEAs receiving subgrants to have plans with standards and assessments provisions and other teaching and learning support provisions. Provides for State approval and shared program responsibility of schools and the LEA in deciding on schoolwide programs and targeted assistance schools. Allows an LEA to only use basic program funds in eligible school attendance areas in which the percentage of children from low-income families is at least as high as that in the LEA as a whole. Sets forth formulas for ranking eligible school attendance areas for purposes of such funding in various cases where there are insufficient funds. Sets forth criteria which a school must meet in order for the LEA to use basic program funds to upgrade the entire educational program at an eligible school (schoolwide programs). Provides that in participating schools that are ineligible for a schoolwide program or that choose not to operate a schoolwide program, an LEA may use basic program funds only for targeted assistance programs that provide services to eligible children identified as having the greatest need for special assistance (targeted assistance schools). Sets forth criteria for eligible children at such schools. Sets forth requirements for parental involvement and for participation of children enrolled in private schools. Provides for assessment and school and district improvement, including local review, designation of Distinguished Schools, school improvement identification, State review and LEA improvement, State establishment of a corps of Distinguished Educators, and State allocations for school improvement. Revises formulas for allocations of funds. Revises Even Start Family Literacy Programs to increase program services and high-poverty-area targeting and include teenage parents. Revises Education of Migratory Children to restrict eligibility to children who have moved within the previous two years. Revises Education of Neglected and Delinquent Youth to require a 20-hour instructional week. Eliminates title I provisions for the National Commission on Migrant Education, rural technical assistance centers, current chapter 2 State block grants under the partnership for educational improvement, national diffusion network, and law-related education. Eliminates under title I, but provides elsewhere for, evaluation and technical assistance and blue ribbon schools. Provides, later in this Act, for programs for handicapped children to be combined with programs under the Individuals with Disabilities Education Act. Establishes a new ESEA title II, Improving Teaching and Learning, with a new part A, Dwight D. Eisenhower Professional Development Program, to support professional development of elementary and secondary school teachers in core academic subjects. (This replaces the current Dwight D. Eisenhower Mathematics and Science Education Act programs.) Gives priority for professional development in mathematics and science. Authorizes appropriations. Establishes a new title II part B, Support and Assistance for ESEA Programs. (This replaces the current Foreign Languages Assistance Act programs.) Includes under such technical assistance program comprehensive regional centers and technology-based technical assistance. Provides for information collection, evaluation, and transition. Authorizes appropriations. Establishes a new ESEA title III, Expanding Opportunities for Learning. (The current title III, Magnet Schools Assistance, is transferred to a new title V, Promoting Equity.) Authorizes appropriations for the following title III parts: (A) Putting Technology to Work for All Students, including educational technology research, development, and demonstration, an Office of Educational Technology, a national long-range plan, and Federal leadership, as well as a revised Star Schools Program; (B) a revised and renamed Fund for the improvement of Education (currently under title IV as the Secretary's Fund for Innovation in Education); (C) a revised Jacob K. Javits Gifted and Talented Education Program (currently under title IV); (D) a new Charter Schools program to increase public school choice through grants for innovative programs and exemptions from regulations that limit school operational and management flexibility; (E) an expanded Arts in Education program; and (F) the Inexpensive Book Distribution Program. Establishes as ESEA title IV a Safe and Drug-Free Schools and Communities program, which replaces and revises the current title V Drug-Free Schools and Communities Act program. (The current title IV Special Programs are replaced as follows: (1) Women's Educational Equity, Gifted and Talented Children, Immigrant Education, and the Secretary's Fund for Innovation are transferred to other titles; and (2) Ellender Fellowships and certain Territorial Assistance are eliminated.) The new program includes: (1) State Grants for Drug and Violence Prevention Programs at State and local levels, including coordinating councils; (2) Postsecondary Drug and Violence Prevention Programs, including higher education institution grants and a national center; and (3) national programs. Establishes as ESEA title V, Promoting Equity, which authorizes appropriations for parts: (A) a revised Magnet Schools Assistance program; (B) a new Equalization Assistance program which provides technical and other assistance, including research, regarding school finance equity; and (C) a revised Women's Educational Equity program. Establishes a new ESEA title VI, Indian Education, which adds revised Indian Education Act programs to ESEA. (Eliminates the current title VI provisions for Projects and Programs Designed to Address School Dropout Problems and to Strengthen Basic Education.) Authorizes appropriations for the following title VI programs: (1) formula grants to LEAs; (2) discretionary programs to improve achievement of Indian children, through grants to Indian-controlled schools and demonstration grants; (3) professional development and adult education programs; (4) national activities and grants to States; and (5) Federal administration through the Office of Indian Education and the National Advisory Council on Indian Education. Revises ESEA title VII, Bilingual Education Programs, while transferring the Emergency Immigrant Education Program to title VII from title IV. Authorizes appropriations for: (1) financial assistance for bilingual education, including enhancement grants and comprehensive district grants; (2) research and evaluation, including academic excellence awards, State grants, and the National Clearinghouse for Bilingual Education; (3) professional development, including grants to higher education institutions, State educational agencies, and LEAs, and academic fellowships; and (4) the Emergency Immigrant Education Program. Establishes a new ESEA title VIII, Impact Aid. (The current impact aid laws are repealed later in this Act.) Revises the impact aid to LEAs by: (1) terminating payments for children whose parents either live on Federal land or work for the Federal Government; and (2) changing the payment formula for those children whose parents work for the Federal Government and live on Federal property, and those who live on Indian lands. Authorizes appropriations. Revises ESEA General Provisions, transferring them from title X to title IX. Provides for: (1) flexibility in the use of administrative and other funds, through consolidation of State administrative funds for elementary and secondary education programs and consolidation of funds for local administration; (2) coordination of programs, including consolidated State and local applications; (3) waivers of statutory and regulatory requirements; and (4) certain uniform provisions. Title II: Amendments to the General Education Provisions Act - Part A: Applicability of the General Education Provisions Act - Amends the General Education Provisions Act (GEPA) to revise applicability and other aspects. Part B: The Department of Education - Revises GEPA with respect to functions of the Department of Education, including an Office of Private Education. Part C: Appropriations and Evaluations - Revises GEPA with respect to availability of appropriations, contingent extension of programs, and biennial evaluation report. Part D: Administration of Education Program - Revises GEPA with respect to joint funding of programs, information collection and dissemination, review of application, use of withheld funds, applications, regulations, reduction of record retention requirements, and equity for students, teachers, and other program beneficiaries. Part E: Advisory Committees - Repeals specified GEPA provisions relating to Advisory Councils. Part F: Enforcement - Repeal specified GEPA provisions relating to use of recovered funds. Part G: Related Amendments to Other Acts - Makes related amendments to the Department of Education Organization Act and the Higher Education Act of 1965 (HEA). Part H: Conforming Amendments - Makes conforming amendments to the Rehabilitation Act of 1973 and to HEA. Title III: Amendments to Other Acts - Part A: Amendments to the Individuals with Disabilities Education Act - Amends the Individuals with Disabilities Education Act (IDEA) to revise provisions for allocations. Combines the current ESEA title I chapter I State agency program for the handicapped with the IDEA programs of grants to States and for infants and toddlers with disabilities. Part B: Amendments to the Stewart B. McKinney Homeless Assistance Act - Amends the Stewart B. McKinney Homeless Assistance Act to revise provisions with respect to grants for State literacy initiatives and grants for State and local activities for the education of homeless children and youth. Authorizes appropriations. Part C: Repeal of Impact Aid Statutes - Repeals certain Federal laws for impact aid. (Impact aid provisions are added to ESEA earlier in this Act.)

