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Bill· SS. 1779 (103rd)open
United States · United States Congress · 22 November 1993
TABLE OF CONTENTS: Title I: Health Care Security Subtitle A: Universal Coverage and Individual Responsibility Subtitle B: Benefits Subtitle C: State Responsibilities Subtitle D: Health Alliances Subtitle E: Health Plans Subtitle F: Federal Responsibilities Subtitle G: Employer Responsibilities Subtitle J (sic): General Definitions; Miscellaneous Provisions Title II: New Benefits Subtitle B (sic): Long-Term Care Title III: Public Health Initiatives Subtitle A: Workforce Priorities Under Federal Payments Subtitle B: Academic Health Centers Subtitle C: Health Research Initiatives Subtitle D: Core Functions of Public Health Programs; National Initiatives Regarding Preventive Health Subtitle E: Health Services for Medically Underserved Populations Subtitle F: Mental Health; Substance Abuse Subtitle G: Comprehensive School Health Education; School-Related Health Services Subtitle H: Public Health Service Initiative Subtitle I: Coordination With COBRA Continuation Coverage Title V (sic): Quality and Consumer Protection Subtitle A: Quality Management and Improvement Subtitle B: Information Systems, Privacy, and Administrative Simplification Subtitle C: Remedies and Enforcement Title VI: Premium Caps; Premium-Based Financing; and Plan Payments Subtitle A: Premium Caps Subtitle B: Premium-Related Financing Subtitle C: Payments to Regional Alliance Health Plans Title VIII (sic): Health and Health-Related Programs of the Federal Government Subtitle E (sic): Amendments to the Employee Retirement Income Security Act of 1974 Title IX: Aggregate Government Payments Subtitle B (sic): Aggregate Federal Alliance Payments Subtitle C: Borrowing Authority to Cover Cash-Flow Shortfalls Title X: Coordination of Medical Portion of Workers Compensation and Automobile Insurance Subtitle A: Workers Compensation Insurance Subtitle C (sic): Commission on Integration of Health Benefits Subtitle E (sic): Davis-Bacon Act and Service Contract Act Subtitle F: Effective Dates Title XI: Transitional Insurance Reform Health Security Act - Title I: Health Care Security - Subtitle A: Universal Coverage and Individual Responsibility - Entitles each eligible individual to: (1) the benefit provided under subtitle B through the applicable health plan in which the individual is enrolled; and (2) a health security card to be issued by the alliance or other entity that offers the applicable health plan in which the individual is enrolled. Defines an eligible individual as an individual who resides in the United States and is: (1) a citizen or national of the United States; (2) an alien permanently residing in the U.S. under color of law; or (3) a long-term nonimmigrant. Entitles a Medicare-eligible individual to benefits under Medicare instead of the above provisions of this Act. (Sec. 1002) Requires each eligible individual to enroll in an applicable health plan and pay any required premium. Prohibits disenrollment of an eligible individual until the individual is either enrolled in another plan or in Medicare. (Sec. 1003) States that nothing in this Act shall be construed as prohibiting: (1) an individual from purchasing any health services; (2) an individual from purchasing supplemental insurance; (3) an individual who is not an eligible individual from purchasing health insurance; or (4) employers from providing additional coverage. (Sec. 1004) States that a regional alliance health plan is the applicable plan for a family, unless a family member is eligible for a corporate alliance health plan. Allows military personnel, veterans, and Indians to enroll either with an alliance or with a military, veteran, or Indian plan, respectively. (Sec. 1005) Prohibits an undocumented alien from enrolling in a health plan under this Act. (Sec. 1011) Defines a family as an eligible individual's eligible spouse and children. Defines couple as meaning an individual and the individual's spouse. Defines a child as being under age 18, or under age 24 in the case of a full-time student. Subtitle B: Benefits - Includes the following terms and services in the comprehensive benefit package: (1) hospital services; (2) services of health professionals; (3) emergency and ambulatory medical and surgical services; (4) clinical preventive services; (5) mental illness and substance abuse services; (6) family planning services and services for pregnant women; (7) hospice care; (8) home health care; (9) extended care services; (10) ambulance services; (11) outpatient laboratory, radiology, and diagnostic services; (12) outpatient prescription drugs and biologicals; (13) outpatient rehabilitation services; (14) durable medical equipment and prosthetic and orthotic devices; (15) vision care; (16) dental care; (17) health education classes; and (18) investigational treatments. Describes such items and services. (Sec. 1131) Requires each health plan to offer to its enrollees only one of the following cost sharing schedules: (1) lower cost sharing; (2) higher cost sharing; or (3) combination cost sharing. Provides that the annual maximum out-of-pocket expenses for an individual in any of the plans shall be $1500 and for a family the annual maximum shall be $3000. (Sec. 1135) Sets forth a table of copayments and coinsurance. (Sec. 1141) Excludes the following items and services: (1) an item or service that is not medically necessary or appropriate; (2) an item or service that the National Health Board may determine is not medically necessary or appropriate; (3) custodial care, except hospice care; (4) surgery performed solely for cosmetic purposes, unless required to correct a congenital anomaly or performed to correct a part of the body injured by either disease or accident; (5) hearing aids; (6) eyeglasses and contact lenses for individuals at least 18 years of age; (7) in vitro fertilization; (8) sex change surgery and related services; (9) private duty nursing; (10) personal comfort items, except in the case of hospice care; and (11) any dental procedures involving orthodontic care, inlays, gold or platinum fillings, bridges, crowns, pin/post retention, dental implants, surgical periodontal procedures, or the preparation of the mouth for the fitting or continued use of dentures, except as specified. (Sec. 1151) Gives the National Health Board the authority to promulgate such regulations or establish such guidelines as necessary to assure uniformity in the application of the comprehensive benefit package across all health plans. Permits the Board to expand the benefit package. (Sec. 1162) Permits a health professional or facility to refuse to provide a benefit if the professional or facility objects on the basis of a religious belief or moral conviction. Subtitle C: State Responsibilities - Requires a State, in order to be approved as a participating State, to submit a document describing the State's health care system. (Sec. 1201) Requires a participating State to: (1) establish one or more regional alliances; (2) establish and publish the criteria used in the certification of its health plan; (3) meet minimum financial solvency requirements for health plans established by the National Health Board; (4) designate an agency or official to coordinate State responsibilities under this Act; (5) conform State laws to meet the requirements of title X of this Act with respect to workers' compensation and automobile insurance; and (6) carry out all the responsibilities of a participating State specified in this Act. (Sec. 1221) Permits a State, with the Board's approval, to operate a single-payer system if specified requirements are met. Subtitle D: Health Alliances - Provides for regional alliances and corporate alliances. (Sec. 1302) Requires a regional alliance to be governed by a Board of Directors consisting of: (1) employers, including self-employed individuals; and (2) members who represent individuals purchasing coverage. Requires each regional alliance to establish a provider advisory board consisting of health care providers and professionals. (Sec. 1311) Includes in a corporate alliance an eligible sponsor who is either a large employer (more than 5000 full-time employees) or a multiemployer plan (a plan with more than 5000 active participants). Excludes: (1) an employer whose primary business is employee leasing; (2) the Federal Government (other than the U.S. Postal Service); and (3) a State or local government. Excludes from corporate alliance eligibility the following classes of individuals: (1) AFDC recipients; (2) SSI recipients; (3) military personnel and families, veterans, and Indians who elect to enroll in specified plans specifically designed for them; and (4) seasonal or temporary employees. (Sec. 1321) Directs each regional alliance to negotiate with any State-certified health plan for a contract with the alliance for the enrollment under the plan of eligible individuals. (Sec. 1322) Requires each regional alliance to offer a choice of health plans, including at least one fee-for-service plan. (Sec. 1326) Requires each regional alliance to establish and maintain an office of an ombudsman to assist consumers in dealing with problems that arise with health plans and the alliance. (Sec. 1329) Permits a regional alliance to adjust payments to plans or use other financial incentives to encourage health plans to expand into areas that have inadequate health services. (Sec. 1341) Set forth provisions concerning the collection of funds by regional alliances from individuals, employers, and others. (Sec. 1351) Requires each regional alliance to compute a blended plan per capita payment amount for each regional alliance health plan for enrollment in the alliance. (Sec. 1361) Requires each regional alliance to comply with specified standards relating to the management of finances, maintenance of records, accounting practices, auditing procedures, financial reporting, and employer payments. (Sec. 1371) Provides for a reduction in cost sharing for low-income families. (Sec. 1373) Provides for premium discounts and reduction in liabilities for low-income families. (Sec. 1381) Permits each corporate alliance to: (1) offer coverage under either an appropriate self-insured health plan; or (2) negotiate with a State-certified plan to enter into a contract with the plan. (Sec. 1382) Requires each corporate alliance to provide a choice of health plans, including at least one fee-for-service plan and two health plans that are not fee-for-service plans. (Sec. 1385) Requires each corporate alliance to make an additional contribution towards the enrollment in health plans of the alliance by certain low-wage families. (Sec. 1386) Sets forth provisions relating to a corporate alliance concerning: (1) consumer information and marketing; (2) plan and information requirements; (3) management of funds; (4) cost control; (5) payments by corporate alliance employers to corporate alliances; (6) ERISA; and (7) disclosure and reserve requirements. Subtitle E: Health Plans - Requires a health plan to: (1) be either a self-insured plan (meaning a group health plan as defined by a the Employee Retirement Income Security Act of 1974) or a State-certified plan (meaning a plan certified by a State or the National Health Board); and (2) meet the applicable regulatory requirements. (Sec. 1402) Requires each health plan offered by either a regional or corporate alliance to accept for enrollment every alliance eligible individual, unless the plan has reached its enrollment limit. Prohibits the limit from being imposed on the basis of any personal characteristics of enrollees such as health status, need for health care, age, occupation, or affiliation with any person or entity. Prohibits a plan from: (1) restricting or terminating coverage for any reason, including nonpayment of premiums; (2) cancelling coverage for any eligible individual until that individual is enrolled in another plan; (3) excluding an eligible individual because of an existing medical condition; (4) imposing a waiting period before coverage begins; or (5) imposing a rider that excludes the coverage of particular eligible individuals. Prohibits discrimination by a health plan on the basis of race, national origin, sex, language, socioeconomic status, age, disability, health status, or anticipated need for health services. (Sec. 1405) Requires each plan to have a grievance procedure. (Sec. 1421) Permits an entity to offer a supplemental insurance policy if the policy and the entity meet specified requirements. (Sec. 1431) Requires each health plan, with respect to each electing essential community provider located within the plan's service area, to enter into either a written provider participation agreement or a written agreement under which the plan will make payment to the provider as specified. Provides a special rule for providers of school health services. Makes the provisions of the preceding sentence applicable only to health plans offered by a health alliance during the five-year period beginning with the first year in which any health plan is offered by the alliance. Directs the Secretary of Health and Human Services to study essential community providers and to make recommendations concerning such providers to the Congress. Provides that such recommendations shall apply unless a joint resolution of disapproval is enacted by the Congress. (Sec. 1441) Requires each health plan to meet specified requirements of title X of this Act with respect to workers' compensation and automobile medical liability services. Subtitle F: Federal Responsibilities - Establishes the National Health Board in the Executive Branch. Directs the President to appoint the Board's seven members. (Sec. 1503) Directs the Board to: (1) interpret the comprehensive benefit package; (2) adjust the delivery of preventive services; (3) take steps to assure that the comprehensive benefit package is available on a uniform national basis; (4) recommend to the President and the Congress appropriate revisions to the package; (5) oversee cost containment requirements; (6) develop and implement eligibility standards; (7) establish a performance based system of quality management; (8) develop and implement standards for a national health information system; (9) establish State requirements and monitor State compliance; (10) establish premium class factors; (11) develop a methodology for the risk-adjustment of premium payments; (12) establish financial requirements for guaranty funds; (13) establish standards for health plan grievance procedures; and (14) report annually to the President and the Congress. (Sec. 1506) Authorizes appropriations for the Board. (Sec. 1511) Requires the Board to approve a State health care system if the system meets the applicable requirements of this Act. Prohibits approval of a State health care system prior to 1996. (Sec. 1512) Imposes sanctions upon States failing to meet conditions for compliance. (Sec. 1515) Provides for planning grants to States for implementation assistance. (Sec. 1521) Provides for the Federal assumption of responsibilities in the absence of a State system. Provides for increased premiums of 15 percent during Federal operation of a State system to provide reimbursement for the Federal cost of operating the system. (Sec. 1541) Directs the Board to develop a risk adjustment and reinsurance methodology. Sets forth guideline for developing such methodology. (Sec. 1543) Directs the Board to establish an advisory committee to provide technical advice and recommendations regarding the risk adjustment and reinsurance methodology. (Sec. 1551) Directs the Board to establish minimum capital requirements for regional alliance health plans under which at least $500,000 of capital must be maintained for each plan in the area. Permits the Board to require additional capital. (Sec. 1552) Requires the Board to establish standards for guaranty funds established by the States. (Sec. 1571) Sets forth the responsibilities of the Secretary of Health and Human Services. Directs the Secretary to administer and implement all provisions of this Act, except those duties delegated to the Board, any other executive agency, or to any State. (Sec. 1572) Directs the Secretary to appoint an Advisory Council on Breakthrough Drugs that will examine the reasonableness of launch prices of new breakthrough drugs. (Sec. 1581) Provides for the certification of essential community providers. Sets forth the following categories of providers automatically certified (under provisions of the Public Health Service Act): (1) migrant health centers; (2) community health centers; (3) homeless program providers; (4) public housing providers; (5) family planning clinics; and (6) AIDS providers under the Ryan White Act. Includes as automatically certified (under other Acts) the following: (1) Indian health programs under the Indian Health Act; and (2) maternal and child health providers and a Federal qualified health center or rural health clinic under the Social Security Act. Includes as automatically certified (under provisions of this Act) the following: (1) providers of school health services; and (2) a qualified community practice network. Provides for the setting of standards for additional health providers. (Sec. 1591) Sets forth the responsibilities of the Secretary of Labor. Includes among those responsibilities the following: (1) enforcement requirements applicable to employers; (2) elections to become corporate alliances; (3) temporary assumption of insolvent self-insured corporate alliance health plans; (4) establishment and administration of the Corporate Alliance Health Plan Insolvency Fund; and (5) administering title I of ERISA as it relates to group health plans maintained by corporate alliances. Subtitle G: Employer Responsibilities - Requires employers to provide for the payments required under title VI of this Act. Sets forth other employer responsibilities including: (1) information reporting requirements; (2) requirements relating to new employees; (3) recordkeeping requirements; and (4) antidiscrimination requirements. (Sec. 1606) Prohibits self-funding of cost sharing benefits by regional alliance employers. (Sec. 1607) Requires an employer to make equal employer premium payments to all qualifying employees, if a voluntary premium payment is made. Places a limit on such voluntary employer premium payments. (Sec. 1608) Sets forth an employer's obligation to a qualifying retired beneficiary where the employer, as of October 1, 1993, was providing a threshold payment. (Sec. 1609) Authorizes the Secretary of Labor to impose a civil penalty of up to $10,000 for each violation of this subtitle with respect to each individual. Subtitle J (sic): General Definition; Miscellaneous Provisions - Sets forth the definitions and rules used in this Act. (Sec. 1911) Grants the National Health Board, the Secretary of Health and Human Services, and the Secretary of Labor authority to issue regulations as necessary to permit the timely implementation of this Act. Title II: New Benefits - Subtitle B (sic): Long-Term Care - Establishes requirements for State plans for home and community-based services to individuals with disabilities. Includes among those requirements the following: (1) a prohibition of limiting eligibility of individuals with disabilities based on income, age, geography, severity of disability, residential setting, or other grounds specified by the Secretary; (2) a requirement to serve low-income individuals; (3) a requirement to specify how Federal and State funds will be managed; (4) quality assurance requirements; and (5) reporting requirements. Requires a State to consult with individuals and groups of individuals with disabilities when developing the plan in order to have the plan approved. (Sec. 2103) Defines individuals with disabilities to mean any individual within one or more of the following four categories: (1) individuals requiring help with the activities of daily living; (2) individuals with severe cognitive or mental impairment; (3) individuals with severe or profound mental retardation; and (4) severely disabled children. (Sec. 2104) Requires a State plan to specify the services available. Requires each individualized plan to be developed in close consultation with the individual and the individual's family. Prohibits a State plan from covering: (1) room and board; (2) services furnished in a hospital, nursing facility, intermediate care facility for the mentally retarded, or other specified institutional setting; or (3) items or services to the extent coverage is provided for an individual under a health plan or Medicare. (Sec. 2105) Sets forth provisions relating to: (1) cost sharing; (2) quality assurance and safeguards; (3) advisory groups; (4) payments to States; and (5) the total Federal budget for State plans and allotments to States. (Sec. 2301) Directs the Secretary, with the advice and assistance of the National Long-Term Care Insurance Advisory Council to promulgate regulations as necessary to implement provisions concerning private long-term care insurance. Directs the Secretary to make appointments to such Council. Authorizes appropriations for such Council. (Sec. 2321) Directs the Secretary, after considering the Council's recommendations to promulgate regulations designed to: (1) standardize formats and terminology used in long-term care policies; (2) require insurers to provide customers on the range of public and private long-term care coverage available; and (3) establish other requirements promoting consumer understanding of benefits. (Sec. 2322) Directs the Secretary to promulgate regulations establishing requirements with respect to the terms of the benefits under long-term care policies, which shall include the following requirements that the policy may not: (1) limit coverage based on a preexisting condition, subject to an exception for a six-month period; (2) condition eligibility for benefits based on the need or receipt of any other service; (3) condition eligibility for any benefit on any particular diagnosis; (4) condition eligibility for benefits by providers on compliance with requirements not required by State or Federal law; and (5) condition coverage of any service by a provider on the provision of such service at a higher level of care than required by the insured individual. Prohibits discrimination by diagnosis in the treatment of: (1) Alzheimer's disease; (2) any organic or inorganic mental illness; (3) mental retardation or any other cognitive or mental impairment; or (4) HIV infection or AIDS. (Sec. 2323) Sets forth other requirements for such policies, including requirements related to: (1) premium; (2) sales practices; (3) continuation, renewal, replacement, conversion, and cancellation of policies; and (4) payment of benefits. (Sec. 2342) Provides for grants to States to enforce the Federal standards concerning long-term care policies. Sets forth requirements for receiving such grants. Authorizes appropriations. Prohibits the sale of a long-term care policy in a State without a regulatory program. (Sec. 2361) Authorizes the Secretary to make grants for the development and implementation of long-term care information, counseling, and other programs to: (1) States; (2) regional alliances (at the option of States within which such alliances are located; and (3) national organizations representing insurance consumers, long-term care providers, and insurers. Authorizes appropriations for such grants. Title III: Public Health Initiatives - Subtitle A: Workforce Priorities Under Federal Payments - Establishes within the Department of Health and Human Services the National Council on Graduate Medical Education. Directs the National Council to designate for each academic year the number of individuals nationwide who are authorized to be enrolled in each specified approved physician training program for each medical specialty. (Sec. 3061) Directs the Secretary to carry out a program with respect to graduate nurse training programs that is equivalent to the program for approved physician training programs. Establishes a National Council on Graduate Nurse Education. (Sec. 3071) Authorizes appropriations for the following programs: (1) primary care physician and physician assistant training; (2) training of underrepresented minorities and disadvantaged persons; and (3) nurse training. (Sec. 3072) Authorizes appropriations for the following programs: (1) a program of skill upgrading and occupational retraining for health care workers; (2) a demonstration program to assist workers in health care institutions in obtaining advanced career positions; (3) a program to develop and operate health-worker job banks in local employment services agencies, subject to certain conditions; (4) a program to provide joint labor-management decision-making in the health care sector on workplace matters related to the restructuring of the health care delivery system of this Act; and (5) a program to facilitate the comprehensive workforce adjustment initiative. (Sec. 3073) Directs the Secretary of Health and Human Services and the Secretary of Labor to jointly establish the National Institute for Health Care Workforce Development. States that the Director of the Institute shall make recommendations to the Secretaries regarding: (1) the supply of health care workers; (2) the impact of this Act; and (3) the development and implementation of high-performance, high-quality health care delivery systems. Directs the Secretaries to establish an advisory board to assist in the development of such recommendations. Subtitle B: Academic Health Centers - Provides for the access of regional and corporate alliance patients to qualified academic health centers. Subtitle C: Health Research Initiatives - Amends the Public Health Service Act to ensure that the National Institutes of Health conducts and supports biomedical and behavioral research on promoting health and preventing diseases, disorders, and other health conditions. Provides for health services research. Authorizes appropriations for such research. Subtitle D: Core Functions of Public Health Programs; National Initiatives Regarding Preventive Health - Authorizes appropriations for the core functions of public health programs and national initiatives regarding health promotion and disease prevention. (Sec. 3312) Authorizes the Secretary to make grants to States to carry out one or more of the following core functions: (1) data collection; (2) activities to protect the environment and to assure the safety of housing, workplaces, and food and water; (3) investigation and control of adverse health conditions; (4) public information and education programs to reduce risks to health such as use of tobacco, alcohol, and drugs, sexual activities that increase the risk of HIV transmission and other sexually transmitted diseases, poor diet, physical inactivity, and low childhood immunization levels; (5) accountability and quality assurance activities; (6) provision of public health laboratory services to complement private clinical laboratory services that screen for diseases and conditions; (7) training and education to assure provision of care by all health professionals; and (8) leadership policy development and administrative activities. (Sec. 3331) Authorizes the Secretary to make grants to agencies of State or local government, private nonprofit organizations, and coalitions that link two or more of these groups for the purpose of carrying out projects to develop and implement innovative community-based strategies to provide for health promotion and disease prevention activities for which there is a significant need. Subtitle E: Health Services for Medically Underserved Populations - Directs the Secretary to make grants to migrant health centers and community health centers, which shall be in addition to other funds available to such centers. Authorizes appropriations. (Sec. 3412) Authorizes appropriations for: (1) grants and contracts for the development of qualified community health plans and practice networks; and (2) loans and guaranteeing the principal and interest to Federal and non-Federal lenders on behalf of public and private entities for the capital costs of developing qualified community health plans and practice networks. (Sec. 3461) Authorizes the Secretary to make grants and enter into contracts with qualified community health groups to provide enabling services such as transportation, community and patient outreach, patient education, and translation services in order to increase the capacity of individuals to utilize the items and services under title I of this Act. Authorizes appropriations. (Sec. 3471) Authorizes appropriations for: (1) the National Health Service Corps; and (2) such amounts as are necessary to ensure that at least 20 percent of participants in the Scholarship Program or the Loan Repayment Program of the Corps are nurses. (Sec. 3481) Entitles a hospital with a low-income utilization rate in a base year of at least 25 percent to a payment as specified. Requires 75 percent of the total available to be allocated to hospitals for low-income assistance. Requires 25 percent of the total available to be allocated to hospitals for assistance in furnishing inpatient hospital services that are not covered services under title I of this Act. Subtitle F: Mental Health; Substance Abuse - Authorizes appropriations to carry out this part. Provides for grants to: (1) increase access to mental health and substance abuse services; (2) improve State and local capacity to coordinate and monitor such services; (3) provide incentives to integrate public and private service systems; and (4) supplement any activity under part B (Alcohol and Drug Abuse and Mental Services Block Grant) of title XIX of the Public Health Service Act. (Sec. 3503) Authorizes the Secretary to make loans for the capital costs incurred in the development of non-acute, residential treatment centers and community-based ambulatory clinics. (Sec. 3521) Requires the establishment of a pilot program demonstrating the integration of the mental illness and substance abuse services of the States with the services included under title I of this Act. Subtitle G: Comprehensive School Health Education; School-Related Health Services - Authorizes appropriations for the programs of this subtitle. States that the purposes of the programs shall be to: (1) support the provision in kindergarten through grade 12 of comprehensive health education programs; (2) establish a national framework within which States can create comprehensive school health education programs that target the health risk behaviors of youth, including tobacco use, alcohol and drug abuse, sexual behaviors resulting in infections, injury prevention, dietary patterns, and sedentary lifestyles; (3) pay the initial costs of planning and establishing such programs; (4) support related Federal demonstrations and training; (5) motivate youth to stay in school, avoid teen pregnancy, and strive for success; (6) improve the knowledge of health education among youth; and (7) further the National Education Goals set forth in title I of the Goals 2000: Educate America Act. Defines comprehensive school health education program. Requires such programs to be sensitive to cultural and ethnic issues, promote involvement by families, and promote personal responsibility. Sets forth requirements for applying for grants and selection of grantees. Subtitle H: Public Health Service Initiative - Establishes a Public Health Service Initiative consisting of specified amounts authorized to be appropriated for the Initiative. States that: (1) the Initiative includes the programs of subtitles C through G of this title and the programs of subtitle D of title VIII; and (2) amounts appropriated to carry out the Initiative, including subtitles A through F of this title, are available to carry out specific programs for which the amounts are appropriated. Subtitle I: Coordination with COBRA Continuation Coverage - Amends title XXII (Requirements for Certain Group Health Plans for Certain State and Local Employees) of the Public Health Service Act to provide for coordination with COBRA continuation coverage. Repeals such title XXII upon implementation of this Act. Title V (sic): Quality and Consumer Protection - Subtitle A: Quality Management and Improvement - Requires the National Health Board to establish and oversee a performance-based program of quality management and improvement designed to enhance the quality, appropriateness, and effectiveness of health care services and access to such services which will be called the National Quality Management Program. (Sec. 5002) Establishes the National Quality Management Council which shall: (1) administer the National Quality Management Program; (2) perform any other duty specified in this subtitle; and (3) advise the National Health Board with respect to its duties under this subtitle. Requires the Council to develop a set of national measures of quality performance to be used in the assessment of and the provision of access to health care services. Requires the Council, in addition, to: (1) recommend to the Board establishing goals for performance by health plans and health care providers on a subset of national measures of quality performance; (2) direct the Administrator for Health Care Policy and Research to develop, review, and disseminate practice guidelines to determine how diseases can most effectively be prevented, diagnosed, treated, and managed; and (3) direct the Administrator for Health Care Policy and Research to support research related to a five-year priority list of performance measures. (Sec. 5008) Directs the National Health Board to: (1) establish and oversee regional professional foundations to perform such duties as develop lifetime learning programs for health professionals and conduct research on health care quality; and (2) establish the National Quality Consortium to perform such duties as establishing continuing education for health professionals and provide advice on research priorities. (Sec. 5012) Requires each regional alliance and each corporate alliance to: (1) disseminate specified information to consumers; and (2) ensure that performance and quality standards are continually approved. Subtitle B: Information System, Privacy, and Administrative Simplification - Directs the National Health Board to develop and implement a health information system, in consultation with Federal agencies, States, employers, health plans, and others, by which the Board shall collect, report, and regulate the collection and dissemination of health care information which shall be used for: (1) health care planning by Federal, State, and local government; (2) establishing and monitoring payments for health services; (3) assessing and improving the quality of health care; (4) managing and containing costs at the alliance and plan levels; and (5) other specified purposes. Requires the establishment of an electronic data network to collect, compile, and transmit information. (Sec. 5120) Sets forth provisions providing for health information privacy standards. (Sec. 5130) Directs the National Health Board to develop the following standard health care benefit forms: (1) an enrollment and disenrollment form; (2) a clinical encounter record; and (3) a claim form. (Sec. 5140) Establishes the National Privacy and Health Data Advisory Council in order to advise the National Health Board with respect to its duties under this subtitle. (Sec. 5141) Sets forth monetary penalties for violating health information system standards. Subtitle C: Remedies and Enforcement - Sets forth provisions with respect to the review of benefit determinations for enrolled individuals, including provisions: (1) regulating the time limits for notice of disposition of a claim; (2) governing a plan's duty to review claim denials; (3) concerning urgent requests for preauthorization; and (4) concerning other time limits with respect to time limits and notice. (Sec. 5202) Requires each State to establish a complaint review office for each regional alliance established by a State. Permits aggrieved individuals to file complaints with the appropriate review office. (Sec. 5205) Provides for a Federal Health Plan Review Board to review the decisions of complaint review office hearing officers. (Sec. 5207) Sets monetary penalties for a plan which unreasonably denies or delays payment or provision of benefits. (Sec. 5211) Directs each State to establish and maintain an Early Resolution Program in each complaint review office. Requires a program to include: (1) forums for mediation of disputes; and (2) other forums of alternative dispute resolution as may be prescribed. Establishes guidelines for the eligibility of cases for submission to the Early Resolution Program. States that conclusions of the mediation proceedings shall be treated as nonbinding and shall not affect any rights to review. (Sec. 5231) Sets forth additional remedies and enforcement provisions. Title VI: Premium Caps; Premium-Based Financing; and Plan Payments - Subtitle A: Premium Caps - Sets forth provisions which provide for the computation of factors that limit the growth of premiums for the comprehensive benefit package in regional alliance health plans, including the computation of a: (1) regional alliance inflation factor; and (2) general health care inflation factor. (Sec. 6002) Directs the Board to determine: (1) a national per capita baseline premium target; (2) the national average per capita current coverage health expenditures; and (3) current health care expenditures. (Sec. 6003) Directs the Board to determine a regional alliance per capita premium. (Sec. 6004) Requires a regional alliance to annually obtain premium bids from each plan seeking to participate as a regional alliance health plan with respect to the alliance. (Sec. 6005) Permits any participating State to assume responsibility for containment of health care expenditures in the State consistent with this Act. (Sec. 6006) Directs the chair of the Board to establish an advisory commission on regional variations in health expenditures. Requires the commission to examine methods of eliminating variation in regional alliance per capital premium targets due to variation in practice patterns, not due to other factors. Requires the Board to submit its recommendations to the Congress. Requires such recommendations to apply unless a joint resolution of disapproval is passed. (Sec. 6011) Subjects each noncomplying regional alliance health plan for a year to a reduction in plan payment as specified, in order to assure that payments to regional alliance health plans by a regional alliance are consistent. Defines a noncomplying plan to include a plan in which the final accepted bid exceeds the maximum complying bid for the per capita target premium. Defines maximum complying bid. (Sec. 6021) Directs the Board to develop a methodology for calculating an annual per capita expenditure equivalent for amounts paid for coverage for the comprehensive benefit package within a corporate alliance. (Sec. 6022) Terminates a corporate alliance with two excess years in a three year period. Provides that employers that were corporate alliance employers with respect to a terminated alliance shall become regional alliance employers. Defines an excess year as one in which the rate of increase for the corporate alliance exceeds the national corporate inflation factor. Defines rate of increase and national corporate inflation factor. (Sec. 6031) Sets forth special rules for a single-payer State. (Sec. 6041) Directs the Secretary to establish a program to monitor prices and expenditures in the U.S. health care system. Subtitle B: Premium-Related Financings - Makes each family enrolled in a regional health alliance plan or in a corporate alliance health plan in a class of family enrollment responsible for payment of the family share of premium payable for enrollment. Provides for income-related discounts and specified credits. (Sec. 6102) Establishes the formula for determining the premiums. (Sec. 6111) Provides for the repayment of alliance credits by certain families. (Sec. 6114) Provides for the special treatment of certain retirees and qualified spouses and children. (Sec. 6121) Requires each regional alliance employer to pay a monthly premium to the regional alliance for a qualifying employee. Sets forth provisions for determining such premium. Varies the premium depending upon such factors as the employer's size and average wages paid. (Sec. 6126) Sets forth provisions applicable to self-employed individuals. (Sec. 6131) Sets forth provisions for determining the corporate employer premium. Subtitle C: Payments to Regional Alliance Health Plans - Sets forth provisions to determine the computation of: (1) the blended plan per capita payment amount; and (2) the plan bid, AFDC, and SSI proportions. Title VIII (sic): Health and Health-Related Programs of the Federal Government - Subtitle E (sic): Amendments to the Employee Retirement Income Security Act of 1974 - Amends the Employee Retirement Income Security Act of 1974 (ERISA) to revise and limit the coverage of group health plans ERISA. Makes certain ERISA provisions inapplicable with respect to State-certified health plans. Provides for an exception from ERISA civil action provisions where review is otherwise available under the Health Security Act (this Act, HSA). (Sec. 8402) Establishes ERISA requirements for expeditious reporting and disclosure applicable to group health plans, through special rules consistent with ERISA and HSA purposes. Excludes plans maintained by regional alliances from treatment as multiple employer welfare arrangements. (Sec. 8403) Revises certain ERISA provisions relating to continuation coverage under group health plans. Repeals such provisions upon implementation of HSA. (Sec. 8404) Makes ERISA standards for group health plans regarding: (1) cases of adoption applicable except to the extent otherwise provided in regulations of the National Health Board under HSA; and (2) coverage of pediatric vaccines inapplicable to a group health plan upon its becoming a corporate alliance health plan under HSA. (Sec. 8405) Requires group health plans under ERISA to comply with HSA requirements relating to health plan claims procedure. Title IX: Aggregate Government Payments - Subtitle B (sic): Aggregate Federal Alliance Payments - States that this section constitutes budget authority in advance of appropriation Acts and obligates the Federal Government to provide for the payment to regional alliances of a capped Federal alliance payment amount. Defines capped Federal alliance payment amount. Subtitle C: Borrowing Authority to Cover Cash-flow Shortfalls - Authorizes the Secretary to make available loans to regional alliances to cover any period of temporary cash-flow shortfall attributable to: (1) any estimation discrepancy; (2) a period of temporary cash-flow shortfall attributable to an administrative error; or (3) a period of temporary cash-flow shortfall relating to the relative timing during the year in which amounts are received and payments are required. Sets forth loan terms and conditions. Title X: Coordination of Medical Portion of Workers Compensation and Automobile Insurance - Subtitle A: Workers Compensation Insurance - Requires each health plan that provides services to enrollees through participating providers to make arrangements to provide workers' compensation to such enrollees. (Sec. 10002) Requires each workers compensation carrier that is liable for payment for workers compensation services furnished by or through a health plan, regardless of whether or not the services are included in the comprehensive benefit package, to make payment for such services. (Sec. 10011) Sets forth requirements for participating States. (Sec. 10031) Authorizes demonstration projects in one or more States with respect to the treatment of work-related injuries and illnesses. Subtitle C (sic): Commission on Integration of Health Benefits - Establishes the Commission on Integration of Health Benefits, which shall study and report on the feasibility and appropriateness of transferring financial responsibility for all medical benefits, including those currently covered by workers' compensation and automobile insurance, to health plans. Authorizes appropriations. Subtitle E (sic): Davis-Bacon Act and Service Contract Act - Amends the Davis-Bacon Act and the Service Contract Act of 1965 to require Health Security Act benefits. Subtitle F: Effective Dates - Sets forth effective date provisions. Title XI: Transitional Insurance Reform - Sets forth transitional provisions concerning: (1) enforcement; (2) preservation of current coverage; (3) restrictions on premium increases during transition; (4) portability requirements; (5) restrictions limiting benefit reductions; and (6) the establishment of the National Transitional Health Insurance Risk Pool.