To restructure the enforcement components of the Immigration and Naturalization Service.

United States · United States Congress · 21 September 1993

Directs the Attorney General to reorganize the enforcement components of the Immigration and Naturalization Service.

Urban Schools of America (USA) Act of 1993

United States · United States Congress · 20 September 1993

TABLE OF CONTENTS: Title I: Urban School Improvement Title II: School Bulding Repair and Renovation Title III: Urban School Research Title IV: General Provisions Urban Schools of America (USA) Act of 1993 - Title I: Urban School Improvement - Authorizes appropriations and sets forth funds allocation factors. (Sec. 105) Requires LEAs to use funds under this title to meet national education goals through programs designed to: (1) increase the academic achievement and graduation rates of urban school children to at least the national average; (2) prepare urban school graduates to enter higher education, pursue careers, and exercise their responsibilities as citizens; (3) recruit and retain qualified teachers; and (4) decrease the use of drugs and alcohol by urban students, and enhance their physical and emotional health. (Sec. 106) Sets forth program accountability requirements. (Sec. 107) Authorizes the Secretary to make competitive incentive awards to individual participating schools that demonstrate exemplary progress in meeting specified program requirements. (Sec. 108) Directs the Secretary to report on the impact of Federal regulations, guidelines, and policies on urban public schools. (Sec. 109) Requires LEAs desiring to receive an allotment to establish (or designate) a local advisory group. (Sec. 110) Sets forth special rules relating to ranking of schools to determine relative need, in general, on the basis of achievement, poverty, and racial isolation. Requires each LEA receiving a grant to serve between ten and 20 percent of its schools. Requires eligible LEAs to have flexibility to serve homeless children, desegregating students, immigrants, migrants, or other highly mobile populations, within the program assisted under this title. Title II: School Building Repair and Renovation - Authorizes appropriations to assist eligible LEAs in repairing and renovating instructional facilities in city schools and for programs for school environmental concerns and safety improvement. (Sec. 203) Limits the period covered by a grant application to three years, and requires annual review by the Secretary. Title III: Urban School Research - Authorizes appropriations for the National Institute for Urban Education (the Institute), established in the Department of Education by this title. (Sec. 302) Amends the Department of Education Organization Act to create an Assistant Secretary for Urban Education (the Assistant Secretary), who is to establish the Institute in the Department. Requires the Institute and allows LEAs to use funds for specified functions involving research, information, and evaluation relating to urban education and title I programs. Title IV: General Provisions - Establishes the Interagency Council on Urban Schools to: (1) review Federal programs to determine effects on urban schools' ability to meet national education goals; (2) track school progress toward such goals; (3) solicit advice and information from urban education experts and urban school representatives on improvement of Federal programs; (4) review Federal regulations for duplication or contradiction; (5) report annually to the Congress and the President on urban school progress; (6) review and recommend improvement or streamlining of Federal data collection in urban schools; and (7) conduct research to help urban school practitioners improve school performance. (Sec. 402) Directs the President to conduct a White House Conference on Urban Education. Authorizes appropriations. (Sec. 403) Establishes a National Commission on Urban Education, which shall: (1) study specified issues relating to urban schools; and (2) report, and recommend changes in Federal legislation, to the President and appropriate congressional committees. Authorizes appropriations.

Affordable Health Care Now Act of 1993

United States · United States Congress · 15 September 1993

TABLE OF CONTENTS: Title I: Improved Access to Affordable Health Care Subtitle A: Increased Availability and Continuity of Health Coverage for Employees and Their Families Subtitle B: Reform of Health Insurance Marketplace for Small Business Subtitle C: Preemption Subtitle D: Health Deduction Fairness Subtitle E: Improved Access to Community Health Services Subtitle F: Improved Access to Rural Health Services Subtitle G: State Flexibility in the Medicaid Program: The Medical Health Allowance Program Title II: Health Care Cost Containment and Quality Enhancement Subtitle A: Medical Malpractice Liability Reform Subtitle B: Administrative Cost Savings Subtitle C: Deduction for Cost of Catastrophic Health Plan; Medical Savings Accounts Subtitle D: Anti-Fraud Subtitle E: Medicare Payment Changes; Part B Premium Tax for High-Income Individuals Subtitle F: Removing Anti-Trust Impediments Subtitle G: Encouraging Enforcement Activities of Medical Self-Regulatory Entities Subtitle H: Prefunding Government Health Benefits for Certain Annuitants Subtitle I: Miscellaneous Provisions Title III: Long-Term Care Subtitle A: Tax Treatment of Long-Term Care Insurance Subtitle B: Protection of Assets Under Medicaid Through Use of Qualified Long-Term Care Insurance Subtitle C: Studies Subtitle D: Volunteer Service Credit Demonstration Projects Affordable Health Care Now Act of 1993 - Title I: Improved Access to Affordable Health Care - Subtitle A: Increased Availability and Continuity of Health Coverage for Employees and Their Families - Part 1: Required Coverage Options for Eligible Employees, Spouses, and Dependents - Requires each employer to make available to each eligible employee a group health plan under which: (1) coverage of each eligible individual with respect to such employee may be elected on an annual basis; (2) coverage is provided for at least the required coverage specified; and (3) employees may elect to have premiums collected through payroll deduction. Does not require employer contributions to the cost of coverage under such a plan. Provides for the exclusion of: (1) employers who have been employers for less than two years or who have no more than two eligible employees or no more than two eligible employees not covered under any group health plan; and (2) family members under specified circumstances. Specifies that a group health plan shall not be treated as failing to meet the requirements of this Act solely because a period of service by an eligible employee of not more than 60 days is required for coverage. Specifies that the required coverage is standard coverage, except that in the case of a small employer that has not contributed during the previous plan year to the cost of coverage for any eligible employee under any group health plan, the required coverage for the plan year is coverage under a MedAccess standard, MedAccess catastrophic, and MedAccess medisave plan. Provides for a five-year transition for existing group health plans. (Sec. 1002) Sets forth provisions regarding: (1) compliance with applicable requirements through multiple employer health arrangements; and (2) coverage options under a State medical health allowance program. Part 2: Preexisting Conditions and Continuity of Coverage; Renewability - Prohibits a group health plan from imposing (and an insurer from requiring an employer from imposing through a waiting period for coverage under a plan or similar requirement) a limitation or exclusion of benefits relating to treatment of a preexisting condition if: (1) the condition relates to a condition that was not diagnosed or treated within three months before the date of coverage under the plan; or (2) the limitation or exclusion extends over more than six month after the date of coverage, applies to an individual who, as of the date of birth, was covered under the plan, or relates to pregnancy. Specifies that, in the case of an individual who is eligible for coverage under a plan but for a waiting period imposed by the employer, the individual shall be treated as having been covered under the plan as of the earliest date of the beginning of the waiting period. (Sec. 1012) Requires each group health plan to waive any period applicable to a preexisting condition for similar benefits with respect to an individual to the extent that the individual, prior to enrollment in such plan, was covered for the condition under any other health plan. (Sec. 1013) Prohibits: (1) a multiemployer plan and an exempted multiple employer health plan from canceling or denying renewal of coverage under such a plan for an employer other than for nonpayment of contributions, fraud or other misrepresentation, noncompliance with plan provisions, or misuse of a provider network provision, or because the plan is ceasing to provide any coverage in a geographic area; (2) an insurer from canceling a health insurance plan or denying renewal of coverage other than as prescribed above; and (3) an insurer who terminates the offering of health insurance plans in an area from offering such a plan to any employer in the area until five years after the date of the termination. Part 3: Enforcement; Effective Dates; Definitions - Makes provisions of the Employee Retirement Income Security Act of 1974 applicable with respect to enforcement of this Act (by the Department of Labor). Amends the Internal Revenue Code (Code) to impose a tax ($100 per day for each individual involved, subject to specified limitations) on the failure of an insurer to comply with the requirements under part 2 unless the Secretary of Health and Human Services (Secretary) determines that the State has in effect a regulatory enforcement mechanism that provides adequate sanctions. Subtitle B: Reform of Health Insurance Marketplace for Small Business - Requires each insurer that makes available a health insurance plan to a small employer in a State to make available to each small employer in the State a MedAccess standard, MedAccess catastrophic, and MedAccess medisave plan, with exceptions for health maintenance organizations (HMOs) and if a State provides for guaranteed availability (rather than guaranteed issue). Requires each insurer that offers a MedAccess plan to a small employer in a State to accept: (1) every small employer in the State that applies for coverage; and (2) every eligible individual who applies for enrollment on a timely basis. Sets forth provision regarding: (1) special rules for HMOs; (2) timely enrollment requirements; and (3) enrollment of spouses and dependents. Makes such requirements inapplicable in a State that has provided (in accordance with specified standards) a mechanism under which each insurer offering a health insurance plan to a small employer in the State must participate in a program for assigning high-risk small employer groups (or individuals within such a group) among some or all such insurers, if the insurers comply. (Sec. 1102) Defines "MedAccess plan" as a health insurance plan that: (1) is designed to provide standard coverage with substantial cost-sharing, only catastrophic coverage, or medisave coverage; (2) includes only essential and medically necessary services; (3) meets applicable requirements relating to guaranteed issue; and (4) meets specifies consumer protection standards. Defines "MedAccess standard plan," "MedAccess catastrophic plan," and "MedAccess medisave plan" to mean a MedAccess plan that provides for at least standard coverage, for only catastrophic coverage, or medisave coverage, respectively. Requests the National Association of Insurance Commissioners (NAIC) to submit to the Secretary a set of rules which NAIC determines is sufficient for determining, in the case of any health insurance plan and for purposes of this subtitle, the actuarial value of the coverage offered by the plan. Directs the Secretary to certify such set of rules for use under this subtitle if they meet such requirements or establish such a set of rules. Specifies that a health insurance plan is considered to provide: (1) standard coverage if the benefits are determined, in accordance with certified rules of actuarial equivalence, to have a value that is within five percentage points of an established target actuarial value for standard coverage; (2) catastrophic coverage if benefits are available under the plan for a year only to the extent that expenses for covered services in a year exceed a deductible amount that is consistent with a specified requirement for a catastrophic health plan under the Code, and are determined, in accordance with certified actuarial equivalence rules, to have a value that is within five percentage points of an established target actuarial value for catastrophic coverage; and (3) medisave coverage if such plan consists of a catastrophic health plan within the meaning of the Code and a medical savings account. Requests NAIC to submit to the Secretary target actuarial values for standard and catastrophic