Bill· SS. 1775 (103rd)open
United States · United States Congress · 22 November 1993
TABLE OF CONTENTS: Title I: Health Care Security Subtitle A: Universal Coverage and Individual Responsibility Subtitle B: Benefits Subtitle C: State Responsibilities Subtitle D: Health Alliances Subtitle E: Health Plans Subtitle F: Federal Responsibilities Subtitle G: Employer Responsibilities Subtitle J (sic): General Definitions; Miscellaneous Provisions Title II: New Benefits Subtitle A: Medicare Outpatient Prescription Drug Benefit Subtitle B: Long-Term Care Title III: Public Health Initiatives Subtitle A: Workforce Priorities Under Federal Payments Subtitle B: Academic Health Centers Subtitle C: Health Research Initiatives Subtitle D: Core Functions of Public Health Programs; National Initiatives Regarding Preventive Health Subtitle E: Health Services for Medically Underserved Populations Subtitle F: Mental Health; Substance Abuse Subtitle G: Comprehensive School Health Education; School-Related Health Services Subtitle H: Public Health Service Initiative Subtitle I: Coordination With COBRA Continuation Coverage Title IV: Medicare and Medicaid Subtitle A: Medicare and the Alliance System Subtitle B: Savings in Medicare Program Subtitle C: Medicaid Subtitle D: Increase in SSI Personal Needs Allowance Title V: Quality and Consumer Protection Subtitle A: Quality Management and Improvement Subtitle B: Information Systems, Privacy, and Administrative Simplification Subtitle C: Remedies and Enforcement Subtitle D: Medical Malpractice Subtitle E: Fraud and Abuse Subtitle F: McCarran-Ferguson Reform Title VI: Premium Caps; Premium-Based Financing; and Plan Payments Subtitle A: Premium Caps Subtitle B: Premium-Related Financing Subtitle C: Payments to Regional Alliance Health Plans Title VII: Revenue Provisions Subtitle A: Financing Provisions Subtitle B: Tax Treatment of Employer-Provided Health Care Subtitle C: Employment Status Provisions Subtitle D: Tax Treatment of Funding of Retiree Health Benefits Subtitle E: Coordination with COBRA Continuing Care Provisions Subtitle F: Tax Treatment of Organizations Providing Health Care Services and Related Organizations Subtitle G: Tax Treatment of Long-term Care Insurance and Services Subtitle H: Tax Incentives for Health Services Providers Subtitle I: Miscellaneous Provisions Title VIII: Health and Health-Related Programs of the Federal Government Subtitle A: Military Health Care Reform Subtitle B: Department of Veterans Affairs Subtitle C: Federal Employees Health Benefits Program Subtitle D: Indian Health Service Subtitle E: Amendments to the Employee Retirement Income Security Act of 1974 Subtitle F: Special Fund for WIC Program Title IX: Aggregate Government Payments to Regional Alliances Subtitle A: Aggregate State Payments Subtitle B: Aggregate Federal Alliance Payments Subtitle C: Borrowing Authority to Cover Cash-Flow Shortfalls Title X: Coordination of Medical Portion of Workers Compensation and Automobile Insurance Subtitle A: Workers Compensation Insurance Subtitle B: Automobile Insurance Subtitle C: Commission on Integration of Health Benefits Subtitle D: Federal Employees' Compensation Act Subtitle E: Davis-Bacon Act and Service Contract Act Subtitle F: Effective Dates Title XI: Transitional Insurance Reform Health Security Act - Title I: Health Care Security - Subtitle A: Universal Courage and Individual Responsibility - Entitles each eligible individual to: (1) the benefit provided under subtitle B through the applicable health plan in which the individual is enrolled; and (2) a health security card to be issued by the alliance or other entity that offers the applicable health plan in which the individual is enrolled. Defines an eligible individual as an individual who resides in the United States and is: (1) a citizen or national of the United States; (2) an alien permanently residing in the U.S. under color of law; or (3) a long-term nonimmigrant. Entitles a Medicare-eligible individual to benefits under Medicare instead of the above provisions of this Act. (Sec. 1002) Requires each eligible individual to enroll in an applicable health plan and pay any required premium. Prohibits disenrollment of an eligible individual until the individual is either enrolled in another plan or in Medicare. (Sec. 1003) States that nothing in this Act shall be construed as prohibiting: (1) an individual from purchasing any health services; (2) an individual from purchasing supplemental insurance; (3) an individual who is not an eligible individual from purchasing health insurance; or (4) employers from providing additional coverage. (Sec. 1004) States that a regional alliance health plan is the applicable plan for a family, unless a family member is eligible for a corporate alliance health plan. Allows military personnel, veterans, and Indians to enroll either with an alliance or with a military, veteran, or Indian plan respectively. (Sec. 1005) Prohibits an undocumented alien from enrolling in a health plan under this Act. (Sec. 1011) Defines a family as an eligible individual's eligible spouse and children. Defines couple as meaning an individual and the individual's spouse. Defines a child as being under age 18, or under age 24 in the case of a full-time student. Subtitle B: Benefits - Includes the following terms and services in the comprehensive benefit package: (1) hospital services; (2) services of health professionals; (3) emergency and ambulatory medical and surgical services; (4) clinical preventive services; (5) mental illness and substance abuse services; (6) family planning services and services for pregnant women; (7) hospice care; (8) home health care; (9) extended care services; (10) ambulance services; (11) outpatient laboratory, radiology, and diagnostic services; (12) outpatient prescription drugs and biologicals; (13) outpatient rehabilitation services; (14) durable medical equipment and prosthetic and orthotic devices; (15) vision care; (16) dental care; (17) health education classes; and (18) investigational treatments. Describes such items and services. (Sec. 1131) Requires each health plan to offer to its enrollees only one of the following cost sharing schedules: (1) lower cost sharing; (2) higher cost sharing; or (3) combination cost sharing. Provides that the annual maximum out-of-pocket expenses for an individual in any of the plans shall be $1500 and for a family the annual maximum shall be $3000. (Sec. 1135) Sets forth a table of copayments and coinsurance. (Sec. 1141) Excludes the following items and services: (1) an item or service that is not medically necessary or appropriate; (2) an item or service that the National Health Board may determine is not medically necessary or appropriate; (3) custodial care, except hospice care; (4) surgery performed solely for cosmetic purposes, unless required to correct a congenital anomaly or performed to correct a part of the body injured by either disease or accident; (5) hearing aids; (6) eyeglasses and contact lenses for individuals at least 18 years of age; (7) in vitro fertilization; (8) sex change surgery and related services; (9) private duty nursing; (10) personal comfort items, except in the case of hospice care; and (11) any dental procedures involving orthodontic care, inlays, gold or platinum fillings, bridges, crowns, pin/post retention, dental implants, surgical periodontal procedures, or the preparation of the mouth for the fitting or continued use of dentures, except as specified. (Sec. 1151) Gives the National Health Board the authority to promulgate such regulations or establish such guidelines as necessary to assure uniformity in the application of the comprehensive benefit package across all health plans. Permits the Board to expand the benefit package. (Sec. 1162) Permits a health professional or facility to refuse to provide a benefit if the professional or facility objects on the basis of a religious belief or moral conviction. Subtitle C: State Responsibilities - Requires a State, in order to be approved as a participating State, to submit a document describing the State's health care system. (Sec. 1201) Requires a participating State to: (1) establish one or more regional alliances; (2) establish and publish the criteria used in the certification of its health plan; (3) meet minimum financial solvency requirements for health plans established by the National Health Board; (4) designate an agency or official to coordinate State responsibilities under this Act; (5) conform State laws to meet the requirements of title X of this Act with respect to workers' compensation and automobile insurance; and (6) carry out all the responsibilities of a participating State specified in this Act. (Sec. 1221) Permits a State, with the Board's approval, to operate a single-payer system if specified requirements are met. Subtitle D: Health Alliances - Provides for regional alliances and corporate alliances. (Sec. 1302) Requires a regional alliance to be governed by a Board of Directors consisting of: (1) employers, including self-employed individuals; and (2) members who represent individuals purchasing coverage. Requires each regional alliance to establish a provider advisory board consisting of health care providers and professionals. (Sec. 1311) Includes in a corporate alliance an eligible sponsor who is either a large employer (more than 5,000 full-time employees) or a multiemployer plan (a plan with more than 5000 active participants). Excludes: (1) an employer whose primary business is employee leasing; (2) the Federal Government (other than the U.S. Postal Service); and (3) a State or local government. Excludes from corporate alliance eligibility the following classes of individuals: (1) AFDC recipients; (2) SSI recipients; (3) military personnel and families, veterans, and Indians who elect to enroll in specified plans specifically designed for them; and (4) seasonal or temporary employees. (Sec. 1321) Directs each regional alliance to enter into a contract with any State-certified health plan to contract with the alliance for the enrollment under the plan of eligible individuals. (Sec. 1322) Requires each regional alliance to offer a choice of health plans, including at least one fee-for-service plan. (Sec. 1326) Requires each regional alliance to establish and maintain an office of an ombudsman to assist consumers in dealing with problems that arise with health plans and the alliance. (Sec. 1329) Permits a regional alliance to adjust payments to plans or use other financial incentives to encourage health plans to expand into areas that have inadequate health services. (Sec. 1341) Set forth provisions concerning the collection of funds by regional alliances from individuals, employers, and others. (Sec. 1351) Requires each regional alliance to compute a blended plan per capita payment amount for each regional alliance health plan for enrollment in the alliance. (Sec. 1353) Requires each regional alliance to make payments to the Federal Government for academic health centers and graduate medical education. (Sec. 1361) Requires each regional alliance to comply with specified standards relating to the management of finances, maintenance of records, accounting practices, auditing procedures, financial reporting, and employer payments. (Sec. 1371) Provides for a reduction in cost sharing for low-income families. (Sec. 1373) Provides for premium discounts and reduction in liabilities for low-income families. (Sec. 1381) Permits each corporate alliance to: (1) offer coverage under either an appropriate self-insured health plan; or (2) negotiate with a State-certified plan to enter into a contract with the plan. (Sec. 1382) Requires each corporate alliance to provide a choice of health plans, including at least one fee-for-service plan and two health plans that are not fee-for-service plans. (Sec. 1385) Requires each corporate alliance to make an additional contribution towards the enrollment in health plans of the alliance by certain low-wage families. (Sec. 1386) Sets forth provisions relating to corporate alliances concerning: (1) consumer information and marketing; (2) plan and information requirements; (3) management of funds; (4) cost control; (5) payments by corporate alliance employers to corporate alliances; (6) ERISA; (7) disclosure and reserve requirements; (8) trusteeship of insolvent corporate alliance health plans; (9) imposition and collection of periodic assessments on self-insured corporate alliance plans; and (10) payments to the Federal Government by multiemployer corporate alliances for academic health centers and gradual medical education. Subtitle E: Health Plans - Requires a health plan to: (1) be either a self-insured plan (meaning a group health plan as defined by a the Employee Retirement Income Security Act of 1974) or a State-certified plan (meaning a plan certified by a State or the National Health Board); and (2) meet the applicable regulatory requirements. (Sec. 1402) Requires each health plan offered by either a regional or corporate alliance to accept for enrollment every alliance eligible individual, unless the plan has reached its enrollment limit. Prohibits the limit from being imposed on the basis of any personal characteristics of enrollees such as health status, need for health care, age, occupation, or affiliation with any person or entity. Prohibits a plan from: (1) restricting or terminating coverage for any reason, including nonpayment of premiums; (2) cancelling coverage for any eligible individual until that individual is enrolled in another plan; (3) excluding an eligible individual because of an existing medical condition; (4) imposing a waiting period before coverage begins; or (5) imposing a rider that excludes the coverage of particular eligible individuals. Prohibits discrimination by a health plan on the basis of race, national origin, sex, language, socio-economic status, age, disability, health status, or anticipated need for health services. (Sec. 1405) Requires each plan to have a grievance procedure. (Sec. 1421) Permits an entity to offer a supplemental insurance policy if the policy and the entity meet specified requirements. (Sec. 1431) Requires each health plan, with respect to each electing essential community provider located within the plan's service area, to either: (1) enter into a written provider participation agreement; or (2) enter into a written agreement under which the plan will make payment to the provider as specified. Provides a special rule for providers of school health services. Makes the provisions of the proceeding sentence applicable only to health plans offered by a health alliance during the five year period beginning with the first year in which any health plan is offered by the alliance. Directs the Secretary of Health and Human Services to study essential community providers and to make recommendations concerning such providers to the Congress. Provides that such recommendations shall apply unless a joint resolution of disapproval is enacted by the Congress. (Sec. 1441) Requires each health plan to meet specified requirements of title X of this Act with respect to workers' compensation and automobile medical liability services. Subtitle F: Federal Responsibilities - Establishes the National Health Board in the Executive Branch. Directs the President to appoint the Board's seven members. (Sec. 1503) Directs the Board to: (1) interpret the comprehensive benefit package; (2) adjust the delivery of preventive services; (3) take steps to assure that the comprehensive benefit package is available on a uniform national basis; (4) recommend to the President and the Congress appropriate revisions to the package; (5) oversee cost containment requirements; (6) develop and implement eligibility standards; (7) establish a performance based system of quality management; (8) develop and implement standards for a national health information system; (9) establish State requirements and monitor State compliance; (10) establish premium class factors; (11) develop a methodology for the risk-adjustment of premium payments; (12) establish financial requirements for guaranty funds; (13) establish standards for health plan grievance procedures; and (14) report annually to the President and the Congress. (Sec. 1506) Authorizes appropriations for the Board. (Sec. 1511) Requires the Board to approve a State health care system if the system meets the applicable requirements of this Act. Prohibits approval of a State health care system prior to 1996. (Sec. 1512) Provides for sanctions for States failing to meet conditions for compliance. (Sec. 1515) Provides for planning grants to States for implementation assistance. (Sec. 1521) Provides for the Federal assumption of responsibilities in the absence of a State system. Provides for increased premiums of 15 percent during Federal operation of a State system to provide reimbursement for the Federal cost of operating the system. (Sec. 1541) Directs the Board to develop a risk adjustment and reinsurance methodology. Sets forth guidelines for developing such methodology. (Sec. 1543) Directs the Board to establish an advisory committee to provide technical advice and recommendations regarding the risk adjustment and reinsurance methodology. (Sec. 1551) Directs the Board to establish minimum capital requirements for regional alliance health plans under which at least $500,000 of capital must be maintained for each plan in the area. Permits the Board to require additional capital. (Sec. 1552) Requires the Board to establish standards for guaranty funds established by the States. (Sec. 1571) Sets forth the responsibilities of the Secretary of Health and Human Services. Directs the Secretary to administer and implement all provisions of this Act, except those duties delegated to the Board, any other executive agency, or to any State. (Sec. 1572) Directs the Secretary to appoint an Advisory Council on Breakthrough Drugs that will examine the reasonableness of launch prices of new breakthrough drugs. (Sec. 1581) Provides for the certification of essential community providers. Sets forth the following categories of providers automatically certified (under provisions of the Public Health Service Act): (1) migrant health centers; (2) community health centers; (3) homeless program providers; (4) public housing providers; (5) family planning clinics; and (6) AIDS providers under the Ryan White Act. Includes as automatically certified (under other Acts) following: (1) Indian health programs under the Indian Health Act; and (2) maternal and child health providers and a federally qualified health center or rural health clinic under the Social Security Act. Includes as automatically certified (under provisions of this Act) the following: (1) providers of school health services; and (2) a qualified community practice network. Provides for the setting of standards for additional health providers. (Sec. 1591) Sets forth the responsibilities of the Secretary of Labor. Includes among those responsibilities the following: (1) enforcement requirements applicable to employers; (2) elections to become corporate alliances; (3) temporary assumption of insolvent self-insured corporate alliance health plans; (4) establishment and administration of the Corporate Alliance Health Plan Insolvency Fund; and (5) administering title I of ERISA as it relates to group health plans maintained by corporate alliances. Subtitle G: Employer Responsibilities - Requires employers to provide for the payments required under title VI of this Act. Sets forth other employer responsibilities including: (1) information reporting requirements; (2) requirements relating to new employees; (3) recordkeeping requirements; and (4) antidiscrimination requirements. (Sec. 1606) Prohibits self-funding of cost sharing benefits by regional alliance employers. (Sec. 1607) Requires an employer to make equal employer premium payments to all qualifying employees, if a voluntary premium payment is made. Places a limit on such voluntary employer premium payments. (Sec. 1608) Sets forth an employer's obligation to a qualifying retired beneficiary where the employer, as of October 1, 1993, was providing a threshold payment. (Sec. 1609) Authorizes the Secretary of Labor to impose a civil penalty of up to $10,000 for each violation of this subtitle with respect to each individual. Subtitle J (sic): General Definitions; Miscellaneous Provisions - Sets forth the definitions and rules used in this Act. Subtitle B: Miscellaneous Provisions (sic) - (Sec. 1911) Grants the National Health Board, the Secretary of Health and Human Services, and the Secretary of Labor authority to issue regulations as necessary to permit the timely implementation of this Act. Title II: New Benefits - Subtitle A: Medicare Outpatient Prescription Drug Benefit - (Secs. 2001 through 2005) Amends title XVIII of the Social Security Act to provide for: (1) Medicare coverage of covered outpatient prescription drugs and biologicals as well as home infusion drug therapy services; (2) payment rules and related requirements, such as those pertaining to deductibles, for covered outpatient prescription drugs; (3) manufacturer rebates to the Secretary under Medicare part B for covered outpatient prescription drugs; and (4) determination of the Medicare part B premium attributable to covered outpatient prescription drugs. Subtitle B: Long-Term Care - Establishes requirements for State plans for home and community-based services to individuals with disabilities. Includes among those requirements the following: (1) a prohibition of limiting eligibility of individuals with disabilities based on income, age, geography, severity of disability, residential setting, or other grounds specified by the Secretary; (2) a requirement to serve low-income individuals; (3) a requirement to specify how Federal and State funds will be managed; (4) quality assurance requirements; and (5) reporting requirements. Requires a State to consult with individuals and groups of individuals with disabilities when developing the plan in order to have the plan approved. (Sec. 2103) Defines "individuals with disabilities" to mean any individual within one or more of the following four categories: (1) individuals requiring help with the activities of daily living; (2) individuals with severe cognitive or mental impairment; (3) individuals with severe or profound mental retardation; and (4) severely disabled children. (Sec. 2104) Requires a State plan to specify the services available. Requires each individualized plan to be developed in close consultation with the individual and the individual's family. Prohibits a State plan from covering: (1) room and board; (2) services furnished in a hospital, nursing facility, intermediate care facility for the mentally retarded, or other specified institutional setting; or (3) items or services to the extent coverage is provided for an individual under a health plan or Medicare. (Sec. 2105) Sets forth provisions relating to: (1) cost sharing; (2) quality assurance and safeguards; (3) advisory groups; (4) payments to States; and (5) the total Federal budget for State plans and allotments to States. (Sec. 2301) directs the Secretary, with the advice and assistance of the National Long-Term Care Insurance Advisory Council to promulgate regulations as necessary to implement provisions concerning private long-term care insurance. Directs the Secretary to make appointments to such Council. Authorizes appropriations for such Council. (Sec. 2321) Directs the Secretary, after considering the Council's recommendations to promulgate regulations designed to: (1) standardize formats and terminology used in long-term care policies; (2) require insurers to provide information to customers on the range of public and private long-term care coverage available; and (3) establish other requirements promoting consumer understanding of benefits. (Sec. 2322) Directs the Secretary to promulgate regulations establishing requirements with respect to the terms of and benefits under long-term care policies, which shall include the following requirements that the policy may not: (1) limit coverage based on a preexisting condition, subject to an exception for a six month period; (2) condition eligibility for benefits based on the need or receipt of any other service; (3) condition eligibility for any benefit on any particular diagnosis; (4) condition eligibility for benefits by providers on compliance with requirements not required by State or Federal law; and (5) condition coverage of any service by a provider on the provision of such service at a higher level of care than required by the insured individual. Prohibits discrimination by diagnosis in the treatment of: (1) Alzheimer's disease; (2) any organic or inorganic mental illness; (3) mental retardation or any other cognitive or mental impairment; or (4) HIV infection or AIDS. Sets forth other requirements for such policies, including requirements related to: (1) premiums; (2) sales practices; (3) continuation, renewal, replacement, conversion, and cancellation of policies; and (4) payment of benefits. (Sec. 2342) Provides for grants to States to enforce the Federal standards concerning long-term care policies. Sets forth requirements for receiving such grants. Authorizes appropriations. Prohibits the sale of a long-term care policy in a State without a regulatory program. (Sec. 2361) Authorizes the Secretary to make grants for the development and implementation of long-term care information, counseling, and other programs to: (1) States; (2) regional alliances (at the option of States within which such alliances are located; and (3) national organizations representing insurance consumers, long-term care providers, and insurers. Authorizes appropriations for such grants. (Sec. 2601) Authorizes the Secretary to conduct a demonstration program to test the effectiveness of various approaches to financing and providing integrated acute and long-term care services for the chronically ill and disabled. Sets forth the services and benefits to be provided, including: (1) all benefits of the comprehensive benefit package provided under title I of this Act; (2) transitional benefits, including assessment and home care; (3) long-term care benefits, including adult day care, home-delivered meals, and nursing facility services in specialized care units; and (4) habilitation services. Permits any of the following to be eligible for such services under criteria to be established by the Secretary: (1) individuals with disabilities under a State program; (2) individuals entitled to benefits under the Medicare program; and (3) individuals entitled to Medicaid and who are also either entitled to Medicare or Supplemental Security Income benefits. Requires reports to the Congress on the demonstration program. Title III: Public Health Initiatives - Subtitle A: Workforce Priorities Under Federal Payments - Establishes within the Department of Health and Human Services the National Council on Graduate Medical Education. Directs the National Council to designate for each academic year the number of individuals nationwide who are authorized to be enrolled in each specified approval physician training program for each medical specialty. Sets forth provisions specifying: (1) Federal formula payments to approved physician training programs; (2) application for payments; and (3) amount of payments. (Sec. 3061) Directs the Secretary to carry out a program with respect to graduate nurse training programs that is equivalent to the program for approved physician training programs. Establishes a National Council on Graduate Nurse Education. (Sec. 3071) Authorizes appropriations for the following programs: (1) primary care physician and physician assistant training; (2) training of underrepresented minorities and disadvantaged persons; and (3) nurse training. (Sec. 3072) Authorizes appropriations for the following programs: (1) a program of skill upgrading and occupational retraining for health care workers; (2) a demonstration program to assist workers in health care institutions in obtaining advanced career positions; (3) a program to develop and operate health-worker job banks in local employment services agencies, subject to certain conditions; (4) a program to provide joint labor-management decision-making in the health care sector on workplace matters related to the restructuring of the health care delivery system of this Act; and (5) a program to facilitate the comprehensive workforce adjustment initiative. (Sec. 3073) Directs the Secretary of Health and Human Services and the Secretary of Labor to jointly establish the National Institute for Health Care Workforce Development. States that the Director of the Institute shall make recommendations to the Secretaries regarding: (1) the supply of health care workers; (2) the impact of this Act; and (3) the development and implementation of high-performance, high-quality health care delivery systems. Directs the Secretaries to establish an advisory board to assist in the development of such recommendations. Subtitle B: Academic Health Centers - Directs the Secretary to make payments to a qualified academic health center or qualified teaching hospital in order to assist such eligible institutions with costs that are not routinely incurred by other entities in providing health services, but are incurred by such institutions by virtue of the academic nature of such institutions. States that such costs include: (1) costs resulting from reduced staff productivity due to teaching responsibilities; (2) the uncompensated costs of clinical research; and (3) exceptional costs associated with an institutions specialized expertise. Provides that the funding for such payments will come from transfers from the Federal Hospital Insurance Trust Fund, payments made by regional alliances to the Federal government for academic health centers and graduate medical education, and payments from corporate alliances. (Sec. 3131) Provides for the access of regional and corporate alliance patients to academic health centers. Subtitle C: Health Research Initiatives - Amends the Public Health Service Act to ensure that the National Institutes of Health conducts and supports biomedical and behavioral research on promoting health and preventing diseases, disorders, and other health conditions. Provides for health services research. Authorizes appropriations for such research. Subtitle D: Core Functions of Public Health Programs; National Initiatives Regarding Preventive Health - Authorizes appropriations for the core functions of public health programs and national initiatives regarding health promotion and disease prevention. (Sec. 3312) Authorizes the Secretary to make grants to States to carry out one or more of the following core functions: (1) data collection; (2) activities to protect the environment and to assure the safety of housing, workplaces, and food and water; (3) investigation and control of adverse health conditions; (4) public information and education programs to reduce risks to health such as use of tobacco, alcohol, and drugs, sexual activities that increase the risk of HIV transmission and other sexually transmitted diseases, poor diet, physical inactivity, and low childhood immunization levels; (5) accountability and quality assurance activities; (6) provision of public health laboratory services to complement private clinical laboratory services that screen for diseases and conditions; (7) training and education to assure provision of care by all health professionals; and (8) leadership policy development and administrative activities. (Sec. 3331) Authorizes the Secretary to make grants to agencies of State or local government, private nonprofit organizations, and coalitions that link two or more of these groups for the purpose of carrying out projects to develop and implement innovative community-based strategies to provide for health promotion and disease prevention activities for which there is a significant need. Subtitle E: Health Services for Medically Underserved Populations - Directs the Secretary to make grants to migrant health centers and community health centers, which shall be in addition to other funds available to such centers. Authorizes appropriations. (Sec. 3412) Authorizes appropriations for: (1) grants and contracts for the development of qualified community health plans and practice networks; and (2) loans and guaranteeing the principal and interest to Federal and non-Federal lenders on behalf of public and private entities for the capital costs of developing qualified community health plans and practice networks. (Sec. 3461) Authorizes the Secretary to make grants and enter into contracts with qualified community health groups to provide enabling services such as transportation, community and patient outreach, patient education, and translation services in order to increase the capacity of individuals to utilize the items and services under title I of this Act. Authorizes appropriations. (Sec. 3471) Authorizes appropriations for: (1) the National Health Service Corps; and (2) such amounts as are necessary to ensure that at least 20 percent of participants in the Scholarship Program or the Loan Repayment Program of the Corps are nurses. (Sec. 3481) Entitles a hospital with a low-income utilization rate in a base year of at least 25 percent to a payment as specified. Requires 75 percent of the total available to be allocated to hospitals for low-income assistance. Requires 25 percent of the total available to be allocated to hospitals for assistance in furnishing inpatient hospital services that are not covered services under title I of this Act. Subtitle F: Mental Health; Substance Abuse - Authorizes appropriations to carry out this part. Provides for grants to: (1) increase access to mental health and substance abuse services; (2) improve State and local capacity to coordinate and monitor such services; (3) provide incentives to integrate public and private service systems; and (4) supplement any activity under part B (Alcohol and Drug Abuse and Mental Services Block Grant) of title XIX of the Public Health Service Act. (Sec. 3503) Authorizes the Secretary to make loans for the capital costs incurred in the development of non-acute, residential treatment centers and community-based ambulatory clinics. (Sec. 3521) Requires the establishment of a pilot program demonstrating the integration of the mental illness and substance abuse services of the States with the services included under title I of this Act. Subtitle G: Comprehensive School Health Education; School-Related Health Services - Authorizes appropriations for the programs of this subtitle. States that the purposes of the programs shall be to: (1) support, in kindergarten through grade 12, the provision of comprehensive health educator programs; (2) establish a national framework within which States can create comprehensive school health education programs that target the health risk behaviors of youth, including tobacco use, alcohol and drug abuse, sexual behaviors resulting in infections, injury prevention, dietary patterns, and sedentary lifestyles; (3) pay the initial costs of planning and establishing such programs; (4) support related Federal demonstrations and training; (5) motivate youth to stay in school, avoid teen pregnancy, and strive for success; (6) improve the knowledge of health education among youth; and (7) further the National Education Goals set forth in title I of the Goals 2000: Educate America Act. Defines "comprehensive school health education program." Requires such programs to be sensitive to cultural and ethnic issues, promote involvement by families, and promote personal responsibility. Sets forth requirements for applying for grants and selection of grantees. Subtitle H: Public Health Service Initiative - Establishes a Public Health Service Initiative consisting of specified amounts authorized to be appropriated for the Initiative. States that: (1) the Initiative includes the programs of subtitles C through G of this title and the programs of subtitle D of title VIII; and (2) amounts appropriated to carry out the Initiative, including subtitles A through F of this title, are available to carry out specific programs for which the amounts are appropriated. Subtitle I: Coordination with COBRA Continuation Coverage - Amends title XXII (Requirements for Certain Group Health Plans for Certain State and Local Employees) of the Public Health Service Act to provide for coordination with COBRA continuation coverage. Repeals such title XXII upon implementation of this Act. Title IV: Medicare and Medicaid - Subtitle A: Medicare and the Alliance System - Amends title XVIII of the Social Security Act to provide for optional State integration of Medicare beneficiaries into regional alliance plans. (Sec. 4002) Allows individuals to elect to remain in certain plans. (Sec. 4003) Provides for payments to regional alliances on behalf of certain Medicare-eligible individuals. (Sec. 4004) Extends protections for working aged and disabled individuals to group health plans of all employers. Repeals the limitation on the period of protection for individuals with end stage renal disease. Prohibits Medicare payment for items and services provided under any health plan under this Act. Simplifies Medicare benefit coordination in cases where the individual is also eligible for benefits under this Act's health plans. (Sec. 4011) Makes various changes concerning eligible organization and Medicare supplemental policy enrollment and comparative informational materials, eligible organization outlier payments, and participating provider point-of-service networks. (Sec. 4022) Provides for expanded Medicare coverage for physician assistant, nurse practitioner, and clinical nurse specialist services. (Sec. 4031) Amends title XI of the Social Security Act to: (1) provide for termination of the separate Medicare peer review program upon adoption of the National Quality Management Program above under subtitle A of title V of this Act; and (2) repeal provisions on surgical procedure review and second opinions. (Sec. 4032) Amends title XVIII of the Social Security Act to provide for mandatory assignment for all Medicare part B services. (Sec. 4033) Directs the Secretary of Health and Human Services to take such steps as may be necessary to consolidate administration of Medicare parts A and B and supersedes certain conflicting requirements to the extent required to achieve such purpose. (Sec. 4035) Prohibits the Secretary from implementing any change in procedures for billing and processing Medicare claims within six months of implementing any previous change. Adds advanced notification to providers as a requirement for carriers and fiscal intermediaries under Medicare. (Sec. 4041) Amends title XI of the Social Security Act to: (1) provide for civil monetary penalties for kickback violations under Medicare and State health care programs (the programs); (2) make other penalty-related changes, including increases in criminal and civil monetary penalties, a new criminal penalty exception for certain providers, additional civil monetary penalty offenses related to alliance systems, and requirements for the deposit of penalties collected into the All-Payer Account established above under title V of this Act; (3) revise exclusion provisions, with changes establishing a minimum period of exclusion for certain individuals and entities subject to permissive exclusion from the programs, and providing for program exclusions based on actions under alliance systems; and (4) modify sanction provisions, with changes removing certain conditions for imposing sanctions and setting specified civil money penalties for use in lieu of authorized sanctions. (Sec. 4042) Amends title XVIII of the Social Security Act to revise the limitations on physician self-referrals. (Sec. 4051) Provides for the termination of payments under Medicare for medical education costs and directs the Secretary to make specified transfers from certain Medicare trust funds to the new accounts established above for funding physician training programs and academic health centers. (Sec. 4061) Amends title XVIII of the Social Security Act to provide for the treatment of: (1) uniformed services and VA health plans as eligible organizations under Medicare; and (2) health care facilities of the Department of Veterans Affairs as providers under Medicare. Subtitle B: Savings in Medicare Program - Amends title XVIII of the Social Security Act to provide for: (1) reductions in the update for inpatient hospital services and the adjustment for indirect medical education costs, in payments for capital-related costs for inpatient hospital services; (2) revisions to payment adjustments for disproportionate share hospitals in States participating under this Act; and (3) an extension of the freeze on updates to routine service costs of skilled nursing facilities. (Sec. 4111) Amends title XVIII of the Social Security Act to provide for: (1) establishment of cumulative expenditure goals for physician services; (2) use of real gross domestic product for volume adjustments; (3) repeal of restrictions on the maximum reduction permitted in default update; (4) reduction in the conversion factor for the physician fee schedule for 1995; (5) place limitations on payment for physicians' services furnished by high-cost hospital medical staffs; (6) requirements for physicians to identify the hospital at which the service was furnished; (7) an increase in practice expense relative value units for certain services while assuring budget neutrality; (8) a study and report to the Congress by the Secretary on a resource-based system for determining practice expense relative value units for each physician's service; (9) an increase in work relative value units for office visits while assuring budget neutrality; (10) a reduction in relative values for office consultations; (11) adjustment of outlier intensity of relative values; (12) changes in underserved area bonus payments; (13) elimination of formula-driven payments for certain outpatient hospital services; (14) copayments for laboratory services; and (15) competitive acquisition procedures for Medicare part B items and services (including clinical diagnostic laboratory tests). (Sec. 4131) Makes changes with respect to: (1) Medicare as secondary payer; (2) payments for health maintenance organizations and competitive medical plans with risk-sharing contracts; and (3) routine cost limits and copayments for, respectively, home health services and visits. (Sec 4135) Directs the Secretary to use a competitive process to contract with centers of excellence for cataract surgery, coronary artery by-pass surgery, and such other services as the Secretary determines to be appropriate. (Sec. 4141) Amends title XVIII of the Social Security Act to revise Medicare part B premium provisions. (Sec. 4151) Requires the Secretary to submit a report to the Congress on the growth in spending under Medicare for FY 2000 through 2003. Subtitle C: Medicaid - Amends title XIX (Medicaid) of the Social Security Act to provide that if a State Medicaid plan provides for payment to regional alliances of the amounts required above it is not required to provide payment for items and services covered under the comprehensive benefit package for alliance eligible individuals and will receive no Federal financial assistance with respect to such items and services. (Sec. 4211) Provides for: (1) spenddown eligibility and increased income and resource disregard for nursing facility residents; and (2) informing such residents about the availability of assistance for home and community-based services. (Sec. 4221) Provides for: (1) treatment of items and services not covered under the comprehensive benefit package; and (2) establishment of a program under Medicare of noncovered items and services for poor children. (Sec. 4231) Discontinues certain payment policies under Medicaid. (Sec. 4241) Limits the frequency of changes in a State's billing and claims processing system, and provides for advance notification to providers of any major billing change. (Sec. 4251) Establishes the Medicaid Commission to study, report, and make recommendations with respect to options involving block grant use, integration of long-term care services, and consolidation of institutional and home- and community-based long-term care in relation to the Medicaid program. Authorizes appropriations. Subtitle D: Increase in SSI Personal Needs Allowance - Amends title XVI (Supplemental Security Income) (SSI) to provide for an increase in the SSI personal needs allowance. Title V: Quality and Consumer Protection - Subtitle A: Quality Management and Improvement - Requires the National Health Board to establish and oversee a performance-based program of quality management and improvement designed to enhance the quality, appropriateness, and effectiveness of heath care services and access to such services which will be called the National Quality Management Program. (Sec. 5002) Establishes the National Quality Management Council which shall: (1) administer the National Quality Management Program; (2) perform any other duty specified in this subtitle; and (3) advise the National Health Board with respect to its duties under this subtitle. Requires the Council to develop a set of national measures of quality performance to be used in the assessment of and the provision of access to health care services. Requires the Council, in addition, to: (1) recommend to the Board establishing goals for performance by health plans and health care providers on a subset of national measures of quality performance; (2) direct the Administrator for Health Care Policy and Research to develop, review, and disseminate practice guidelines to determine how diseases can most effectively be prevented, diagnosed, treated, and managed; and (3) direct the Administrator for Health Care Policy and Research to support research related to a five year priority list of performance measures. (Sec. 5008) Directs the National Health Board to: (1) establish and oversee regional professional foundations to perform such duties as develop lifetime learning programs for health professionals and conduct research on health care quality; and (2) establish the National Quality Consortium to perform such duties as establishing continuing education for health professionals and provide advice on research priorities. (Sec. 5012) Requires each regional alliance and each corporate alliance to: (1) disseminate specified information to consumers; and (2) ensure that performance and quality standards are continually improved. Subtitle B: Information Systems, Privacy, and Administrative Simplification - Directs the National Health Board to develop and implement a health information system, in consultation with Federal agencies, States, employers, health plans, and others, by which the Board shall collect, report, and regulate the collection and dissemination of health care information which shall be used for: (1) health care planning by Federal, State, and local government; (2) establishing and monitoring payments for health services; (3) assessing and improving the quality of health care; (4) managing and containing costs at the alliance and plan levels; and (5) other specified purposes. Requires the establishment of an electronic data network to collect, compile, and transmit information. (Sec. 5120) Sets forth provisions providing for health information privacy standards. (Sec. 5130) Directs the National Health Board to develop the following standard health care benefit forms: (1) an enrollment and disenrollment form; (2) a clinical encounter record; and (3) a claim form. (Sec. 5140) Establishes the National Privacy and Health Data Advisory Council in order to advise the National Health Board with respect to its duties under this subtitle. (Sec. 5141) Sets forth monetary penalties for violating health information system standards. Subtitle C: Remedies and Enforcement - Sets forth provisions with respect to the review of benefit determinations for enrolled individuals, including provisions: (1) regulating the time limits for notice of disposition of a claim; (2) governing a plan's duty to review claim denials; (3) concerning urgent requests for preauthorization; and (4) concerning other time limits with respect to time limits and notice. (Sec. 5202) Requires each State to establish a complaint review office for each regional alliance established by a State. Permits aggrieved individuals to file complaints with the appropriate review office. (Sec. 5205) Provides for a Federal Health Plan Review Board to review the decisions of complaint review office hearing officers. (Sec. 5207) Sets monetary penalties for a plan which unreasonably denies or delays payment or provision of benefits. (Sec. 5211) Directs each State to establish and maintain an Early Resolution Program in each complaint review office. Requires a program to include: (1) forums for mediation disputes; and (2) other forums of alternative dispute resolution as may be prescribed. Establishes guidelines for the eligibility of cases for submission to the Early Resolution Program. States that conclusions of the mediation proceedings shall be treated as nonbinding and shall not affect any rights to review. (Sec. 5231) Sets forth additional remedies and enforcement provisions. Subtitle D: Medical Malpractice - Prohibits any medical malpractice liability action until the final resolution of the claim under alternative dispute resolution. Requires each regional alliance health plan and corporate alliance health plan to adopt at least one specified method of alternative dispute resolution. Prohibits an individual from bringing a medical malpractice liability action unless the individual submits an affidavit that includes a report by a qualified specialist that states that there is a meritorious cause for filing the action. (Sec. 5311) Directs the Secretary to establish: (1) a project to demonstrate whether substituting liability for medical malpractice on the part of the health plan in which a physician participates for the personal liability of the physician will result in improvements in the quality of care, reductions in defense medical practices, and better risk management; (2) a pilot program under which the Secretary provides funds to one or more eligible States to determine the effect of applying practice guidelines in the resolution of medical malpractice liability actions. Subtitle E: Fraud and Abuse - Directs the Secretary and the Attorney General to establish a program: (1) to coordinate the functions of the Attorney General, the Secretary, and other organizations with respect to the prevention, detection, and control of health care fraud and abuse; (2) to conduct investigations, audits, evaluations, and inspections relating to the delivery of and payment for health care; and (3) to facilitate the enforcement of this and other statutes applicable to health care fraud. (Sec. 5402) Creates, in the Treasury, the All-Payer Health Care Fraud and Abuse Control Account which shall consist of: (1) gifts and bequests; (2) administrative penalties and assessments and portions of civil monetary penalties imposed under provisions of the Social Security Act; (3) all criminal fines imposed in cases involving a Federal health care offense; (4) penalties imposed under the False Claims Act involving claims related to the provision of health care items and services; and (5) amounts resulting from the forfeiture of property by reason of Federal health care offense. States that amounts in the fund may be used to cover costs incurred in operating the Program. (Sec. 5411) Excludes from participation in any health plan any individual or entity excluded from participation in a public program under provisions of the Social Security Act. (Sec. 5413) Sets forth physician self-referral limitations. (Sec. 5431) Amends the Federal criminal code to set penalties for knowingly executing a scheme or artifice to: (1) defraud any health alliance, health plan, or other person (alliance) in connection with the delivery of, or payment for, health care benefits, items, or services (benefits); and (2) obtain, by false or fraudulent means, money or property owned by, or under the custody of control of, any such alliance in connection with the delivery of, or payment for, health care benefits. (Sec. 5432) Amends: (1) the Federal criminal code to require the court, in imposing sentence on a person convicted of a Federal health care offense that poses a serious threat to the health of any person or has a significant detrimental impact on the health care system, to order such person to forfeit property used in the commission of the offense or that constitutes, or is derived from, proceeds traceable to the commission of the offense which is of a value proportionate to the seriousness of the offense; and (2) the Federal judicial code to require that all proceeds of forfeiture relating to Federal health care offenses be deposited into the Department of Justice Assets Forfeiture Fund. (Sec. 5433) Amends the Federal criminal code to set penalties for: (1) knowingly and willfully falsifying, concealing, or covering up a material fact, making any false, fictitious, or fraudulent statements or representations, or making or using any false writing or document knowing it to contain any false, fictitious, or fraudulent statement or entry, in any matter involving a health alliance or health plan; and (2) bribery of, and graft by, a health care official. (Sec. 5435) Authorizes: (1) the Attorney General to commence a civil action in Federal court to enjoin a Federal health care offense; and (2) a person privy to certain grand jury information concerning a health law violation to disclose that information to an attorney for the Government to use in any civil proceeding related to a Federal health care offense. (Sec. 5437) Sets penalties for: (1) theft or embezzlement in connection with a health alliance, health plan, or fund connected with such alliance or plan; and (2) misuse of a health security card issued, or unique identifier provided, pursuant to this Act. (Sec. 5441) Makes provisions of the Civil False Claims Act applicable to the use of false records or statements made to a health plan. Includes within the definition of "claim" for purposes of such Act any request or demand for money or property which is made or presented to a health plan. Subtitle F: McCarran-Ferguson Reform - Amends the McCarran-Ferguson Act to repeal the exemption under specified antitrust laws for the business of insurance to the extent that such business relates to the provision of health benefits. Title VI: Premium Caps; Premium-Based Financing; and Plan Payments - Subtitle A: Premium Caps - Sets forth provisions which provide for the computation of factors that limit the growth of premiums for the comprehensive benefit package in regional alliance health plans, including the computation of a: (1) regional alliance inflation factor; and (2) general health care inflation factor. (Sec. 6002) Directs the Board to determine: (1) a national per capita baseline premium target; (2) the national average per capita current coverage health expenditures; and (3) current health care expenditures. (Sec. 6003) Directs the Board to determine a regional alliance per capita premium. (Sec. 6004) Requires a regional alliance to annually obtain premium bids from each plan seeking to participate as a regional alliance health plan with respect to the alliance. (Sec. 6005) Permits any participating State to assume responsibility for containment of health care expenditures in the State consistent with this Act. (Sec. 6006) Directs the chair of the Board to establish an advisory commission on regional variations in health expenditures. Requires the commission to examine methods of eliminating variation in regional alliance per capita premium targets due to variation in practice patterns, not due to other factors. Requires the Board to submit its recommendations to the Congress. Requires such recommendations to apply unless a joint resolution of disapproval is passed. (Sec. 6011) Subjects each noncomplying regional alliance health plan for a year to a reduction in plan payment as specified, in order to assure that payments to regional alliance health plans by a regional alliance are consistent. Defines a noncomplying plan to include a plan in which the final accepted bid exceeds the maximum complying bid for the per capita target premium. Defines "maximum complying bid." (Sec. 6021) Directs the Board to develop a methodology for calculating an annual per capita expenditure equivalent for amounts paid for coverage for the comprehensive benefit package within a corporate alliance. (Sec. 6022) Terminates a corporate alliance with two excess years in a three year period. Provides that employers that were corporate alliance employers with respect to a terminated alliance shall become regional alliance employers. Defines an excess year as one in which the rate of increase for the corporate alliance exceeds the national corporate inflation factor. Defines rate of increase and national corporate inflation factor. (Sec. 6031) Sets forth special rules for a single-payer State. (Sec. 6041) Directs the Secretary to establish a program to monitor prices and expenditures in the U.S. health care system. Subtitle B: Premium-Related Financings - Makes each family enrolled in a regional health alliance plan or in a corporate alliance health plan in a class of family enrollment responsible for payment of the family share of premium payable for enrollment. Provides for income related discounts and specified credits. (Sec. 6102) Establishes the formula for determining the premiums. (Sec. 6111) Provides for the repayment of credit by certain families. (Sec. 6114) Provides for the special treatment of certain retirees and qualified spouses and children. (Sec. 6121) Requires each regional alliance employer to pay a monthly premium to the regional alliance for a qualifying employee. Sets forth provisions for determining such premium. Varies the premium depending upon such factors as the employer's size and average wages paid. (Sec. 6126) Sets forth provisions applicable to self-employed individuals. (Sec. 6131) Sets forth provisions for determining the corporate employer premium. Subtitle C: Payments to Regional Alliance Health Plans - Sets forth provisions to determine the computation of: (1) the blended plan per capita payment amount; and (2) the plan bid, AFDC, and SSI proportions. Title VII: Revenue Provisions - Subtitle A: Financing Provisions - Amends the Internal Revenue Code to increase the excise taxes on cigarettes and other tobacco products. (Sec. 7113) Imposes an excise tax on the manufacture or importation of roll-your-own tobacco. (Sec. 7121) Imposes an assessment on each corporate alliance employer and a temporary assessment on employers with retiree health benefit costs. Requires such assessments to be paid in the same manner as employment taxes. (Sec. 7131) Provides for the recapture of certain health care subsidies received by high-income individuals. Transfers such amounts to the Supplemental Medical Insurance Trust Fund. (Sec. 7141) Requires certain shareholders of S corporations and limited partners who materially participate in corporate activities to include their share of income or loss from such corporation when determining net earnings from self-employment. (Sec. 7142) Provides for extending Medicare coverage and applying the hospital insurance tax to all State and local government employees. Subtitle B: Tax Treatment of Employer-Provided Health Care - Provides exceptions to the exclusion of employer-provided contributions to an accident or health plan from the gross income of an employee. (Sec. 7202) Prohibits the provision of health benefit under cafeteria plans. (Sec. 7203) Makes permanent the deduction for health insurance costs of self-employed individuals. Increases such deduction to 100 percent of the basic coverage purchased from a health alliance with limitations. Subtitle C: Employment Status Provisions - Requires the Secretary of the Treasury to prescribe regulations defining an employee for employment tax purposes. (Sec. 7302) Increases the penalty for failure to file correct returns involving payments for services. (Sec. 7303) Sets forth rules to limit retroactive employment tax reclassifications. Subtitle D: Tax Treatment of Funding of Retiree Health Benefits - Requires additional reserves for post-retirement medical and life insurance benefits to cover not less than ten years of the working lives of covered employees and to be maintained as separate accounts. (Sec. 7402) Terminates the authority of pension plans to maintain health benefits accounts. Subtitle E: Coordination with COBRA Continuing Care Provisions - Repeals provisions concerning continuation coverage requirements of group health plans upon implementation of this Act. Subtitle F: Tax Treatment of Organizations Providing Health Care Services and Related Organizations - Provides for the tax treatment of charitable organizations providing health care services, insurance provided by health maintenance organizations, and certain private foundations. (Sec. 7602) Sets forth transitional rules for taxing certain organizations providing health insurance and other prepaid health care services as insurance companies other than life insurance companies. (Sec. 7603) Exempts regional alliances from income tax. Subtitle G: Tax Treatment of Long-term Care Insurance and Services - Treats qualified long-term care services as medical care for purposes of the medical expense deduction. (Sec. 7702) Provides for the treatment of long-term care insurance as accident and health insurance. (Sec. 7703) Allows accelerated death benefits under life insurance contracts to be paid to terminally ill individuals. Subtitle H: Tax Incentives for Health Service Providers - Allows a tax credit for certain qualified individuals who provide primary health services full time in a health professional shortage area. (Sec. 7802) Increases the allowable depreciation deduction for expensing certain medical equipment. Subtitle I: Miscellaneous Provisions - Allows a tax credit for the cost of personal assistance services required by an employed individual who for medical reasons is unable to engage in substantial gainful activity. (Sec. 7902) Denies tax-exempt status for private activity bonds of regional alliances, corporate alliances, or guaranty funds established under this Act. Title VIII: Health and Health-Related Programs of the Federal Government - Subtitle A: Military Health Care Reform - Directs the Secretary of Defense to establish one or more uniformed services health plans in order to provide health care services to members of the armed forces on active duty for 30 or more days as well as their covered beneficiaries. Requires conformity of such plans with health plan requirements set forth in this Act. (Sec. 8001b) Allows any such plan to rely upon the use of military health care facilities, supplemented by civilian health care providers or health plans under agreements entered into by the Secretary. Requires at least the items and services in the comprehensive benefit package under this Act to be included in each such plan. Preempts any conflicting State health plan requirements. Provides for plan enrollment, effect of failure to enroll, and choosing between a uniformed services health plan and other available plans. Prohibits the imposition of plan charges to an active-duty member other than subsistence charges, but allows the Secretary to impose limited charges for covered beneficiaries. Establishes in the Department of Defense a financial account for payments received in connection with a uniformed services health plan, allowing such funds to be used only for purposes directly related to the delivery and financing of health care services under this Subtitle. Subtitle B: Department of Veterans Affairs - Allows each veteran who is an eligible individual under this Act and individuals currently enrolled in a health plan under the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) to be enrolled with a Department of Veterans Affairs (VA) health plan. Requires conformity of such plans with health plan requirements set forth in this Act, with all the items and services of the comprehensive benefit package under this Act included. Allows such plans to offer supplemental health benefits and cost-sharing policies as consistent with this Act. Provides a limitation with regard to veterans enrolled with health plans outside the VA. Prohibits the imposition of any plan enrollment charges upon service-connected disabled veterans, veterans receiving disability compensation from the VA, former prisoners of war, and veterans unable to defray the costs of such care. Allows the Secretary of Veterans Affairs to establish plan charges for other veterans. Deems a VA facility to be a Medicare provider for purposes of any program administered by the Secretary of Health and Human Services. Allows for the recovery of certain care and services provided under a VA plan in the case of an individual who has coverage under another plan. Establishes in the Treasury the Department of Veterans Affairs Health Plan Fund to be used for VA health plan payments and services. Preserves existing benefits for VA facilities not operating within a health plan certified under this Act. (Sec. 8102) Directs the Secretary of Veterans Affairs to organize health plans and operate VA facilities as, or within, health plans under this Act. Preempts existing State health plan standards or requirements. Authorizes the Secretary to contract for the provision of services by a VA health plan when cost-effective, or to share resources with other health care plans, providers, or organizations. Authorizes appropriations to the VA for FY 1995 through 1997 for VA health plans under this Subtitle, subject to availability of appropriations. Requires a report from the Secretary to the Congress concerning the operation of the VA health care system within the requirements of this Act. Authorizes the Secretary to accept and use grants for health care services provided to special populations if used by the VA while operating under a VA health plan. Subtitle C: Federal Employees Health Benefits Programs - (Secs. 8202 through 8204) Provides for termination of the Federal Employees Health Benefits Program (FEHB) and treatment of Federal employees, annuitants, and other individuals (including those residing abroad) who would otherwise have been eligible for FEHBP under this Act's health plans. Subtitle D: Indian Health Service - Makes qualifying Indians eligible to enroll in a comprehensive benefits health program of the Indian Health Service. (Sec. 8303) Authorizes appropriations for supplemental Indian health care benefits. (Sec. 8305) Exempts tribal governments and organizations from making employer payments. (Sec. 8306) Sets forth provisions regarding health service to non-enrollees and non-Indians. (Sec. 8311) Requires each health program of the Indian Health Service to establish a comprehensive benefit package fund. (Sec. 8313) Authorizes appropriations for the Indian Health Service programs. Subtitle E: Amendments to the Employee Retirement Income Security Act of 1974 - Amends the Employee Retirement Income Security Act of 1974 (ERISA) to revise and limit the coverage of group health plans under ERISA. Makes certain ERISA provisions inapplicable with respect to State-certified health plans. Provides for an exception from ERISA civil action provisions where review is otherwise available under the Health Security Act (this Act, HSA). (Sec. 8402) Establishes ERISA requirements for expeditious reporting and disclosure applicable to group health plans, through special rules consistent with ERISA and HSA purposes. Excludes plans maintained by regional alliances from treatment as multiple employer welfare arrangements. (Sec. 8403) Revises certain ERISA provisions relating to continuation coverage under group health plans. Repeals such provisions upon implementation of HSA. (Sec. 8404) Makes ERISA standards for group health plans regarding: (1) cases of adoption applicable except to the extent otherwise provided in regulations of the National Health Board under HSA; and (2) coverage of pediatric vaccines inapplicable to a group health plan upon its becoming a corporate alliance health plan under HSA. (Sec. 8405) Requires group health plans under ERISA to comply with HSA requirements relating to health plan claims procedure. Subtitle F: Special Fund for WIC Program - Authorizes appropriations through FY 2000 for the special supplemental food program for women, infants, and children under the Child Nutrition Act of 1966. Title IX: Aggregate Government Payments - Subtitle A: Aggregate State Payments - Sets forth provisions which have formulas for determining each participating State's payment to regional alliances within the State. Provides two different formulas. Establishes one payment formula for non-cash assistance recipients. Establishes another formula relating to cash assistance recipients. Defines a non-cash assistance adult as an individual who is: (1) over 21 years; (2) a U.S. citizen or lawful alien; and (3) is not an AFDC or SSI recipient or a Medicare-eligible individual. (Sec. 9022) Directs the National Health Board to review appropriateness of such payments. Subtitle B: Aggregate Federal Alliance Payments - Sets forth the formula for determining Federal payments to regional alliances for cash assistance recipients. (Sec. 9102) States that this section constitutes budget authority in advance of appropriation Acts and obligates the Federal Government to provide for the payment to regional alliances of a capped Federal alliance payment amount. Defines "capped Federal alliance payment amount." Subtitle C: Borrowing Authority to Cover Cash-flow Shortfalls - Authorizes the Secretary to make available loans to regional alliances to cover any period of temporary cash-flow shortfall attributable to: (1) any estimation discrepancy; (2) a period of temporary cash-flow shortfall attributable to an administrative error; or (3) a period of temporary cash-flow shortfall relating to the relative timing during the year in which amounts are received and payments are required. Sets forth loan terms and conditions. Title X: Coordination of Medical Portion of Workers Compensation and Automobile Insurance - Subtitle A: Workers Compensation Insurance - Requires each health plan that provides services to enrollees through participating providers to make arrangements to provide workers compensation to such enrollees. (Sec. 10002) Requires each workers' compensation carrier that is liable for payment for workers' compensation services furnished by or through a health plan, regardless of whether or not the services are included in the comprehensive benefit package, to make payment for such services. (Sec. 10011) Sets forth requirements for participating States. (Sec. 10031) Authorizes demonstration projects in one or more States with respect to the treatment of work-related injuries and illnesses. Subtitle B: Automobile Insurance - Requires an individual entitled to automobile insurance medical benefits and enrolled in a health plan to receive automobile insurance medical services through the provision of such services by the health plan. (Sec. 10102) Requires each automobile insurance carrier that is liable for payment for automobile insurance medical services furnished by or through a health plan, regardless of whether or not the services are included in the comprehensive benefit package, to make payment for such services. (Sec. 10111) Requires each participating State to develop a fee schedule applicable to payment for automobile insurance medical services for which a fee is not included in the applicable fee schedule. Subtitle C: Commission on Integration of Health Benefits - Establishes the Commission on Integration of Health Benefits which shall study and report on the feasibility and appropriateness of transferring financial responsibility for all medical benefits, including those currently covered by workers compensation and automobile insurance, to health plans. Authorizes appropriations. Subtitle D: Federal Employees' Compensation Act - Requires the Federal Employees' Compensation Act to be interpreted and administered consistent with the provisions of subtitle A. Subtitle E: Davis-Bacon Act and Service Contract Act - Amends the Davis-Bacon Act and the Service Contract Act of 1965 to require Health Security Act benefits. Subtitle F: Effective Dates - Sets forth effective date provisions. Title XI: Transitional Insurance Reform - Sets forth transitional provisions concerning: (1) enforcement; (2) preservation of current coverage; (3) restrictions on premium increases during transition; (4) portability requirements; (5) restrictions limiting benefit reductions; and (6) the establishment of the National Transitional Health Insurance Risk Pool.
Bill· HRH.R. 3629 (103rd)open
United States · United States Congress · 22 November 1993
Postal Service Fiscal Responsibility Act of 1993 - Rescinds a specified amount of the funds made available for the U.S. Postal Service in the Treasury, Postal Service, and General Government Appropriations Act, 1994 on January 1, 1994, unless, before such date, the Postmaster General notifies the Congress that the Postal Service will not proceed with the adoption and implementation of a new corporate logo.
Bill· SS. 1757 (103rd)open
United States · United States Congress · 20 November 1993
TABLE OF CONTENTS: Title I: Health Care Security Subtitle A: Universal Coverage and Individual Responsibility Subtitle B: Benefits Subtitle C: State Responsibilities Subtitle D: Health Alliances Subtitle E: Health Plans Subtitle F: Federal Responsibilities Subtitle G: Employer Responsibilities Subtitle J (sic): General Definitions; Miscellaneous Provisions Title II: New Benefits Subtitle A: Medicare Outpatient Prescription Drug Benefit Subtitle B: Long-Term Care Title III: Public Health Initiatives Subtitle A: Workforce Priorities Under Federal Payments Subtitle B: Academic Health Centers Subtitle C: Health Research Initiatives Subtitle D: Core Functions of Public Health Programs; National Initiatives Regarding Preventive Health Subtitle E: Health Services for Medically Underserved Populations Subtitle F: Mental Health; Substance Abuse Subtitle G: Comprehensive School Health Education; School-Related Health Services Subtitle H: Public Health Service Initiative Subtitle I: Coordination With COBRA Continuation Coverage Title IV: Medicare and Medicaid Subtitle A: Medicare and the Alliance System Subtitle B: Savings in Medicare Program Subtitle C: Medicaid Subtitle D: Increase in SSI Personal Needs Allowance Title V: Quality and Consumer Protection Subtitle A: Quality Management and Improvement Subtitle B: Information Systems, Privacy, and Administrative Simplification Subtitle C: Remedies and Enforcement Subtitle D: Medical Malpractice Subtitle E: Fraud and Abuse Subtitle F: McCarran-Ferguson Reform Title VI: Premium Caps; Premium-Based Financing; and Plan Payments Subtitle A: Premium Caps Subtitle B: Premium-Related Financing Subtitle C: Payments to Regional Alliance Health Plans Title VII: Revenue Provisions Subtitle A: Financing Provisions Subtitle B: Tax Treatment of Employer-Provided Health Care Subtitle C: Employment Status Provisions Subtitle D: Tax Treatment of Funding of Retiree Health Benefits Subtitle E: Coordination with COBRA Continuing Care Provisions Subtitle F: Tax Treatment of Organizations Providing Health Care Services and Related Organizations Subtitle G: Tax Treatment of Long-term Care Insurance and Services Subtitle H: Tax Incentives for Health Services Providers Subtitle I: Miscellaneous Provisions Title VIII: Health and Health-Related Programs of the Federal Government Subtitle A: Military Health Care Reform Subtitle B: Department of Veterans Affairs Subtitle C: Federal Employees Health Benefits Program Subtitle D: Indian Health Service Subtitle E: Amendments to the Employee Retirement Income Security Act of 1974 Subtitle F: Special Fund for WIC Program Title IX: Aggregate Government Payments to Regional Alliances Subtitle A: Aggregate State Payments Subtitle B: Aggregate Federal Alliance Payments Subtitle C: Borrowing Authority to Cover Cash-Flow Shortfalls Title X: Coordination of Medical Portion of Workers Compensation and Automobile Insurance Subtitle A: Workers Compensation Insurance Subtitle B: Automobile Insurance Subtitle C: Commission on Integration of Health Benefits Subtitle D: Federal Employees' Compensation Act Subtitle E: Davis-Bacon Act and Service Contract Act Subtitle F: Effective Dates Title XI: Transitional Insurance Reform Health Security Act - Title I: Health Care Security - Subtitle A: Universal Courage and Individual Responsibility - Entitles each eligible individual to: (1) the benefit provided under subtitle B through the applicable health plan in which the individual is enrolled; and (2) a health security card to be issued by the alliance or other entity that offers the applicable health plan in which the individual is enrolled. Defines an eligible individual as an individual who resides in the United States and is: (1) a citizen or national of the United States; (2) an alien permanently residing in the U.S. under color of law; or (3) a long-term nonimmigrant. Entitles a Medicare-eligible individual to benefits under Medicare instead of the above provisions of this Act. (Sec. 1002) Requires each eligible individual to enroll in an applicable health plan and pay any required premium. Prohibits disenrollment of an eligible individual until the individual is either enrolled in another plan or in Medicare. (Sec. 1003) States that nothing in this Act shall be construed as prohibiting: (1) an individual from purchasing any health services; (2) an individual from purchasing supplemental insurance; (3) an individual who is not an eligible individual from purchasing health insurance; or (4) employers from providing additional coverage. (Sec. 1004) States that a regional alliance health plan is the applicable plan for a family, unless a family member is eligible for a corporate alliance health plan. Allows military personnel, veterans, and Indians to enroll either with an alliance or with a military, veteran, or Indian plan respectively. (Sec. 1005) Prohibits an undocumented alien from enrolling in a health plan under this Act. (Sec. 1011) Defines a family as an eligible individual's eligible spouse and children. Defines couple as meaning an individual and the individual's spouse. Defines a child as being under age 18, or under age 24 in the case of a full-time student. Subtitle B: Benefits - Includes the following terms and services in the comprehensive benefit package: (1) hospital services; (2) services of health professionals; (3) emergency and ambulatory medical and surgical services; (4) clinical preventive services; (5) mental illness and substance abuse services; (6) family planning services and services for pregnant women; (7) hospice care; (8) home health care; (9) extended care services; (10) ambulance services; (11) outpatient laboratory, radiology, and diagnostic services; (12) outpatient prescription drugs and biologicals; (13) outpatient rehabilitation services; (14) durable medical equipment and prosthetic and orthotic devices; (15) vision care; (16) dental care; (17) health education classes; and (18) investigational treatments. Describes such items and services. (Sec. 1131) Requires each health plan to offer to its enrollees only one of the following cost sharing schedules: (1) lower cost sharing; (2) higher cost sharing; or (3) combination cost sharing. Provides that the annual maximum out-of-pocket expenses for an individual in any of the plans shall be $1500 and for a family the annual maximum shall be $3000. (Sec. 1135) Sets forth a table of copayments and coinsurance. (Sec. 1141) Excludes the following items and services: (1) an item or service that is not medically necessary or appropriate; (2) an item or service that the National Health Board may determine is not medically necessary or appropriate; (3) custodial care, except hospice care; (4) surgery performed solely for cosmetic purposes, unless required to correct a congenital anomaly or performed to correct a part of the body injured by either disease or accident; (5) hearing aids; (6) eyeglasses and contact lenses for individuals at least 18 years of age; (7) in vitro fertilization; (8) sex change surgery and related services; (9) private duty nursing; (10) personal comfort items, except in the case of hospice care; and (11) any dental procedures involving orthodontic care, inlays, gold or platinum fillings, bridges, crowns, pin/post retention, dental implants, surgical periodontal procedures, or the preparation of the mouth for the fitting or continued use of dentures, except as specified. (Sec. 1151) Gives the National Health Board the authority to promulgate such regulations or establish such guidelines as necessary to assure uniformity in the application of the comprehensive benefit package across all health plans. Permits the Board to expand the benefit package. (Sec. 1162) Permits a health professional or facility to refuse to provide a benefit if the professional or facility objects on the basis of a religious belief or moral conviction. Subtitle C: State Responsibilities - Requires a State, in order to be approved as a participating State, to submit a document describing the State's health care system. (Sec. 1201) Requires a participating State to: (1) establish one or more regional alliances; (2) establish and publish the criteria used in the certification of its health plan; (3) meet minimum financial solvency requirements for health plans established by the National Health Board; (4) designate an agency or official to coordinate State responsibilities under this Act; (5) conform State laws to meet the requirements of title X of this Act with respect to workers' compensation and automobile insurance; and (6) carry out all the responsibilities of a participating State specified in this Act. (Sec. 1221) Permits a State, with the Board's approval, to operate a single-payer system if specified requirements are met. Subtitle D: Health Alliances - Provides for regional alliances and corporate alliances. (Sec. 1302) Requires a regional alliance to be governed by a Board of Directors consisting of: (1) employers, including self-employed individuals; and (2) members who represent individuals purchasing coverage. Requires each regional alliance to establish a provider advisory board consisting of health care providers and professionals. (Sec. 1311) Includes in a corporate alliance an eligible sponsor who is either a large employer (more than 5,000 full-time employees) or a multiemployer plan (a plan with more than 5000 active participants). Excludes: (1) an employer whose primary business is employee leasing; (2) the Federal Government (other than the U.S. Postal Service); and (3) a State or local government. Excludes from corporate alliance eligibility the following classes of individuals: (1) AFDC recipients; (2) SSI recipients; (3) military personnel and families, veterans, and Indians who elect to enroll in specified plans specifically designed for them; and (4) seasonal or temporary employees. (Sec. 1321) Directs each regional alliance to enter into a contract with any State-certified health plan to contract with the alliance for the enrollment under the plan of eligible individuals. (Sec. 1322) Requires each regional alliance to offer a choice of health plans, including at least one fee-for-service plan. (Sec. 1326) Requires each regional alliance to establish and maintain an office of an ombudsman to assist consumers in dealing with problems that arise with health plans and the alliance. (Sec. 1329) Permits a regional alliance to adjust payments to plans or use other financial incentives to encourage health plans to expand into areas that have inadequate health services. (Sec. 1341) Set forth provisions concerning the collection of funds by regional alliances from individuals, employers, and others. (Sec. 1351) Requires each regional alliance to compute a blended plan per capita payment amount for each regional alliance health plan for enrollment in the alliance. (Sec. 1353) Requires each regional alliance to make payments to the Federal Government for academic health centers and graduate medical education. (Sec. 1361) Requires each regional alliance to comply with specified standards relating to the management of finances, maintenance of records, accounting practices, auditing procedures, financial reporting, and employer payments. (Sec. 1371) Provides for a reduction in cost sharing for low-income families. (Sec. 1373) Provides for premium discounts and reduction in liabilities for low-income families. (Sec. 1381) Permits each corporate alliance to: (1) offer coverage under either an appropriate self-insured health plan; or (2) negotiate with a State-certified plan to enter into a contract with the plan. (Sec. 1382) Requires each corporate alliance to provide a choice of health plans, including at least one fee-for-service plan and two health plans that are not fee-for-service plans. (Sec. 1385) Requires each corporate alliance to make an additional contribution towards the enrollment in health plans of the alliance by certain low-wage families. (Sec. 1386) Sets forth provisions relating to corporate alliances concerning: (1) consumer information and marketing; (2) plan and information requirements; (3) management of funds; (4) cost control; (5) payments by corporate alliance employers to corporate alliances; (6) ERISA; (7) disclosure and reserve requirements; (8) trusteeship of insolvent corporate alliance health plans; (9) imposition and collection of periodic assessments on self-insured corporate alliance plans; and (10) payments to the Federal Government by multiemployer corporate alliances for academic health centers and gradual medical education. Subtitle E: Health Plans - Requires a health plan to: (1) be either a self-insured plan (meaning a group health plan as defined by a the Employee Retirement Income Security Act of 1974) or a State-certified plan (meaning a plan certified by a State or the National Health Board); and (2) meet the applicable regulatory requirements. (Sec. 1402) Requires each health plan offered by either a regional or corporate alliance to accept for enrollment every alliance eligible individual, unless the plan has reached its enrollment limit. Prohibits the limit from being imposed on the basis of any personal characteristics of enrollees such as health status, need for health care, age, occupation, or affiliation with any person or entity. Prohibits a plan from: (1) restricting or terminating coverage for any reason, including nonpayment of premiums; (2) cancelling coverage for any eligible individual until that individual is enrolled in another plan; (3) excluding an eligible individual because of an existing medical condition; (4) imposing a waiting period before coverage begins; or (5) imposing a rider that excludes the coverage of particular eligible individuals. Prohibits discrimination by a health plan on the basis of race, national origin, sex, language, socio-economic status, age, disability, health status, or anticipated need for health services. (Sec. 1405) Requires each plan to have a grievance procedure. (Sec. 1421) Permits an entity to offer a supplemental insurance policy if the policy and the entity meet specified requirements. (Sec. 1431) Requires each health plan, with respect to each electing essential community provider located within the plan's service area, to either: (1) enter into a written provider participation agreement; or (2) enter into a written agreement under which the plan will make payment to the provider as specified. Provides a special rule for providers of school health services. Makes the provisions of the proceeding sentence applicable only to health plans offered by a health alliance during the five year period beginning with the first year in which any health plan is offered by the alliance. Directs the Secretary of Health and Human Services to study essential community providers and to make recommendations concerning such providers to the Congress. Provides that such recommendations shall apply unless a joint resolution of disapproval is enacted by the Congress. (Sec. 1441) Requires each health plan to meet specified requirements of title X of this Act with respect to workers' compensation and automobile medical liability services. Subtitle F: Federal Responsibilities - Establishes the National Health Board in the Executive Branch. Directs the President to appoint the Board's seven members. (Sec. 1503) Directs the Board to: (1) interpret the comprehensive benefit package; (2) adjust the delivery of preventive services; (3) take steps to assure that the comprehensive benefit package is available on a uniform national basis; (4) recommend to the President and the Congress appropriate revisions to the package; (5) oversee cost containment requirements; (6) develop and implement eligibility standards; (7) establish a performance based system of quality management; (8) develop and implement standards for a national health information system; (9) establish State requirements and monitor State compliance; (10) establish premium class factors; (11) develop a methodology for the risk-adjustment of premium payments; (12) establish financial requirements for guaranty funds; (13) establish standards for health plan grievance procedures; and (14) report annually to the President and the Congress. (Sec. 1506) Authorizes appropriations for the Board. (Sec. 1511) Requires the Board to approve a State health care system if the system meets the applicable requirements of this Act. Prohibits approval of a State health care system prior to 1996. (Sec. 1512) Provides for sanctions for States failing to meet conditions for compliance. (Sec. 1515) Provides for planning grants to States for implementation assistance. (Sec. 1521) Provides for the Federal assumption of responsibilities in the absence of a State system. Provides for increased premiums of 15 percent during Federal operation of a State system to provide reimbursement for the Federal cost of operating the system. (Sec. 1541) Directs the Board to develop a risk adjustment and reinsurance methodology. Sets forth guidelines for developing such methodology. (Sec. 1543) Directs the Board to establish an advisory committee to provide technical advice and recommendations regarding the risk adjustment and reinsurance methodology. (Sec. 1551) Directs the Board to establish minimum capital requirements for regional alliance health plans under which at least $500,000 of capital must be maintained for each plan in the area. Permits the Board to require additional capital. (Sec. 1552) Requires the Board to establish standards for guaranty funds established by the States. (Sec. 1571) Sets forth the responsibilities of the Secretary of Health and Human Services. Directs the Secretary to administer and implement all provisions of this Act, except those duties delegated to the Board, any other executive agency, or to any State. (Sec. 1572) Directs the Secretary to appoint an Advisory Council on Breakthrough Drugs that will examine the reasonableness of launch prices of new breakthrough drugs. (Sec. 1581) Provides for the certification of essential community providers. Sets forth the following categories of providers automatically certified (under provisions of the Public Health Service Act): (1) migrant health centers; (2) community health centers; (3) homeless program providers; (4) public housing providers; (5) family planning clinics; and (6) AIDS providers under the Ryan White Act. Includes as automatically certified (under other Acts) following: (1) Indian health programs under the Indian Health Act; and (2) maternal and child health providers and a federally qualified health center or rural health clinic under the Social Security Act. Includes as automatically certified (under provisions of this Act) the following: (1) providers of school health services; and (2) a qualified community practice network. Provides for the setting of standards for additional health providers. (Sec. 1591) Sets forth the responsibilities of the Secretary of Labor. Includes among those responsibilities the following: (1) enforcement requirements applicable to employers; (2) elections to become corporate alliances; (3) temporary assumption of insolvent self-insured corporate alliance health plans; (4) establishment and administration of the Corporate Alliance Health Plan Insolvency Fund; and (5) administering title I of ERISA as it relates to group health plans maintained by corporate alliances. Subtitle G: Employer Responsibilities - Requires employers to provide for the payments required under title VI of this Act. Sets forth other employer responsibilities including: (1) information reporting requirements; (2) requirements relating to new employees; (3) recordkeeping requirements; and (4) antidiscrimination requirements. (Sec. 1606) Prohibits self-funding of cost sharing benefits by regional alliance employers. (Sec. 1607) Requires an employer to make equal employer premium payments to all qualifying employees, if a voluntary premium payment is made. Places a limit on such voluntary employer premium payments. (Sec. 1608) Sets forth an employer's obligation to a qualifying retired beneficiary where the employer, as of October 1, 1993, was providing a threshold payment. (Sec. 1609) Authorizes the Secretary of Labor to impose a civil penalty of up to $10,000 for each violation of this subtitle with respect to each individual. Subtitle J (sic): General Definitions; Miscellaneous Provisions - Sets forth the definitions and rules used in this Act. Subtitle B: Miscellaneous Provisions (sic) - (Sec. 1911) Grants the National Health Board, the Secretary of Health and Human Services, and the Secretary of Labor authority to issue regulations as necessary to permit the timely implementation of this Act. Title II: New Benefits - Subtitle A: Medicare Outpatient Prescription Drug Benefit - (Secs. 2001 through 2005) Amends title XVIII of the Social Security Act to provide for: (1) Medicare coverage of covered outpatient prescription drugs and biologicals as well as home infusion drug therapy services; (2) payment rules and related requirements, such as those pertaining to deductibles, for covered outpatient prescription drugs; (3) manufacturer rebates to the Secretary under Medicare part B for covered outpatient prescription drugs; and (4) determination of the Medicare part B premium attributable to covered outpatient prescription drugs. Subtitle B: Long-Term Care - Establishes requirements for State plans for home and community-based services to individuals with disabilities. Includes among those requirements the following: (1) a prohibition of limiting eligibility of individuals with disabilities based on income, age, geography, severity of disability, residential setting, or other grounds specified by the Secretary; (2) a requirement to serve low-income individuals; (3) a requirement to specify how Federal and State funds will be managed; (4) quality assurance requirements; and (5) reporting requirements. Requires a State to consult with individuals and groups of individuals with disabilities when developing the plan in order to have the plan approved. (Sec. 2103) Defines "individuals with disabilities" to mean any individual within one or more of the following four categories: (1) individuals requiring help with the activities of daily living; (2) individuals with severe cognitive or mental impairment; (3) individuals with severe or profound mental retardation; and (4) severely disabled children. (Sec. 2104) Requires a State plan to specify the services available. Requires each individualized plan to be developed in close consultation with the individual and the individual's family. Prohibits a State plan from covering: (1) room and board; (2) services furnished in a hospital, nursing facility, intermediate care facility for the mentally retarded, or other specified institutional setting; or (3) items or services to the extent coverage is provided for an individual under a health plan or Medicare. (Sec. 2105) Sets forth provisions relating to: (1) cost sharing; (2) quality assurance and safeguards; (3) advisory groups; (4) payments to States; and (5) the total Federal budget for State plans and allotments to States. (Sec. 2301) directs the Secretary, with the advice and assistance of the National Long-Term Care Insurance Advisory Council to promulgate regulations as necessary to implement provisions concerning private long-term care insurance. Directs the Secretary to make appointments to such Council. Authorizes appropriations for such Council. (Sec. 2321) Directs the Secretary, after considering the Council's recommendations to promulgate regulations designed to: (1) standardize formats and terminology used in long-term care policies; (2) require insurers to provide information to customers on the range of public and private long-term care coverage available; and (3) establish other requirements promoting consumer understanding of benefits. (Sec. 2322) Directs the Secretary to promulgate regulations establishing requirements with respect to the terms of and benefits under long-term care policies, which shall include the following requirements that the policy may not: (1) limit coverage based on a preexisting condition, subject to an exception for a six month period; (2) condition eligibility for benefits based on the need or receipt of any other service; (3) condition eligibility for any benefit on any particular diagnosis; (4) condition eligibility for benefits by providers on compliance with requirements not required by State or Federal law; and (5) condition coverage of any service by a provider on the provision of such service at a higher level of care than required by the insured individual. Prohibits discrimination by diagnosis in the treatment of: (1) Alzheimer's disease; (2) any organic or inorganic mental illness; (3) mental retardation or any other cognitive or mental impairment; or (4) HIV infection or AIDS. Sets forth other requirements for such policies, including requirements related to: (1) premiums; (2) sales practices; (3) continuation, renewal, replacement, conversion, and cancellation of policies; and (4) payment of benefits. (Sec. 2342) Provides for grants to States to enforce the Federal standards concerning long-term care policies. Sets forth requirements for receiving such grants. Authorizes appropriations. Prohibits the sale of a long-term care policy in a State without a regulatory program. (Sec. 2361) Authorizes the Secretary to make grants for the development and implementation of long-term care information, counseling, and other programs to: (1) States; (2) regional alliances (at the option of States within which such alliances are located; and (3) national organizations representing insurance consumers, long-term care providers, and insurers. Authorizes appropriations for such grants. (Sec. 2601) Authorizes the Secretary to conduct a demonstration program to test the effectiveness of various approaches to financing and providing integrated acute and long-term care services for the chronically ill and disabled. Sets forth the services and benefits to be provided, including: (1) all benefits of the comprehensive benefit package provided under title I of this Act; (2) transitional benefits, including assessment and home care; (3) long-term care benefits, including adult day care, home-delivered meals, and nursing facility services in specialized care units; and (4) habilitation services. Permits any of the following to be eligible for such services under criteria to be established by the Secretary: (1) individuals with disabilities under a State program; (2) individuals entitled to benefits under the Medicare program; and (3) individuals entitled to Medicaid and who are also either entitled to Medicare or Supplemental Security Income benefits. Requires reports to the Congress on the demonstration program. Title III: Public Health Initiatives - Subtitle A: Workforce Priorities Under Federal Payments - Establishes within the Department of Health and Human Services the National Council on Graduate Medical Education. Directs the National Council to designate for each academic year the number of individuals nationwide who are authorized to be enrolled in each specified approval physician training program for each medical specialty. Sets forth provisions specifying: (1) Federal formula payments to approved physician training programs; (2) application for payments; and (3) amount of payments. (Sec. 3061) Directs the Secretary to carry out a program with respect to graduate nurse training programs that is equivalent to the program for approved physician training programs. Establishes a National Council on Graduate Nurse Education. (Sec. 3071) Authorizes appropriations for the following programs: (1) primary care physician and physician assistant training; (2) training of underrepresented minorities and disadvantaged persons; and (3) nurse training. (Sec. 3072) Authorizes appropriations for the following programs: (1) a program of skill upgrading and occupational retraining for health care workers; (2) a demonstration program to assist workers in health care institutions in obtaining advanced career positions; (3) a program to develop and operate health-worker job banks in local employment services agencies, subject to certain conditions; (4) a program to provide joint labor-management decision-making in the health care sector on workplace matters related to the restructuring of the health care delivery system of this Act; and (5) a program to facilitate the comprehensive workforce adjustment initiative. (Sec. 3073) Directs the Secretary of Health and Human Services and the Secretary of Labor to jointly establish the National Institute for Health Care Workforce Development. States that the Director of the Institute shall make recommendations to the Secretaries regarding: (1) the supply of health care workers; (2) the impact of this Act; and (3) the development and implementation of high-performance, high-quality health care delivery systems. Directs the Secretaries to establish an advisory board to assist in the development of such recommendations. Subtitle B: Academic Health Centers - Directs the Secretary to make payments to a qualified academic health center or qualified teaching hospital in order to assist such eligible institutions with costs that are not routinely incurred by other entities in providing health services, but are incurred by such institutions by virtue of the academic nature of such institutions. States that such costs include: (1) costs resulting from reduced staff productivity due to teaching responsibilities; (2) the uncompensated costs of clinical research; and (3) exceptional costs associated with an institutions specialized expertise. Provides that the funding for such payments will come from transfers from the Federal Hospital Insurance Trust Fund, payments made by regional alliances to the Federal government for academic health centers and graduate medical education, and payments from corporate alliances. (Sec. 3131) Provides for the access of regional and corporate alliance patients to academic health centers. Subtitle C: Health Research Initiatives - Amends the Public Health Service Act to ensure that the National Institutes of Health conducts and supports biomedical and behavioral research on promoting health and preventing diseases, disorders, and other health conditions. Provides for health services research. Authorizes appropriations for such research. Subtitle D: Core Functions of Public Health Programs; National Initiatives Regarding Preventive Health - Authorizes appropriations for the core functions of public health programs and national initiatives regarding health promotion and disease prevention. (Sec. 3312) Authorizes the Secretary to make grants to States to carry out one or more of the following core functions: (1) data collection; (2) activities to protect the environment and to assure the safety of housing, workplaces, and food and water; (3) investigation and control of adverse health conditions; (4) public information and education programs to reduce risks to health such as use of tobacco, alcohol, and drugs, sexual activities that increase the risk of HIV transmission and other sexually transmitted diseases, poor diet, physical inactivity, and low childhood immunization levels; (5) accountability and quality assurance activities; (6) provision of public health laboratory services to complement private clinical laboratory services that screen for diseases and conditions; (7) training and education to assure provision of care by all health professionals; and (8) leadership policy development and administrative activities. (Sec. 3331) Authorizes the Secretary to make grants to agencies of State or local government, private nonprofit organizations, and coalitions that link two or more of these groups for the purpose of carrying out projects to develop and implement innovative community-based strategies to provide for health promotion and disease prevention activities for which there is a significant need. Subtitle E: Health Services for Medically Underserved Populations - Directs the Secretary to make grants to migrant health centers and community health centers, which shall be in addition to other funds available to such centers. Authorizes appropriations. (Sec. 3412) Authorizes appropriations for: (1) grants and contracts for the development of qualified community health plans and practice networks; and (2) loans and guaranteeing the principal and interest to Federal and non-Federal lenders on behalf of public and private entities for the capital costs of developing qualified community health plans and practice networks. (Sec. 3461) Authorizes the Secretary to make grants and enter into contracts with qualified community health groups to provide enabling services such as transportation, community and patient outreach, patient education, and translation services in order to increase the capacity of individuals to utilize the items and services under title I of this Act. Authorizes appropriations. (Sec. 3471) Authorizes appropriations for: (1) the National Health Service Corps; and (2) such amounts as are necessary to ensure that at least 20 percent of participants in the Scholarship Program or the Loan Repayment Program of the Corps are nurses. (Sec. 3481) Entitles a hospital with a low-income utilization rate in a base year of at least 25 percent to a payment as specified. Requires 75 percent of the total available to be allocated to hospitals for low-income assistance. Requires 25 percent of the total available to be allocated to hospitals for assistance in furnishing inpatient hospital services that are not covered services under title I of this Act. Subtitle F: Mental Health; Substance Abuse - Authorizes appropriations to carry out this part. Provides for grants to: (1) increase access to mental health and substance abuse services; (2) improve State and local capacity to coordinate and monitor such services; (3) provide incentives to integrate public and private service systems; and (4) supplement any activity under part B (Alcohol and Drug Abuse and Mental Services Block Grant) of title XIX of the Public Health Service Act. (Sec. 3503) Authorizes the Secretary to make loans for the capital costs incurred in the development of non-acute, residential treatment centers and community-based ambulatory clinics. (Sec. 3521) Requires the establishment of a pilot program demonstrating the integration of the mental illness and substance abuse services of the States with the services included under title I of this Act. Subtitle G: Comprehensive School Health Education; School-Related Health Services - Authorizes appropriations for the programs of this subtitle. States that the purposes of the programs shall be to: (1) support, in kindergarten through grade 12, the provision of comprehensive health educator programs; (2) establish a national framework within which States can create comprehensive school health education programs that target the health risk behaviors of youth, including tobacco use, alcohol and drug abuse, sexual behaviors resulting in infections, injury prevention, dietary patterns, and sedentary lifestyles; (3) pay the initial costs of planning and establishing such programs; (4) support related Federal demonstrations and training; (5) motivate youth to stay in school, avoid teen pregnancy, and strive for success; (6) improve the knowledge of health education among youth; and (7) further the National Education Goals set forth in title I of the Goals 2000: Educate America Act. Defines "comprehensive school health education program." Requires such programs to be sensitive to cultural and ethnic issues, promote involvement by families, and promote personal responsibility. Sets forth requirements for applying for grants and selection of grantees. Subtitle H: Public Health Service Initiative - Establishes a Public Health Service Initiative consisting of specified amounts authorized to be appropriated for the Initiative. States that: (1) the Initiative includes the programs of subtitles C through G of this title and the programs of subtitle D of title VIII; and (2) amounts appropriated to carry out the Initiative, including subtitles A through F of this title, are available to carry out specific programs for which the amounts are appropriated. Subtitle I: Coordination with COBRA Continuation Coverage - Amends title XXII (Requirements for Certain Group Health Plans for Certain State and Local Employees) of the Public Health Service Act to provide for coordination with COBRA continuation coverage. Repeals such title XXII upon implementation of this Act. Title IV: Medicare and Medicaid - Subtitle A: Medicare and the Alliance System - Amends title XVIII (Medicare) of the Social Security Act to provide for optional State integration of Medicare beneficiaries into regional alliance plans. (Sec. 4002) Allows individuals to elect to remain in certain plans. (Sec. 4003) Provides for payments to regional alliances on behalf of certain Medicare-eligible individuals. (Sec. 4004) Extends protections for working aged and disabled individuals to group health plans of all employers. Repeals the limitation on the period of protection for individuals with end stage renal disease. Prohibits Medicare payment for items and services provided under any health plan under this Act. Simplifies Medicare benefit coordination in cases where the individual is also eligible for benefits under this Act's health plans. (Sec. 4011) Makes various changes concerning eligible organization and Medicare supplemental policy enrollment and comparative informational materials, eligible organization outlier payments, and participating provider point-of-service networks. (Sec. 4022) Provides for expanded Medicare coverage for physician assistant, nurse practitioner, and clinical nurse specialist services. (Sec. 4031) Amends title XI of the Social Security Act to: (1) provide for termination of the separate Medicare peer review program upon adoption of the National Quality Management Program above under subtitle A of title V of this Act; and (2) repeal provisions on surgical procedure review and second opinions. (Sec. 4032) Amends title XVIII of the Social Security Act to provide for mandatory assignment for all Medicare part B services. (Sec. 4033) Directs the Secretary of Health and Human Services to take such steps as may be necessary to consolidate administration of Medicare parts A and B and supersedes certain conflicting requirements to the extent required to achieve such purpose. (Sec. 4035) Prohibits the Secretary from implementing any change in procedures for billing and processing Medicare claims within six months of implementing any previous change. Adds advanced notification to providers as a requirement for carriers and fiscal intermediaries under Medicare. (Sec. 4041) Amends title XI of the Social Security Act to: (1) provide for civil monetary penalties for kickback violations under Medicare and State health care programs (the programs); (2) make other penalty-related changes, including increases in criminal and civil monetary penalties, a new criminal penalty exception for certain providers, additional civil monetary penalty offenses related to alliance systems, and requirements for the deposit of penalties collected into the All-Payer Account established above under title V of this Act; (3) revise exclusion provisions, with changes establishing a minimum period of exclusion for certain individuals and entities subject to permissive exclusion from the programs, and providing for program exclusions based on actions under alliance systems; and (4) modify sanction provisions, with changes removing certain conditions for imposing sanctions and setting specified civil money penalties for use in lieu of authorized sanctions. (Sec. 4042) Amends title XVIII of the Social Security Act to revise the limitations on physician self-referrals. (Sec. 4051) Provides for the termination of payments under Medicare for medical education costs and directs the Secretary to make specified transfers from certain Medicare trust funds to the new accounts established above for funding physician training programs and academic health centers. (Sec. 4061) Amends title XVIII of the Social Security Act to provide for the treatment of: (1) uniformed services and VA health plans as eligible organizations under Medicare; and (2) health care facilities of the Department of Veterans Affairs as providers under Medicare. Subtitle B: Savings in Medicare Program - Amends title XVIII of the Social Security Act to provide for: (1) reductions in the update for inpatient hospital services and the adjustment for indirect medical education costs, in payments for capital-related costs for inpatient hospital services; (2) revisions to payment adjustments for disproportionate share hospitals in States participating under this Act; and (3) an extension of the freeze on updates to routine service costs of skilled nursing facilities. (Sec. 4111) Amends title XVIII of the Social Security Act to provide for: (1) establishment of cumulative expenditure goals for physician services; (2) use of real gross domestic product for volume adjustments; (3) repeal of restrictions on the maximum reduction permitted in default update; (4) reduction in the conversion factor for the physician fee schedule for 1995; (5) place limitations on payment for physicians' services furnished by high-cost hospital medical staffs; (6) requirements for physicians to identify the hospital at which the service was furnished; (7) an increase in practice expense relative value units for certain services while assuring budget neutrality; (8) a study and report to the Congress by the Secretary on a resource-based system for determining practice expense relative value units for each physician's service; (9) an increase in work relative value units for office visits while assuring budget neutrality; (10) a reduction in relative values for office consultations; (11) adjustment of outlier intensity of relative values; (12) changes in underserved area bonus payments; (13) elimination of formula-driven payments for certain outpatient hospital services; (14) copayments for laboratory services; and (15) competitive acquisition procedures for Medicare part B items and services (including clinical diagnostic laboratory tests). (Sec. 4131) Makes changes with respect to: (1) Medicare as secondary payer; (2) payments for health maintenance organizations and competitive medical plans with risk-sharing contracts; and (3) routine cost limits and copayments for, respectively, home health services and visits. (Sec 4135) Directs the Secretary to use a competitive process to contract with centers of excellence for cataract surgery, coronary artery by-pass surgery, and such other services as the Secretary determines to be appropriate. (Sec. 4141) Amends title XVIII of the Social Security Act to revise Medicare part B premium provisions. (Sec. 4151) Requires the Secretary to submit a report to the Congress on the growth in spending under Medicare for FY 2000 through 2003. Subtitle C: Medicaid - Amends title XIX (Medicaid) of the Social Security Act to provide that if a State Medicaid plan provides for payment to regional alliances of the amounts required above it is not required to provide payment for items and services covered under the comprehensive benefit package for alliance eligible individuals and will receive no Federal financial assistance with respect to such items and services. (Sec. 4211) Provides for: (1) spenddown eligibility and increased income and resource disregard for nursing facility residents; (2) informing such residents about the availability of assistance for home and community-based services; (3) treatment of items and services not covered under the comprehensive benefit package; and (4) establishment of a program under Medicare of noncovered items and services for poor children. (Sec. 4231) Discontinues certain payment policies under Medicaid. (Sec. 4241) Limits the frequency of changes in a State's billing and claims processing system, and provides for advance notification to providers of any major billing change. (Sec. 4251) Establishes the Medicaid Commission to study, report, and make recommendations with respect to options involving block grant use, integration of long-term care services, and consolidation of institutional and home- and community-based long-term care in relation to the Medicaid program. Authorizes appropriations. Subtitle D: Increase in SSI Personal Needs Allowance - Amends title XVI (Supplemental Security Income) (SSI) to provide for an increase in the SSI personal needs allowance. Title V: Quality and Consumer Protection - Subtitle A: Quality Management and Improvement - Requires the National Health Board to establish and oversee a performance-based program of quality management and improvement designed to enhance the quality, appropriateness, and effectiveness of heath care services and access to such services which will be called the National Quality Management Program. (Sec. 5002) Establishes the National Quality Management Council which shall: (1) administer the National Quality Management Program; (2) perform any other duty specified in this subtitle; and (3) advise the National Health Board with respect to its duties under this subtitle. Requires the Council to develop a set of national measures of quality performance to be used in the assessment of and the provision of access to health care services. Requires the Council, in addition, to: (1) recommend to the Board establishing goals for performance by health plans and health care providers on a subset of national measures of quality performance; (2) direct the Administrator for Health Care Policy and Research to develop, review, and disseminate practice guidelines to determine how diseases can most effectively be prevented, diagnosed, treated, and managed; and (3) direct the Administrator for Health Care Policy and Research to support research related to a five year priority list of performance measures. (Sec. 5008) Directs the National Health Board to: (1) establish and oversee regional professional foundations to perform such duties as develop lifetime learning programs for health professionals and conduct research on health care quality; and (2) establish the National Quality Consortium to perform such duties as establishing continuing education for health professionals and provide advice on research priorities. (Sec. 5012) Requires each regional alliance and each corporate alliance to: (1) disseminate specified information to consumers; and (2) ensure that performance and quality standards are continually improved. Subtitle B: Information Systems, Privacy, and Administrative Simplification - Directs the National Health Board to develop and implement a health information system, in consultation with Federal agencies, States, employers, health plans, and others, by which the Board shall collect, report, and regulate the collection and dissemination of health care information which shall be used for: (1) health care planning by Federal, State, and local government; (2) establishing and monitoring payments for health services; (3) assessing and improving the quality of health care; (4) managing and containing costs at the alliance and plan levels; and (5) other specified purposes. Requires the establishment of an electronic data network to collect, compile, and transmit information. (Sec. 5120) Sets forth provisions providing for health information privacy standards. (Sec. 5130) Directs the National Health Board to develop the following standard health care benefit forms: (1) an enrollment and disenrollment form; (2) a clinical encounter record; and (3) a claim form. (Sec. 5140) Establishes the National Privacy and Health Data Advisory Council in order to advise the National Health Board with respect to its duties under this subtitle. (Sec. 5141) Sets forth monetary penalties for violating health information system standards. Subtitle C: Remedies and Enforcement - Sets forth provisions with respect to the review of benefit determinations for enrolled individuals, including provisions: (1) regulating the time limits for notice of disposition of a claim; (2) governing a plan's duty to review claim denials; (3) concerning urgent requests for preauthorization; and (4) concerning other time limits with respect to time limits and notice. (Sec. 5202) Requires each