coverage. Permits NAIC to submit periodic revisions of, and permits the Secretary to revise, the set of rules of actuarial equivalence and target actuarial values where necessary to take into account changes in the relevant types of health benefits provisions, in deductible levels for catastrophic coverage, or in relevant demographic conditions. (Sec. 1103) Directs the Secretary to request NAIC to develop model regulations that specify standards with respect to requirements: (1) that insurers make available MedAccess plans; (2) of guaranteed availability of MedAccess plans to small employers; (3) relating to limits on premiums and certain consumer protections; and (4) relating to limitation of annual premium increases. Requires the Secretary to review such standards and, if NAIC fails to specify standards meeting such requirements, to promulgate standards. Sets forth provisions regarding: (1) the application of MedAccess standards and consumer protection standards by the States; and (2) the Federal role. (Sec. 1104) Sets forth provisions: (1) regarding limits on premiums and annual premium increases; and (2) requiring an insurer, at the time of offering a health insurance plan to a small employer, to fully disclose rating practices for health insurance plans, including rating practices for different populations and benefit designs. (Sec. 1106) Directs the Secretary to: (1) request NAIC to develop models for reinsurance or allocation of risk mechanisms for health insurance plans made available to small employers for whom an insurer is at risk of incurring high costs under the plan; and (2) review such models or specify models. Sets forth provisions regarding implementation of reinsurance or allocation of risk mechanisms by the States and the Federal role. Amends the Code to provide for the imposition of a tax on any health insurance plan which covers any employee in a Federal reinsurance State. (Sec. 1108) Directs the Secretary to establish an Office of Private Health Care Coverage. Requires the Office Director to submit to the Congress annual reports evaluating health care coverage reform. (Sec. 1109) Authorizes the Director to conduct: (1) research on the impact of this subtitle on the availability of affordable health coverage for employees and dependents in the small employers group health care coverage market and other specified topics; and (2) demonstration projects relating to such topics. Requires the Director to develop: (1) methods for measuring the relative health risks of eligible individuals in terms of the expected costs of providing benefits under health insurance plans and, in particular, MedAccess plans; and (2) a model for equitably distributing health risks among insurers in the small employer health care coverage market. Authorizes appropriations. Subtitle C: Preemption - Part 1: Scope of State Regulation - Prohibits: (1) State benefit mandates for group health plans; and (2) State or local law prohibitions against two or more employers obtaining coverage under an insured multiple employer health plan. (Sec. 1203) Preempts State restrictions concerning: (1) reimbursement rates or selective contracting; (2) differential financial incentives; and (3) utilization review methods. Directs the Comptroller General to conduct a study of the benefits and cost effectiveness of the use of managed care in the delivery of health services. Part 2: Multiple Employer Health Benefits Protections - Amends the Employee Retirement Income Security Act of 1974 (ERISA) to allow a limited exemption under preemption rules for multiple employer plans providing health benefits subject to certain Federal standards. (Sec. 1212) Relieves exempted multiple employer plans providing medical care benefits of certain restrictions on preemption of State law. Treats such plans as employee welfare benefit plans. Allows commencement of new arrangements only if such exemption is in effect or an application is pending and the Secretary of Labor determines that provisional protection is appropriate. Sets forth exemption procedures, eligibility requirements, and additional requirements applicable to exempted arrangements. Requires certain disclosures to participating employers, maintenance of reserves, and corrective actions. Provides for expiration, suspension, and revocation of exemptions, and for review of actions by the Secretary. (Sec. 1213) Revises provisions relating to scope of preemption rules, and to treatment of single employer arrangements and of certain collectively bargained arrangements. (Sec. 1215) Establishes special rules for employee leasing healthcare arrangements. Treats such arrangements as multiple employer welfare arrangements except when they are multiple employer health plans. (Sec. 1216) Sets forth enforcement provisions relating to multiple employer welfare arrangements and employee leasing health care arrangements. (Sec. 1217) Sets forth filing requirements for multiple employer welfare arrangements. (Sec. 1218) Provides for cooperation between Federal and State authorities in enforcing ERISA requirements for multiple employer welfare arrangements with the limited exemption. Part 3: Encouragement of Multiple Employer Arrangements Providing Basic Health Benefits - Amends the Internal Revenue Code to eliminate the commonality of interest or geographic location requirement for tax exempt trust status for multiple employer health plans and insured multiple employer health plans if they meet certain requirements under ERISA and this Act. Part 4: Simplifying Filing of Reports for Employers Covered under Insured Multiple Employer Health Plans - Amends ERISA to direct the Secretary of Labor to prescribe an alternative method providing for a single annual report with respect to all employers who are covered under the same insured multiple employer health plan. Part 5: Compliance with Coverage Option Requirements - Provides for compliance with applicable coverage requirements through multiemployer plans and other multiple employer health arrangements. Subtitle D: Health Deduction Fairness - Amends the Internal Revenue Code to provide: (1) for a permanent extension and increase in the health insurance tax deduction for self-employed individuals; and (2) that the deduction for certain health insurance costs be determined without regard to an adjusted gross income threshold. Disallows the deduction to individuals eligible for employer-subsidized coverage. Allows the deduction whether or not the individual itemizes other deductions. Subtitle E: Improved Access to Community Health Services - Part 1: Increased Authorization for Community and Migrant Health Centers - Directs the Secretary to provide for grants to migrant and community health centers to promote primary health care services for underserved individuals. Allows grants to be used to promote the provision of off-site services, to improve birth outcomes in areas with high infant mortality and morbidity, to establish primary care clinics in areas in need, and for recruitment and training costs of necessary providers and operating costs for unreimbursed services. Authorizes appropriations. Directs the Secretary to conduct a study of the impact of such grants on access to health care, birth outcomes, and the use of emergency room services. Part 2: Grants for Projects for Coordinating Delivery of Services - Amends the Public Health Service Act to authorize the Secretary to make grants to public and nonprofit private entities: (1) to carry out demonstration projects to increase access to outpatient primary health services in specified geographic areas (i.e., areas that are rational areas for the delivery of health services, have a population of not more than 500,000 individuals, and have been designated by the Secretary as areas with a shortage of personal health services or that have a significant number of individuals with low incomes or insufficient health care insurance through coordinating the delivery of such services under Federal, State, local, and private programs; and (2) for developing plans to carry out such projects. Authorizes appropriations. Subtitle F: Improved Access to Rural Health Services - Part 1: Establishment of Rural Emergency Access Care Hospitals Under Medicare - Amends title XVIII (Medicare) of the Social Security Act (SSA) to provide for: (1) establishment of rural emergency access care hospitals under Medicare; and (2) coverage of and payment for rural emergency access care hospital services under Medicare part B (Supplementary Medical Insurance). Part 2: Rural Medical Emergencies Air Transport - Amends the Public Health Service Act to direct the Secretary to make grants to States to assist in the creation or enhancement of air medical transport systems that provide victims of medical emergencies in rural areas with access to treatments. Sets forth provisions regarding: (1) application and State plan requirements; (2) considerations in awarding grants; (3) State administration and use of grants; (4) the number of grants; and (5) reporting requirements. Authorizes