State to establish a complaint review office for each regional alliance established by a State. Permits aggrieved individuals to file complaints with the appropriate review office. (Sec. 5205) Provides for a Federal Health Plan Review Board to review the decisions of complaint review office hearing officers. (Sec. 5207) Sets monetary penalties for a plan which unreasonably denies or delays payment or provision of benefits. (Sec. 5211) Directs each State to establish and maintain an Early Resolution Program in each complaint review office. Requires a program to include: (1) forums for mediation disputes; and (2) other forums of alternative dispute resolution as may be prescribed. Establishes guidelines for the eligibility of cases for submission to the Early Resolution Program. States that conclusions of the mediation proceedings shall be treated as nonbinding and shall not affect any rights to review. (Sec. 5231) Sets forth additional remedies and enforcement provisions. Subtitle D: Medical Malpractice - Prohibits any medical malpractice liability action until the final resolution of the claim under alternative dispute resolution. Requires each regional alliance health plan and corporate alliance health plan to adopt at least one specified method of alternative dispute resolution. Prohibits an individual from bringing a medical malpractice liability action unless the individual submits an affidavit that includes a report by a qualified specialist that states that there is a meritorious cause for filing the action. (Sec. 5311) Directs the Secretary to establish: (1) a project to demonstrate whether substituting liability for medical malpractice on the part of the health plan in which a physician participates for the personal liability of the physician will result in improvements in the quality of care, reductions in defense medical practices, and better risk management; (2) a pilot program under which the Secretary provides funds to one or more eligible States to determine the effect of applying practice guidelines in the resolution of medical malpractice liability actions. Subtitle E: Fraud and Abuse - Directs the Secretary and the Attorney General to establish a program: (1) to coordinate the functions of the Attorney General, the Secretary, and other organizations with respect to the prevention, detection, and control of health care fraud and abuse; (2) to conduct investigations, audits, evaluations, and inspections relating to the delivery of and payment for health care; and (3) to facilitate the enforcement of this and other statutes applicable to health care fraud. (Sec. 5402) Creates, in the Treasury, the All-Payer Health Care Fraud and Abuse Control Account which shall consist of: (1) gifts and bequests; (2) administrative penalties and assessments and portions of civil monetary penalties imposed under provisions of the Social Security Act; (3) all criminal fines imposed in cases involving a Federal health care offense; (4) penalties imposed under the False Claims Act involving claims related to the provision of health care items and services; and (5) amounts resulting from the forfeiture of property by reason of Federal health care offense. States that amounts in the fund may be used to cover costs incurred in operating the Program. (Sec. 5411) Excludes from participation in any health plan any individual or entity excluded from participation in a public program under provisions of the Social Security Act. (Sec. 5413) Sets forth physician self-referral limitations. (Sec. 5431) Amends the Federal criminal code to set penalties for knowingly executing a scheme or artifice to: (1) defraud any health alliance, health plan, or other person (alliance) in connection with the delivery of, or payment for, health care benefits, items, or services (benefits); and (2) obtain, by false or fraudulent means, money or property owned by, or under the custody of control of, any such alliance in connection with the delivery of, or payment for, health care benefits. (Sec. 5432) Amends: (1) the Federal criminal code to require the court, in imposing sentence on a person convicted of a Federal health care offense that poses a serious threat to the health of any person or has a significant detrimental impact on the health care system, to order such person to forfeit property used in the commission of the offense or that constitutes, or is derived from, proceeds traceable to the commission of the offense which is of a value proportionate to the seriousness of the offense; and (2) the Federal judicial code to require that all proceeds of forfeiture relating to Federal health care offenses be deposited into the Department of Justice Assets Forfeiture Fund. (Sec. 5433) Amends the Federal criminal code to set penalties for: (1) knowingly and willfully falsifying, concealing, or covering up a material fact, making any false, fictitious, or fraudulent statements or representations, or making or using any false writing or document knowing it to contain any false, fictitious, or fraudulent statement or entry, in any matter involving a health alliance or health plan; and (2) bribery of, and graft by, a health care official. (Sec. 5435) Authorizes: (1) the Attorney General to commence a civil action in Federal court to enjoin a Federal health care offense; and (2) a person privy to certain grand jury information concerning a health law violation to disclose that information to an attorney for the Government to use in any civil proceeding related to a Federal health care offense. (Sec. 5437) Sets penalties for: (1) theft or embezzlement in connection with a health alliance, health plan, or fund connected with such alliance or plan; and (2) misuse of a health security card issued, or unique identifier provided, pursuant to this Act. (Sec. 5441) Makes provisions of the Civil False Claims Act applicable to the use of false records or statements made to a health plan. Includes within the definition of "claim" for purposes of such Act any request or demand for money or property which is made or presented to a health plan. Subtitle F: McCarran-Ferguson Reform - Amends the McCarran-Ferguson Act to repeal the exemption under specified antitrust laws for the business of insurance to the extent that such business relates to the provision of health benefits. Title VI: Premium Caps; Premium-Based Financing; and Plan Payments - Subtitle A: Premium Caps - Sets forth provisions which provide for the computation of factors that limit the growth of premiums for the comprehensive benefit package in regional alliance health plans, including the computation of a: (1) regional alliance inflation factor; and (2) general health care inflation factor. (Sec. 6002) Directs the Board to determine: (1) a national per capita baseline premium target; (2) the national average per capita current coverage health expenditures; and (3) current health care expenditures. (Sec. 6003) Directs the Board to determine a regional alliance per capita premium. (Sec. 6004) Requires a regional alliance to annually obtain premium bids from each plan seeking to participate as a regional alliance health plan with respect to the alliance. (Sec. 6005) Permits any participating State to assume responsibility for containment of health care expenditures in the State consistent with this Act. (Sec. 6006) Directs the chair of the Board to establish an advisory commission on regional variations in health expenditures. Requires the commission to examine methods of eliminating variation in regional alliance per capita premium targets due to variation in practice patterns, not due to other factors. Requires the Board to submit its recommendations to the Congress. Requires such recommendations to apply unless a joint resolution of disapproval is passed. (Sec. 6011) Subjects each noncomplying regional alliance health plan for a year to a reduction in plan payment as specified, in order to assure that payments to regional alliance health plans by a regional alliance are consistent. Defines a noncomplying plan to include a plan in which the final accepted bid exceeds the maximum complying bid for the per capita target premium. Defines "maximum complying bid." (Sec. 6021) Directs the Board to develop a methodology for calculating an annual per capita expenditure equivalent for amounts paid for coverage for the comprehensive benefit package within a corporate alliance. (Sec. 6022) Terminates a corporate alliance with two excess years in a three year period. Provides that employers that were corporate alliance employers with respect to a terminated alliance shall become regional alliance employers. Defines an excess year as one in which the rate of increase for the corporate alliance exceeds the national corporate inflation factor. Defines rate of increase and national corporate inflation factor. (Sec. 6031) Sets forth special rules for a single-payer State. (Sec. 6041) Directs the Secretary to establish a program to monitor prices and expenditures in the U.S. health care system. Subtitle B: Premium-Related Financings - Makes each family enrolled in a regional health alliance plan or in a corporate alliance health plan in a class of family enrollment responsible for payment of the family share of premium payable for enrollment. Provides for income related discounts and specified credits. (Sec. 6102) Establishes the formula for determining the premiums. (Sec. 6111) Provides for the repayment of credit by certain families. (Sec. 6114) Provides for the special treatment of certain retirees and qualified spouses and children. (Sec. 6121) Requires each regional alliance employer to pay a monthly premium to the regional alliance for a qualifying employee. Sets forth provisions for determining such premium. Varies the premium depending upon such factors as the employer's size and average wages paid. (Sec. 6126) Sets forth provisions applicable to self-employed individuals. (Sec. 6131) Sets forth provisions for determining the corporate employer premium. Subtitle C: Payments to Regional Alliance Health Plans - Sets forth provisions to determine the computation of: (1) the blended plan per capita payment amount; and (2) the plan bid, AFDC, and SSI proportions. Title VII: Revenue Provisions - Subtitle A: Financing Provisions - Amends the Internal Revenue Code to increase the excise taxes on cigarettes and other tobacco products. (Sec. 7113) Imposes an excise tax on the manufacture or importation of roll-your-own tobacco. (Sec. 7121) Imposes an assessment on each corporate alliance employer and a temporary assessment on employers with retiree health benefit costs. Requires such assessments to be paid in the same manner as employment taxes. (Sec. 7131) Provides for the recapture of certain health care subsidies received by high-income individuals. Transfers such amounts to the Supplemental Medical Insurance Trust Fund. (Sec. 7141) Requires certain shareholders of S corporations and limited partners who materially participate in corporate activities to include their share of income or loss from such corporation when determining net earnings from self-employment. (Sec. 7142) Provides for extending Medicare coverage and applying the hospital insurance tax to all State and local government employees. Subtitle B: Tax Treatment of Employer-Provided Health Care - Provides exceptions to the exclusion of employer-provided contributions to an accident or health plan from the gross income of an employee. (Sec. 7202) Prohibits the provision of health benefit under cafeteria plans. (Sec. 7203) Makes permanent the deduction for health insurance costs of self-employed individuals. Increases such deduction to 100 percent of the basic coverage purchased from a health alliance with limitations. Subtitle C: Employment Status Provisions - Requires the Secretary of the Treasury to prescribe regulations defining an employee for employment tax purposes. (Sec. 7302) Increases the penalty for failure to file correct returns involving payments for services. (Sec. 7303) Sets forth rules to limit retroactive employment tax reclassifications. Subtitle D: Tax Treatment of Funding of Retiree Health Benefits - Requires additional reserves for post-retirement medical and life insurance benefits to cover not less than ten years of the working lives of covered employees and to be maintained as separate accounts. (Sec. 7402) Terminates the authority of pension plans to maintain health benefits accounts. Subtitle E: Coordination with COBRA Continuing Care Provisions - Repeals provisions concerning continuation coverage requirements of group health plans upon implementation of this Act. Subtitle F: Tax Treatment of Organizations Providing Health Care Services and Related Organizations - Provides for the tax treatment of charitable organizations providing health care services, insurance provided by health maintenance organizations, and certain private foundations. (Sec. 7602) Sets forth transitional rules for taxing certain organizations providing health insurance and other prepaid health care services as insurance companies other than life insurance companies. (Sec. 7603) Exempts regional alliances from income tax. Subtitle G: Tax Treatment of Long-term Care Insurance and Services - Treats qualified long-term care services as medical care for purposes of the medical expense deduction. (Sec. 7702) Provides for the treatment of long-term care insurance as accident and health insurance. (Sec. 7703) Allows accelerated death benefits under life insurance contracts to be paid to terminally ill individuals. Subtitle H: Tax Incentives for Health Service Providers - Allows a tax credit for certain qualified individuals who provide primary health services full time in a health professional shortage area. (Sec. 7802) Increases the allowable depreciation deduction for expensing certain medical equipment. Subtitle I: Miscellaneous Provisions - Allows a tax credit for the cost of personal assistance services required by an employed individual who for medical reasons is unable to engage in substantial gainful activity. (Sec. 7902) Denies tax-exempt status for private activity bonds of regional alliances, corporate alliances, or guaranty funds established under this Act. Title VIII: Health and Health-Related Programs of the Federal Government - Subtitle A: Military Health Care Reform - Directs the Secretary of Defense to establish one or more uniformed services health plans in order to provide health care services to members of the armed forces on active duty for 30 or more days as well as their covered beneficiaries. Requires conformity of such plans with health plan requirements set forth in this Act. (Sec. 8001b) Allows any such plan to rely upon the use of military health care facilities, supplemented by civilian health care providers or health plans under agreements entered into by the Secretary. Requires at least the items and services in the comprehensive benefit package under this Act to be included in each such plan. Preempts any conflicting State health plan requirements. Provides for plan enrollment, effect of failure to enroll, and choosing between a uniformed services health plan and other available plans. Prohibits the imposition of plan charges to an active-duty member other than subsistence charges, but allows the Secretary to impose limited charges for covered beneficiaries. Establishes in the Department of Defense a financial account for payments received in connection with a uniformed services health plan, allowing such funds to be used only for purposes directly related to the delivery and financing of health care services under this Subtitle. Subtitle B: Department of Veterans Affairs - Allows each veteran who is an eligible individual under this Act and individuals currently enrolled in a health plan under the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) to be enrolled with a Department of Veterans Affairs (VA) health plan. Requires conformity of such plans with health plan requirements set forth in this Act, with all the items and services of the comprehensive benefit package under this Act included. Allows such plans to offer supplemental health benefits and cost-sharing policies as consistent with this Act. Provides a limitation with regard to veterans enrolled with health plans outside the VA. Prohibits the imposition of any plan enrollment charges upon service-connected disabled veterans, veterans receiving disability compensation from the VA, former prisoners of war, and veterans unable to defray the costs of such care. Allows the Secretary of Veterans Affairs to establish plan charges for other veterans. Deems a VA facility to be a Medicare provider for purposes of any program administered by the Secretary of Health and Human Services. Allows for the recovery of certain care and services provided under a VA plan in the case of an individual who has coverage under another plan. Establishes in the Treasury the Department of Veterans Affairs Health Plan Fund to be used for VA health plan payments and services. Preserves existing benefits for VA facilities not operating within a health plan certified under this Act. (Sec. 8102) Directs the Secretary of Veterans Affairs to organize health plans and operate VA facilities as, or within, health plans under this Act. Preempts existing State health plan standards or requirements. Authorizes the Secretary to contract for the provision of services by a VA health plan when cost-effective, or to share resources with other health care plans, providers, or organizations. Authorizes appropriations to the VA for FY 1995 through 1997 for VA health plans under this Subtitle, subject to availability of appropriations. Requires a report from the Secretary to the Congress concerning the operation of the VA health care system within the requirements of this Act. Authorizes the Secretary to accept and use grants for health care services provided to special populations if used by the VA while operating under a VA health plan. Subtitle C: Federal Employees Health Benefits Programs - (Secs. 8202 through 8204) Provides for termination of the Federal Employees Health Benefits Program (FEHB) and treatment of Federal employees, annuitants, and other individuals (including those residing abroad) who would otherwise have been eligible for FEHBP under this Act's health plans. Subtitle D: Indian Health Service - Makes qualifying Indians eligible to enroll in a comprehensive benefits health program of the Indian Health Service. (Sec. 8303) Authorizes appropriations for supplemental Indian health care benefits. (Sec. 8305) Exempts tribal governments and organizations from making employer payments. (Sec. 8306) Sets forth provisions regarding health service to non-enrollees and non-Indians. (Sec. 8311) Requires each health program of the Indian Health Service to establish a comprehensive benefit package fund. (Sec. 8313) Authorizes appropriations for the Indian Health Service programs. Subtitle E: Amendments to the Employee Retirement Income Security Act of 1974 - Amends the Employee Retirement Income Security Act of 1974 (ERISA) to revise and limit the coverage of group health plans under ERISA. Makes certain ERISA provisions inapplicable with respect to State-certified health plans. Provides for an exception from ERISA civil action provisions where review is otherwise available under the Health Security Act (this Act, HSA). (Sec. 8402) Establishes ERISA requirements for expeditious reporting and disclosure applicable to group health plans, through special rules consistent with ERISA and HSA purposes. Excludes plans maintained by regional alliances from treatment as multiple employer welfare arrangements. (Sec. 8403) Revises certain ERISA provisions relating to continuation coverage under group health plans. Repeals such provisions upon implementation of HSA. (Sec. 8404) Makes ERISA standards for group health plans regarding: (1) cases of adoption applicable except to the extent otherwise provided in regulations of the National Health Board under HSA; and (2) coverage of pediatric vaccines inapplicable to a group health plan upon its becoming a corporate alliance health plan under HSA. (Sec. 8405) Requires group health plans under ERISA to comply with HSA requirements relating to health plan claims procedure. Subtitle F: Special Fund for WIC Program - Authorizes appropriations through FY 2000 for the special supplemental food program for women, infants, and children under the Child Nutrition Act of 1966. Title IX: Aggregate Government Payments - Subtitle A: Aggregate State Payments - Sets forth provisions which have formulas for determining each participating State's payment to regional alliances within the State. Provides two different formulas. Establishes one payment formula for non-cash assistance recipients. Establishes another formula relating to cash assistance recipients. Defines a non-cash assistance adult as an individual who is: (1) over 21 years; (2) a U.S. citizen or lawful alien; and (3) is not an AFDC or SSI recipient or a Medicare-eligible individual. (Sec. 9022) Directs the National Health Board to review appropriateness of such payments. Subtitle B: Aggregate Federal Alliance Payments - Sets forth the formula for determining Federal payments to regional alliances for cash assistance recipients. (Sec. 9102) States that this section constitutes budget authority in advance of appropriation Acts and obligates the Federal Government to provide for the payment to regional alliances of a capped Federal alliance payment amount. Defines "capped Federal alliance payment amount." Subtitle C: Borrowing Authority to Cover Cash-flow Shortfalls - Authorizes the Secretary to make available loans to regional alliances to cover any period of temporary cash-flow shortfall attributable to: (1) any estimation discrepancy; (2) a period of temporary cash-flow shortfall attributable to an administrative error; or (3) a period of temporary cash-flow shortfall relating to the relative timing during the year in which amounts are received and payments are required. Sets forth loan terms and conditions. Title X: Coordination of Medical Portion of Workers Compensation and Automobile Insurance - Subtitle A: Workers Compensation Insurance - Requires each health plan that provides services to enrollees through participating providers to make arrangements to provide workers compensation to such enrollees. (Sec. 10002) Requires each workers' compensation carrier that is liable for payment for workers' compensation services furnished by or through a health plan, regardless of whether or not the services are included in the comprehensive benefit package, to make payment for such services. (Sec. 10011) Sets forth requirements for participating States. (Sec. 10031) Authorizes demonstration projects in one or more States with respect to the treatment of work-related injuries and illnesses. Subtitle B: Automobile Insurance - Requires an individual entitled to automobile insurance medical benefits and enrolled in a health plan to receive automobile insurance medical services through the provision of such services by the health plan. (Sec. 10102) Requires each automobile insurance carrier that is liable for payment for automobile insurance medical services furnished by or through a health plan, regardless of whether or not the services are included in the comprehensive benefit package, to make payment for such services. (Sec. 10111) Requires each participating State to develop a fee schedule applicable to payment for automobile insurance medical services for which a fee is not included in the applicable fee schedule. Subtitle C: Commission on Integration of Health Benefits - Establishes the Commission on Integration of Health Benefits which shall study and report on the feasibility and appropriateness of transferring financial responsibility for all medical benefits, including those currently covered by workers compensation and automobile insurance, to health plans. Authorizes appropriations. Subtitle D: Federal Employees' Compensation Act - Requires the Federal Employees' Compensation Act to be interpreted and administered consistent with the provisions of subtitle A. Subtitle E: Davis-Bacon Act and Service Contract Act - Amends the Davis-Bacon Act and the Service Contract Act of 1965 to require Health Security Act benefits. Subtitle F: Effective Dates - Sets forth effective date provisions. Title XI: Transitional Insurance Reform - Sets forth transitional provisions concerning: (1) enforcement; (2) preservation of current coverage; (3) restrictions on premium increases during transition; (4) portability requirements; (5) restrictions limiting benefit reductions; and (6) the establishment of the National Transitional Health Insurance Risk Pool.
Bill· HRH.R. 3600 (103rd)reported
United States · United States Congress · 20 November 1993
TABLE OF CONTENTS: Title I: Health Care Security Subtitle A: Universal Coverage and Individual Responsibility Subtitle B: Benefits Subtitle C: State Responsibilities Subtitle D: Health Alliances Subtitle E: Health Plans Subtitle F: Federal Responsibilities Subtitle G: Employer Responsibilities Subtitle J (sic): General Definitions; Miscellaneous Provisions Title II: New Benefits Subtitle A: Medicare Outpatient Prescription Drug Benefit Subtitle B: Long-Term Care Title III: Public Health Initiatives Subtitle A: Workforce Priorities Under Federal Payments Subtitle B: Academic Health Centers Subtitle C: Health Research Initiatives Subtitle D: Core Functions of Public Health Programs; National Initiatives Regarding Preventive Health Subtitle E: Health Services for Medically Underserved Populations Subtitle F: Mental Health; Substance Abuse Subtitle G: Comprehensive School Health Education; School-Related Health Services Subtitle H: Public Health Service Initiative Subtitle I: Coordination With COBRA Continuation Coverage Title IV: Medicare and Medicaid Subtitle A: Medicare and the Alliance System Subtitle B: Savings in Medicare Program Subtitle C: Medicaid Subtitle D: Increase in SSI Personal Needs Allowance Title V: Quality and Consumer Protection Subtitle A: Quality Management and Improvement Subtitle B: Information Systems, Privacy, and Administrative Simplification Subtitle C: Remedies and Enforcement Subtitle D: Medical Malpractice Subtitle E: Fraud and Abuse Subtitle F: McCarran-Ferguson Reform Title VI: Premium Caps; Premium-Based Financing; and Plan Payments Subtitle A: Premium Caps Subtitle B: Premium-Related Financing Subtitle C: Payments to Regional Alliance Health Plans Title VII: Revenue Provisions Subtitle A: Financing Provisions Subtitle B: Tax Treatment of Employer-Provided Health Care Subtitle C: Employment Status Provisions Subtitle D: Tax Treatment of Funding of Retiree Health Benefits Subtitle E: Coordination with COBRA Continuing Care Provisions Subtitle F: Tax Treatment of Organizations Providing Health Care Services and Related Organizations Subtitle G: Tax Treatment of Long-term Care Insurance and Services Subtitle H: Tax Incentives for Health Services Providers Subtitle I: Miscellaneous Provisions Title VIII: Health and Health-Related Programs of the Federal Government Subtitle A: Military Health Care Reform Subtitle B: Department of Veterans Affairs Subtitle C: Federal Employees Health Benefits Program Subtitle D: Indian Health Service Subtitle E: Amendments to the Employee Retirement Income Security Act of 1974 Subtitle F: Special Fund for WIC Program Title IX: Aggregate Government Payments to Regional Alliances Subtitle A: Aggregate State Payments Subtitle B: Aggregate Federal Alliance Payments Subtitle C: Borrowing Authority to Cover Cash-Flow Shortfalls Title X: Coordination of Medical Portion of Workers Compensation and Automobile Insurance Subtitle A: Workers Compensation Insurance Subtitle B: Automobile Insurance Subtitle C: Commission on Integration of Health Benefits Subtitle D: Federal Employees' Compensation Act Subtitle E: Davis-Bacon Act and Service Contract Act Subtitle F: Effective Dates Title XI: Transitional Insurance Reform Health Security Act - Title I: Health Care Security - Subtitle A: Universal Courage and Individual Responsibility - Entitles each eligible individual to: (1) the benefit provided under subtitle B through the applicable health plan in which the individual is enrolled; and (2) a health security card to be issued by the alliance or other entity that offers the applicable health plan in which the individual is enrolled. Defines an eligible individual as an individual who resides in the United States and is: (1) a citizen or national of the United States; (2) an alien permanently residing in the U.S. under color of law; or (3) a long-term nonimmigrant. Entitles a Medicare-eligible individual to benefits under Medicare instead of the above provisions of this Act. (Sec. 1002) Requires each eligible individual to enroll in an applicable health plan and pay any required premium. Prohibits disenrollment of an eligible individual until the individual is either enrolled in another plan or in Medicare. (Sec. 1003) States that nothing in this Act shall be construed as prohibiting: (1) an individual from purchasing any health services; (2) an individual from purchasing supplemental insurance; (3) an individual who is not an eligible individual from purchasing health insurance; or (4) employers from providing additional coverage. (Sec. 1004) States that a regional alliance health plan is the applicable plan for a family, unless a family member is eligible for a corporate alliance health plan. Allows military personnel, veterans, and Indians to enroll either with an alliance or with a military, veteran, or Indian plan respectively. (Sec. 1005) Prohibits an undocumented alien from enrolling in a health plan under this Act. (Sec. 1011) Defines a family as an eligible individual's eligible spouse and children. Defines couple as meaning an individual and the individual's spouse. Defines a child as being under age 18, or under age 24 in the case of a full-time student. Subtitle B: Benefits - Includes the following terms and services in the comprehensive benefit package: (1) hospital services; (2) services of health professionals; (3) emergency and ambulatory medical and surgical services; (4) clinical preventive services; (5) mental illness and substance abuse services; (6) family planning services and services for pregnant women; (7) hospice care; (8) home health care; (9) extended care services; (10) ambulance services; (11) outpatient laboratory, radiology, and diagnostic services; (12) outpatient prescription drugs and biologicals; (13) outpatient rehabilitation services; (14) durable medical equipment and prosthetic and orthotic devices; (15) vision care; (16) dental care; (17) health education classes; and (18) investigational treatments. Describes such items and services. (Sec. 1131) Requires each health plan to offer to its enrollees only one of the following cost sharing schedules: (1) lower cost sharing; (2) higher cost sharing; or (3) combination cost sharing. Provides that the annual maximum out-of-pocket expenses for an individual in any of the plans shall be $1500 and for a family the annual maximum shall be $3000. (Sec. 1135) Sets forth a table of copayments and coinsurance. (Sec. 1141) Excludes the following items and services: (1) an item or service that is not medically necessary or appropriate; (2) an item or service that the National Health Board may determine is not medically necessary or appropriate; (3) custodial care, except hospice care; (4) surgery performed solely for cosmetic purposes, unless required to correct a congenital anomaly or performed to correct a part of the body injured by either disease or accident; (5) hearing aids; (6) eyeglasses and contact lenses for individuals at least 18 years of age; (7) in vitro fertilization; (8) sex change surgery and related services; (9) private duty nursing; (10) personal comfort items, except in the case of hospice care; and (11) any dental procedures involving orthodontic care, inlays, gold or platinum fillings, bridges, crowns, pin/post retention, dental implants, surgical periodontal procedures, or the preparation of the mouth for the fitting or continued use of dentures, except as specified. (Sec. 1151) Gives the National Health Board the authority to promulgate such regulations or establish such guidelines as necessary to assure uniformity in the application of the comprehensive benefit package across all health plans. Permits the Board to expand the benefit package. (Sec. 1162) Permits a health professional or facility to refuse to provide a benefit if the professional or facility objects on the basis of a religious belief or moral conviction. Subtitle C: State Responsibilities - Requires a State, in order to be approved as a participating State, to submit a document describing the State's health care system. (Sec. 1201) Requires a participating State to: (1) establish one or more regional alliances; (2) establish and publish the criteria used in the certification of its health plan; (3) meet minimum financial solvency requirements for health plans established by the National Health Board; (4) designate an agency or official to coordinate State responsibilities under this Act; (5) conform State laws to meet the requirements of title X of this Act with respect to workers' compensation and automobile insurance; and (6) carry out all the responsibilities of a participating State specified in this Act. (Sec. 1221) Permits a State, with the Board's approval, to operate a single-payer system if specified requirements are met. Subtitle D: Health Alliances - Provides for regional alliances and corporate alliances. (Sec. 1302) Requires a regional alliance to be governed by a Board of Directors consisting of: (1) employers, including self-employed individuals; and (2) members who represent individuals purchasing coverage. Requires each regional alliance to establish a provider advisory board consisting of health care providers and professionals. (Sec. 1311) Includes in a corporate alliance an eligible sponsor who is either a large employer (more than 5,000 full-time employees) or a multiemployer plan (a plan with more than 5000 active participants). Excludes: (1) an employer whose primary business is employee leasing; (2) the Federal Government (other than the U.S. Postal Service); and (3) a State or local government. Excludes from corporate alliance eligibility the following classes of individuals: (1) AFDC recipients; (2) SSI recipients; (3) military personnel and families, veterans, and Indians who elect to enroll in specified plans specifically designed for them; and (4) seasonal or temporary employees. (Sec. 1321) Directs each regional alliance to enter into a contract with any State-certified health plan to contract with the alliance for the enrollment under the plan of eligible individuals. (Sec. 1322) Requires each regional alliance to offer a choice of health plans, including at least one fee-for-service plan. (Sec. 1326) Requires each regional alliance to establish and maintain an office of an ombudsman to assist consumers in dealing with problems that arise with health plans and the alliance. (Sec. 1329) Permits a regional alliance to adjust payments to plans or use other financial incentives to encourage health plans to expand into areas that have inadequate health services. (Sec. 1341) Set forth provisions concerning the collection of funds by regional alliances from individuals, employers, and others. (Sec. 1351) Requires each regional alliance to compute a blended plan per capita payment amount for each regional alliance health plan for enrollment in the alliance. (Sec. 1353) Requires each regional alliance to make payments to the Federal Government for academic health centers and graduate medical education. (Sec. 1361) Requires each regional alliance to comply with specified standards relating to the management of finances, maintenance of records, accounting practices, auditing procedures, financial reporting, and employer payments. (Sec. 1371) Provides for a reduction in cost sharing for low-income families. (Sec. 1373) Provides for premium discounts and reduction in liabilities for low-income families. (Sec. 1381) Permits each corporate alliance to: (1) offer coverage under either an appropriate self-insured health plan; or (2) negotiate with a State-certified plan to enter into a contract with the plan. (Sec. 1382) Requires each corporate alliance to provide a choice of health plans, including at least one fee-for-service plan and two health plans that are not fee-for-service plans. (Sec. 1385) Requires each corporate alliance to make an additional contribution towards the enrollment in health plans of the alliance by certain low-wage families. (Sec. 1386) Sets forth provisions relating to corporate alliances concerning: (1) consumer information and marketing; (2) plan and information requirements; (3) management of funds; (4) cost control; (5) payments by corporate alliance employers to corporate alliances; (6) ERISA; (7) disclosure and reserve requirements; (8) trusteeship of insolvent corporate alliance health plans; (9) imposition and collection of periodic assessments on self-insured corporate alliance plans; and (10) payments to the Federal Government by multiemployer corporate alliances for academic health centers and gradual medical education. Subtitle E: Health Plans - Requires a health plan to: (1) be either a self-insured plan (meaning a group health plan as defined by a the Employee Retirement Income Security Act of 1974) or a State-certified plan (meaning a plan certified by a State or the National Health Board); and (2) meet the applicable regulatory requirements. (Sec. 1402) Requires each health plan offered by either a regional or corporate alliance to accept for enrollment every alliance eligible individual, unless the plan has reached its enrollment limit. Prohibits the limit from being imposed on the basis of any personal characteristics of enrollees such as health status, need for health care, age, occupation, or affiliation with any person or entity. Prohibits a plan from: (1) restricting or terminating coverage for any reason, including nonpayment of premiums; (2) cancelling coverage for any eligible individual until that individual is enrolled in another plan; (3) excluding an eligible individual because of an existing medical condition; (4) imposing a waiting period before coverage begins; or (5) imposing a rider that excludes the coverage of particular eligible individuals. Prohibits discrimination by a health plan on the basis of race, national origin, sex, language, socio-economic status, age, disability, health status, or anticipated need for health services. (Sec. 1405) Requires each plan to have a grievance procedure. (Sec. 1421) Permits an entity to offer a supplemental insurance policy if the policy and the entity meet specified requirements. (Sec. 1431) Requires each health plan, with respect to each electing essential community provider located within the plan's service area, to either: (1) enter into a written provider participation agreement; or (2) enter into a written agreement under which the plan will make payment to the provider as specified. Provides a special rule for providers of school health services. Makes the provisions of the proceeding sentence applicable only to health plans offered by a health alliance during the five year period beginning with the first year in which any health plan is offered by the alliance. Directs the Secretary of Health and Human Services to study essential community providers and to make recommendations concerning such providers to the Congress. Provides that such recommendations shall apply unless a joint resolution of disapproval is enacted by the Congress. (Sec. 1441) Requires each health plan to meet specified requirements of title X of this Act with respect to workers' compensation and automobile medical liability services. Subtitle F: Federal Responsibilities - Establishes the National Health Board in the Executive Branch. Directs the President to appoint the Board's seven members. (Sec. 1503) Directs the Board to: (1) interpret the comprehensive benefit package; (2) adjust the delivery of preventive services; (3) take steps to assure that the comprehensive benefit package is available on a uniform national basis; (4) recommend to the President and the Congress appropriate revisions to the package; (5) oversee cost containment requirements; (6) develop and implement eligibility standards; (7) establish a performance based system of quality management; (8) develop and implement standards for a national health information system; (9) establish State requirements and monitor State compliance; (10) establish premium class factors; (11) develop a methodology for the risk-adjustment of premium payments; (12) establish financial requirements for guaranty funds; (13) establish standards for health plan grievance procedures; and (14) report annually to the President and the Congress. (Sec. 1506) Authorizes appropriations for the Board. (Sec. 1511) Requires the Board to approve a State health care system if the system meets the applicable requirements of this Act. Prohibits approval of a State health care system prior to 1996. (Sec. 1512) Provides for sanctions for States failing to meet conditions for compliance. (Sec. 1515) Provides for planning grants to States for implementation assistance. (Sec. 1521) Provides for the Federal assumption of responsibilities in the absence of a State system. Provides for increased premiums of 15 percent during Federal operation of a State system to provide reimbursement for the Federal cost of operating the system. (Sec. 1541) Directs the Board to develop a risk adjustment and reinsurance methodology. Sets forth guidelines for developing such methodology. (Sec. 1543) Directs the Board to establish an advisory committee to provide technical advice and recommendations regarding the risk adjustment and reinsurance methodology. (Sec. 1551) Directs the Board to establish minimum capital requirements for regional alliance health plans under which at least $500,000 of capital must be maintained for each plan in the area. Permits the Board to require additional capital. (Sec. 1552) Requires the Board to establish standards for guaranty funds established by the States. (Sec. 1571) Sets forth the responsibilities of the Secretary of Health and Human Services. Directs the Secretary to administer and implement all provisions of this Act, except those duties delegated to the Board, any other executive agency, or to any State. (Sec. 1572) Directs the Secretary to appoint an Advisory Council on Breakthrough Drugs that will examine the reasonableness of launch prices of new breakthrough drugs. (Sec. 1581) Provides for the certification of essential community providers. Sets forth the following categories of providers automatically certified (under provisions of the Public Health Service Act): (1) migrant health centers; (2) community health centers; (3) homeless program providers; (4) public housing providers; (5) family planning clinics; and (6) AIDS providers under the Ryan White Act. Includes as automatically certified (under other Acts) following: (1) Indian health programs under the Indian Health Act; and (2) maternal and child health providers and a federally qualified health center or rural health clinic under the Social Security Act. Includes as automatically certified (under provisions of this Act) the following: (1) providers of school health services; and (2) a qualified community practice network. Provides for the setting of standards for additional health providers. (Sec. 1591) Sets forth the responsibilities of the Secretary of Labor. Includes among those responsibilities the following: (1) enforcement requirements applicable to employers; (2) elections to become corporate alliances; (3) temporary assumption of insolvent self-insured corporate alliance health plans; (4) establishment and administration of the Corporate Alliance Health Plan Insolvency Fund; and (5) administering title I of ERISA as it relates to group health plans maintained by corporate alliances. Subtitle G: Employer Responsibilities - Requires employers to provide for the payments required under title VI of this Act. Sets forth other employer responsibilities including: (1) information reporting requirements; (2) requirements relating to new employees; (3) recordkeeping requirements; and (4) antidiscrimination requirements. (Sec. 1606) Prohibits self-funding of cost sharing benefits by regional alliance employers. (Sec. 1607) Requires an employer to make equal employer premium payments to all qualifying employees, if a voluntary premium payment is made. Places a limit on such voluntary employer premium payments. (Sec. 1608) Sets forth an employer's obligation to a qualifying retired beneficiary where the employer, as of October 1, 1993, was providing a threshold payment. (Sec. 1609) Authorizes the Secretary of Labor to impose a civil penalty of up to $10,000 for each violation of this subtitle with respect to each individual. Subtitle J (sic): General Definitions; Miscellaneous Provisions - Sets forth the definitions and rules used in this Act. Subtitle B: Miscellaneous Provisions (sic) - (Sec. 1911) Grants the National Health Board, the Secretary of Health and Human Services, and the Secretary of Labor authority to issue regulations as necessary to permit the timely implementation of this Act. Title II: New Benefits - Subtitle A: Medicare Outpatient Prescription Drug Benefit - (Secs. 2001 through 2005) Amends title XVIII of the Social Security Act to provide for: (1) Medicare coverage of covered outpatient prescription drugs and biologicals as well as home infusion drug therapy services; (2) payment rules and related requirements, such as those pertaining to deductibles, for covered outpatient prescription drugs; (3) manufacturer rebates to the Secretary under Medicare part B for covered outpatient prescription drugs; and (4) determination of the Medicare part B premium attributable to covered outpatient prescription drugs. Subtitle B: Long-Term Care - Establishes requirements for State plans for home and community-based services to individuals with disabilities. Includes among those requirements the following: (1) a prohibition of limiting eligibility of individuals with disabilities based on income, age, geography, severity of disability, residential setting, or other grounds specified by the Secretary; (2) a requirement to serve low-income individuals; (3) a requirement to specify how Federal and State funds will be managed; (4) quality assurance requirements; and (5) reporting requirements. Requires a State to consult with individuals and groups of individuals with disabilities when developing the plan in order to have the plan approved. (Sec. 2103) Defines "individuals with disabilities" to mean any individual within one or more of the following four categories: (1) individuals requiring help with the activities of daily living; (2) individuals with severe cognitive or mental impairment; (3) individuals with severe or profound mental retardation; and (4) severely disabled children. (Sec. 2104) Requires a State plan to specify the services available. Requires each individualized plan to be developed in close consultation with the individual and the individual's family. Prohibits a State plan from covering: (1) room and board; (2) services furnished in a hospital, nursing facility, intermediate care facility for the mentally retarded, or other specified institutional setting; or (3) items or services to the extent coverage is provided for an individual under a health plan or Medicare. (Sec. 2105) Sets forth provisions relating to: (1) cost sharing; (2) quality assurance and safeguards; (3) advisory groups; (4) payments to States; and (5) the total Federal budget for State plans and allotments to States. (Sec. 2301) directs the Secretary, with the advice and assistance of the National Long-Term Care Insurance Advisory Council to promulgate regulations as necessary to implement provisions concerning private long-term care insurance. Directs the Secretary to make appointments to such Council. Authorizes appropriations for such Council. (Sec. 2321) Directs the Secretary, after considering the Council's recommendations to promulgate regulations designed to: (1) standardize formats and terminology used in long-term care policies; (2) require insurers to provide information to customers on the range of public and private long-term care coverage available; and (3) establish other requirements promoting consumer understanding of benefits. (Sec. 2322) Directs the Secretary to promulgate regulations establishing requirements with respect to the terms of and benefits under long-term care policies, which shall include the following requirements that the policy may not: (1) limit coverage based on a preexisting condition, subject to an exception for a six month