appropriations. Part 3: Emergency Medical Services Amendments - Amends the Public Health Service Act to direct the Secretary to: (1) establish an Office of Emergency Medical Services, headed by a Director; (2) engage in specified emergency medical services activities, including disseminating information obtained in carrying out specified activities to public and private entities, providing technical assistance to State and local agencies, coordinating Department of Health and Human Services (DHHS) activities with those of other Federal agencies; and (3) ensure that such activities are carried out consistent with certain requirements regarding maintaining an adequate number of health professionals with expertise in the provision of services, developing, periodically reviewing, and revising as appropriate guidelines for the provision of such services, appropriately using available technologies, and serving the unique needs of underserved inner-city and rural areas. (Sec. 1522) Authorizes the Secretary to make grants to States for the purpose of improving the availability and quality of emergency medical services through the operation of State offices of emergency medical services, subject to specified matching fund, budgetary, and other requirements. (Sec. 1523) Provides for demonstration projects to establish telecommunications between rural medical facilities and medical facilities with expertise or equipment. Directs the Secretary to ensure that the telecommunications technologies demonstrated include interactive video telecommunications, static video imaging transmitted through the telephone system, and facsimiles transmitted through such system. (Sec. 1524) Authorizes appropriations for: (1) emergency medical services (including for State offices of Emergency Medical Services and for telecommunications demonstrations); and (2) trauma care and certain other activities. Subtitle G: State Flexibility in the Medicaid Program: The Medical Health Allowance Program - Amends SSA title XIX (Medicaid) to provide for the establishment of State health allowance programs under which the State makes payments to a group health plan which provides coverage to an eligible individual as an allowance towards the costs of providing the individual with benefits under the plan. Subtitle H: Medicaid Program Flexibility - Amends SSA title XIX Medicaid) to modify: (1) Federal requirements to allow States more flexibility in contracting for coordinated care services under Medicaid; and (2) provisions regarding the extension of certain waivers. Title II: Health Care Cost Containment and Quality Enhancement - Subtitle A: Medical Malpractice Liability Reform - Part 1: General Provisions - Makes this subtitle applicable with respect to any medical malpractice liability claim and to any medical malpractice liability action brought in State or Federal court, except a claim or action for damages arising from a vaccine-related injury or death to the extent that title XXI of the Public Health Service Act applies. Sets forth provisions regarding: (1) preemption of State law; (2) effect on sovereign immunity and choice of law or venue; (3) jurisdiction; and (4) effective dates. Part 2: Medical Malpractice and Product Liability Reform - Prohibits a medical malpractice liability action from being brought in any State court during a calendar year unless the relevant claim has been initially resolved (i.e., a decision has been reached on whether the defendant is liable to the plaintiff for damages and on the amount of damages) under a certified alternative dispute resolution (ADR) system or an alternative Federal system. Prohibits a medical malpractice liability action from being brought in Federal court based on diversity of citizenship during a calendar year unless the relevant claim has been initially resolved under such a system in the State whose law applies. Directs the Attorney General to establish an ADR process for tort claims consisting of medical malpractice liability claims brought against the United States under chapter 171 of the Federal judicial code (U.S. Court of Federal Claims). Prohibits a medical malpractice liability action based on such a claim from being brought in any Federal court unless the claim has been initially resolved under such process. Sets forth procedures for filing actions. (Sec. 2012) Limits to $250,000 the amount of noneconomic damages that may be awarded to a claimant and family members in a medical malpractice liability action. Sets limits on punitive damages and on periodic payments for future losses. (Sec. 2013) Set forth provisions regarding: (1) limits on attorney fees and other costs; (2) joint and several liability (generally, liability may be found only for those damages directly attributable to the person's proportionate share of fault or responsibility for the injury); (3) a statute of limitations of seven years; and (4) a uniform standard for determining negligence (the defendant's conduct at the time of providing the health care services was not reasonable). (Sec. 2017) Specifies that in the case of a medical malpractice liability claim relating to services provided during labor or the delivery of a baby, if the health care professional did not previously treat the injured individual for the pregnancy, the trier of fact may not find that the defendant committed malpractice nor assess damages unless the malpractice is proven by clear and convincing evidence. Part 3: Requirements for State Alternative Dispute Resolution Systems - Lists requirements for State ADR systems, including that such a system: (1) applies to all medical malpractice liability claims under the jurisdiction of the courts of that State; (2) requires that a written opinion resolving the dispute be issued within six months after each party against whom the claim is filed has received notice of the claim; (3) is approved by the State or local governments; (4) provides for the transmittal to the State agency responsible for monitoring or disciplining health care professionals and providers of any findings of malpractice; and (5) provides for the regular transmittal of information on disputes resolved under the system to the Administrator for Health Care Policy and Research in a manner that protects the identity of the parties involved. (Sec. 2032) Directs the Secretary, by October 1 of each year, to certify State ADR systems that meet such requirements. Directs the Secretary to establish an alternative Federal ADR system for the resolution of medical malpractice liability claims in States that do not have in effect a certified ADR system. (Sec. 2033) Directs the Secretary, within five years, to submit to the Congress a report describing and evaluating State ADR systems and the alternative Federal system, including: (1) information on the effect of the ADR systems on health care costs, access to health care, and quality of care provided within the State; and (2) to the extent that such report does not provide information on no-fault systems operated by States as ADR systems, an analysis of the feasibility and desirability of establishing a system for resolving medical malpractice liability claims on a no-fault basis. Part 4: Other Provisions Relating to Medical Malpractice Liability - Authorizes a State agency responsible for disciplinary actions for a type of health care practitioner to enter into agreements with State or county professional societies to permit their participation in the licensing of such practitioner and to review any health care malpractice action, claims, or allegation, or other information concerning the practice patterns of any such practitioner. Sets forth agreement requirements. (Sec. 2042) Directs the Secretary to study incentives adopted by State and local governments, insurers, medical societies, and other entities to encourage physicians to volunteer to provide health care services in medically underserved areas. (Sec. 2043) Directs each State to require: (1) each health care professional and health care provider to participate in a risk management program to prevent, and provide early warning of, practices which may result in injuries to patients or endanger patient safety; and (2) each provider of health care professional and provider liability insurance in the State to establish risk management programs or sanction programs of risk management for health care professionals and providers provided by other entities, and require each such professional or provider, as a condition of maintaining insurance, to participate in one such program at least once in each three-year period. (Sec. 2044) Directs the Secretary to make grants: (1) for basic research in the prevention of, and compensation for, injuries resulting from health care professional or provider malpractice and for research of the outcomes of health care procedures; (2) to the States to assist in improving their ability to license and discipline health care professionals; and (3) to States and local governments, private nonprofit organizations, and health