period; (2) condition eligibility for benefits based on the need or receipt of any other service; (3) condition eligibility for any benefit on any particular diagnosis; (4) condition eligibility for benefits by providers on compliance with requirements not required by State or Federal law; and (5) condition coverage of any service by a provider on the provision of such service at a higher level of care than required by the insured individual. Prohibits discrimination by diagnosis in the treatment of: (1) Alzheimer's disease; (2) any organic or inorganic mental illness; (3) mental retardation or any other cognitive or mental impairment; or (4) HIV infection or AIDS. Sets forth other requirements for such policies, including requirements related to: (1) premiums; (2) sales practices; (3) continuation, renewal, replacement, conversion, and cancellation of policies; and (4) payment of benefits. (Sec. 2342) Provides for grants to States to enforce the Federal standards concerning long-term care policies. Sets forth requirements for receiving such grants. Authorizes appropriations. Prohibits the sale of a long-term care policy in a State without a regulatory program. (Sec. 2361) Authorizes the Secretary to make grants for the development and implementation of long-term care information, counseling, and other programs to: (1) States; (2) regional alliances (at the option of States within which such alliances are located; and (3) national organizations representing insurance consumers, long-term care providers, and insurers. Authorizes appropriations for such grants. (Sec. 2601) Authorizes the Secretary to conduct a demonstration program to test the effectiveness of various approaches to financing and providing integrated acute and long-term care services for the chronically ill and disabled. Sets forth the services and benefits to be provided, including: (1) all benefits of the comprehensive benefit package provided under title I of this Act; (2) transitional benefits, including assessment and home care; (3) long-term care benefits, including adult day care, home-delivered meals, and nursing facility services in specialized care units; and (4) habilitation services. Permits any of the following to be eligible for such services under criteria to be established by the Secretary: (1) individuals with disabilities under a State program; (2) individuals entitled to benefits under the Medicare program; and (3) individuals entitled to Medicaid and who are also either entitled to Medicare or Supplemental Security Income benefits. Requires reports to the Congress on the demonstration program. Title III: Public Health Initiatives - Subtitle A: Workforce Priorities Under Federal Payments - Establishes within the Department of Health and Human Services the National Council on Graduate Medical Education. Directs the National Council to designate for each academic year the number of individuals nationwide who are authorized to be enrolled in each specified approval physician training program for each medical specialty. Sets forth provisions specifying: (1) Federal formula payments to approved physician training programs; (2) application for payments; and (3) amount of payments. (Sec. 3061) Directs the Secretary to carry out a program with respect to graduate nurse training programs that is equivalent to the program for approved physician training programs. Establishes a National Council on Graduate Nurse Education. (Sec. 3071) Authorizes appropriations for the following programs: (1) primary care physician and physician assistant training; (2) training of underrepresented minorities and disadvantaged persons; and (3) nurse training. (Sec. 3072) Authorizes appropriations for the following programs: (1) a program of skill upgrading and occupational retraining for health care workers; (2) a demonstration program to assist workers in health care institutions in obtaining advanced career positions; (3) a program to develop and operate health-worker job banks in local employment services agencies, subject to certain conditions; (4) a program to provide joint labor-management decision-making in the health care sector on workplace matters related to the restructuring of the health care delivery system of this Act; and (5) a program to facilitate the comprehensive workforce adjustment initiative. (Sec. 3073) Directs the Secretary of Health and Human Services and the Secretary of Labor to jointly establish the National Institute for Health Care Workforce Development. States that the Director of the Institute shall make recommendations to the Secretaries regarding: (1) the supply of health care workers; (2) the impact of this Act; and (3) the development and implementation of high-performance, high-quality health care delivery systems. Directs the Secretaries to establish an advisory board to assist in the development of such recommendations. Subtitle B: Academic Health Centers - Directs the Secretary to make payments to a qualified academic health center or qualified teaching hospital in order to assist such eligible institutions with costs that are not routinely incurred by other entities in providing health services, but are incurred by such institutions by virtue of the academic nature of such institutions. States that such costs include: (1) costs resulting from reduced staff productivity due to teaching responsibilities; (2) the uncompensated costs of clinical research; and (3) exceptional costs associated with an institutions specialized expertise. Provides that the funding for such payments will come from transfers from the Federal Hospital Insurance Trust Fund, payments made by regional alliances to the Federal government for academic health centers and graduate medical education, and payments from corporate alliances. (Sec. 3131) Provides for the access of regional and corporate alliance patients to academic health centers. Subtitle C: Health Research Initiatives - Amends the Public Health Service Act to ensure that the National Institutes of Health conducts and supports biomedical and behavioral research on promoting health and preventing diseases, disorders, and other health conditions. Provides for health services research. Authorizes appropriations for such research. Subtitle D: Core Functions of Public Health Programs; National Initiatives Regarding Preventive Health - Authorizes appropriations for the core functions of public health programs and national initiatives regarding health promotion and disease prevention. (Sec. 3312) Authorizes the Secretary to make grants to States to carry out one or more of the following core functions: (1) data collection; (2) activities to protect the environment and to assure the safety of housing, workplaces, and food and water; (3) investigation and control of adverse health conditions; (4) public information and education programs to reduce risks to health such as use of tobacco, alcohol, and drugs, sexual activities that increase the risk of HIV transmission and other sexually transmitted diseases, poor diet, physical inactivity, and low childhood immunization levels; (5) accountability and quality assurance activities; (6) provision of public health laboratory services to complement private clinical laboratory services that screen for diseases and conditions; (7) training and education to assure provision of care by all health professionals; and (8) leadership policy development and administrative activities. (Sec. 3331) Authorizes the Secretary to make grants to agencies of State or local government, private nonprofit organizations, and coalitions that link two or more of these groups for the purpose of carrying out projects to develop and implement innovative community-based strategies to provide for health promotion and disease prevention activities for which there is a significant need. Subtitle E: Health Services for Medically Underserved Populations - Directs the Secretary to make grants to migrant health centers and community health centers, which shall be in addition to other funds available to such centers. Authorizes appropriations. (Sec. 3412) Authorizes appropriations for: (1) grants and contracts for the development of qualified community health plans and practice networks; and (2) loans and guaranteeing the principal and interest to Federal and non-Federal lenders on behalf of public and private entities for the capital costs of developing qualified community health plans and practice networks. (Sec. 3461) Authorizes the Secretary to make grants and enter into contracts with qualified community health groups to provide enabling services such as transportation, community and patient outreach, patient education, and translation services in order to increase the capacity of individuals to utilize the items and services under title I of this Act. Authorizes appropriations. (Sec. 3471) Authorizes appropriations for: (1) the National Health Service Corps; and (2) such amounts as are necessary to ensure that at least 20 percent of participants in the Scholarship Program or the Loan Repayment Program of the Corps are nurses. (Sec. 3481) Entitles a hospital with a low-income utilization rate in a base year of at least 25 percent to a payment as specified. Requires 75 percent of the total available to be allocated to hospitals for low-income assistance. Requires 25 percent of the total available to be allocated to hospitals for assistance in furnishing inpatient hospital services that are not covered services under title I of this Act. Subtitle F: Mental Health; Substance Abuse - Authorizes appropriations to carry out this part. Provides for grants to: (1) increase access to mental health and substance abuse services; (2) improve State and local capacity to coordinate and monitor such services; (3) provide incentives to integrate public and private service systems; and (4) supplement any activity under part B (Alcohol and Drug Abuse and Mental Services Block Grant) of title XIX of the Public Health Service Act. (Sec. 3503) Authorizes the Secretary to make loans for the capital costs incurred in the development of non-acute, residential treatment centers and community-based ambulatory clinics. (Sec. 3521) Requires the establishment of a pilot program demonstrating the integration of the mental illness and substance abuse services of the States with the services included under title I of this Act. Subtitle G: Comprehensive School Health Education; School-Related Health Services - Authorizes appropriations for the programs of this subtitle. States that the purposes of the programs shall be to: (1) support, in kindergarten through grade 12, the provision of comprehensive health educator programs; (2) establish a national framework within which States can create comprehensive school health education programs that target the health risk behaviors of youth, including tobacco use, alcohol and drug abuse, sexual behaviors resulting in infections, injury prevention, dietary patterns, and sedentary lifestyles; (3) pay the initial costs of planning and establishing such programs; (4) support related Federal demonstrations and training; (5) motivate youth to stay in school, avoid teen pregnancy, and strive for success; (6) improve the knowledge of health education among youth; and (7) further the National Education Goals set forth in title I of the Goals 2000: Educate America Act. Defines "comprehensive school health education program." Requires such programs to be sensitive to cultural and ethnic issues, promote involvement by families, and promote personal responsibility. Sets forth requirements for applying for grants and selection of grantees. Subtitle H: Public Health Service Initiative - Establishes a Public Health Service Initiative consisting of specified amounts authorized to be appropriated for the Initiative. States that: (1) the Initiative includes the programs of subtitles C through G of this title and the programs of subtitle D of title VIII; and (2) amounts appropriated to carry out the Initiative, including subtitles A through F of this title, are available to carry out specific programs for which the amounts are appropriated. Subtitle I: Coordination with COBRA Continuation Coverage - Amends title XXII (Requirements for Certain Group Health Plans for Certain State and Local Employees) of the Public Health Service Act to provide for coordination with COBRA continuation coverage. Repeals such title XXII upon implementation of this Act. Title IV: Medicare and Medicaid - Subtitle A: Medicare and the Alliance System - Amends title XVIII of the Social Security Act to provide for optional State integration of Medicare beneficiaries into regional alliance plans. (Sec. 4002) Allows individuals to elect to remain in certain plans. (Sec. 4003) Provides for payments to regional alliances on behalf of certain Medicare-eligible individuals. (Sec. 4004) Extends protections for working aged and disabled individuals to group health plans of all employers. Repeals the limitation on the period of protection for individuals with end stage renal disease. Prohibits Medicare payment for items and services provided under any health plan under this Act. Simplifies Medicare benefit coordination in cases where the individual is also eligible for benefits under this Act's health plans. (Sec. 4011) Makes various changes concerning eligible organization and Medicare supplemental policy enrollment and comparative informational materials, eligible organization outlier payments, and participating provider point-of-service networks. (Sec. 4022) Provides for expanded Medicare coverage for physician assistant, nurse practitioner, and clinical nurse specialist services. (Sec. 4031) Amends title XI of the Social Security Act to: (1) provide for termination of the separate Medicare peer review program upon adoption of the National Quality Management Program above under subtitle A of title V of this Act; and (2) repeal provisions on surgical procedure review and second opinions. (Sec. 4032) Amends title XVIII of the Social Security Act to provide for mandatory assignment for all Medicare part B services. (Sec. 4033) Directs the Secretary of Health and Human Services to take such steps as may be necessary to consolidate administration of Medicare parts A and B and supersedes certain conflicting requirements to the extent required to achieve such purpose. (Sec. 4035) Prohibits the Secretary from implementing any change in procedures for billing and processing Medicare claims within six months of implementing any previous change. Adds advanced notification to providers as a requirement for carriers and fiscal intermediaries under Medicare. (Sec. 4041) Amends title XI of the Social Security Act to: (1) provide for civil monetary penalties for kickback violations under Medicare and State health care programs (the programs); (2) make other penalty-related changes, including increases in criminal and civil monetary penalties, a new criminal penalty exception for certain providers, additional civil monetary penalty offenses related to alliance systems, and requirements for the deposit of penalties collected into the All-Payer Account established above under title V of this Act; (3) revise exclusion provisions, with changes establishing a minimum period of exclusion for certain individuals and entities subject to permissive exclusion from the programs, and providing for program exclusions based on actions under alliance systems; and (4) modify sanction provisions, with changes removing certain conditions for imposing sanctions and setting specified civil money penalties for use in lieu of authorized sanctions. (Sec. 4042) Amends title XVIII of the Social Security Act to revise the limitations on physician self-referrals. (Sec. 4051) Provides for the termination of payments under Medicare for medical education costs and directs the Secretary to make specified transfers from certain Medicare trust funds to the new accounts established above for funding physician training programs and academic health centers. (Sec. 4061) Amends title XVIII of the Social Security Act to provide for the treatment of: (1) uniformed services and VA health plans as eligible organizations under Medicare; and (2) health care facilities of the Department of Veterans Affairs as providers under Medicare. Subtitle B: Savings in Medicare Program - Amends title XVIII of the Social Security Act to provide for: (1) reductions in the update for inpatient hospital services and the adjustment for indirect medical education costs, in payments for capital-related costs for inpatient hospital services; (2) revisions to payment adjustments for disproportionate share hospitals in States participating under this Act; and (3) an extension of the freeze on updates to routine service costs of skilled nursing facilities. (Sec. 4111) Amends title XVIII of the Social Security Act to provide for: (1) establishment of cumulative expenditure goals for physician services; (2) use of real gross domestic product for volume adjustments; (3) repeal of restrictions on the maximum reduction permitted in default update; (4) reduction in the conversion factor for the physician fee schedule for 1995; (5) place limitations on payment for physicians' services furnished by high-cost hospital medical staffs; (6) requirements for physicians to identify the hospital at which the service was furnished; (7) an increase in practice expense relative value units for certain services while assuring budget neutrality; (8) a study and report to the Congress by the Secretary on a resource-based system for determining practice expense relative value units for each physician's service; (9) an increase in work relative value units for office visits while assuring budget neutrality; (10) a reduction in relative values for office consultations; (11) adjustment of outlier intensity of relative values; (12) changes in underserved area bonus payments; (13) elimination of formula-driven payments for certain outpatient hospital services; (14) copayments for laboratory services; and (15) competitive acquisition procedures for Medicare part B items and services (including clinical diagnostic laboratory tests). (Sec. 4131) Makes changes with respect to: (1) Medicare as secondary payer; (2) payments for health maintenance organizations and competitive medical plans with risk-sharing contracts; and (3) routine cost limits and copayments for, respectively, home health services and visits. (Sec 4135) Directs the Secretary to use a competitive process to contract with centers of excellence for cataract surgery, coronary artery by-pass surgery, and such other services as the Secretary determines to be appropriate. (Sec. 4141) Amends title XVIII of the Social Security Act to revise Medicare part B premium provisions. (Sec. 4151) Requires the Secretary to submit a report to the Congress on the growth in spending under Medicare for FY 2000 through 2003. Subtitle C: Medicaid - Amends title XIX (Medicaid) of the Social Security Act to provide that if a State Medicaid plan provides for payment to regional alliances of the amounts required above it is not required to provide payment for items and services covered under the comprehensive benefit package for alliance eligible individuals and will receive no Federal financial assistance with respect to such items and services. (Sec. 4211) Provides for: (1) spenddown eligibility and increased income and resource disregard for nursing facility residents; and (2) informing such residents about the availability of assistance for home and community-based services. (Sec. 4221) Provides for: (1) treatment of items and services not covered under the comprehensive benefit package; and (2) establishment of a program under Medicare of noncovered items and services for poor children. (Sec. 4231) Discontinues certain payment policies under Medicaid. (Sec. 4241) Limits the frequency of changes in a State's billing and claims processing system, and provides for advance notification to providers of any major billing change. (Sec. 4251) Establishes the Medicaid Commission to study, report, and make recommendations with respect to options involving block grant use, integration of long-term care services, and consolidation of institutional and home- and community-based long-term care in relation to the Medicaid program. Authorizes appropriations. Subtitle D: Increase in SSI Personal Needs Allowance - Amends title XVI (Supplemental Security Income) (SSI) to provide for an increase in the SSI personal needs allowance. Title V: Quality and Consumer Protection - Subtitle A: Quality Management and Improvement - Requires the National Health Board to establish and oversee a performance-based program of quality management and improvement designed to enhance the quality, appropriateness, and effectiveness of heath care services and access to such services which will be called the National Quality Management Program. (Sec. 5002) Establishes the National Quality Management Council which shall: (1) administer the National Quality Management Program; (2) perform any other duty specified in this subtitle; and (3) advise the National Health Board with respect to its duties under this subtitle. Requires the Council to develop a set of national measures of quality performance to be used in the assessment of and the provision of access to health care services. Requires the Council, in addition, to: (1) recommend to the Board establishing goals for performance by health plans and health care providers on a subset of national measures of quality performance; (2) direct the Administrator for Health Care Policy and Research to develop, review, and disseminate practice guidelines to determine how diseases can most effectively be prevented, diagnosed, treated, and managed; and (3) direct the Administrator for Health Care Policy and Research to support research related to a five year priority list of performance measures. (Sec. 5008) Directs the National Health Board to: (1) establish and oversee regional professional foundations to perform such duties as develop lifetime learning programs for health professionals and conduct research on health care quality; and (2) establish the National Quality Consortium to perform such duties as establishing continuing education for health professionals and provide advice on research priorities. (Sec. 5012) Requires each regional alliance and each corporate alliance to: (1) disseminate specified information to consumers; and (2) ensure that performance and quality standards are continually improved. Subtitle B: Information Systems, Privacy, and Administrative Simplification - Directs the National Health Board to develop and implement a health information system, in consultation with Federal agencies, States, employers, health plans, and others, by which the Board shall collect, report, and regulate the collection and dissemination of health care information which shall be used for: (1) health care planning by Federal, State, and local government; (2) establishing and monitoring payments for health services; (3) assessing and improving the quality of health care; (4) managing and containing costs at the alliance and plan levels; and (5) other specified purposes. Requires the establishment of an electronic data network to collect, compile, and transmit information. (Sec. 5120) Sets forth provisions providing for health information privacy standards. (Sec. 5130) Directs the National Health Board to develop the following standard health care benefit forms: (1) an enrollment and disenrollment form; (2) a clinical encounter record; and (3) a claim form. (Sec. 5140) Establishes the National Privacy and Health Data Advisory Council in order to advise the National Health Board with respect to its duties under this subtitle. (Sec. 5141) Sets forth monetary penalties for violating health information system standards. Subtitle C: Remedies and Enforcement - Sets forth provisions with respect to the review of benefit determinations for enrolled individuals, including provisions: (1) regulating the time limits for notice of disposition of a claim; (2) governing a plan's duty to review claim denials; (3) concerning urgent requests for preauthorization; and (4) concerning other time limits with respect to time limits and notice. (Sec. 5202) Requires each State to establish a complaint review office for each regional alliance established by a State. Permits aggrieved individuals to file complaints with the appropriate review office. (Sec. 5205) Provides for a Federal Health Plan Review Board to review the decisions of complaint review office hearing officers. (Sec. 5207) Sets monetary penalties for a plan which unreasonably denies or delays payment or provision of benefits. (Sec. 5211) Directs each State to establish and maintain an Early Resolution Program in each complaint review office. Requires a program to include: (1) forums for mediation disputes; and (2) other forums of alternative dispute resolution as may be prescribed. Establishes guidelines for the eligibility of cases for submission to the Early Resolution Program. States that conclusions of the mediation proceedings shall be treated as nonbinding and shall not affect any rights to review. (Sec. 5231) Sets forth additional remedies and enforcement provisions. Subtitle D: Medical Malpractice - Prohibits any medical malpractice liability action until the final resolution of the claim under alternative dispute resolution. Requires each regional alliance health plan and corporate alliance health plan to adopt at least one specified method of alternative dispute resolution. Prohibits an individual from bringing a medical malpractice liability action unless the individual submits an affidavit that includes a report by a qualified specialist that states that there is a meritorious cause for filing the action. (Sec. 5311) Directs the Secretary to establish: (1) a project to demonstrate whether substituting liability for medical malpractice on the part of the health plan in which a physician participates for the personal liability of the physician will result in improvements in the quality of care, reductions in defense medical practices, and better risk management; (2) a pilot program under which the Secretary provides funds to one or more eligible States to determine the effect of applying practice guidelines in the resolution of medical malpractice liability actions. Subtitle E: Fraud and Abuse - Directs the Secretary and the Attorney General to establish a program: (1) to coordinate the functions of the Attorney General, the Secretary, and other organizations with respect to the prevention, detection, and control of health care fraud and abuse; (2) to conduct investigations, audits, evaluations, and inspections relating to the delivery of and payment for health care; and (3) to facilitate the enforcement of this and other statutes applicable to health care fraud. (Sec. 5402) Creates, in the Treasury, the All-Payer Health Care Fraud and Abuse Control Account which shall consist of: (1) gifts and bequests; (2) administrative penalties and assessments and portions of civil monetary penalties imposed under provisions of the Social Security Act; (3) all criminal fines imposed in cases involving a Federal health care offense; (4) penalties imposed under the False Claims Act involving claims related to the provision of health care items and services; and (5) amounts resulting from the forfeiture of property by reason of Federal health care offense. States that amounts in the fund may be used to cover costs incurred in operating the Program. (Sec. 5411) Excludes from participation in any health plan any individual or entity excluded from participation in a public program under provisions of the Social Security Act. (Sec. 5413) Sets forth physician self-referral limitations. (Sec. 5431) Amends the Federal criminal code to set penalties for knowingly executing a scheme or artifice to: (1) defraud any health alliance, health plan, or other person (alliance) in connection with the delivery of, or payment for, health care benefits, items, or services (benefits); and (2) obtain, by false or fraudulent means, money or property owned by, or under the custody of control of, any such alliance in connection with the delivery of, or payment for, health care benefits. (Sec. 5432) Amends: (1) the Federal criminal code to require the court, in imposing sentence on a person convicted of a Federal health care offense that poses a serious threat to the health of any person or has a significant detrimental impact on the health care system, to order such person to forfeit property used in the commission of the offense or that constitutes, or is derived from, proceeds traceable to the commission of the offense which is of a value proportionate to the seriousness of the offense; and (2) the Federal judicial code to require that all proceeds of forfeiture relating to Federal health care offenses be deposited into the Department of Justice Assets Forfeiture Fund. (Sec. 5433) Amends the Federal criminal code to set penalties for: (1) knowingly and willfully falsifying, concealing, or covering up a material fact, making any false, fictitious, or fraudulent statements or representations, or making or using any false writing or document knowing it to contain any false, fictitious, or fraudulent statement or entry, in any matter involving a health alliance or health plan; and (2) bribery of, and graft by, a health care official. (Sec. 5435) Authorizes: (1) the Attorney General to commence a civil action in Federal court to enjoin a Federal health care offense; and (2) a person privy to certain grand jury information concerning a health law violation to disclose that information to an attorney for the Government to use in any civil proceeding related to a Federal health care offense. (Sec. 5437) Sets penalties for: (1) theft or embezzlement in connection with a health alliance, health plan, or fund connected with such alliance or plan; and (2) misuse of a health security card issued, or unique identifier provided, pursuant to this Act. (Sec. 5441) Makes provisions of the Civil False Claims Act applicable to the use of false records or statements made to a health plan. Includes within the definition of "claim" for purposes of such Act any request or demand for money or property which is made or presented to a health plan. Subtitle F: McCarran-Ferguson Reform - Amends the McCarran-Ferguson Act to repeal the exemption under specified antitrust laws for the business of insurance to the extent that such business relates to the provision of health benefits. Title VI: Premium Caps; Premium-Based Financing; and Plan Payments - Subtitle A: Premium Caps - Sets forth provisions which provide for the computation of factors that limit the growth of premiums for the comprehensive benefit package in regional alliance health plans, including the computation of a: (1) regional alliance inflation factor; and (2) general health care inflation factor. (Sec. 6002) Directs the Board to determine: (1) a national per capita baseline premium target; (2) the national average per capita current coverage health expenditures; and (3) current health care expenditures. (Sec. 6003) Directs the Board to determine a regional alliance per capita premium. (Sec. 6004) Requires a regional alliance to annually obtain premium bids from each plan seeking to participate as a regional alliance health plan with respect to the alliance. (Sec. 6005) Permits any participating State to assume responsibility for containment of health care expenditures in the State consistent with this Act. (Sec. 6006) Directs the chair of the Board to establish an advisory commission on regional variations in health expenditures. Requires the commission to examine methods of eliminating variation in regional alliance per capita premium targets due to variation in practice patterns, not due to other factors. Requires the Board to submit its recommendations to the Congress. Requires such recommendations to apply unless a joint resolution of disapproval is passed. (Sec. 6011) Subjects each noncomplying regional alliance health plan for a year to a reduction in plan payment as specified, in order to assure that payments to regional alliance health plans by a regional alliance are consistent. Defines a noncomplying plan to include a plan in which the final accepted bid exceeds the maximum complying bid for the per capita target premium. Defines "maximum complying bid." (Sec. 6021) Directs the Board to develop a methodology for calculating an annual per capita expenditure equivalent for amounts paid for coverage for the comprehensive benefit package within a corporate alliance. (Sec. 6022) Terminates a corporate alliance with two excess years in a three year period. Provides that employers that were corporate alliance employers with respect to a terminated alliance shall become regional alliance employers. Defines an excess year as one in which the rate of increase for the corporate alliance exceeds the national corporate inflation factor. Defines rate of increase and national corporate inflation factor. (Sec. 6031) Sets forth special rules for a single-payer State. (Sec. 6041) Directs the Secretary to establish a program to monitor prices and expenditures in the U.S. health care system. Subtitle B: Premium-Related Financings - Makes each family enrolled in a regional health alliance plan or in a corporate alliance health plan in a class of family enrollment responsible for payment of the family share of premium payable for enrollment. Provides for income related discounts and specified credits. (Sec. 6102) Establishes the formula for determining the premiums. (Sec. 6111) Provides for the repayment of credit by certain families. (Sec. 6114) Provides for the special treatment of certain retirees and qualified spouses and children. (Sec. 6121) Requires each regional alliance employer to pay a monthly premium to the regional alliance for a qualifying employee. Sets forth provisions for determining such premium. Varies the premium depending upon such factors as the employer's size and average wages paid. (Sec. 6126) Sets forth provisions applicable to self-employed individuals. (Sec. 6131) Sets forth provisions for determining the corporate employer premium. Subtitle C: Payments to Regional Alliance Health Plans - Sets forth provisions to determine the computation of: (1) the blended plan per capita payment amount; and (2) the plan bid, AFDC, and SSI proportions. Title VII: Revenue Provisions - Subtitle A: Financing Provisions - Amends the Internal Revenue Code to increase the excise taxes on cigarettes and other tobacco products. (Sec. 7113) Imposes an excise tax on the manufacture or importation of roll-your-own tobacco. (Sec. 7121) Imposes an assessment on each corporate alliance employer and a temporary assessment on employers with retiree health benefit costs. Requires such assessments to be paid in the same manner as employment taxes. (Sec. 7131) Provides for the recapture of certain health care subsidies received by high-income individuals. Transfers such amounts to the Supplemental Medical Insurance Trust Fund. (Sec. 7141) Requires certain shareholders of S corporations and limited partners who materially participate in corporate activities to include their share of income or loss from such corporation when determining net earnings from self-employment. (Sec. 7142) Provides for extending Medicare coverage and applying the hospital insurance tax to all State and local government employees. Subtitle B: Tax Treatment of Employer-Provided Health Care - Provides exceptions to the exclusion of employer-provided contributions to an accident or health plan from the gross income of an employee. (Sec. 7202) Prohibits the provision of health benefit under cafeteria plans. (Sec. 7203) Makes permanent the deduction for health insurance costs of self-employed individuals. Increases such deduction to 100 percent of the basic coverage purchased from a health alliance with limitations. Subtitle C: Employment Status Provisions - Requires the Secretary of the Treasury to prescribe regulations defining an employee for employment tax purposes. (Sec. 7302) Increases the penalty for failure to file correct returns involving payments for services. (Sec. 7303) Sets forth rules to limit retroactive employment tax reclassifications. Subtitle D: Tax Treatment of Funding of Retiree Health Benefits - Requires additional reserves for post-retirement medical and life insurance benefits to cover not less than ten years of the working lives of covered employees and to be maintained as separate accounts. (Sec. 7402) Terminates the authority of pension plans to maintain health benefits accounts. Subtitle E: Coordination with COBRA Continuing Care Provisions - Repeals provisions concerning continuation coverage requirements of group health plans upon implementation of this Act. Subtitle F: Tax Treatment of Organizations Providing Health Care Services and Related Organizations - Provides for the tax treatment of charitable organizations providing health care services, insurance provided by health maintenance organizations, and certain private foundations. (Sec. 7602) Sets forth transitional rules for taxing certain organizations providing health insurance and other prepaid health care services as insurance companies other than life insurance companies. (Sec. 7603) Exempts regional alliances from income tax. Subtitle G: Tax Treatment of Long-term Care Insurance and Services - Treats qualified long-term care services as medical care for purposes of the medical expense deduction. (Sec. 7702) Provides for the treatment of long-term care insurance as accident and health insurance. (Sec. 7703) Allows accelerated death benefits under life insurance contracts to be paid to terminally ill individuals. Subtitle H: Tax Incentives for Health Service Providers - Allows a tax credit for certain qualified individuals who provide primary health services full time in a health professional shortage area. (Sec. 7802) Increases the allowable depreciation deduction for expensing certain medical equipment. Subtitle I: Miscellaneous Provisions - Allows a tax credit for the cost of personal assistance services required by an employed individual who for medical reasons is unable to engage in substantial gainful activity. (Sec. 7902) Denies tax-exempt status for private activity bonds of regional alliances, corporate alliances, or guaranty funds established under this Act. Title VIII: Health and Health-Related Programs of the Federal Government - Subtitle A: Military Health Care Reform - Directs the Secretary of Defense to establish one or more uniformed services health plans in order to provide health care services to members of the armed forces on active duty for 30 or more days as well as their covered beneficiaries. Requires conformity of such plans with health plan requirements set forth in this Act. (Sec. 8001b) Allows any such plan to rely upon the use of military health care facilities, supplemented by civilian health care providers or health plans under agreements entered into by the Secretary. Requires at least the items and services in the comprehensive benefit package under this Act to be included in each such plan. Preempts any conflicting State health plan requirements. Provides for plan enrollment, effect of failure to enroll, and choosing between a uniformed services health plan and other available plans. Prohibits the imposition of plan charges to an active-duty member other than subsistence charges, but allows the Secretary to impose limited charges for covered beneficiaries. Establishes in the Department of Defense a financial account for payments received in connection with a uniformed services health plan, allowing such funds to be used only for purposes directly related to the delivery and financing of health care services under this Subtitle. Subtitle B: Department of Veterans Affairs - Allows each veteran who is an eligible individual under this Act and individuals currently enrolled in a health plan under the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) to be enrolled with a Department of Veterans Affairs (VA) health plan. Requires conformity of such plans with health plan requirements set forth in this Act, with all the items and services of the comprehensive benefit package under this Act included. Allows such plans to offer supplemental health benefits and cost-sharing policies as consistent with this Act. Provides a limitation with regard to veterans enrolled with health plans outside the VA. Prohibits the imposition of any plan enrollment charges upon service-connected disabled veterans, veterans receiving disability compensation from the VA, former prisoners of war, and veterans unable to defray the costs of such care. Allows the Secretary of Veterans Affairs to establish plan charges for other veterans. Deems a VA facility to be a Medicare provider for purposes of any program administered by the Secretary of Health and Human Services. Allows for the recovery of certain care and services provided under a VA plan in the case of an individual who has coverage under another plan. Establishes in the Treasury the Department of Veterans Affairs Health Plan Fund to be used for VA health plan payments and services. Preserves existing benefits for VA facilities not operating within a health plan certified under this Act. (Sec. 8102) Directs the Secretary of Veterans Affairs to organize health plans and operate VA facilities as, or within, health plans under this Act. Preempts existing State health plan standards or requirements. Authorizes the Secretary to contract for the provision of services by a VA health plan when cost-effective, or to share resources with other health care plans, providers, or organizations. Authorizes appropriations to the VA for FY 1995 through 1997 for VA health plans under this Subtitle, subject to availability of appropriations. Requires a report from the Secretary to the Congress concerning the operation of the VA health care system within the requirements of this Act. Authorizes the Secretary to accept and use grants for health care services provided to special populations if used by the VA while operating under a VA health plan. Subtitle C: Federal Employees Health Benefits Programs - (Secs. 8202 through 8204) Provides for termination of the Federal Employees Health Benefits Program (FEHB) and treatment of Federal employees, annuitants, and other individuals (including those residing abroad) who would otherwise have been eligible for FEHBP under this Act's health plans. Subtitle D: Indian Health Service - Makes qualifying Indians eligible to enroll in a comprehensive benefits health program of the Indian Health Service. (Sec. 8303) Authorizes appropriations for supplemental Indian health care benefits. (Sec. 8305) Exempts tribal governments and organizations from making employer payments. (Sec. 8306) Sets forth provisions regarding health service to non-enrollees and non-Indians. (Sec. 8311) Requires each health program of the Indian Health Service to establish a comprehensive benefit package fund. (Sec. 8313) Authorizes appropriations for the Indian Health Service programs. Subtitle E: Amendments to the Employee Retirement Income Security Act of 1974 - Amends the Employee Retirement Income Security Act of 1974 (ERISA) to revise and limit the coverage of group health plans under ERISA. Makes certain ERISA provisions inapplicable with respect to State-certified health plans. Provides for an exception from ERISA civil action provisions where review is otherwise available under the Health Security Act (this Act, HSA). (Sec. 8402) Establishes ERISA requirements for expeditious reporting and disclosure applicable to group health plans, through special rules consistent with ERISA and HSA purposes. Excludes plans maintained by regional alliances from treatment as multiple employer welfare arrangements. (Sec. 8403) Revises certain ERISA provisions relating to continuation coverage under group health plans. Repeals such provisions upon implementation of HSA. (Sec. 8404) Makes ERISA standards for group health plans regarding: (1) cases of adoption applicable except to the extent otherwise provided in regulations of the National Health Board under HSA; and (2) coverage of pediatric vaccines inapplicable to a group health plan upon its becoming a corporate alliance health plan under HSA. (Sec. 8405) Requires group health plans under ERISA to comply with HSA requirements relating to health plan claims procedure. Subtitle F: Special Fund for WIC Program - Authorizes appropriations through FY 2000 for the special supplemental food program for women, infants, and children under the Child Nutrition Act of 1966. Title IX: Aggregate Government Payments - Subtitle A: Aggregate State Payments - Sets forth provisions which have formulas for determining each participating State's payment to regional alliances within the State. Provides two different formulas. Establishes one payment formula for non-cash assistance recipients. Establishes another formula relating to cash assistance recipients. Defines a non-cash assistance adult as an individual who is: (1) over 21 years; (2) a U.S. citizen or lawful alien; and (3) is not an AFDC or SSI recipient or a Medicare-eligible individual. (Sec. 9022) Directs the National Health Board to review appropriateness of such payments. Subtitle B: Aggregate Federal Alliance Payments - Sets forth the formula for determining Federal payments to regional alliances for cash assistance recipients. (Sec. 9102) States that this section constitutes budget authority in advance of appropriation Acts and obligates the Federal Government to provide for the payment to regional alliances of a capped Federal alliance payment amount. Defines "capped Federal alliance payment amount." Subtitle C: Borrowing Authority to Cover Cash-flow Shortfalls - Authorizes the Secretary to make available loans to regional alliances to cover any period of temporary cash-flow shortfall attributable to: (1) any estimation discrepancy; (2) a period of temporary cash-flow shortfall attributable to an administrative error; or (3) a period of temporary cash-flow shortfall relating to the relative timing during the year in which amounts are received and payments are required. Sets forth loan terms and conditions. Title X: Coordination of Medical Portion of Workers Compensation and Automobile Insurance - Subtitle A: Workers Compensation Insurance - Requires each health plan that provides services to enrollees through participating providers to make arrangements to provide workers compensation to such enrollees. (Sec. 10002) Requires each workers' compensation carrier that is liable for payment for workers' compensation services furnished by or through a health plan, regardless of whether or not the services are included in the comprehensive benefit package, to make payment for such services. (Sec. 10011) Sets forth requirements for participating States. (Sec. 10031) Authorizes demonstration projects in one or more States with respect to the treatment of work-related injuries and illnesses. Subtitle B: Automobile Insurance - Requires an individual entitled to automobile insurance medical benefits and enrolled in a health plan to receive automobile insurance medical services through the provision of such services by the health plan. (Sec. 10102) Requires each automobile insurance carrier that is liable for payment for automobile insurance medical services furnished by or through a health plan, regardless of whether or not the services are included in the comprehensive benefit package, to make payment for such services. (Sec. 10111) Requires each participating State to develop a fee schedule applicable to payment for automobile insurance medical services for which a fee is not included in the applicable fee schedule. Subtitle C: Commission on Integration of Health Benefits - Establishes the Commission on Integration of Health Benefits which shall study and report on the feasibility and appropriateness of transferring financial responsibility for all medical benefits, including those currently covered by workers compensation and automobile insurance, to health plans. Authorizes appropriations. Subtitle D: Federal Employees' Compensation Act - Requires the Federal Employees' Compensation Act to be interpreted and administered consistent with the provisions of subtitle A. Subtitle E: Davis-Bacon Act and Service Contract Act - Amends the Davis-Bacon Act and the Service Contract Act of 1965 to require Health Security Act benefits. Subtitle F: Effective Dates - Sets forth effective date provisions. Title XI: Transitional Insurance Reform - Sets forth transitional provisions concerning: (1) enforcement; (2) preservation of current coverage; (3) restrictions on premium increases during transition; (4) portability requirements; (5) restrictions limiting benefit reductions; and (6) the establishment of the National Transitional Health Insurance Risk Pool.