professional schools for educating the general public about the appropriate use of health care, realistic expectations of medical intervention, and the resources and role of health care professional licensing and disciplinary boards in investigating claims of incompetence or health care malpractice, and for developing programs of faculty training and curricula for educating health care professionals in quality assurance, risk management, and medical injury prevention. Authorizes appropriations. Subtitle B: Administrative Cost Savings - Part 1: Standardization of Claims Processing - Directs the Secretary to adopt standards relating to: (1) data elements for use in paper and electronic claims processing under health benefit plans and in utilization review and management of care; (2) uniform claims forms; and (3) uniform electronic transmission of the data elements. (Sec. 2102) Authorizes the Secretary, two years after standards are adopted for classes of services upon determining that a significant number of claims for benefits for such services under health benefit plans are not being submitted in accordance with such standards, to require that all providers of such services submit claims to health benefit plans in accordance with such standards. (Sec. 2103) Directs the Secretary to: (1) provide for the ongoing receipt and review of comments and suggestions for changes in the standards adopted and promulgated; (2) establish a schedule for the periodic review of such standards; and (3) revise such standards. Part 2: Electronic Medical Data Standards - Directs the Secretary to promulgate standards for hospitals concerning electronic medical data, including standards for transmission of such data and confidentiality of patient-specific information. Authorizes the Secretary to periodically revise such standards. (Sec. 2112) Sets forth requirements with respect to: (1) the sharing of hospital information under Medicare; (2) waiver of such requirements; and (3) application of such requirements to hospitals of the Department of Veterans Affairs. (Sec. 2113) Authorizes the head of a Federal agency to require a provider to present and transmit a required data element electronically in accordance with applicable presentation or transmission standard. (Sec. 2114) Sets forth limitations on data requirements where standards with respect to data elements are in effect. (Sec. 2115) Directs the Secretary to establish an advisory commission on the standards established under this part and operational concerns about the implementation of such standards. Authorizes appropriations. Part 3: Development and Distribution of Comparative Value Information - Directs the Secretary to determine whether each State is developing and implementing a health care value information program that meets specified criteria and a specified schedule. Authorizes the Secretary to: (1) make grants to enable each State to plan development and initiate implementation of its health care value information program; and (2) recover the amount of such a grant by offset against any other amount payable to the State under the Social Security Act under specified circumstances. Authorizes appropriations. (Sec. 2122) Directs the Secretary to take actions necessary to implement a comparable program in a State that fails to develop or implement a health care value information program in accordance with such criteria and schedule. Authorizes the Secretary to charge fees for the information materials provided pursuant to such a program. (Sec. 2123) Directs the head of each Federal agency with responsibility for the provision of health insurance or health care services to individuals to develop health care value information relating to each program that such head administers and covering the same types of data that a State program meeting such criteria would provide. (Sec. 2124) Directs the Secretary to: (1) develop model systems to facilitate the gathering of data on health care cost, quality, and outcome and the analysis of such data in a manner that will permit the valid comparison of such data among providers and among health plans; (2) support experimentation with different approaches to achieve such objectives in the most cost effective manner; and (3) evaluate the various methods to determine their relative success. Authorizes the Secretary to establish standards for the collective and reporting of data on health care cost, quality, and outcomes. Authorizes appropriations. Part 4: Additional Standards and Requirements; Research and Demonstrations - Directs the Secretary to: (1) adopt standards relating to the design and use of magnetized Medicare identification cards to assist health care providers in determining whether individuals are eligible for benefits for provided services under the Medicare program and in billing the Medicare program for covered services; (2) take steps to encourage and assist States in the design and use of magnetized Medicaid identification cards under their Medicaid plans; and (3) establish a Medicare and Medicaid information system to provide information on group health and other health benefit plans that are primary payors to the Medicare and Medicaid programs. Authorizes appropriations. (Sec. 2132) Specifies that, effective January 1, 1994, no effect shall be given to any provision of State law that requires medical or health insurance records (including billing information) to be maintained in written, rather than electronic, form. (Sec. 2133) Requires, effective January 1, 1995, each health benefit plan: (1) to use a beneficiary's social security number as the personal identifier for claims processing and related purposes (authorizes the Secretary to impose a civil money penalty on any plan that fails to do so); and (2) to use the unique identifier under title XVIII of the Social Security Act (Medicare) for a provider that furnishes health care items or services to a beneficiary under the plan as the identifier of that provider for claims processing and related purposes. (Sec. 2134) Directs the Secretary to: (1) determine, where benefits are payable under two or more health benefit plans, whether problems relating to the rules for determining the liability of plans or the availability of information among plans causes significant administrative costs; and (2) promulgate standards, if the implementation of standards would significantly reduce such administrative costs. Authorizes the Secretary to impose a civil money penalty on plans that fail to comply with such standards. (Sec. 2135) Directs the Secretary to provide grants to qualified entities for research on the application of comprehensive information systems in continuously monitoring and improving patient care. Authorizes the Secretary to make grants to: (1) two to five community organizations or coalitions of health care providers, health benefit plans, and purchasers to establish and document the efficacy of communication links between the information systems of health benefit plans and of health care providers; (2) two to five public or private nonprofit entities for the development of regional or community-based clinical information systems; and (3) public or private nonprofit entities to develop and test the definition of a comprehensive set of data elements and the specification and manner of presentation of the individual data elements of the set, for electronic medical data generated by physicians and other entities (other than hospitals) that provide health care services. Authorizes appropriations. Subtitle C: Deduction for Cost of Catastrophic Health Plan; Medical Savings Account - Amends the Internal Revenue Code to include under the medical expense deduction the portion of such expense attributable to coverage under a catastrophic health plan. (Sec. 2202) Allows individuals a tax deduction for percentage of contributions made to a medical care savings account established for the benefit of an eligible individual. Allows such deduction whether or not an individual itemizes deductions. Disallows distributions from such accounts as medical expense deductions. Excludes employer contributions to such accounts from employment taxes. Establishes an excise tax for excess contributions to medical care savings accounts. Subtitle D: Anti-Fraud - Part 1: Criminal Prosecution of Health Care Fraud - Amends the Federal criminal code to: (1) set penalties for health care providers who knowingly engage in any scheme or artifice to defraud any person in connection with the provision of health care; and (2) make activity which, if engaged in by the U.S. Postal Service, would be a violation of mail fraud provisions punishable to the same extent with respect to private or commercial interstate carriers. (Sec. 2303) Authorizes appropriations to hire, equip, and train no fewer than: (1) 225 special agents of the Federal Bureau of Investigation and support staff to investigate health care fraud cases; (2) 50 assistant United States Attorneys and support staff to prosecute such cases; and (3) 25 investigators in the Office of Inspector General, DHHS, to be devoted exclusively to health care fraud cases. (Sec. 2304) Amends the Federal criminal code to authorize the Attorney General to make payments of up to $10,000 to a person who furnishes information unknown to the Government relating to a possible prosecution of health care fraud, subject to specified requirements and exceptions. Part 2: Coordination of Health Care Anti-Fraud and Abuse Activities - Directs the Secretary to establish in the Office of the Inspector General of DHHS a program (all-payer fraud and abuse control program) to: (1) coordinate Federal, State, and local law enforcement programs to control fraud and abuse with respect to the delivery of, and payment for, health care in the United States; (2) conduct investigations, audits, evaluations, and inspections relating to such delivery and payment; and (3) facilitate the enforcement of provisions of the Social Security Act and other statutes applicable to health care fraud and abuse. Directs the Secretary to establish standards to carry out such program, including standards relating to the furnishing of information by health insurers, providers, and other to enable the Secretary to carry out the program and procedures to assure that such information is provided and utilized in a manner that protects the confidentiality of the information and the privacy of individuals receiving health care services. Sets forth provisions regarding: (1) qualified immunity for providing information; (2) ensuring access to documentation; and (3) failure to comply as grounds for exclusion from the Medicare and Medicaid programs. (Sec. 2312) Authorizes additional appropriations to enable the Secretary to conduct investigations of allegations of health care fraud and to carry out the all-payor fraud and abuse control program. (Sec. 2313) Establishes in the Treasury an Anti-Fraud and Abuse Trust Fund to be used to assist the Inspector General of DHHS in carrying out the all-payor fraud and abuse control program in the fiscal year involved. Sets forth provisions regarding: (1) the deposit into the Fund of Federal health anti-fraud and abuse penalties; and (2) the use of such penalties to repay beneficiaries for cost-sharing. (Sec. 2314) Amends SSA title XI to provide for the application of Federal health anti-fraud and abuse sanctions to all fraud and abuse against private health benefit plans. Subtitle E: Medicare Payment Changes; Part B Premium Tax for High-Income Individuals: Part 1 - Medicare Payment Changes - Amends SSA title XVIII to: (1) eliminate the membership limitation for Medicare health maintenance organizations; and (2) revise the Medicare select policy program and provide for a civil money penalty for misrepresentations made in connection with a Medicare select policy. (Sec. 2402) Amends the Omnibus Budget Reconciliation Act of 1990 to: (1) make permanent the Medicare select policy program; and (2) allow access to Medicare select policies in all States. (Sec. 2403) Directs the Secretary of Health and Human Services to take such steps as may be necessary to consolidate the administration of Medicare parts A and B. Part 2: Part B Premium Tax for High-Income Individuals - (Sec. 2411) Amends the Internal Revenue Code to impose a tax on the Medicare part B premiums of high income individuals. Subtitle F: Removing Anti-Trust Impediments - Directs the Attorney General to promulgate guidelines under which a health care joint venture may submit an application requesting that the Attorney General provide the entities participating in the venture with an exemption under which: (1) monetary recovery on an antitrust claim brought against the entity shall be limited to actual damages if specified conditions are met; and (2) the conduct of the entity in making or performing a contract to carry out the venture shall not be deemed illegal per se. Requires the Attorney General to approve or disapprove the application within a specified time frame and to provide a statement explaining the reasons for any disapproval. Directs the Attorney General to approve the application if an entity participating in the venture submits to the Attorney General an application that contains the identities of the parties to the venture; the nature, objectives, and planned activities of the venture; and specified assurances and information. Sets forth provisions regarding: (1) revocation and renewal of exemptions and withdrawal of an application; (2) requirements relating to notice and publication of exemptions; and (3) issuance of health care certificates of public advantage to each eligible health care joint venture that complies with specified requirements. Establishes the Interagency Advisory Committee on Competition, Antitrust Policy, and Health Care to: (1) discuss and evaluate competition and antitrust policy and their implications regarding the performance of health care markets; (2) analyze the effectiveness of health care joint ventures receiving exemptions in reducing costs and expanding access; and (3) make recommendations to the Congress. Subtitle G: Encouraging Enforcement Activities of Medical Self-Regulatory Entities - Part 1: Application of the Clayton Act to Medical Self-Regulatory Entities - Provides that no damages, cost of suit, or attorney fee may be recovered under section 4, 4A, or 4C of the Clayton Act, or under any similar State law, except by a State or the United States, from any medical self-regulatory entity as a result of engaging in standard setting or enforcement activities that are: (1) designed to promote the quality of health care provided to patients; and (2) not conducted for purposes of financial gain. Directs the court to award the cost of such a suit, including a reasonable attorney fee, to a substantially prevailing defendant. Part 2: Consultation by Federal Agencies - Requires any Federal agency engaged in the establishment of medical profession standards to consult with appropriate medical societies or associations, specialty boards, or recognized accrediting agencies, if available, in carrying out medical professional standard setting and guidelines or standards relating to the practice of medicine. Subtitle H: Prefunding Government Health Benefit for Certain Annuitants - Requires that certain agencies prefund Government health benefits contributions for their annuitants. Subtitle I: Miscellaneous Provisions - Amends Civil Service and Federal Employees' Retirement Systems law to increase the minimum age required to be eligible for an immediate retirement annuity. Provides for the conformance of other Federal retirement systems with the minimum age increase made above. Title III: Long-Term Care - Subtitle A: Tax Treatment of Long-Term Care Insurance - Amends the Internal Revenue Code to provide for the treatment of qualified long-term care insurance as accident and health insurance for purposes of insurance company taxation. (Sec. 3002) Excludes from gross income benefits provided under a long-term care insurance contract. Includes in gross income employer-provided coverage for long-term care services. (Sec. 3003) Includes amounts paid for qualified long-term care services as medical expenses for individual itemized deductions. Includes any parent or grandparent as a dependent for purposes of such expenses. (Sec. 3004) Provides for the nonrecognition of gain or loss on the exchange of any life insurance contract or an endowment or annuity contract for a long-term care insurance contract. (Sec. 3005) Excludes from gross income certain amounts withdrawn from individual retirement accounts and certain employer cash or deferred arrangement to pay long-term care premiums. (Sec. 3006) Allows insurance companies to issue accelerated death benefit riders on life insurance contracts. Subtitle B: Protection of Assets Under Medicaid Through Use of Qualified Long-Term Care Insurance - Amends SSA title XIX to require State Medicaid plans to disregard some or all of the individual's assets attributable to coverage under a qualified long-term care insurance contract in determining the individual's eligibility for long-term care services. Subtitle C: Studies - Requires the Comptroller General to study the feasibility of: (1) encouraging health care providers to donate their services to homebound patients; and (2) providing heads of households who care for elderly family members in their home with an income tax credit. (Sec. 3203) Requires the Secretary of Health and Human Services to study and report to the Congress on the feasibility of encouraging or requiring the use of a single designate public or nonprofit agency to coordinate, through case management, the provision of long-term care benefits under current Federal, State, and local programs in a geographic area. Subtitle D: Volunteer Service Credit Demonstration Projects - (Sec. 3301) Amends the Older Americans Act of 1965 to require the Commissioner of the Administration on Aging to establish and operate a volunteer service credit demonstration project in each State.