Bill· HRH.R. 3566 (103rd)referred
United States · United States Congress · 19 November 1993
TABLE OF CONTENTS: Title I: Expenditure Limitations, Contribution Limitations, Matching Funds, and Reduced Third-Class Mail Rate for Eligible House of Representatives Candidates Title II: Elimination of Multicandidate Political Committee Contributions in House of Representatives Elections; Miscellaneous Provisions Relating to Contributions Under the Federal Election Campaign Act of 1971 Title III: Requirement of Budget Neutrality Title IV: Independent Expenditures Title V: Contributions Through Intermediaries and Conduits; Provisions Relating to Political Party Committees Title VI: Prohibitions Relating to Political Committees and Foreign Nationals Title VII: Limitation on Carryover of Campaign Funds Title VIII: Campaign Advertising Title IX: Contribution Solicitation Title X: Reporting Requirements Title XI: Effective Date Comprehensive Campaign Finance Reform Act - Title I: Expenditure Limitations, Contribution Limitations, Matching Funds, and Reduced Third-Class Mail Rate for Eligible House of Representatives Candidates - Amends the Federal Election Campaign Act of 1971 (FECA) to set forth limitations regarding House of Representatives (House) election expenditures, contributions, and matching funds. Limits aggregate expenditures made by an eligible House of Representatives candidate in an election cycle to $500,000, with specified limitations in primary, special, and runoff elections. Sets forth graduated civil penalties for excess expenditures and contributions. Establishes the Make Democracy Work Fund (the Fund) for payment of matching funds and initial expenditures incurred by the Federal Election Commission (FEC) in the administration of this Act. Outlines FEC examination, audit, and repayment procedures. Subjects FEC actions to judicial review. Precludes a House candidate from receiving Fund assistance without prior certification that any television commercial prepared or distributed by the candidate permits closed captioning. Amends Federal Postal Service law to provide reduced third-class mailing rates to eligible House of Representatives candidates during a general election period. Title II: Elimination of Multicandidate Political Committee Contributions in House of Representatives Elections; Miscellaneous Provisions Relating to Contributions Under the Federal Election Campaign Act of 1971 - Amends FECA to prohibit a House candidate from accepting any multicandidate political committee (PAC) contributions. (Sec. 202) Treats contributions by dependents not of voting age as contributions of the persons upon whom they are dependent. (Sec. 203) Aggregates, for contribution limit purposes, contributions from State and local party committees with all contributions from such political party. (Sec. 204) Excludes from the meaning of "contribution" certain reimbursed campaign expenses voluntarily paid for by a campaign worker as an advance to the campaign. (Sec. 205) Reduces the maximum Federal election contribution permitted to be made by a person other than a PAC. Title III: Requirement of Budget Neutrality - Provides that the net costs of providing certain benefits under this Act must be fully offset by specified measures that either raise revenues or reduce spending by a specified deadline (thus achieving budget neutrality). Title IV: Independent Expenditures - Sets forth reporting requirements for certain independent expenditures. Title V: Contributions Through Intermediaries and Conduits; Provisions Relating to Political Party Committees - Amends FECA to delineate circumstances where a person's contribution shall be considered as being made through an intermediary or a conduit (and therefore treated as contributions from such person). (Sec. 502) Defines "State Party Grassroots Fund." (Sec. 503) Subjects national, State, and local party committees to "soft money" limitations, prohibitions, and reporting requirements. (Sec. 504) Prohibits Federal office holders or candidates from soliciting contributions from tax-exempt organizations significantly involved in voter registration or get-out-the-vote campaigns. Title VI: Prohibitions Relating to Political Committees and Foreign Nationals - Prohibits the use of leadership committees and establishes a deadline for their disbursement of funds. Prohibits an unauthorized political committee from using the name of any candidate in any fundraising activity on its behalf in a context which suggests that the committee is the candidate's authorized committee. (Sec. 602) Prohibits a foreign national from controlling, influencing, or participating in election-related activities, including making contributions or expenditures. Title VII: Limitation on Carryover of Campaign Funds - Amends FECA to limit the carryover of surplus House campaign funds for a subsequent election. Title VIII: Campaign Advertising - Amends FECA to prescribe guidelines for print and broadcast campaign advertising. (Sec. 802) Amends the Communications Act of 1934 to require equal candidate broadcasting time. (Sec. 803) Revises broadcast rate determinations. Prohibits licensee preemption of a candidate's broadcast time except in an emergency. Title IX: Contribution Solicitation - Amends FECA to prohibit the solicitation of contributions by false representation by any person as a candidate or as a representative of a candidate or of a political party or committee. Title X: Reporting Requirements - Amends FECA to require certain reports to identify any person (other than a committee) who contributes more than $50 (currently, more than $200). Directs the FEC to: (1) require that operating expenditures be reported on an election cycle basis, by category; and (2) maintain computerized indices of contributions of $50 or more. Title XI: Effective Date - Sets forth the effective date of this Act.
Resolution· HRESH.Res. 285 (103rd)passed
United States · United States Congress · 26 October 1993
Urges the Attorney General and the Director of the Federal Bureau of Investigation (FBI) to cooperate with the U.S. Postal Service and the Polly Klaas Search Center to use nationwide mailings to disseminate information concerning the kidnapping of Polly Klaas. Commends the community of Petaluma, California, the Petaluma Police Department, and the FBI for their hard work on this case.
Resolution· SCONRESS.Con.Res. 48 (103rd)passed
United States · United States Congress · 21 October 1993
Makes technical corrections in the enrollment of H.R. 2403 (Department of the Treasury, United States Postal Service, the Executive Office of the President, and certain independent agencies appropriations).
Bill· HRH.R. 3328 (103rd)referred
United States · United States Congress · 21 October 1993
Prohibits the U.S. Postal Service from expending, in any year, any amounts in connection with instituting a new logo if its total obligations and expenditures incurred in the previous year exceeded its total revenues.
Bill· SS. 1541 (103rd)referred
United States · United States Congress · 13 October 1993
Prohibits the U.S. Postal Service or the Attorney General from fining or otherwise penalizing any person who transmits by private express or other unlawful means, delivers to any agent thereof, or deposits at any appointed place any letter or packet. Amends the Federal criminal code to conform with this Act.
Bill· SS. 1533 (103rd)open
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.
Bill· HRH.R. 3192 (103rd)referred
United States · United States Congress · 30 September 1993
Amends the Internal Revenue Code with respect to political organizations to establish a campaign contribution limitation scheme applicable to the campaign committee of a candidate for election to the House of Representatives. Provides that excess campaign contributions received by such an organization shall be included in its gross income. Amends the Communications Act of 1934 and Federal postal service law to condition the lowest unit charge for campaign ads upon a candidate's certification of compliance with such contribution limitation. Expresses the sense of the Congress that additional costs incurred by the United Postal Service in providing reduced rates of postage pursuant to this Act should be funded out of revenues attributable to this Act.
Bill· HRH.R. 3196 (103rd)referred
United States · United States Congress · 30 September 1993
Amends the Federal Election Campaign Act of 1971 to limit out-of-State contributions to a candidate for the House of Representatives to 49 percent of the aggregate of contributions accepted from all sources. Reduces from $5,000 to $1,000 the permissible campaign contribution from a multicandidate political committee (PAC) to a candidate for Federal office. Prohibits any PAC from contributing to another PAC. Mandates that any multicandidate political committee that is affiliated with another organization include the entire organization name within its own name. Proscribes contributions made through an intermediary or conduit (bundling). Requires lobbyists to: (1) accompany their contributions with a written disclosure of their lobbyist status; and (2) report contributions to the Federal Election Commission by a specified deadline. Mandates that campaign contribution reports concerning elections for the House of Representatives segregate and itemize all out-of-State contributions. Bans "soft money" contributions. Modifies the recordkeeping requirements for political party committees. Prescribes guidelines for the allocation of contributions and expenditures for mixed activities by political party committees. Requires a labor organization to make certain annual written disclosures to all employees within its bargaining units concerning its political contributions and expenditures. Amends the Internal Revenue Code to deny tax-exempt status to: (1) organizations that participate or intervene in a political campaign for Federal office; and (2) certain politically active organizations. Amends the Federal Election Campaign Act of 1971 regarding limitations on contributions and expenditures to subject to its purview "political organizations maintained by a candidate". Limits the size of contributions permissible in any calendar year to political committees established and maintained by a State or local political party in connection with any activity that may influence an election for Federal office. Increases from $25,000 to $50,000 the aggregate permissible contributions made by an individual in any calendar year. Amends Postal Service law to lengthen from 60 days to 90 days the pre-election period during which Members of Congress may not send franked mass mailings.
Resolution· HRESH.Res. 261 (103rd)passed
United States · United States Congress · 28 September 1993
Waives points of order against the consideration of the conference report on H.R. 2403 (FY 1994 appropriations for the Department of the Treasury, the United States Postal Service, the Executive Office of the President, and certain independent agencies).
Law· HJRESH.J.Res. 267 (103rd)enacted
United States · United States Congress · 27 September 1993
Makes continuing appropriations for FY 1994 for projects or activities, including the costs of direct loans and loan guarantees, provided for in the following Acts: (1) the Agriculture, Rural Development, Food and Drug Administration, and Related Agencies Appropriations Act, 1994; (2) the Departments of Commerce, Justice, and State, the Judiciary, and Related Agencies Appropriations Act, 1994; (3) the Department of Defense Appropriations Act, 1994; (4) the District of Columbia Appropriations Act, 1994; (5) the Energy and Water Development Appropriations Act, 1994; (6) the Department of the Interior and Related Agencies Appropriations Act, 1994; (7) the Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 1994; (8) the Military Construction Appropriations Act, 1994; (9) the Department of Transportation and Related Agencies Appropriations Act, 1994; (10) the Treasury, Postal Service, and General Government Appropriations Act, 1994; and (11) the Departments of Veterans Affairs and Housing and Urban Development, and Independent Agencies Appropriations Act, 1994. Sets forth limitations on the use of such funds. Requires the following functions to be maintained at the current rate of operations: (1) the Council on Environmental Quality and Office of Environmental Quality activities; and (2) activities funded by the Selective Service System salaries and expenses account.
Bill· HRH.R. 3093 (103rd)referred
United States · United States Congress · 21 September 1993
Health Care Fraud Prosecution Act of 1993 - Amends the Federal criminal code to set penalties for: (1) knowingly executing a scheme or artifice to defraud to obtain a health care payment; or (2) presenting a statement as part of, or in support of, a claim for health care payment, knowing that such statement contains false or misleading information concerning any material fact. Limits such penalties to a fine and ten years' imprisonment, unless the offender knowingly or recklessly caused: (1) serious bodily injury to, or endangered the life of, an individual (up to 15 years' imprisonment); or (2) caused the death of an individual (up to 25 years' imprisonment). Sets forth provisions regarding illegal remunerations. Permits: (1) persons injured by violations of such provisions to recover treble damages in a civil action; and (2) the court to award the prevailing party a reasonable attorney fee. Makes provisions regarding injunctions against fraud and criminal forfeiture of fraud proceeds applicable to health care fraud. Authorizes the Attorney General to pay specified rewards for information leading to the prosecution and conviction of persons engaging in health care fraud, with exceptions. Directs the Attorney General to establish: (1) regional health care fraud task forces and a data base for the reporting of final adverse actions against health care providers, suppliers, or practitioners; and (2) a national, toll-free health care fraud and abuse hotline. Authorizes appropriations: (1) for the Federal Bureau of Investigation, U.S. Attorneys, and the Office of Inspector General of the Department of Health and Human Services to hire, equip, and train personnel in connection with the investigation and prosecution of health care fraud cases; and (2) to establish, operate, and administer health care task forces and the national health care fraud and abuse data base and hotline, and to publicize the data base and hotline. Amends the Federal criminal code to make: (1) 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 (express company fraud); and (2) health care fraud and express company fraud predicates to violations of prohibitions against the laundering of monetary instruments.
Bill· HRH.R. 3080 (103rd)open
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.
Record· NominationPN562 (103rd)open
United States · United States Senate · 6 August 1993
Bill· HRH.R. 2847 (103rd)open
United States · United States Congress · 3 August 1993
TABLE OF CONTENTS: Title I: Death Penalty Title II: Habeas Corpus Reform Title III: Exclusionary Rule Title IV: Rural Crime and Drug Control Title V: Firearms and Related Amendments Title VI: Juveniles and Gangs Title VII: Terrorism and International Matters Title VIII: Sexual Violence, Child Abuse, and Victims' Rights Title IX: Equal Justice Act Title X: Funding, Grant Programs, and Studies Title XI: Illegal Drugs Title XII: Public Consumption Title XIII: General Provisions Title XIV: Technical Corrections Title XV: Federal Law Enforcement Agencies Title XVI: Federal Prisons Title XVII: Pre-Trial Interrogation Title XVIII: Funding Crime Control Act of 1993 - Title I: Death Penalty - Federal Death Penalty Act of 1993 - Amends the Federal criminal code to establish criteria for the imposition of the death penalty for Federal crimes. (Sec. 102) Allows the defendant and the Government to present any information relevant to sentencing (including victim impact statements), but permits evidence to be excluded where its probative value is substantially outweighed by the danger of creating unfair prejudice, confusing the issues, or misleading the jury. Sets forth: (1) procedures for the implementation of, and appeal from, a sentence of death; and (2) provisions regarding the appointment of counsel, deadlines for collateral attacks on judgments imposing a death sentence, and stays of execution. (Sec. 110) Provides for the imposition of the death penalty for various offenses, including: (1) murder committed by prisoners in Federal prisons; (2) murder for hire; (3) murder in the aid of racketeering activity; (4) specified violations of the Controlled Substances Act (CSA); (5) murder of Federal witnesses; (6) rape and child molestation murders; and (7) murders in the District of Columbia. Title II: Habeas Corpus Reform - Subtitle A: General Habeas Corpus Reform - Habeas Corpus Reform Act of 1993 - Amends the Federal judicial code to establish a one-year statute of limitations for habeas corpus actions brought by State prisoners. (Sec. 204) Vests authority to issue certificates of probable cause for appeal of habeas corpus orders exclusively in the courts of appeals. Subtitle B: Death Penalty Litigation Procedures - Death Penalty Litigation Procedures Act of 1993 - Amends the Federal judicial code to set forth special habeas corpus procedures in capital cases. Subtitle C: Equalization of Capital Habeas Corpus Litigation Funding - Amends the Omnibus Crime Control and Safe Streets Act of 1968 (Omnibus Act) to require the Director of the Bureau of Justice Assistance (BJA) to provide grants to the States to support litigation pertaining to Federal habeas corpus petitions in capital cases. Title III: Exclusionary Rule - Amends the Federal criminal code to bar the exclusion of evidence obtained as a result of a search or seizure carried out under circumstances justifying an objectively reasonable belief that it was in conformity with the fourth amendment. Title IV: Rural Crime and Drug Control - Subtitle A: Drug Trafficking in Rural Areas - Amends the Omnibus Act to authorize appropriations for rural law enforcement agencies (LEAs) and increase the base allocation to nonrural States for rural drug enforcement assistance. (Sec. 402) Requires: (1) the Attorney General to establish a Rural Crime and Drug Enforcement Task Force in each Federal judicial district which encompasses significant rural lands, and to cross-designate up to 100 law enforcement officers from specified Federal agencies to enforce provisions of the CSA on non-Federal lands and the Federal criminal code; and (2) the Director of the Federal Law Enforcement Training Center to develop specialized training for rural law enforcement officers. Subtitle B: Rural Drug Prevention and Treatment - Amends the Public Health Service Act to require the Director of the Office for Treatment Improvement to establish a program to provide grants to hospitals, community health centers, and other appropriate entities in developing and implementing projects that provide, or expand the availability of, substance abuse treatment services. Subtitle C: Rural Areas Enhancement - Sets forth provisions regarding: (1) forfeiture of assets seized as a result of investigations initiated by a Rural Drug Enforcement Task Force; and (2) the bringing of criminal charges (including counts involving illegal disposal of hazardous waste and knowing endangerment of the environment) and civil actions (including assessment of environmental and health-related damages) against the operators of clandestine methamphetamine and other dangerous drug laboratories. Title V: Firearms and Related Amendments - Subtitle A: General Provisions - Amends the Federal criminal code to establish penalties for smuggling firearms in aid of drug trafficking and for theft of firearms and explosives. (Sec. 503) Increases penalties for: (1) making knowingly false, material statements in connection with the acquisition of a firearm from a licensed dealer; and (2) interstate gun trafficking. (Sec. 504) Authorizes the summary destruction of explosives subject to forfeiture under specified circumstances. Sets forth requirements for reimbursement of the value of destroyed property. (Sec. 506) Prohibits: (1) the receipt of firearms by non-residents of the State in which the transferor resides, unless such receipt is for lawful sporting purposes; (2) transactions involving stolen firearms which have moved in interstate or foreign commerce; and (3) the possession of explosives by felons and specified others. (Sec. 511) Amends: (1) the Internal Revenue Code regarding the disposition of forfeited firearms; and (2) the Federal criminal code regarding the definition of burglary under the Armed Career Criminal Act of 1984. Subtitle B: Brady Handgun Violence Prevention Act - 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 violated 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 funds for failure to meet set deadlines. Title VI: Juveniles and Gangs - Anti-Gang and Juvenile Offenders Act of 1993 - Subtitle A: Increased Penalties for Employing Children to Distribute Drugs Near Schools and Playgrounds - Amends the 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. Subtitle B: Antigang Provisions - 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 to States and units of local government to assist them in planning, coordinating, and evaluating projects to reduce the formation or continuation of juvenile gangs and the use and sale of illegal drugs by juveniles. (Sec. 623) Sets penalties for the commission of a felony crime of violence, felony involving a controlled substance, and specified other offenses in, for, or in association with a criminal street gang. Subtitle C: Juvenile Penalties - Amends the Federal criminal code to: (1) add certain firearms offenses to those over which the United States has juvenile delinquency jurisdiction; and (2) provide for the treatment of violent juveniles who commit firearms offenses as adults under certain circumstances. (Sec. 632) Classifies as serious drug offenses for purposes of the Armed Career Criminal Act serious drug offenses committed by juveniles. (Sec. 633) Amends the Omnibus Act to require the Director of the BJA to make grants to States, for use by States and units of local governments, to develop alternatives to incarceration and probation for young offenders which promote reduced recidivism, crime prevention, and victim assistance. Subtitle D: Other Provisions - Includes among permissible uses of drug control and system improvement grants (under the Omnibus Act) programs that address the need for effective bindover systems for the prosecution of violent 16- and 17-year olds in courts with jurisdiction over adults for specified crimes. (Sec. 642) Directs: (1) the Attorney General to develop a national strategy to coordinate gang-related investigations by Federal LEAs, and prepare a report on national gang violence to be submitted to the President and the Congress; and (2) the Director of the Federal Bureau of Investigation (FBI) to acquire and collect information on incidents of gang violence for inclusion in an annual uniform crime report. (Sec. 643) Prohibits a juvenile from being transferred to adult prosecution or a hearing held under section 5037 (disposition after a finding of juvenile delinquency) until any prior juvenile court records have been received by the court or other specified conditions are met. Title VII: Terrorism and International Matters - Repeals the Antiterrorism Act of 1990. Establishes a civil remedy for U.S. nationals (and their survivors or estates) injured, in their person, property, or business, by acts of international terrorism. (Sec. 702) Amends the Federal criminal code to: (1) make it a criminal offense to provide material support to terrorists; and (2) provide for forfeiture of assets used to support terrorists. (Sec. 704) Authorizes the Attorney General to waive immigration admission and other legal requirements and grant permanent resident status for alien witnesses who cooperate with the Government in Federal or State prosecutions. (Sec. 713) Amends the Federal criminal code to: (1) 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; (2) provide for the prosecution of individuals who murder U.S. nationals abroad; and (3) permit FBI access to telephone subscriber information under specified circumstances. Title VIII: Sexual Violence, Child Abuse, and Victims' Rights - Subtitle A: Sexual Violence and Child Abuse - Sexual Assault Prevention Act of 1993 - Chapter 1: Sexual Violence - Subchapter A: Penalties and Remedies - Provides for: (1) pretrial detention in sex offense cases; and (2) the imposition of the death penalty for murders committed by sex offenders. (Sec. 803) Increases penalties for: (1) recidivist sex offenders; and (2) sex offenses against victims below age 16. (Sec. 805) Sets forth provisions regarding: (1) sentencing guideline increases for sex offenses; (2) human immunodeficiency virus testing, penalty enhancement, and cost of testing in sex offense cases; (3) restitution and suspension of Federal benefits; and (4) creation of a civil remedy for victims of sexual violence. Subchapter B: Rules of Evidence, Practice, and Procedure - Amends the Federal Rules of Evidence to allow evidence of similar offenses in criminal or civil sexual assault and child molestation cases. (Sec. 822) Revises the rape victim shield law, including making the past sexual behavior of an alleged victim inadmissible in civil as well as criminal cases. Makes inadmissible evidence to show provocation or invitation by the victim in a sex offense criminal case. (Sec. 824) Sets forth provisions regarding: (1) review of proposed Rules of Professional Conduct for Lawyers in Federal Practice; (2) a victim's right to allocation (to be present, make a statement, and present information) at the sentencing hearing of a defendant convicted of a crime of violence or sexual abuse; and (3) a victim's right of privacy. Subchapter C: Safe Campuses - Directs the Attorney General to provide for a national baseline study on campus sexual assault. Subchapter D: Assistance to States and Localities - Authorizes the Attorney General to make grants to support projects and programs relating to sexual violence, and supplementary grants for States adopting effective laws relating to sexual violence. Chapter 2: Domestic Violence and Offenses Against the Family - Amends the Federal criminal code to: (1) set penalties for noncompliance with child support obligations in interstate cases; and (2) require full faith and credit for protective orders. (Sec. 853) Creates a presumption against child custody for spouse abusers. (Sec. 854) Directs the Attorney General to report to the Congress on: (1) the status of battered women's syndrome as a medical and psychological condition and its effect in criminal trials; (2) the means by which abusive spouses may obtain information concerning the addresses or locations of estranged or former spouses; and (3) problems of recordkeeping of criminal complaints involving domestic violence. (Sec. 857) Authorizes the Attorney General to make grants to support projects and programs relating to domestic violence and other unlawful acts that particularly affect women. Chapter 3: National Task Force on Violence Against Women - Directs the Attorney General to establish a National Task Force on Violence Against Women. Subtitle B: Victims' Rights - Sets forth provisions regarding: (1) restitution and suspension of Federal benefits; and (2) the number of peremptory challenges under the Federal Rules of Criminal Procedure. Subtitle C: National Child Protection Act - National Child Protection Act of 1993 - Provides for: (1) State reporting of child abuse crime information to a national criminal background check system; (2) funding to improve such information; and (3) the withholding of a portion of such funding to States not in compliance with a timetable established under this Act. Subtitle D: Jacob Wetterling Crimes Against Children Registration Act - Jacob Wetterling Crimes Against Children Registration Act - Directs the Attorney General to establish guidelines for State programs requiring any person who is convicted of a criminal offense against a minor to register a current address with a designated State law enforcement agency for ten years after release from prison or being placed on parole or supervised release. Sets forth registration, State compliance, and related requirements. Title IX: Equal Justice Act - Equal Justice Act - Requires that the death penalty and all other penalties be administered by the United States and by every State without regard to the race or color of the defendant or victim. Bars the use of any racial quota or statistical test for the imposition or execution of any penalty. (Sec. 903) Sets forth provisions regarding: (1) safeguards against racial prejudice or bias in criminal courts; and (2) jury instructions and certification, and racial motivation in killings as an aggravating factor, in Federal capital cases. (Sec. 905) Amends specified civil rights provisions to cover conspiracy against rights, and deprivation of rights under color of law, of any person in (currently, inhabitant of) a State, territory, or district. Title X: Funding, Grant Programs, and Studies - Subtitle A: Safer Streets and Neighborhoods - Law Enforcement Enhancement Act of 1993 - Amends the Omnibus Act to: (1) authorize grants to State and local agencies for the hiring of law enforcement personnel; (2) continue the Federal-State funding formula through 1994; and (3) revise the funding formula with respect to the allocation and distribution of funds under formula grants. Subtitle B: Retired Public Safety Officer Death Benefit - Includes retired public safety officers who have died or become permanently and totally disabled as a result of injuries sustained while responding to a fire, rescue, or police emergency among those eligible for death and disability benefits. Subtitle C: Study on Police Officers' Rights - 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. Subtitle D: Cop-on-the-Beat Grants - Cop-on-the-Beat Act of 1993 - Amends the Omnibus Act to authorize the Director of the BJA to make grants to units of local government and community groups to establish or expand cooperative efforts between police and a community for purposes of increasing the police presence in the community. Subtitle E: National Commission to Support Law Enforcement - National Commission to Support Law Enforcement Act - Establishes a National Commission to Support Law Enforcement to study and recommend changes regarding LEAs and law enforcement issues on the Federal, State, and local levels. Subtitle F: Other Provisions - Amends the Omnibus Act to: (1) require the Director of the BJA to establish guidelines and oversee the implementation of family-friendly policies within law enforcement-related offices and divisions in the Department of Justice, identify and evaluate model programs that provide support services to law enforcement personnel and families, and take other specified actions; and (2) authorize the Director to make grants to States and local LEAs to provide family support services to law enforcement personnel. (Sec. 1063) Requires the Bureau of Prisons to notify, in writing and within a specified time frame, the chief law enforcement officer of the State and local jurisdiction in which a prisoner released on supervised release will reside. Title XI: Illegal Drugs - Subtitle A: Drug Testing - Amends the Federal criminal code to require: (1) the Director of the Administrative Office of the U.S. Courts to establish a program of drug testing of criminal defendants on post-conviction release; and (2) the chief probation officer in each district (where feasible) to arrange for the drug testing of such defendants. Requires, as an explicit condition of probation, parole, or supervised release of a defendant involving a felony or a specified violent or drug offense, that the defendant refrain from any unlawful use of a controlled substance and submit to periodic drug tests. Subtitle B: Precursor Chemicals - Chemical Control and Environmental Responsibility Act of 1993 - Amends the CSA to replace references to "listed precursor chemicals" with "list I chemicals" and "listed essential chemicals" with "list II chemicals." (Sec. 1123) Requires every person who manufacturers or distributes, or who proposes to engage in the manufacture or distribution of, a list I chemical to obtain annually a registration issued by the Attorney General. Makes provisions regarding the denial, revocation, and suspension of registration relating to the manufacture, distribution, or dispensation of controlled substances explicitly applicable to list I chemicals. (Sec. 1131) Makes it a felony for a person who possesses a listed chemical with intent that it be used in the illegal manufacture of a controlled substance to manage the listed chemical or waste from such manufacture other than as required under the Solid Waste Disposal Act. (Sec. 1132) Amends the Health Care Quality Improvement Act of 1986 to grant the Attorney General access to information in the National Practitioner Data Bank. Subtitle C: Other Provisions - Sets forth miscellaneous provisions and amends various laws concerning controlled substances. Title XII: Public Corruption - Anti-Corruption Act of 1993 - Amends the Federal criminal code to prescribe criminal penalties to be imposed against anyone who uses any facility of, or affects, interstate or foreign commerce to deprive or defraud the inhabitants of a State or political subdivision of a State of the honest services of a government official or employee, or of a fair and impartially conducted election process. (Sec. 1202) Prescribes criminal penalties to be imposed upon any official, or person selected to be a public official, who, in order to carry out or conceal any scheme or artifice to defraud, discriminates, harasses, or takes adverse action against any employee or official of the United States, or any State or political subdivision. Authorizes such an adversely affected employee or official to obtain relief through a civil action, provided such person did not participate in the scheme or artifice. (Sec. 1203) Amends mail fraud provisions to prohibit the use of any facility of interstate or foreign commerce in the execution of a scheme or artifice to defraud. (Sec. 1204) Sets forth prohibitions regarding narcotics-related public corruption. Title XIII: General Provisions - Subtitle A: Violent Crimes - Sets penalties for attempted: (1) robbery; (2) kidnapping; (3) smuggling; and (4) malicious mischief. (Sec. 1320) Increases penalties for: (1) certain assaults; (2) manslaughter; (3) interstate and foreign travel or transportation in aid of racketeering enterprises; and (4) conspiracy to commit murder for hire. Subtitle B: Civil Rights Offenses - Increases maximum penalties for certain civil rights violations, including damage to religious property. Subtitle C: White Collar and Property Crimes - Establishes penalties for knowingly receiving the proceeds of: (1) a postal robbery; (2) extortion; and (3) a kidnapping. (Sec. 1330) Includes within mail fraud provisions depositing specified matter to be sent by any private or commercial interstate carrier. (Current law applies only to matter sent by the U.S. Postal Service.) (Sec. 1332) Increases penalties for trafficking in counterfeit goods and services. (Sec. 1333) 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 computer 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 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. Creates a civil cause of action for persons suffering damage or loss by virtue of a violation of this Act. Subtitle D: Other Provisions - Sets forth provisions regarding: (1) venue for espionage and related offenses; (2) required reporting by criminal court clerks; and (3) audit requirements for State and local LEAs receiving Federal asset forfeiture funds. (Sec. 1364) 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 the Director of the FBI 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. 1365) Authorizes 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. Title XIV: Technical Corrections - Makes technical corrections to the Omnibus Act, the Federal criminal code, the CSA, and the Foreign Corrupt Practices Act of 1977. Title XV: Federal Law Enforcement Agencies - Federal Law Enforcement Act of 1993 - Authorizes appropriations for the Drug Enforcement Administration, the FBI, the Immigration and Naturalization Service, the U.S. attorneys, the U.S. Marshals Service, the Bureau of Alcohol, Tobacco and Firearms, and the U.S. courts. Title XVI: Federal Prisons - Authorizes appropriations for new prison construction. Title XVII: Pre-Trial Interrogation - Expresses the sense of the Congress that the Attorney General shall instruct all U.S. attorneys, and implement policies consistent therewith, that confessions obtained in conformity with Federal provisions related to such admissibility will be offered into evidence. Title XVIII: Funding - Rescinds 16 percent of unobligated funds to specified Federal agencies, and for specified funds and purposes, for FY 1992 and 1993.
Bill· SS. 1334 (103rd)referred
United States · United States Congress · 30 July 1993
Designates the U.S. Postal Service facility located at 401 South Washington Street, Chillicothe, Missouri, as the Jerry L. Litton United States Post Office Building.
Bill· SS. 1134 (103rd)open
United States · United States Congress · 22 June 1993
TABLE OF CONTENTS: Title I: Committee on Agriculture, Nutrition, and Forestry Subtitle A: Commodity Programs Subtitle B: Restructuring of Loan Programs Subtitle C: Food Stamp Program Subtitle D: Agricultural Trade Subtitle E: Miscellaneous Title II: Committee on Armed Services Title III: Committee on Banking, Housing, and Urban Affairs Title IV: Communications and Transportation Title V: Committee on Energy and Natural Resources Subtitle A: Recreation and Commercial Use Fees Subtitle B: Hardrock Mining Claim Maintenance Fee Subtitle C: Commonwealth of Northern Mariana Islands Agreement Subtitle D: Mineral Receipts Title VI: Committee on Environment and Public Works Title VII: Finance Committee Reconciliation Provisions Relating to Medicare, Medicaid, and Other Programs Subtitle A: Medicare Subtitle B: Medicaid Program Subtitle C: Income Security Programs Subtitle D: Miscellaneous Provisions Title VIII: Finance Committee Revenue Provisions Subtitle A: Training and Investment Incentives Subtitle B: Revenue Increases Title IX: Committee on Foreign Relations Title X: Committee on Governmental Affairs Subtitle A: Civil Service Subtitle B: Postal Service Title XI: Judiciary Title XII: Committee on Labor and Human Resources Subtitle A: Student Loan Provisions Subtitle B: Public Health Service Act Provisions Subtitle C: Improved Immunization Delivery and Monitoring Subtitle D: ERISA Amendments Title XIII: Veterans' Programs Omnibus Budget Reconciliation Act of 1993 - Title I: Committee on Agriculture, Nutrition, and Forestry - Agricultural Reconciliation Act of 1993 - Subtitle A: Commodity Programs - Amends the Agricultural Act of 1949 to reduce, with specified exceptions, the acreage eligible for deficiency payments from 92 percent to 85 percent for wheat, feed grains, upland cotton, and rice. (Sec. 1105) Extends the dairy support program. Sets forth purchase price ceilings for butter and nonfat dry milk. Reduces milk prices by ten cents per hundredweight for 1996. Prohibits the sale of bovine growth hormone during a specified time period. (Sec. 1106) Amends the Agricultural Adjustment Act of 1938 to require domestic cigarette manufacturers to certify the amount of U.S.-produced tobacco in their products. Establishes a domestic marketing assessment. Requires domestic cigarette manufacturers to purchase specified amounts of Burley and Flue-cured tobacco from producer-owned cooperatives. Amends the Agricultural Act of 1949 to require importers of foreign tobacco to pay: (1) specified marketing assessments; and (2) specified assessments to the No Net Cost Tobacco Fund. Amends the Tobacco Adjustment Act of 1983 to subject imported tobacco to inspection fees on the same basis as domestic tobacco. Amends the Agricultural Adjustment Act of 1938 to extend quota reduction floor authority (with waiver authority to avoid excess inventories) for Burley and Flue-cured tobacco. (Sec. 1107) Increases 1995 and 1996 sugarcane and sugarbeet marketing assessment rates. (Sec. 1108) Reduces 1994 and 1995 loan levels for soybeans and oilseeds. Revises loan maturation provisions. Eliminates loan origination fees for post-1993 crop years. (Sec. 1109) Increases 1994 and 1995 peanut marketing assessment and first purchaser-producer assessment rates. (Sec. 1110) Reduces 1994 through 1997 honey price support levels and individual payment ceilings. (Sec. 1111) Amends the National Wool Act of 1954 to reduce 1995 through 1997 wool and mohair individual payment ceilings. Maintains the 1993 support price for shorn wool through 1997. Eliminates specified marketing assessments. Subtitle B: Restructuring of Loan Programs - Amends the Rural Electrification Act of 1936 to restructure Rural Electrification Administration electric and telephone loan programs, including the establishment of: (1) electric hardship loans and cost-of-money loans; and (2) telephone hardship loans and cost-of-money loans. Revises the definition of "rural area" for purposes of rural electrification and telephone service. Amends the Consolidated Farm and Rural Development Act to permit electric and telephone borrowers to qualify for: (1) water and waste disposal loans; and (2) rural economic development assistance. Subtitle C: Food Stamp Program - Amends the Food Stamp Act of 1977 to reduce to 50 percent Federal cost-sharing expenses for: (1) food stamp investigations and prosecutions; and (2) immigration status verifications under the Social Security Act. Includes automated data processing and information retrieval systems among eligible cost-sharing activities. Subtitle D: Agricultural Trade - Amends the Agricultural Trade Act of 1978 to eliminate required FY 1994 and 1995 additional funding levels for the market promotion program and obligate certain sums for specified categories of exporters. (Sec. 1402) Amends the Omnibus Budget Reconciliation Act of 1990 to: (1) remove specified acreage reduction requirements for grain sorghum and barley; and (2) eliminate certain support level adjustment provisions. (Sec. 1403) Amends the Agricultural Trade Act of 1978 to prohibit the entry into or the withdrawal from a warehouse of any imported wheat or barley that it is not covered by an end-use certificate. (Sec. 1404) Expresses the sense of the Congress that the Secretary of Agriculture should aggressively promote the export of vegetable oil. Subtitle E: Miscellaneous - Amends the Federal Crop Insurance Act to direct the Federal Crop Insurance Corporation to take specified actions to improve the actuarial soundness of Federal crop insurance coverage. (Sec. 1502) Amends the Food Security Act of 1985 with regard to the conservation reserve program to: (1) make the current discretionary enrollment provision mandatory; and (2) reduce acreage requirements. Extends the wetlands reserve program and revises acreage enrollment provisions. (Sec. 1503) Authorizes the Secretary of Agriculture to charge admission, entrance, and recreation fees at appropriate sites, and public or recreation areas. (Sec. 1504) Expresses the sense of the Senate that: (1) farmers should pay no more than their fair share of any budget reduction necessary to achieve deficit reduction; and (2) the level of budget reduction should take into account taxes, interest rates, and user fees. Title II: Committee on Armed Services - Directs the Secretary of Defense to provide a limited increase in the military retired pay of former military personnel who became members of the armed forces before August 1, 1986. Specifies the month for which such increases becoming effective on December 1 of FY 1994 through 1998 shall be payable as part of retired pay. Title III: Committee on Banking, Housing, and Urban Affairs - Amends the Federal Deposit Insurance Act (FDICA) to prescribe an order of priority for the distribution of amounts realized from the resolution of any insured depository institution. (Sec. 3002) Amends the Federal Reserve Act to mandate for FY 1997 and FY 1998 the transfer into the Treasury of specified percentages of the surplus fund of any Federal reserve bank. Prohibits a Federal reserve bank from replenishing its surplus fund by the amount of such transfer. (Sec. 3003) Amends the Stewart B. McKinney Homeless Assistance Amendments Act of 1988 to: (1) include certain Indian housing programs within the parameters of the Department of Housing and Urban Development program; (2) require submission of certain income disclosure consent forms to verify applicant eligibility for benefits; and (3) revise applicant, participant, and public housing agency protections. Amends the United States Housing Act of 1937 to declare that adjustments to a public housing agency's operating subsidy shall reflect actual changes in rental income collections resulting from application of the Stewart B. McKinney Homeless Assistance Amendments Act of 1988. (Sec. 3004) Amends the National Housing Act to direct the Government National Mortgage Association (GNMA) to: (1) charge fees in connection with its multiclass securities guarantee program (the program); (2) take steps to assure that a certain portion of the benefit resulting from the program accrues to mortgagors who execute eligible mortgages; (3) summarize program activities in its annual report; and (4) report to certain congressional committees on specified risk minimization aspects of the program. (Sec. 3005) Directs the Secretary of Housing and Urban Development to increase the rate at which the Secretary earns the single premium payment collected at the time of insurance of a mortgage that is an obligation of the Mutual Mortgage Insurance Fund. Title IV: Communications and Transportation - Subtitle A: Spectrum Allocation and Auction - Emerging Telecommunications Technologies Act of 1993 - Directs the Assistant Secretary of Commerce for Communications and Information and the Chairman of the Federal Communications Commission (FCC) to meet at least biannually to conduct joint spectrum planning with respect to: (1) future spectrum requirements for public and private uses and the allocation actions to accommodate those uses; and (2) actions to promote the efficient use of the spectrum. Directs the Assistant Secretary and the Chairman to report jointly to specialized congressional committees on their recommendations. Requires the FCC to develop procedures to ensure that minority-owned businesses and small businesses are given the opportunity to provide spectrum-based services. Directs the FCC to report to the Congress a study of current and future spectrum needs of State and local government public safety agencies through the year 2010. (Sec. 404) Directs the Secretary of Commerce to identify radio band frequencies that are allocated on a primary basis for Federal use, are not currently required for Federal needs, can easily be made available for other uses, and have the greatest potential for productive uses and public benefits. Directs the Secretary to recommend to the President and the Congress the immediate reallocation of no less than 30 megahertz of such frequencies. Requires a preliminary and final report on other reallocable frequencies, with an opportunity for public comment. (Sec. 405) Directs the President, after receipt of the Secretary's recommendation, to: (1) withdraw the assignment of appropriate frequencies no longer needed by the Government; (2) assign other frequencies to Federal stations; (3) reallocate for public or mixed use appropriate frequencies; and (4) provide notice of his actions to the FCC and the Congress. Authorizes appropriations. (Sec. 406) Directs the FCC to issue rules for the allocation of all frequencies made available for immediate reallocation under this Act. Authorizes the President to reclaim reassigned frequencies for reassignment to Federal stations. (Sec. 408) Amends the Communications Act of 1934 to direct the FCC, during FY 1994 through 1998, to use competitive bidding procedures to grant all radio spectrum licenses for which two or more mutually exclusive applications have been filed. Requires a report on such procedures. Provides rural program license procedures. Provides for the State and local tax treatment of radio licenses and permits. (Sec. 409) Revises the FCC's regulatory authority in the management of mobile communications services. Considers a person engaged in the provision of commercial mobile services to be a common carrier and, therefore, required to establish physical connections with such service as required under the Communications Act. Prohibits a person engaged in private land mobile service from being considered to be a common carrier for such purposes. Prohibits any State or local government from imposing any rate or entry regulation upon any commercial or private land mobile service, but allows a State to regulate other terms and conditions of commercial mobile service, under certain conditions. Provides certain FCC deadlines with respect to rules, licenses, and permits for personal communications services. Subtitle B: Vessel Tonnage Duties - Amends Federal law relating to shipping to extend the years during which certain tonnage duties are imposed. Title V: Committee on Energy and Natural Resources - Subtitle A: Recreation and Commercial Use Fees - Amends the Land and Water Conservation Fund Act of 1965 to: (1) authorize the charging of admission fees for FY 1994 through 1998 at Bureau of Land Management (BLM) national monuments and scenic areas and areas of concentrated public use; (2) strike a provision prohibiting a recreation fee for the use of visitors' centers, picnic tables, or boat ramps; (3) authorize the Secretaries of Agriculture and the Interior to withhold from a special account made up of user fees an amount determined to be equal to the additional fee collection costs for each fiscal year; (4) direct the Secretary of the Interior, for FY 1994 through 1998, to establish and collect fees on commercial tour vehicles entering units of the National Park System in which fees are authorized; and (5) authorize the Secretaries to allow businesses and other organizations to sell and collect fees for the Golden Eagle Passport (an admission passport valid for an entire year). (Sec. 5003) Directs the Secretaries to assess and collect charges for utilization of radio and television communication sites located on Federal lands administered by the Forest Service or BLM. Requires such users to provide the Forest Service or BLM with a list identifying all additional site users and all revenues received from such users. Requires the Secretaries to establish a broad based advisory group to determine the market value for radio and television communication site users. Requires a report to specified congressional committees. Subtitle B: Hardrock Mining Claim Maintenance Fee - Mandates payment for maintenance fees of $100 per claim by each claimant of an unpatented mining claim, mill or tunnel site on federally-owned lands in order to hold such claims for the assessment year. Declares that such fee is in lieu of assessment work and related filing requirements contained in certain Federal laws. Waives such fees under certain conditions. (Sec. 5102) Mandates the payment of a location fee for every unpatented mining claim, mill or tunnel site located after the date of enactment of this Act and before September 30, 1998. Replaces certain assessment requirements and expenditures with the annual maintenance fee. Subtitle C: Commonwealth of Northern Mariana Islands Agreement - Limits the payments to the Northern Mariana Islands for FY 1994 through 1998 to the amounts and for the purposes set forth in the Agreement of the Special Representatives on Future Financial Assistance of the Northern Mariana Islands of December 1992. Continues funding after 1998 at a specified annual amount. Subtitle D: Mineral Receipts - Amends the Mineral Leasing Act to provide that in calculating the amount to be paid to States of revenues derived from Federal onshore mineral and geothermal steam leasing receipts, 50 percent of the portion of the appropriation allocable for administration and enforcement shall be deducted from those receipts in approximately equal amounts each month before their division and distribution between the States and the United States. Title VI: Committee on Environment and Public Works - Amends the Omnibus Budget Reconcilitation Act of 1990 to extend from 1995 to 1998 the authority of the Nuclear Regulatory Commission to assess and collect annual charges. (Sec. 6002) Amends the Flood Control Act of 1968 to authorize the Secretary of the Army to charge fees for the use of developed recreation sites and facilities with specified exceptions. Mandates deposit of such fees into a certain account established for the Army Corps of Engineers. Title VII: Finance Committee Reconciliation Provisions Relating to Medicare, Medicaid, and Other Programs - Subtitle A: Medicare - Part I: Provisions Relating to Part A - Amends title XVIII (Medicare) of the Social Security Act (SSA) to: (1) provide for a reduction in payment updates for inpatient hospital services; (2) provide for a reduction in payment for the indirect costs of medical education; (3) extend payments for Medicare-dependent, small rural hospitals; (4) repeal the requirement for a return on equity for proprietary skilled nursing facilities; (5) extend the ten percent reduction in payments for capital-related costs of inpatient hospital services; (6) lower the per diem limits with respect to payments for routine service costs of extended care services; and (7) change the update formula for hospice care payment starting in 1994. (Sec. 7103) Provides for continuation of the other urban payment rate through 1994. Requires the Secretary of Health and Human Services to: (1) permit hospitals that fail to qualify as rural referral centers due to their urban reclassification to decline their reclassification and retain their former status; and (2) make lump-sum retroactive payments to such hospitals. Part II: Provisions Relating to Part B: Subpart A - Physician Services - Amends SSA title XVIII to: (1) reduce the default update for the conversion factor otherwise applicable to surgical and non-surgical services (except primary care services) in 1994; (2) increase the performance standard factor starting in 1994; (3) double the maximum reduction in the default update allowed for 1994 starting in 1995; (4) provide for classification of primary care services as a separate category of services for purposes related to the application of volume performance standards and updates in conversion factors for physicians' services; (5) directs the Secretary to phase-in reductions to the practice expense relative value units for certain services; (6) revise the payment policy for anesthesia care teams; (7) repeal the prohibition on separate billing for the interpretation of electrocardiograms (EKGs); (8) repeal payment reductions for new physicians and practitioners; (9) require adjustments in the relative value units for services provided by physicians and other practitioners in order to ensure budget neutrality; (10) revise the application of the limiting charge policy with respect to claims submitted on a nonassignment basis; (11) add payment and billing rules for services furnished by certain practitioners; (12) set forth requirements for Medicare carriers to provide limiting charge information on the explanation of benefits form furnished to Medicare beneficiaries and screen unassigned claims by service providers before making payment to determine whether the amount billed exceeds the applicable limiting charge; and (13) require the Secretary's report to the Congress on changes in expenditures for physician services to reflect information on charges in excess of the applicable limiting charge. Subpart B: Outpatient Hospital Services and Ambulatory Surgical Services - Amends SSA title XVIII to: (1) extend the ten percent reduction in payments for capital-related costs of outpatient hospital services; (2) extend the reduction in payments for other costs of outpatient hospital services; and (3) make changes to payment formulae for outpatient hospital services. (Sec. 7224) Amends the Omnibus Budget Reconciliation Act of 1990 (OMBRA '90) to reduce payments for intraocular lenses. Subpart C: Durable Medical Equipment - Amends SSA title XVIII to: (1) revise the payment rules for durable medical equipment (DME); (2) provide for the treatment of nebulizers and aspirators and payment for accessories relating to such items; (3) provide a method for determining payment for surgical dressings; and (4) reduce payments for TENS devices. Subpart D: Part B Premium - Amends SSA title XVIII to revise current law establishing the monthly part B premium for Medicare beneficiaries. Subpart E: Other Provisions - Amends SSA title XVIII to: (1) provide for a freeze, then reduction, in updates for certain items and services covered under Medicare part B (Supplementary Medical Insurance), including DME and ambulatory surgical center services; and (2) lower the cap on payments for clinical diagnostic laboratory tests performed after December 31, 1993. Part III: Provisions Relating to Parts A and B - Amends SSA title XVIII to: (1) revise weighting factors and other criteria used in determining payments for direct graduate medical education costs; (2) include preventive care services as part of the initial residency period; (3) include successor exams in the definition of an FMGEMS examination; (4) modify home health agency cost limits; (5) extend the ban on certain referrals by physicians to cover additional specified health services and include new exceptions as well as modified ones related to its application; and (6) reduce payments for erythropoietin. (Sec. 7303) Amends SSA title XVIII and the Internal Revenue Code (IRC) to make numerous changes with respect to Medicare as secondary payer. Subtitle B: Medicaid Program - Part I: Program Savings Provisions - Subpart A: Repeal of Mandate - Amends SSA title XIX to: (1) repeal the mandate that States cover personal care services under their Medicaid programs for all individuals entitled to nursing facility benefits; and (2) give States the option of covering personal care services furnished in a home or other location. Subpart B: Outpatient Prescription Drugs - Amends SSA title XIX to: (1) allow States, under certain conditions, to establish formularies limiting coverage of prescription drugs under their Medicaid programs; (2) eliminate the prohibition on a State's subjecting covered outpatient drugs to prior authorization during the first six months after the drug is approved by the Food and Drug Administration; and (3) make modifications to the Medicaid prescription drug program. Subpart C: Restrictions on Divestiture of Assets and Estate Recovery - Amends SSA title XIX to: (1) revise provisions regarding adjustments and recoveries and transfers of assets; and (2) set forth rules for the treatment of trusts for purposes of determining an individual's eligibility for, and amount of, benefits under a State's Medicaid plan. Subpart D: Improvement in Identification and Collection of Third Party Payments - Amends SSA title XIX to: (1) address the liability of third parties to pay for care and services under Medicaid; and (2) require States to have in effect certain specified laws relating to medical child support. (Sec. 7433) Amends IRC and SSA title XIX to provide for collection of payment obligations relating to medical assistance from State and Federal tax refunds. Subpart E: Assuring Proper Payments to Disproportionate Share Hospitals - Amends SSA title XIX to make changes with regard to payments for disproportionate share hospitals. Subpart F: Anti-Fraud and Abuse Provisions - Amends SSA title XIX to prohibit payment with respect to any amount expended for an item or service for which payment would be denied under the Medicare ban on certain physician referrals if the item or service were furnished to an individual entitled to benefits under Medicare. Part II: Other Medicaid Provisions - Amends OMBRA '90 to revise : (1) the limits on expenditures and funding for demonstration projects to study the effect of allowing States to extend Medicaid coverage to certain low-income families not otherwise qualified to receive Medicaid benefits; and (2) project reporting requirements. Subtitle C: Income Security Programs - Amends SSA title IV part A (Aid to Families with Dependent Children) (AFDC) to make changes with regard to Federal matching of State AFDC administrative expenditures. Amends SSA titles I (Old Age Assistance), X (Aid to the Blind), XIV (Aid to the Permanently and Totally Disabled), and XVI (Supplemental Security Income) to revise the formula for determining Federal payments to the States for expenses incurred in administering their State plans under such SSA titles. Amends SSA title XI to change the requirements for attesting to citizenship status. (Sec. 7602) Amends SSA title IV part D (Child Support and Establishment of Paternity) to: (1) modify performance standards for State paternity establishment programs; and (2) modify existing, and require certain additional, procedures under State law with respect to child support enforcement. (Sec. 7603) Amends SSA title XVI (SSI) and other Federal law to: (1) require the Social Security Administration to charge States fees for the Federal cost of administering State supplemental SSI payments; and (2) require the Secretary to charge fees for additional services requested by the State that are beyond the level customarily provided in administering a State's supplemental SSI payments. Subtitle D: Miscellaneous Provisions - Part I: Trade Provisions - Amends the Consolidated Omnibus Budget Reconciliation Act of 1985 to extend authority for levying customs user fees. (Sec. 7702) Amends the Trade Act of 1974 to provide for an extension of, and authorization of appropriations for, the trade adjustment assistance program. Part II: Improved Access to Childhood Immunizations - Amends SSA title XIX to direct the Secretary to promulgate a list of vaccines that provide immunization against naturally occurring infectious diseases and are recommended for universal use in children. Provides for immunization outreach through the EPSDT (Early and Periodic Screening, Diagnostic, and Treatment Services) Program. Requires Medicaid managed care plans to comply with specified requirements relating to EPSDT. Allows State plans to make payments directly to the manufacturer of the vaccine under a voluntary replacement program. Requires the Secretary to provide for demonstration projects designed to improve the rate and timeliness of immunization against childhood diseases in the case of any Medicaid-eligible child up to age two who is part of a family eligible for AFDC. (Sec. 7803) Amends SSA to add a new title XXI entitled "Central Bulk Purchasing Program For Pediatric Vaccines" under which the Secretary shall provide for the purchase and delivery on behalf of the applicant State of such quantities of pediatric vaccines as may be necessary for the immunization of each eligible child in the State. Part III: Disclosure Provisions - Amends the Internal Revenue Code to extend the authority to disclose return information for the administration of certain veterans programs. (Sec. 7902) Authorizes the disclosure of such information: (1) in the administration of repayments of certain student loans; and (2) for income verification under certain housing assistance programs. (Sec. 7904) Amends title XI of the Social Security Act to provide for the establishment of a Third Party Liability Clearinghouse to identify third parties responsible for payment for health care items and services furnished to beneficiaries of Medicare and Medicaid. Authorizes the disclosure of certain taxpayer return information for purposes of identifying health insurance coverage of certain individuals and spouses. Requires employers to report whether a group health plan is available to an employee on wage statements. Part IV: Other Provisions - Expands the 45-day interest-free period for refunding tax overpayments to all returns, as well as to amended returns and claims for refunds. Provides that if interest is not refunded within 45 days after the taxpayer files an amended return or claim for refund, interest will be paid only for periods after the date on which the return or claim is filed. (Sec. 7951) Requires the establishment of a program requiring the payment of user fees for the processing of applications for certificates of alcohol label approval and exemption, formula reviews, and statements of process (including laboratory tests and analyses). (Sec. 7952) Removes authority to use the Harbor Maintenance Trust Fund for administrative expenses of certain customs fee collections. (Sec. 7953) Increases the amount that individuals may designate to the Presidential Election Campaign Fund on their tax returns. (Sec. 7954) Increases the public debt limit and repeals the temporary limit on such increases. Title VIII: Revenue Provisions - Revenue Reconciliation Act of 1993 - Subtitle A: Training and Investment Incentives - Extends until June 30, 1994, the tax exclusion for employer-provided educational assistance and the targeted jobs credit. (Sec. 8111) Suspends the credit for increasing research activities from July 1, 1992, through June 30, 1993, and any period after June 30, 1994. Modifies the fixed base percentage of such credit for startup companies for taxable years after 1993. (Sec. 8115) Eliminates the depreciation adjustment for computing adjusted current earnings for such property placed in service after December 31, 1993. (Sec. 8119) Increases the dollar limitation on the election to expense certain depreciable small business assets. (Sec. 8121) Extends until June 30, 1994, the authority to issue qualified small issue bonds to finance manufacturing facilities and farm property. (Sec. 8131) Repeals certain interaction rules of the earned income credit with respect to the medical expense deduction, the deduction for health insurance, and the dependent care credit. Revises credit and phaseout percentages for 1994. (Sec. 8141) Extends the authority to issue qualified mortgage bonds and qualified mortgage credit certificates until June 30, 1994. Makes permanent the low-income housing credit. (Sec. 8143) Provides for the treatment of rental real estate activities under the limitations on losses from passive activities. (Sec. 8144) Modifies exceptions to the exclusion of real property acquired by a qualified organization from the meaning of acquisition indebtedness. Makes certain exceptions inapplicable to sales out of foreclosure by a financial institution. (Sec. 8145) Repeals the special rule for publicly traded partnerships with respect to the treatment of unrelated business taxable income. (Sec. 8146) Permits a tax-exempt title-holding company to receive unrelated business taxable income if the unrelated income is incidentally derived from the holding of real property. (Sec. 8147) Excludes from unrelated business taxable income: (1) gains from the sale, exchange or other disposition of real property acquired from financial institutions that are in conservatorship or receivership; and (2) loan commitment fees and certain option premiums. Provides for the tax treatment of pension fund investments in real estate investment trusts. (Sec. 8151) Increases the depreciation recovery period for nonresidential real property. (Sec. 8161) Repeals the luxury excise tax on boats, aircraft, jewelry, and furs. Modifies the luxury excise tax on automobiles to index the threshold for inflation occurring after 1990 and make such tax applicable to the first retail sale. (Sec. 8162) Exempts from the luxury excise tax parts or accessories installed for use of passenger vehicles by disabled individuals. (Sec. 8163) Extends the current diesel fuel excise tax to diesel fuel used by noncommercial motorboats. Retains such taxes in the General Fund of the Treasury. (Sec. 8171) Repeals the tax preference for the appreciated property charitable deduction. Disallows an adjustment related to the earnings and profits effects of any charitable contribution from being made in computing adjusted current earnings. (Sec. 8172) Establishes substantiation requirements for charitable contributions of $250 or more. (Sec. 8173) Sets forth disclosure requirements for an organization that receives a quid pro quo contribution (payment made partly as a contribution and partly in consideration for goods or services provided to the payor by the donee organization). Imposes a penalty for failure to make such disclosure. (Sec. 8174) Amends the Railroad Retirement Solvency Act of 1983 to make permanent the treatment of certain railroad retirement benefits as received under employer plans. (Sec. 8175) Provides for the temporary extension of the deduction of health insurance costs of self-employed individuals. Subtitle B: Revenue Increases - Lowers the tax rates for certain taxpayers and increases the tax rate for certain higher incomes. Imposes a surtax on certain higher incomes. (Sec. 8203) Increases the tentative minimum tax for taxpayers other than corporations. (Sec. 8204) Makes permanent the overall limitation on itemized deductions and the phaseout of personal exemptions for high-income taxpayers. (Sec. 8206) Sets forth provisions to prevent the conversion of ordinary income to capital gain in certain financial transactions. Repeals certain exceptions to market discount rules. Provides for the treatment of purchases of stripped preferred stock after April 30, 1993. Revises the methods of : (1) computing the limitation on the deductibility of investment interest; and (2) determining substantial appreciation of partnership inventory items. (Sec. 8207) Repeals the limitation on the amount of wages subject to the health insurance employment tax. (Sec. 8208) Increases and makes permanent the highest estate and gift tax rate. (Sec. 8209) Reduces the deduction for business meals and entertainment expenses. (Sec. 8210) Disallows a tax deduction for social membership dues, except for employee recreational expenses. (Sec. 8211) Disallows a deduction as a trade or business expense for remuneration to certain employees in excess of $1 million. (Sec. 8212) Reduces the compensation taken into account in determining contributions and benefits under qualified retirement plans. (Sec. 8213) Removes qualified residence sales, purchases, or leases and meals from the deduction for moving expenses. Places a dollar limitation on the deduction for moving expenses. (Sec. 8214) Revises the limitation on using the preceding year's tax to calculate an individual's estimated tax payments. (Sec. 8215) Increases the amount of social security and tier 1 railroad retirement benefits to be included in the gross income of certain taxpayers. (Sec. 8221) Increases the tax rate for corporate income in excess of $10 million and the tax rate on personal service corporations. (Sec. 8222) Denies a tax deduction for lobbying expenses. Subjects lobbying organizations to special reporting requirements. (Sec. 8223) Requires any security which is inventory in the hands of the dealer to be included in inventory at its fair market value. Requires any dealer in securities that holds any security which is not in inventory at the close of any taxable year to: (1) recognize gain or loss as if the security were sold on the last business day of the taxable year; and (2) take into account any such gain or loss for such year (the mark-to-market requirement). (Sec. 8224) Requires taking into account: (1) certain Federal Savings and Loan Insurance Corporation (FSLIC) assistance as compensation for loss; and (2) any FSLIC assistance for any debt for determining whether such debt is worthless and in determining the amount of any addition to a reserve for bad debts arising from such worthlessness or partial worthlessness. (Sec. 8225) Increases the required annual payment for corporations that fail to pay estimated income tax. Modifies the periods for applying such annualization. (Sec. 8226) Repeals the stock for debt exception in determining income from discharge of indebtedness. (Sec. 8227) Limits the Puerto Rico and possession tax credit to 40 percent of the possession corporation's qualified possession wages by 1998 and thereafter. (Sec. 8228) Modifies the limitation on corporate deductions for interest paid to related persons to take into account disqualified guarantees of indebtedness and the imposition of a gross basis tax. (Sec. 8231) Requires U.S. shareholders of controlled foreign corporations to include in gross income a pro rata share of the corporations' excess passive assets. Sets forth rules for determining such amounts. Modifies the rule on taxation of investment in United States property and takes into account excessive passive assets. (Sec. 8233) Excepts from foreign personal holding income dividends attributable to earnings and profits of the distributing corporation accumulated during any period during which the person receiving such dividend did not hold such stock. Requires the establishment of an excess limitation account by taxpayers who receive foreign tax credits in a year they receive previously taxed earnings and profits. (Sec. 8234) Reduces the amount allowed as allocation and apportionment of research and experimental expenditures from sources within the United States. (Sec. 8235) Excludes passive dividends or interest income from foreign oil and gas income. (Sec. 8236) Modifies accuracy-related penalties for tax underpayments. (Sec. 8237) Denies the inclusion of certain contingent interest in the exemption for portfolio interest for nonresident aliens. (Sec. 8238) Authorizes the Secretary of the Treasury to prescribe regulations recharacterizing any multiple-party financing transaction as a transaction directly among any two or more such parties where appropriate to prevent any tax avoidance. (Sec. 8239) Provides that export property eligible for certain tax incentives does not include any unprocessed softwood timber for purposes of: (1) taxation of foreign sales corporations (FSCs); and (2) taxation of domestic international sales corporations (DISCs). Requires any income from the sale of such unprocessed timber which was cut from an area in the United States to be sourced in the United States. Repeals the deferral for income of the controlled foreign corporation from sales or milling (outside the United States) of unprocessed softwood timber to the extent that any controlled foreign corporation is owned by ten percent or more U.S. shareholders. (Sec. 8241) Increases the excise tax on gasoline, diesel fuel, aviation fuel, and other transportation fuels. (Sec. 8242) Imposes an excise tax on fuel (separate from the gasoline tax and the tax on aviation). Exempts from such tax diesel fuel: (1) used by trains and intercity, local, or school buses; and (2) which is dyed or marked in accordance within regulations prescribed by the Secretary of the Treasury. Provides that the Airport and Airway Trust Fund financing rate does not apply to aviation fuel sold by a producer or importer for use by the purchaser in a nontaxable use. Imposes a civil penalty on persons who use reduced-rate fuel for a taxable use. (Sec. 8243) Imposes a floor stocks tax on any person holding diesel fuel on April 1, 1994. (Sec. 8224) Increases the tax on gasoline and diesel fuels for purposes of the Highway Trust Fund financing rate. Increases the amount to be transferred to the Mass Transit Account from such Fund. (Sec. 8251) Requires information reporting on payments to corporations for services. (Sec. 8252) Modifies provisions concerning substantial understatement and return-preparer penalties to allow reasonable cause exceptions. (Sec. 8253) Requires certain financial entities (including the Federal Deposit Insurance Corporation, the Resolution Trust Corporation, and the National Credit Union Administration, and their successors or subunits) to file information returns regarding discharges of indebtedness of $600 or more. (Sec. 8261) Allows an amortization deduction with respect to certain intangible property, including goodwill, that is acquired and held by a taxpayer in connection with the conduct of a trade or business or an activity engaged in for the production of income. (Sec. 8271) Denies the business travel expense deduction for spouses, dependents, or others. (Sec. 8272) Increases the withholding rate for supplemental wage payments. (Sec. 8273) Makes permanent the excise tax on certain vaccines. Title IX: Committee on Foreign Relations - Delays cost-of-living adjustments in Foreign Service retirement benefits during FY 1994 through 1996. (Sec. 9002) Eliminates the lump sum retirement option for certain Foreign Service employees. Title X: Committee on Governmental Affairs - Subtitle A: Civil Service - Delays cost-of-living adjustments in Federal employee retirement benefits during FY 1994 through 1996. (Sec. 1002) Eliminates permanently the lump sum retirement option for certain Federal employees. (Sec. 1003) Amends Federal law to make changes regarding District of Columbia government contributions for specified periods for certain employee and annuitant health benefits. Subtitle B: Postal Service - Directs the United States Postal Service to make a specified additional payment into the Civil Service Retirement and Disability Fund and the Employee Health Benefits Fund to cover increases due to retirement cost-of-living adjustments and increases in health benefits costs. Subtitle C: Miscellaneous - Makes changes under the Civil Service and Federal Employees Retirement Systems regarding survivor annuities. Title XI: Judiciary - Amends the Omnibus Budget Reconciliation Act of 1990 to extend through FY 1998 the surcharge fees for Patent and Trademark Office users. Title XII: Committee on Labor and Human Resources - Subtitle A: Student Loan Provisions - Student Loan Reform Act of 1993 - Amends the Higher Education Act of 1965 (HEA) to replace the Federal Family Education Loan Program, under which loans made by private lenders are guaranteed by the Government, with a Federal Direct Student Loan Program, over a four-year transition period. Chapter 1: Federal Direct Student Loan Program - Amends HEA to change the Federal Direct Loan Demonstration Program to the Federal Direct Student Loan Program (FDSL). (Sec. 12011) Sets forth program authority for making necessary sums available to make FDSL loans to all eligible students (and parents) at participating higher education institutions selected by the Secretary of Education (Secretary), for the period beginning July 1, 1994. Requires such loans to be made by participating institutions that also have agreements with the Secretary to originate loans, or by alternative originators designated by the Secretary. Directs the Secretary to provide funds for such student and parent loans either directly to a participating institution that also has an origination agreement or to a designated alternative originator, on the basis of need and eligibility of students and parents at each participating institution. Requires the Secretary to pay fees to assist in meeting costs of loan origination to participating institutions or alternative originators. Declares that no institution shall have a right to participate in FDSL programs. Provides for phase-in of the program, and application of the requirements of the Cash Management Improvement Act of 1990 on a transition schedule. Sets forth selection criteria for an institution's participation in the FDSL program and in origination agreements. Allows consortia of eligible participating institutions to apply to originate FDSL loans as consortia. Sets forth FDSL program participation and origination agreement requirements for institutions. Sets forth terms and conditions for FDSL loans, including certain parallels with Stafford, supplemental, parent, and unsubsidized Stafford loans under the FFEL program. Sets interest rates according to different formulas for loans made before rather than on or after July 1, 1997. Sets minimum and maximum loan fees to be charged to borrowers. Provides for standard, extended, graduated, and income contingent repayment plan options. Sets forth deferment and forbearance possibilities (including national service). Sets forth provisions for consolidation, borrower defenses, optically imaged records, and nondischargeability in bankruptcy. Authorizes the Secretary to award contracts under the FDSL program for: (1) alternative origination of loans; (2) servicing and collection of loans; (3) data systems for records maintenance; and (4) services to assist in orderly transition from FFEL to FDSL programs. Authorizes the Secretary to use funds for research on, or demonstration or evaluation of, any FDSL program aspects, including flexible repayment plans. Provides funds for specified administrative expenses of the FDSL program and the transition from the FFEL program, including certain transition expenses of guaranty agencies. Establishes a bipartisan National Student Loan Reform Commission to study the advisability of replacing the FFEL program with direct lending. Authorizes appropriations. Chapter 2: Student Loan Savings - (Sec. 12022) Revises interest rates for new student loans after July 1, 1994. (Sec. 12023) Reduces student loan origination fees paid by students. Requires lenders to pay fees. (Sec. 12024) Requires the Student Loan Marketing Association (Sallie Mae) to pay an offset fee to the Secretary. (Sec. 12025) Reduces the amount of the tax exemption granted to holders of certain student loans. (Sec. 12026) Reduces the interest rate for consolidation loans. Requires holders of consolidation loans to pay a rebate fee to the Secretary. (Sec. 12027) Reduces certain maximum interest premiums and eliminates certain reinsurance fees. (Sec. 12028) Requires the transferee to pay the Secretary a loan transfer fee. (Sec. 12030) Establishes a $10,000 annual limit on PLUS loans, still subject to the limitation based on need. Requires multiple disbursement. Chapter 3: Conforming Amendments - Subchapter A: Conforming Amendments to the Higher Education Act of 1965 - Amends HEA to provide for access to FFEL program student and parent loans during the transition to the FDSL program. Provides for advances to guaranty agencies for lender-of-last-resort services. Requires Sallie Mae or its designated agent to begin making FFEL loans as lender-of-last-resort, subject to certain limitations, upon the Secretary's request, and to cease such lending when the triggering conditions have ceased. (Sec. 12043) Modifies terms of loans under the FFEL program. Authorizes requiring a defaulted borrower to make income contingent repayments. Subchapter B: Amendments to Other Laws - Amends the Internal Revenue Code to add or revise provisions relating to disclosure of tax return information with respect to income contingent repayment of student loans, individuals who owe on overpayment of Federal Pell Grants, and collection of payments on Federal Direct Student Loans. Chapter 4: Cost Sharing by States - Amends HEA to require any State in which there are higher education institutions with cohort default rates exceeding 20 percent to pay the Secretary specified portions of costs related to such loan defaults. Allows States to charge institutions fees based on their cohort default rate and the State's risk of loss. Chapter 5: General Effective Date - Sets forth the effective dates of subtitle A. Subtitle B: Public Health Service Act Provisons - Amends the Public Health Service Act (PHSA) to create a new title establishing the Health Coverage Clearinghouse to identify third parties which may be liable for payment for health care items and services furnished by a covered health program (defined as certain entities under the PHSA, a non-Federal entity under the Indian Self-Determination Act, or any other federally funded program providing payments for medical services that may be covered under a private health insurance policy). Requires: (1) the Secretary of the Treasury to furnish tax information to the Clearinghouse on the identity and employer of the spouse or parents; and (2) employers to furnish information on group health plan coverage of the individual, spouse, or parents. Requires the Clearinghouse to maintain a data bank containing such information. Authorizes disclosure of any information in the data bank to: (1) the Secretary, administrators of covered health programs (CHPs), employers, insurers; and (2) Federal and State law enforcement officials in connection with proceedings relating to a CHP. Mandates service fees to cover Clearinghouse costs. Amends the Employee Retirement Income Security Act of 1974 (ERISA) to require the administrator of each employee benefit plan to comply with the amendments made by these provisions. (Sec. 12102) Mandates a study on referral of a patient by a health care provider to an entity in which the provider has a financial interest or from which the provider receives a financial benefit for the referral. (Sec. 12103) Delays, during specified fiscal years, cost-of-living increases for National Health Service Corps retiree annuitants. (Sec. 12104) Allows a members of the Corps who is covered by provisions of Federal law relating to retirement or the Federal Employees' Retirement System and has a critical medical condition to elect annuity benefits under specified provisions. (Sec. 12105) Amends the PHSA to allow malpractice coverage, in certain circumstances, for officers, employees, and contractors of entities that are migrant or community health centers or that provide health services for the homeless or for residents of public housing when they provide services to individuals who are not patients of the entities. Subtitle C: Improved Immunization Delivery and Monitoring - Comprehensive Child Immunization Act of 1993 - Amends the Public Health Service Act to mandate establishment of a list of the vaccines that the Secretary of Health and Human Services recommends for administration to all children and a recommended administration schedule. Requires that the list and schedule be subordinate to State law. Mandates allotments to States. Provides for the establishment of State registries to monitor the immunization status of all children. Requires States to monitor and enforce compliance with these provisions by health care providers. Authorizes appropriations. Establishes a national immunization surveillance program to assess the effects of these provisions, provide technical assistance to States, and receive aggregate epidemiologic data collected by States. Authorizes appropriations. Directs the Secretary of Health and Human Services to provide for the distribution, without charge, of pediatric vaccines purchased by the Secretary to health care providers who are: (1) members of a uniformed service; (2) U.S. officers or employees; (3) federally qualified health centers; (4) migrant or community health centers; (5) entities providing health services for the homeless or for residents of public housing; or (6) public or nonprofit entities receiving funds under provisions of the Social Security Act relating to special projects of regional and national significance. Prohibits a provider receiving the vaccine from imposing a charge for the vaccine but allows a charge for the actual costs of the administration of the vaccine. Mandates activities to improve Federal, State, and local vaccine delivery systems and immunization outreach and education efforts, including a National Immunization Public Awareness Campaign and incorporation of immunization status assessment and referral in the application process for various types of Federal assistance. Authorizes grants to States to develop, revise, and implement immunization improvement plans. Requires States to establish child immunization rate goals. Authorizes appropriations. Mandates: (1) a biennial report on the costs, efficiency, and effectiveness of procedures established to deliver vaccine to health care providers; and (2) a report by the National Academy of Sciences on the role of the National Vaccine Program established under this title in achieving progress toward the established immunization goals for the year 2000. (Sec. 12203) Requires that the Vaccine Injury Table of the National Vaccine Injury Compensation Program include any vaccine on the list established under this subtitle. Allows a special master to award reasonable attorney's fees whether or not an election has been made to file a civil action regarding a vaccine injury compensation petition. Requires that compensation under the Program be used as determined by the special master to be in the best interests of the petitioner. (Current law requires that the compensation be used, with the consent of the petitioner, as determined by the special master to be in the best interests of the petitioner.) Sets time limits regarding applications for attorney's fees and costs. Authorizes appropriations for payment of compensation under the Program regarding vaccines administered before the effective date of the Program. Revises requirements regarding: (1) time limits on actions when the Table is revised; and (2) extensions of time limits for decisions. Mandates an annual report on amounts collected under provisions regarding subrogation of petitioners' rights. Requires the Advisory Commission on Childhood Vaccines to monitor the balance of the Vaccine Injury Trust Fund and recommend changes in the tax per dose. Revises requirements regarding vaccine information materials. Authorizes appropriations from the Trust Fund for administering the National Vaccine Program. (Sec. 12204) Removes provisions authorizing grants for research on the prevention and control of diseases through vaccination and related demonstration projects, public information programs, and health professionals training and clinical skills improvement. Subtitle D: ERISA Amendments - Chapter 1: Group Health Amendments - Amends the Employee Retirement Income Security Act of 1974 (ERISA) to modify requirements regarding supersedure of State laws in connection with title XIX (Medicaid) of the Social Security Act requirements. (Sec. 12302) Prohibits a group health plan from reducing its coverage of pediatric vaccine costs below the coverage it provided on a specified date. Chapter 2: Liabilities and Penalties - Mandates joint and several liability for any person who participates in an act or omission of a fiduciary, knowing that the act or omission was a breach of fiduciary responsibility. (Sec. 12312) Changes requirements regarding civil enforcement actions brought by a participant, beneficiary, or fiduciary or by the Secretary of Labor and requires amounts recovered to be subject to a civil penalty. Limits awards of punitive damages and monetary relief. Modifies civil penalty requirements. Allows waiving or reducing penalties if the person will not be able to restore all losses to the plan, participants, or beneficiaries (currently, to the plan) without severe financial hardship. Requires reduction of penalties by the amount of any penalty or tax imposed by provisions of the Internal Revenue Code relating to minimum funding standards and prohibited transactions. Chapter 3: Public Health Service Act - Amends the Public Health Service Act to prohibit any health insurance policy in effect before a specified date from reducing coverage for pediatric vaccine costs below the coverage on the date of enactment of this provision. Mandates civil money penalties for violations. Title XIII: Veterans' Programs - Extends permanently (currently, ends September 30, 1997) the $90 monthly pension limitation for veterans having neither spouse nor child and being furnished domiciliary care by the Department of Veterans Affairs. (Sec. 13002) States that the FY 1994 cost of living increases in veterans' disability compensation and dependency and indemnity compensation shall be no more than the percentage increases under title II (Old Age, Survivors and Disability Insurance) of the Social Security Act. (Sec. 13003) Requires an increased reduction in the monthly basic pay of active duty and reserve personnel entering into service after FY 1993 for participation in the Montgomery GI Bill educational assistance program. Provides similar increases for those enrolled in such program before either voluntary or involuntary separation from the armed forces. (Sec. 13004) Extends permanently (currently terminated as of December 31, 1992) certain procedures applicable to liquidation sales on defaulted home loans to veterans which were guaranteed by the Department. Increases the home loan fees charged to such veterans for such guarantee loans. (Sec. 13006) Extends permanently: (1) the authority of the United States to recover from third party insurers the cost of certain care and services provided to veterans through the Department; (2) a required minimum copayment for medication received by certain veterans on an outpatient basis; and (3) the authority of the Secretary of Veterans Affairs to obtain, and the Secretary of the Treasury to provide, certain financial information of veterans for income verification purposes.
Resolution· HRESH.Res. 201 (103rd)passed
United States · United States Congress · 17 June 1993
Sets forth the rule for the consideration of H.R. 2403 (Department of the Treasury, United States Postal Service, and certain Independent Agencies appropriations).
Bill· HJRESH.J.Res. 215 (103rd)open
United States · United States Congress · 16 June 1993
Directs the U.S. Postal Service to issue a commemorative postage stamp in honor of Justice Thurgood Marshall.
Law· HRH.R. 2403 (103rd)enacted
United States · United States Congress · 14 June 1993
TABLE OF CONTENTS: Title I: Department of the Treasury Title II: Postal Service Title III: Executive Office of the President and Funds Appropriated to the President Title IV: Independent Agencies Title V: General Provisions Title VI: Governmentwide General Provisions Treasury, Postal Service, and General Government Appropriations Act, 1994 - Title I: Department of the Treasury - Treasury Department Appropriations Act, 1994 - Makes appropriations to the Department of the Treasury and its related agencies for FY 1994. Sets forth provisions on the uses of such appropriations, including specified directives to the Bureau of Engraving and Printing. Title II: Postal Service - Postal Service Appropriations Act, 1994 - Makes appropriations to the Postal Service Fund for FY 1994. Title III: Executive Office of the President and Funds Appropriated to the President - Executive Office Appropriations Act, 1994 - Makes appropriations for FY 1994 for the Executive Office of the President and related offices and programs. Title IV: Independent Agencies - Independent Agencies Appropriations Act, 1994 - Makes appropriations for FY 1994 for the following independent agencies: (1) the General Services Administration; (2) the Office of Personnel Management; (3) the Advisory Commission on Intergovernmental Relations; (4) the Committee for Purchase From People Who Are Blind or Severely Disabled; (5) the Federal Election Commission; (6) the Federal Labor Relations Authority; (7) the Merit Systems Protection Board; (8) the National Archives and Records Administration; (9) the Office of Government Ethics; (10) the Office of Special Counsel; and (11) the United States Tax Court. Title V: General Provisions (this Act) - Sets forth certain prohibitions and limitations on the use of appropriations made under this Act. (Sec. 524) Facilitates a transfer of property in Suitland, Maryland, to enable the Washington Metropolitan Area Transit Authority to construct a metrorail station and related surface facilities. Title VI: Governmentwide General Provisions - Sets forth certain requirements for and prohibitions and limitations on the use of appropriations by departments, agencies, and corporations.