A bill respecting the relationship between the workers' compensation benefits and the benefits available under the Migrant and Seasonal Agricultural Worker Protection Act.

United States · United States Congress · 13 September 1993

Amends the Legislative Branch Appropriations Act, 1993 to make State workers' compensation laws the exclusive remedy for agricultural worker injuries under the Migrant and Seasonal Agricultural Worker Protection Act for all cases in which a final judgment has not been entered before October 6, 1992.

To prohibit the admission to the United States as refugees of individuals who have served in the armed forces of Iraq during the Persian Gulf conflict.

United States · United States Congress · 8 September 1993

Prohibits the refugee admission into the United States of persons who served in the Iraqi armed forces during the Persian Gulf conflict.

Regarding the resettlement of enemy prisoners of war.

United States · United States Congress · 8 September 1993

Expresses the sense of the Congress that the Federal Government should terminate the policy of allowing resettlement of members of the Iraqi armed forces in the United States.

Doris Meissner, of Maryland, to be Commissioner of Immigration and Naturalization, vice Gene McNary, resigned.

United States · United States Senate · 7 September 1993

A bill to limit the funding to the Northern Mariana Islands pursuant to the provisions set forth in the Agreement of the Special Representatives on Future Federal Financial Assistance, and for other purposes.

United States · United States Congress · 6 August 1993

Limits Federal assistance to the Northern Mariana Islands for FY 1994 through 1998 as set forth in the Agreement of the Special Representatives on Future Federal Financial Assistance of the Northern Mariana Islands of December 1992. Continues the payment of a specified annual amount after FY 1998 unless otherwise provided by law. Bars the obligation of funds in accordance with the Agreement until the Secretary of the Interior certifies to specified congressional committees in each fiscal year that the Northern Mariana Islands: (1) does not have an amount of aliens that exceeds the 1992 average daily number of aliens in the Islands as determined by the Commissioner of the Immigration and Naturalization Service (INS) and imposes a specified numerical limitation on the number of alien workers admitted for employment in the garment industry; (2) is implementing a petitioning mechanism to measure and compare the number of alien admissions with the 1992 average and provides the INS with such information for verification purposes; (3) has enacted and is enforcing measures to raise revenues; (4) is implementing a rate schedule approved by the Secretary that will phase in charges for users of utilities to recover specified costs of power, water, and sewer services; (5) has plans approved by the Secretary for the use of project funds; and (6) has enacted and is enforcing laws to provide no greater deductions from wages for housing, food, transportation, health care, employment fees, or other expenses for workers not permanently admitted into the Islands than are contained in the Fair Labor Standards Act of 1938 and which allow for the same exemptions from the payment of minimum wages as provided in such Act.

A bill for the relief of Gorsha Michaelovich Sur.

United States · United States Congress · 5 August 1993

Waives certain naturalization requirements under the Immigration and Nationality Act with regard to a named individual.

Immigration Stabilization Act of 1993

United States · United States Congress · 4 August 1993

TABLE OF CONTENTS: Title I: Admission of Immigrants Title II: Admission of Refugees Title III: Asylum Reform Title IV: Criminal Aliens Title V: Financial Responsibility Title VI: Employer Sanctions Title VII: Border Security Title VIII: Alien Smuggling Title IX: Local Cooperation Title X: Citizenship Immigration Stabilization Act of 1993 - Title I: Admission of Immigrants - Amends the Immigration and Nationality Act (Act) with respect to: (1) immigration levels; (2) visa allotment; and (3) petition approval. Title II: Admission of Refugees - Limits nonemergency refugee admissions in any fiscal year to 50,000. Title III: Asylum Reform - Amends provisions with respect to: (1) alien inspection and exclusion by immigration officers; (2) asylum; and (3) judicial review. Title IV: Criminal Aliens - Expands the definition of "aggravated felony." (Sec. 402) Provides for the expedited deportation of certain nonpermanent resident aliens convicted of an aggravated felony. (Sec. 403) Authorizes judicial deportation for an alien convicted of a felony. (Sec. 404) Increases penalties for reentry or failure to depart. (Sec. 406) Authorizes the deportation of an alien prisoner prior to sentence completion under specified circumstances. (Sec. 407) Amends Federal criminal law to require the issuance of a judicial order of deportation in the case of an alien being sentenced for an aggravated felony. (Sec. 408) Authorizes Federal incarceration and deportation of certain State-convicted aliens. (Sec. 409) Amends Federal criminal law to increase penalties for specified visa and passport related crimes. (Sec. 410) Requires State or local law enforcement agencies to notify the district Immigration and Naturalization Service office upon the felony arrest of an alien. Title V: Financial Responsibility - Authorizes the admission of an alien otherwise excludable as a public charge (as defined by this Act) if such alien has a sponsor guarantee of financial responsibility. (Sec. 503) Limits benefits, including unemployment benefits, for illegal aliens. Title VI: Employer Sanctions - Revises employer sanction provisions, including: (1) work eligibility documents; and (2) social security telephone verification. Title VII: Border Security - Increases Border Patrol personnel levels. Establishes: (1) a border crossing fee; and (2) a Border Control Trust Fund. (Sec. 704) Amends the Act to establish increased penalties or a required pilot program for international carriers that bring in more than specified numbers of undocumented aliens. Title VIII: Alien Smuggling - Directs the Secretary of State to enter into cooperative foreign arrangements to prevent the unlawful entry of aliens into the United States. (Sec. 802) Directs the Secretary of Defense to instruct the Coast Guard with respect to preventing the illegal entry of aliens into the United States by sea. (Sec. 803) Amends Federal criminal law to bring specified alien related activities under the purview of the Racketeer Influenced and Corrupt Organizations (RICO) provisions. (Sec. 804) Increases alien smuggling penalties. (Sec. 805) Expands forfeiture provisions for smuggling or harboring aliens. (Sec. 806) Amends Federal criminal law to authorize wiretaps for alien smuggling investigations. Title IX: Local Cooperation - Prohibits specified Federal program assistance to States or local entities that do not use the SAVE system to verify an alien applicant's immigration status. Title X: Citizenship - Makes it unlawful (and establishes penalties) for a noncitizen to vote in a Federal or State election.