Bill· SS. 1090 (103rd)referred
United States · United States Congress · 10 June 1993
TABLE OF CONTENTS: Title I: Agriculture Appropriations Title II: Commerce, Justice, and State, the Judiciary, and Related Agencies Appropriations Subtitle A: Department of Commerce Subtitle B: Related Agencies Subtitle C: Department of State Title III: Defense Appropriations Subtitle A: Research, Development, Test and Evaluation Subtitle B: Other Department of Defense Programs Subtitle C: Operations and Maintenance Title IV: Energy and Water Appropriations Subtitle A: Corps of Engineers Subtitle B: Department of Energy Title V: Interior Appropriations Title VI: Transportation Appropriations Title VII: Treasury, Postal Service, and General Government Appropriations Title VIII: Veterans Affairs, Housing and Urban Development, and Independent Agencies Appropriations Subtitle A: Department of Veterans Affairs Subtitle B: Independent Agencies Subtitle C: Department of Housing and Urban Development Title IX: Blue Smoke and Mirrors Spending Priority Reform Act of 1993 - Expresses the sense of the Congress that any money returned to the Treasury as a result of this Act should be deposited in the General Fund to be applied against the Federal budget deficit. Title I: Agriculture Appropriations - Rescinds FY 1993 appropriations to the Department of Agriculture for certain special research grants and for the construction of buildings and facilities of the Cooperative State Research Service which were not authorized, not awarded on a competitive basis, or not subjected to congressional hearings ("unauthorized"). Title II: Commerce, Justice, and State, the Judiciary and Related Agencies Appropriations - Subtitle A: Department of Commerce - Rescinds FY 1993 specified appropriations to the National Oceanic and Atmospheric Administration and the International Trade Administration. Subtitle B: Related Agencies - Rescinds FY 1993 appropriations to the Small Business Administration for unauthorized grants for specified miscellaneous projects. Subtitle C: Department of State - Rescinds FY 1993 appropriations to the Department of State for an unauthorized grant for the North/South Center at the University of Miami, Miami, Florida, and certain educational and cultural exchange programs. Title III: Defense Appropriations - Subtitle A: Research, Development, Test and Evaluation - Rescinds unauthorized FY 1993 appropriations made to the Department of Defense for: (1) university grants; (2) electrical vehicle demonstration projects; (3) Army industrial preparedness and manufacturing technology development programs; (4) medical research; (5) naval research, development, testing, and evaluation; and (5) the Space Surveillance Network Improvement Program. Subtitle B: Other Department of Defense Programs - Rescinds FY 1993 appropriations for efforts to prevent brown tree snakes from entering Hawaii from Guam. Subtitle C: Operations and Maintenance - Rescinds FY 1993 appropriations for the following projects: (1) self-powered locks; (2) grants for World University and 1996 Summer Olympics games and World Cup 1994; (3) Army procurement of extended cold weather clothing systems; (4) study of nuclear disposal by the former Soviet Union and for Project Peace; and (5) the Hawaiian Volcano Observatory. Title IV: Energy and Water Appropriations - Subtitle A: Corps of Engineers - Rescinds unauthorized FY 1993 appropriations for funding of surveys and planning activities and construction of water resource projects. Subtitle B: Department of Energy - Rescinds unauthorized FY 1993 appropriations made under the Energy and Water Development Appropriations Act, 1993, for funding certain energy supply, research, and development activities. Title V: Interior Appropriations - Rescinds FY 1993 appropriations for unauthorized funding of: (1) certain National Park System projects; (2) certain construction projects of the U.S. Fish and Wildlife Service; and (3) certain National Forest Service projects. Title VI: Transportation Appropriations - Rescinds FY 1993 appropriations to the Department of Transportation for unauthorized funding of: (1) certain airway science programs; (2) a certain highway research, development, and technology project; (3) certain construction and maintenance projects; (4) certain Federal Highway Administration demonstration projects; and (5) transit planning and research. Title VII: Treasury, Postal Service and General Government Appropriations - Rescinds FY 1993 appropriations to the General Services Administration for certain unauthorized grants for projects funded through the Federal Buildings Fund. Rescinds FY 1993 appropriations to the Office of Personnel Management for the establishment of health promotion and disease prevention programs. Title VIII: Veterans Affairs, Housing and Urban Development, and Independent Agencies Appropriations - Subtitle A: Department of Veterans Affairs - Rescinds FY 1993 appropriations to be Department of Veterans Affairs for unauthorized construction projects. Subtitle B: Independent Agencies - Rescinds 1993 appropriations to: (1) the Environmental Protection Agency for certain unauthorized projects; (2) the Consortium for International Earth Science Information Network; and (3) the National Aeronautics and Space Administration for certain unauthorized research and development projects and construction projects. Subtitle C: Department of Housing and Urban Development - Rescinds FY 1993 appropriations to the Department of Housing and Urban Development for unauthorized funding of certain housing projects and assistance programs. Title IX: Blue Smoke and Mirrors - Expresses the sense of the Congress that, with regard to the appropriations process, "forward funding" tactics should no longer be utilized and Congress should operate within the funding limits prescribed for each fiscal year.
Bill· HRH.R. 2370 (103rd)open
United States · United States Congress · 10 June 1993
Federal Employee Antistalking Act of 1993 - Amends the Federal criminal code to set penalties for persons who: (1) repeatedly engage in a pattern of conduct directed at an officer or employee in the executive or legislative branch of Government (including the U.S. Postal Service) while such officer or employee is engaged in, or on account of, official duties; (2) know or should know that such conduct is likely to place that officer or employee in reasonable fear of sexual battery, bodily injury, or death; and (3) thereby induce such fear. Specifies that if a sentence of probation is imposed the court shall require the defendant to undergo appropriate psychiatric, psychological, or social counseling. Allows an aggrieved officer or employee to obtain appropriate relief in a civil action, including punitive damages (in the case of a violation) and reasonable attorney's fees.
Bill· HJRESH.J.Res. 207 (103rd)referred
United States · United States Congress · 27 May 1993
Authorizes the United States Postal Service to issue a commemorative postage stamp in honor of Dr. Martha Hughes Cannon.
Law· HRH.R. 2294 (103rd)enacted
United States · United States Congress · 26 May 1993
Designates the U.S. Postal Service Main Post Office facility at 1000 Lamar Street, Wichita Falls, Texas, as the Graham B. Purcell, Jr., Post Office and Federal Building.
Law· HRH.R. 2264 (103rd)enacted
United States · United States Congress · 25 May 1993
TABLE OF CONTENTS: Title I: Committee on Agriculture Title II: Committee on Armed Services Title III: Committee on Banking, Finance and Urban Affairs Title IV: Education and Labor Title V: Committee on Energy and Commerce Title VI: Committee on Foreign Affairs Title VII: Committee on the Judiciary Title VIII: Committee on Merchant Marine and Fisheries Title IX: Committee on Natural Resources Title X: Committee on Post Office and Civil Service Title XI: Committee on Public Works and Transportation Title XII: Committee on Veterans Affairs Title XIII: Committee on Ways and Means-Savings Title XIV: Revenue Provisions Title I: Committee on Agriculture - Agricultural Reconciliation Act of 1993 - Subtitle A: Commodity Programs - Amends the Agricultural Act of 1949 to reduce payment acres for wheat, feed grains, upland cotton, and rice. (Sec. 1101) Extends specified loan, payment, and acreage reduction programs for wheat, feed grains, upland cotton, rice, milk and dairy products, tobacco, sugar, oilseeds, peanuts, honey, and wool and mohair. Sets forth maximum purchase prices for butter and nonfat dry milk. Increases marketing assessments for tobacco and sugar. Establishes an additional marketing assessment for peanuts. (Sec. 1109) Amends the Harmonized Tariff Schedule of the United States to provide temporary additional customs duties on peanut butter and peanut paste. Subjects peanut butter to import quotas. (Sec. 1110) Amends the Agricultural Act of 1949 to reduce the support rate and annual payments for honey. Eliminates marketing assessments. (Sec. 1111) Reduces annual payments for wool and mohair. Eliminates marketing assessments. Subtitle B: Restructuring of Loan Programs - Amends the Rural Electrification Act of 1936 to restructure current Rural Electrification Administration (REA) electric and telephone loan programs, including creation of categories of hardship loans and municipal (electric) loans. Authorizes appropriations. (Sec. 1202) Transfers REA authority to the Department of Agriculture's Rural Development Administration. Subtitle C: Food Stamp Program - Mickey Leland Childhood Hunger Relief Act - Chapter 1: Ensuring Adequate Food Assistance - Amends the Food Stamp Act of 1977 to increase the basic food stamp program (program) benefit to 104 percent of the thrifty food plan. (Sec. 1312) Increases the age for students whose income is excluded from consideration as program income. (Sec. 1313) Removes (with an interim increase) the excess shelter cap. (Sec. 1314) Eliminates food stamp reductions for certain reapplying households. (Sec. 1315) Excludes third party payments for transitional housing for the homeless from consideration as program income. (Sec. 1318) Increases funding for the nutrition assistance program in Puerto Rico. (Sec. 1316) Excludes general assistance vendor payments from consideration as program income. Chapter 2: Promoting Self Sufficiency - Excludes education assistance and certain child support from consideration as program income. (Sec. 1324) Increases dependent care deductions and participant and State agency reimbursements in connection with employment and training activities. (Sec. 1325) Increases annually the fair market value limits of vehicles that program recipients may own. (Sec. 1326) Excludes from financial resources the value of a household vehicle used to carry heating fuel or water for home use. (Sec. 1327) Authorizes resource accumulation demonstration projects. Chapter 3: Simplifying the Provision of Food Assistance - Permits related adults living in the same household to apply for separate program benefits. (Sec. 1332) Makes children living with parents who are partcipating in drug or alcohol treatment programs eligible for food stamps. (Sec. 1333) Permits a participating family made up of, or including, an elderly or disabled member to own $3,000 in allowable financial resources. (Sec. 1334) Repeals provisions authorizing benefit reductions due to funding. Chapter 4: Improving Program Integrity - Expands: (1) the permitted use and disclosure of information provided by retail and wholesale food concerns; and (2) claims collections alternatives. (Sec. 1343) Authorizes demonstration projects aimed at coupon trafficking. Chapter 5: Improving Food Stamp Program Management - Excludes from categorical eligibility any household disqualified from participation because of workfare noncompliance. (Sec. 1353) Disqualifies program participants for trading food stamp coupons for controlled substances or for firearms, ammunition, or explosives. (Sec. 1356) Modifies the program's quality control system. Requires an error measurement study. Chapter 6: Uniform Reimbursement Rates - Revises State reimbursement rates. Chapter 7: Implementation and Effective Dates - Sets forth implementation and effective dates. Subtitle D: Miscellaneous Provisions - Amends the Agricultural Trade Act of 1978 to extend and reduce expenditure levels for the market promotion program. (Sec. 1402) Authorizes the Secretary of Agriculture (Secretary) to improve admission and recreation fees at specified public use areas. (Sec. 1403) Requires reduction of Department of Agriculture expenditures through personnel and office consolidations. (Sec. 1404) Amends the Food Security Act of 1985 to: (1) reduce the conservation reserve program acreage requirement; and (2) revise and make mandatory wetlands reserve program acreage requirements. (Sec. 1405) Amends the Federal Crop Insurance Act to direct the Federal Crop Insurance Corporation to make available four levels of commodity insurance based upon percentage of loss in yield. Title II: Committee on Armed Services - Directs the Secretary of Defense to provide a limited increase in the military retired pay of any former military personnel who became a member of the armed forces before August 1, 1986. (Sec. 2002) Waives the automatic FY 1994 increase in the rates of basic pay, basic allowance for quarters, and basic subsistence allowance. Provides that if the General Schedule pay rates for Federal employees is increased during any of FY 1995 through 1998, then military pay rates shall be increased. Title III: Committee on Banking, Finance and Urban Affairs - Amends the Federal Deposit Insurance Act to prescribe an order of priority for the distribution of amounts realized from the resolution of any insured depository institution. Requires distributions in connection with certain claims to be accompanied by an accounting report. (Sec. 3002) Amends the Federal Reserve Act to mandate that for FY 1994 through FY 1998 specified percentages of the surplus fund of any Federal reserve bank be transferred to the Treasury. Prohibits a Federal reserve bank from replenishing its surplus fund by the amount of such transfer. (Sec. 3003) Amends the Stewart B. McKinney Homeless Assistance Amendments Act of 1988 to: (1) require that certain income disclosure consent forms be submitted for verification of eligibility for benefits; and (2) amend applicant, participant, and public housing agency protections. (Sec. 3004) Amends the National Housing Act to direct the Government National Mortgage Association (GNMA) to: (1) charge fees in connection with its multiclass securities guarantee program; (2) assure that a portion of program benefits accrue to mortgagors who execute eligible mortgages; and (3) summarize program activities to the Congress. (Sec. 3005) Directs the Secretary of Housing and Urban Development to increase the rate at which the Secretary earns the single premium payment collected at the time of insurance of a mortgage that is an obligation of the Mutual Mortgage Insurance Fund. Title IV: Education and Labor - Subtitle A: Federal Direct Loan Program - Student Loan Reform Act of 1993 - Amends the Higher Education Act of 1965 (HEA) to replace the Federal Family Education Loan Program, under which loans made by private lenders are guaranteed by the Government, with a Federal Direct Student Loan Program. Chapter 1: Amendments to Part D of Title IV of the Higher Education Act of 1965 - Amends HEA to change the Federal Direct Loan Demonstration Program to the Federal Direct Student Loan Program (FDSL). (Sec. 4002) Sets forth program authority for making sums available for FDSL loans to all eligible students (and parents). Directs the Secretary of Education to provide funds for such student and parent loans on the basis of need and eligibility of students and parents at each participating institution. Declares that no institution shall have a right to participate in FDSL programs. Provides for application of the requirements of the Cash Management Improvement Act of 1990 on a transition schedule. Sets forth selection criteria for an institution's participation in the FDSL program and in origination agreements. Allows consortia to apply to originate FDSL loans. Sets forth terms and conditions for FDSL loans, including certain parallels with Stafford, supplemental, parent, and unsubsidized Stafford loans under the FFEL program. Sets interest rates. Sets minimum and maximum loan fees. Provides for standard, extended, graduated, and income contingent (EXCEL account) repayment plan options. Sets forth deferment and forbearance possibilities (including national service). Authorizes the Secretary to award contracts under the FDSL program for: (1) alternative origination of loans; (2) servicing and collection of loans; (3) data systems for records maintenance; and (4) services to assist in orderly transition from FFEL to FDSL programs. Authorizes the use of funds for research on FDSL program aspects, including flexible repayment plans. Chapter 2: Conforming Amendments - Amends HEA with respect to FFEL program student and parent loans during the transition to the FDSL program. (Sec. 4021) Provides for advances to guaranty agencies for lender-of-last-resort services. Requires the Student Loan Marketing Association (Sallie Mae) to begin making FFEL loans as lender-of-last-resort and to cease such lending when the triggering conditions have ceased. (Sec. 4028) Requires a study of alternatives for Sallie Mae during and after the transition to FDSL, including its own transition from a Government-sponsored enterprise to a private corporation. (Sec. 4030) Amends the Balanced Budget and Emergency Deficit Control Act of 1985 (Gramm-Rudman-Hollings Act) to provide that any reductions in the FDSL program required by a sequestration order shall be achieved only through a specified increase in the loan fee. Chapter 3: Effective Dates; Study - Sets forth effective dates for amendments made by this Act. (Sec. 4032) Directs the Secretary to report to the Congress on the feasibility of Internal Revenue Service (IRS) collection of student loan repayments. (Sec. 4033) Expresses the preference of the House Committee on Education and Labor for an IRS collection mechanism. Subtitle B: Cost Sharing by States - Amends HEA to require any State in which there are higher education institutions with cohort default rates exceeding 20 percent to pay portions of costs related to such loan defaults. Allows States to charge institutions fees based on their cohort default rate and the State's risk of loss. Subtitle C: ERISA Amendments Relating to Group Health Plans - Amends the Employee Retirement Income Security Act of 1974 (ERISA) to coordinate ERISA preemption rules with Medicaid provisions for liability of third parties. (Sec. 4202) Prohibits a group health plan from reducing its coverage of the costs of pediatric vaccines below that provided as of May 1, 1993. (Sec. 4203) Sets forth rules whereby: (1) ERISA preemption of State laws shall be inapplicable to certain State laws (of Hawaii, Maryland, Minnesota, and New York); or (2) the Secretary of Labor can assist such States in effectuating the policies of certain provisions superseded by ERISA. Title V: Committee on Energy and Commerce - Subtitle A: Medicare Program - Chapter 1: Provisions Relating to Part B - Subchapter A: Physicians' Services - Amends title XVIII (Medicare) of the Social Security Act (SSA) to, among other things: (1) reduce the default update for the conversion factor otherwise applicable to surgical and non-surgical services (except primary care services) in 1994; (2) increase the performance standard factor; (3) provide for classification of primary care services as a separate category of services with respect to volume performance standards and updates in conversion factors for physicians' services; (4) phase-in reductions to the practice expense relative value units; (5) revise the payment policy for anesthesia care teams; (6) repeal the prohibition on separate billing for the interpretation of electrocardiograms (EKGs); (7) require adjustments in the relative value units for services in order to ensure budget neutrality; (8) require Medicare carriers to screen unassigned claims; (9) include antigens prepared by a physician on the physician fee schedule; and (10) specify the conditions under which the Secretary can recognize substitute billing arrangements between two physicians. (Sec. 5011) Requires the Secretary to develop relative values for pediatric physicians' services. Subchapter B: Outpatient Hospital Services and Ambulatory Surgical Services - Amends SSA title XVIII to: (1) extend the ten percent reduction in payments for capital-related costs of outpatient hospital services, as well as the 5.8 percent reduction in payments for other costs of such services; and (2) extend special payment rates for certain eye or eye and ear hospitals. (Sec. 5023) Directs the Secretary to suspend the annual update for ambulatory surgery payments for FY 1994. (Sec. 5025) Amends the Omnibus Budget Reconciliation Act of 1990 (OMBRA '90) to extend the cap on payments for intraocular lenses. Subchapter C: Durable Medical Equipment - Amends SSA title XVIII to: (1) revise payment rules for items of durable medical equipment (DME) and supplies; (2) remove aspirators and nebulizers from the category of DME items requiring frequent and substantial servicing, and specifically provide for payment of related accessories; (3) set forth requirements which suppliers of medical equipment and supplies must satisfy in order to qualify for Medicare reimbursement; (4) require development of standardized certificates of medical necessity forms; (5) require DME suppliers to submit claims to the carrier with jurisdiction over the geographic area including the patient's permanent residence; (6) place restrictions on certain DME supplier marketing and sales practices; (7) specify circumstances under which Medicare beneficiaries are not financially liable for covered items and services furnished by a supplier; (8) address adjustments made to unreasonable DME payment amounts; (9) determine payments for surgical dressings; and (10) reduce the DME fee schedule amount for transcutaneous electrical nerve stimulation devices. (Sec. 5032) Freezes payments during 1994 for parenteral and enteral nutrients, supplies, and equipment at 1993 levels. (Sec. 5034) Directs the Secretary to report to the Congress on: (1) the effect of the uniform criteria established pursuant to this Act for DME items; and (2) appropriate methodology for determining payment under Medicare for prosthetic devices and orthotics. (Sec. 5037) Amends SSA title XI to modify anti-kickback provisions. (Sec. 5042) Requires a report to the Congress on variations in DME supplier costs. Subchapter D: Part B Premium - Amends SSA title XVIII to extend current law with respect to the monthly Medicare part B premium for beneficiaries enrolled in Medicare. Subchapter E: Other Provisions - Revises provisions of SSA title XVIII, including: (1) to revise payments for clinical diagnostic laboratory tests; (2) to address the provision of x-ray services by rural health clinics and federally-qualified health centers; (3) to condition payment for mammograms on the certification status of the facility; and (4) to provide Medicare coverage of oral cancer drugs. (Sec. 5064) Amends the Omnibus Budget Reconciliation Act of 1986 (OMBRA '86) to extend the Alzheimer's Disease Demonstration. (Sec. 5066) Amends the Consolidated Omnibus Budget Reconciliation Act of 1985 (COMBRA '85) to extend certain municipal health service demonstration projects. (Sec. 5069A) Requires a report to the Congress on annual payment limitations for outpatient physicial and occupational therapy services. Chapter 2: Provisions Relating to Parts A and B - Amends Medicare part C (Miscellaneous) provisions relating to Medicare parts A (Hospital Insurance) and B (Supplementary Medical Insurance) to: (1) eliminate requirements for special adjustments for administrative costs of hospital-based home health agencies; (2) make changes with regard to Medicare as secondary payor; (3) reduce payment for erythropoientin; (4) require nursing facilities and home health agencies to inform Medicare beneficiaries of the hospice benefit; and (5) require revision of the capitation payment methodology for health maintenance organizations (HMOs) to account for regional variations in application of Medicare secondary payor provisions. (Sec. 5073) Amends Medicare part B with regard to use of carriers to recover erroneous payments from primary payers. (Sec. 5072, 5074, and 5078) Requires: (1) a report on Medicare payments to hospitals for medical residency training program costs; (2) a report on the use of the new shared facility arrangement exception to ownership and compensation arrangements under the ban on certain referrals by physicians; and (3) establishment of a method of outreach to newly eligible Medicare beneficiaries qualifying for Medicaid payment of out-of-pocket expenses. (Sec. 5077) Amends OMBRA '86 to extend certain waivers under Medicare for the Watts Health Foundation. (Sec. 5079) Amends the Omnibus Budget Reconciliation Act of 1987 (OMBRA '87) to extend the waivers under Medicare for social health maintenance organization (SHMO) demonstration projects. Amends the Deficit Reduction Act of 1984 to require additional SHMO demonstration projects and permit one project to enroll Medicare end stage renal disease beneficiaries. (Sec. 5082) Amends the Omnibus Budget Reconciliation Act of 1990 (OMBRA '90) to revise the payment methodology for organizations under a risk-sharing contract with the Secretary. Chapter 3: Provisions Relating to Medicare Supplemental Insurance Policies - Amends OMBRA '90 and Medicare to make changes to Federal standards respecting the sale of Medicare supplemental insurance policies. Subtitle B: Medicaid Program and Other Health Care Provisions- Chapter 1: Medicaid Program - Subchapter A: Program Savings Provisions - Amends SSA title XIX to, among other things: (1) repeal the mandate that States cover personal care services under their Medicaid programs for all individuals entitled to nursing facility benefits; (2) allow States to establish formularies limiting coverage of prescription drugs under their Medicaid programs; (3) prohibit States from disregarding assets in cases where an individual has received payments under a long-term care policy; (4) address the liability of third parties to pay for care and services provided to Medicaid eligibles; (5) require States to have in effect certain laws relating to medical child support; and (6) make changes with regard to payments for disproportionate share hospitals. (Sec. 5117) Amends SSA to add a new title XXI requiring establishment of a Health Coverage Clearinghouse to identify third parties which may be liable for payment of health care items and services furnished to Medicare, Medicaid, Indian Health Service, and Maternal and Child Health Service beneficiaries. Subchapter B: Miscellaneous Provisions - Amends SSA title XIX to, among other things: (1) provide for the application under Medicaid of the physician self-referral prohibitions currently under Medicare; (2) require State maintenance of annual expenditures (adjusted) for State Medicaid fraud control units; (3) change treatment of HMO enrollees in determining the Medicaid inpatient utilization rate of a hospital seeking to qualify as a disproportionate share hospital; (4) raise, with respect to eligible States, Federal Medicaid matching payments for State expenses incurred in the provision of bona fide emergency medical services to undocumented aliens; (5) establish an option for States to make TB-infected individuals eligible for limited TB-related services; (6) require that mammographies paid for under Medicaid be conducted by a facility certified under the Mammography Quality Standards Act of 1992; and (7) make permanent the current law requirement for continued Medicaid coverage of families who lose eligibility for cash assistance under the Aid to Families with Dependent Chidren Program because they work. (Sec. 5132 and 5144) Amends SSA title XI to: (1) authorize an alternative intermediate remedy for redressing kickback offenses; (2) change procedures for initiation of a civil monetary penalty action; and (3) raise the ceiling on Federal Medicaid matching payments to Puerto Rico and other specified territories. (Sec. 5137) Extends the period during which the Secretary is required to waive application of the enrollment mix requirement under Medicaid for certain HMOs under the Dayton Area Health Plan, Inc. (Sec. 5138, 5146, and 5150) Amends the Omnibus Budget Reconciliation Act of 1989 with respect to the Tennessee Primary Care Network, certain demonstration projects for low-income pregnant women and children, and the Kent Community Hospital Complex and the Saginaw Community Hospital. (Sec. 5139) Directs the Secretary to waive application of the enrollment mix requirement under Medicaid with respect to the District of Columbia Chartered Health Plan, Inc.. (Sec. 5140) Amends the Family Support Act of 1988 to extend the period during which the Secretary is required to waive application of certain provisions of Medicaid law for the Minnesota Prepaid Demonstration Project. Subchapter C: Miscellaneous and Technical Corrections Relating to OMBRA '90 - Amends OMBRA '90 to make miscellaneous and technical corrections to various specified Medicaid-related provisions. Chapter 2: Universal Access to Childhood Immunizations - Amends the Public Health Service Act to entitle each State to the Federal purchase of enough pediatric vaccines to immunize each child in the State who is: (1) covered under title XIX (Medicaid) of the Social Security Act; (2) uninsured, or has insurance which does not cover vaccinations; or (3) an Indian. (Sec. 5181) Establishes the National Childhood Immunization Trust Fund. Exempts the vaccine program from reduction under the Balanced Budget and Emergency Deficit Control Act of 1985. Mandates State allotments for a registry of information on every child, including immunization data. Authorizes appropriations. Mandates grants to States to achieve objectives for immunizing U.S. children. Authorizes appropriations. (Sec. 5182) Amends the Omnibus Budget Reconcilation Act of 1989 to authorize appropriations from the Vaccine Injury Compensation Trust Funds to administer certain provisions of the National Vaccine Injury Compensation Program. Amends the Public Health Service Act to modify provisions regulating the effect on the statute of limitations of revisions to the Vaccine Injury Table. (Sec. 5183) Amends Medicaid provisions to require notifying all Medicaid-eligible persons under 21 of the need for immunizations. Adds grant entities under Public Health Service Act health provisions for residents of public housing to the list of entities within the definition of "Federally-qualified health center." (Sec. 5184) Allows Medicaid payments directly to vaccine manufacturers under certain programs. (Sec. 5185) Authorizes grants for demonstration projects providing comprehensive services to reduce the incidence of infant mortality and morbidity, fetal deaths, maternal mortality, fetal alcohol syndrome, and low birth weight. Authorizes appropriations. (Sec. 5186) Amends title V (Maternal and Child Health Services Block Grant) of the Social Security Act to authorize appropriations to carry out specified provisions. (Sec. 5187) Modifies compensation requirements regarding members of the National Advisory Council on the National Health Service Corps. Allows certain entities that are migrant, community, homeless, and public housing health services providers to elect certain treatment under the Public Health Service for purposes of malpractice actions. Removes provisions allowing waiver of rights to recover National Health Service Corps scholarship or loan repayment amounts after default. Subtitle C: Communications Licensing Improvement - Chapter 1: Competitive Bidding Authority - Licensing Improvement Act of 1993 - Amends the Communications Act of 1934 to empower the Federal Communications Commission (FCC) to use a system of competitive bidding in the granting of licenses involving the use of the electromagnetic spectrum (public airwaves). Outlines certain provisions, including: (1) uses to which such bidding may apply; (2) establishment by the FCC of a competitive bidding methodology; (3) alternative payment schedules for the use of airwaves; and (4) bidder and licensee qualifications. (Sec. 5205) Revises the FCC's regulatory authority in the mangagement of mobile communications services. Considers a person engaged in the provision of commercial mobile services to be a common carrier and, therefore, required to establish physical connections as required under the Communications Act. Prohibits State or local government imposition of any rate or entry regulation on commercial mobile service, but allows the FCC to grant a State petition to regulate rates under certain conditions. Chapter 2: Emerging Telecommunications Technologies - Emerging Telecommunications Technologies Act of 1993 - Amends the National Telecommunications and Information Administration Organization Act to require the Assistant Secretary of Commerce for Communications and Information and the FCC Chairman to conduct joint electromagnetic spectrum planning with respect to future spectrum requirements and promotion of efficient use of the spectrum. (Sec. 5222) Directs the Secretary to report to the President and the Congress identifying bands of frequencies that are allocated primarily for Government, are eligible for licensing, and are not required by the Government. Requires a report to the Congress on preliminary identification of reallocable bands of frequencies. Requires that an advisory committee be convened to assist in carrying out this Chapter. Directs certain actions after receipt of the advisory committee report on reallocation of band frequency assignments between Government and private uses. Authorizes the President to substitute alternative frequencies in the interest of national defense, governmental needs, public health or safety, or financial considerations. Directs the FCC to submit a plan for the distribution of reallocated frequency bands. Authorizes the President to reclaim reassigned frequencies. Chapter 3: Communications Technical Amendments - Sets forth corrections and technical amendments to communications provisions. Subtitle D: Energy Programs - Amends the Omnibus Budget Reconciliation Act of 1990 to extend from September 30, 1995, to September 30, 1998, the authority of the Nuclear Regulatory Commission to collect annual charges. Title VI: Committee on Foreign Affairs - States that the Committee on Foreign Affairs recommends changes in Federal law which would reduce direct spending under the Foreign Service Retirement and Disability Fund and the Foreign Service Pension System by requiring a three-month delay in cost-of-living adjustments for each year, FY 1994 through 1996. Title VII: Committee on the Judiciary - Amends the Omnibus Budget Reconciliation Act of 1990 to extend through FY 1998 the authorization for the collection of surcharges for use of the Patent and Trademark Office. Title VIII: Committee on Merchant Marine and Fisheries - Amends Federal shipping law to extend the years during which certain tonnage duties are imposed. (Sec. 8002) Declares the sense of the Congress that the inland waterways fuel tax should not be increased beyond those increases already mandated by law. Title IX: Committee on Natural Resources - Amends specified Federal law regarding the political union of the Commonwealth of the Northern Mariana Islands (Commonwealth) with the United States to repeal the direct grant asssitance for such Islands. Prescribes guidelines under which the United States commits its full faith and credit for specified payments to certain U.S. possessions and territories, including payments for capital improvements projects. Requires reports on the minimum wage and immigration policies of the Commonwealth. (Sec. 9002) Amends the Mineral Leasing Act to provide that, in calculating the amount to be paid to States of revenues derived from Federal onshore mineral and geothermal steam leasing receipts, 50 percent of the portion of the appropriation allocable for administration and enforcement shall be deducted from those receipts in approximately equal amounts each month prior to their division and distribution between the States and the United States. (Sec. 9003) Mandates the payment of a specified minimum flat claim maintenance fee and location fee by the holder of an unpatented mining claim, mill, or tunnel site in lieu of the assessment work and related filing requirements under certain Federal mining law. Exempts certain oil shale claims from the fee requirement. Waives fees under certain conditions. (Sec. 9004) Amends Federal reclamation laws to mandate that non-Federal recipients of water delivered by way of Federal facilities pay an operation and maintenance charge to the United States. Establishes the Natural Resources Restoration Fund for the benefit of fish and wildlife resources and habitat affected by Federal reclamation projects. (Sec. 9005) Amends the Land and Water Conservation Fund Act of 1965 to prohibit recreation user fees for campgrounds lacking specified amenities. Revises the terms of "Golden Age" passports in the National Park System. Establishes user fees for rights-of-way, tour vehicles or aircraft, and commercial telephone transmission facilities on Federal lands. (Sec. 9007) Directs the Secretaries of Energy and of the Interior adjust fees and other charges in order to recover the cost of Government services and establish a fee mechanism to recover Government costs of providing services which are currently free. (Sec. 9008) Directs the President to transmit in the annual budget an estimate of unfunded future Federal liabilities that are not accounted for in the budget itself. Title X: Committee on Post Office and Civil Service - Subtitle A: Civil Service - Delays the cost-of-living adjustments scheduled to take effect under certain Federal employee retirement systems during FY 1994 through 1996. (Sec. 1002) Amends the Civil Service and Federal Employees' Retirement Systems and the Foreign Service and Central Intelligence Agency systems to permanently eliminate the lump sum retirement option except for employees with a critical medical condition. (Sec. 1003) Eliminates the 1994 annual cost-of-living adjustment for Members of Congress and Federal employees. Amends the Ethics Reform Act of 1989 and other Federal law to modify the formulae for computing such adjustments for 1995 through 1997. (Sec. 1004) Amends Federal law to delay locality-based comparability payments until July of 1994. Limits the total amounts payable for locality payments between July 1, 1994, and September 30, 1998. Authorizes the President to specify locality payments less than the minimum amounts which would otherwise be required if necessary to comply with such limitations. Delays annual cost-of-living adjustments for Federal employees and Members of Congress until July of each year for the period between January 1, 1995, and December 31, 2003. Repeals provisions excluding senior executives from the limitation on the accumulation of annual leave. Prohibits cash awards during FY 1994 through 1998. Limits the average total number of civilian employees in the executive branch (except employees of the U.S. Postal Service and Postal Rate Commission) during FY 1994 through 1998. Requires the Director of the Administrative Office of United States Courts to apply the prohibitions and limitations of this Act with respect to annual cost-of-living adjustments and locality-based comparability payments to employees under the separate system of the Office. (Sec. 1005) Requires certain Federal Employees Health Benefits Program (FEHBP) plans to apply the Medicare part B limiting charges for physicians' services to enrolled retirees who are 65 or older and do not participate in Medicare part B. (Sec. 1006) Extends the proxy premium formula for determining Government contributions under FEHBP through contract year 1998 in the absence of a Government-wide indemnity benefit plan. Expresses the sense of the Congress that such extension should not be considered to reflect any view on the appropriateness, merits, or timing, or any other aspect of any comprehensive health care reform legislation. Subtitle B: Postal Service - Directs the U.S. Postal Service to make a specified additional payment into the Civil Service Retirement and Disability Fund and the Employee Health Benefits Fund to cover increases due to retirement cost-of-living adjustments and increases in health benefits costs. Subtitle C: Revenue Forgone Reform - Revenue Forgone Reform Act - Amends Federal postal service law to repeal the authorization of appropriations under the Overseas Citizens Voting Rights Act of 1975 and the Federal Voting Assistance Act of 1955 for mail sent at reduced postage rates. Revises provisions relating to the treatment of reduced-rate categories of mail. (Sec. 10203) Repeals certain Federal provisions authorizing appropriations to the Postal Service for certain accumulated operating indebtedness and directing the Postal Service to provide door or curbline delivery to certain permanent addresses. Authorizes appropriations for FY 1994 through 2035 to cover losses. (Sec. 10205) Prohibits reduced mailing rates for mail adverstising or offering products or services if: (1) the sale is not related to the purposes allowing mail at such rates; or (2) the mail matter involved is part of a cooperative mailing with a person not authorized to mail at reduced rates. Revises provisions with respect to the mailing rates of books. (Sec. 10207) Expresses the sense of the Congress that any legislation enacted after September 30, 1994, which would expand the class of mail eligible for reduced rates should provide for funding ensuring no losses to the Postal Service nor increases in rates for other classes of mail. Title XI: Committee on Public Works and Transportation - Amends the Federal Aviation Act of 1958 to revise fees charged for aircraft registration, designation as an aviation medical examiner, issuance of an airman's certificate to be a pilot and costs associated with processing forms for fuel system repairs. Requires fees be deposited in the Airport and Airway Trust Fund. (Sec. 11002) Amends the Flood Control Act of 1968 to authorize the Secretary of the Army to collect fees for the use of developed recreation facilities, including campsites, beaches, and boat launching ramps. Requires fees to be deposited into the Treasury account for the Corps of Engineers. Title XII: Committee on Veterans Affairs - Veterans Reconciliation Act of 1993 - Amends the Omnibus Reconciliation Act of 1990 to extend through September 30, 1998, the requirement that veterans with a certain minimum income level make copayments in exchange for receiving certain health care benefits through the Department of Veterans Affairs. Extends: (1) the requirement of a minimal copayment for medications received by veteran outpatients; (2) authority to recover the cost of veterans' services from third party insurers; (3) the authority of the Secretary of the Treasury to provide certain financial information for income verification purposes; (4) a monthly pension limitation for certain recipients of nursing home care covered under Medicaid; and (5) procedures applicable to liquidation sales on defaulted home loans to veterans. (Sec. 12006) Prohibits any FY 1994 cost-of-living adjustment in the rates of dependency and indemnity compensation paid to surviving spouses. (Sec. 12008) Increases the home loan fee charged to veterans for loans guaranteed by the Department, closed after September 30, 1993, and before October 1, 1998. (Sec. 12009) Reduces by one percentage point the FY 1994 cost-of-living adjustment for educational assistance benefits payable to active duty and reserve personnel under the Montgomery GI Bill educational assistance program. (Sec. 12010) Excludes a person who is not the natural or legally adopted child of the parent from eligibility for survivors' and dependents' educational assistance. Title XIII: Committee on Ways and Means: Savings - Subtitle A: Old-Age, Survivors and Disability Insurance Programs - Amends OMBRA '90 to require the Secretary to reestablish and maintain in service the same number of telephone lines to each local social security office that were in place as of September 30, 1989. (Sec. 13003) Makes amendments to SSA title II, including to: (1) permit States collecting social security numbers to use those numbers to eliminate duplicate names and names of convicted felons from jury source lists; (2) extend to all States the option to provide police officers and firefighters with social security coverage; (3) disregard the windfall elimination provision in computing any U.S. totalization benefit and the amount of a regular U.S. benefit of an individual who receives a foreign totalization benefit based in part on U.S. employment, and who does not receive any other pension based on noncovered employment; (4) provide that military pensions based wholly on service in the military reserves before 1988 shall not trigger application of the Government pension offset or windfall elimination provision to the individual's social security benefits; (5) permit the Department of Agriculture to share its list of names, social security numbers, and employer identification numbers of the owners of retail grocery stores which redeem food stamps with other Federal agencies for the purpose of investigating food stamp fraud and other crimes; and (6) prohibit a State from using social security numbers in the administration of any driver's license or motor vehicle registration law where the State has not contracted to provide death certificate and related information to the Secretary, or where use of death information is restricted. (Sec. 13005) Exempts from payment liability and penalties ministers who were American citizens and residents of Canada prior to the 1984 totalization agreement between the United States and Canada and failed to file a tax return or pay self-employment taxes. (Sec. 13010) Amends IRC to: (1) authorize the Secretary of the Treasury to disclose information from tax returns on individuals' mortality status to the Secretary for eipdemiological research purposes; (2) coordinate the collection of domestic service employment taxes with the collection of income taxes; and (3) change threshold requirements with respect to social security employment taxes on domestic services. (Sec. 13015) Requires the Secretary to study and report to the Congress on the rising costs of disability benefits. (Sec. 13016) Amends the Social Disability Amendments of 1980 to extend the Secretary's authority to conduct disability work incentive demonstration projects. Subtitle B: Human Resources Amendments - Chapter 1: Child Welfare Services, Foster Care, and Adoption Assistance - Amends SSA title IV part B (Child-Welfare Services) to, among other thing: (1) create a capped entitlement program to provide child welfare services designed to strengthen and preserve families; (2) repeal provisions linking the payment of title IV part B funds to the implementation of protections for children in foster care; (3) require State part B plans to contain a description of the specific measures taken by the State to comply with the Indian Child Welfare Act; and (4) provide for child welfare traineeships. (Sec. 13212) Directs the Secretary to provide grants for State courts to improve foster care placement and adoption proceedings. (Sec. 13216) Amends SSA title IV part E (Foster Care and Adoption Assistance) (FCAA) to change the reimbursement policy with respect to foster care maintenance payments made on behalf of certain children whose adoption has been set aside by a court or whose voluntary placement in foster care has been judicially determined to be in the best interests of the child. Requires States to review their foster care maintenance payment and adoption assistance levels. Requires the health and education records in each child's case plan include a record that the foster care provider was advised (where appropriate) of the child's eligibility for certain Medicaid services. Makes permanent the authorization for the independent living program. Sets forth case plan requirements for children placed in foster care a substantial distance from their homes or in a different State. (Sec. 13218) Directs the Secretary to study and report to the Congress on the ways in which States implement the reasonable efforts requirements for State part E plans. (Sec. 13225) Amends OMBRA '89 to extend permanently (and retroactively to October 1, 1992) the level of Federal reimbursement under part E for the training of personnel employed by the State or local child welfare agency, and for the training of foster and adoptive parents. (Sec. 13227) Amends SSA title XI part A to overturn certain limitations in Suter v. Artist M. on private enforceability of State plan requirements. (Sec. 13232) Prohibits the Secretary, until October 1, 1994, from reducing any payment to any State under parts B or E because of State noncompliance with part B foster care protections. (Sec. 13233) Requires the Secretary to make grants to eligible institutions to train individuals to deliver culturally sensitive and bilingual child welfare services in border areas with Mexico. Authorizes approprations. Chapter 2: Child Support Enforcement - Amends SSA title IV part D (Child Support and Establishment of Paternity) to set up new paternity establishment performance standards and procedures for State child support enforcement programs. Outlines State plan requirements. Requires State child support enforcement agencies to periodically report, at no charge, the names and amounts of obligors at least two months delinquent in child support payments to bona fide consumer reporting agencies. Chapter 3: Supplemental Security Income - Amends SSA title XVI (Supplemental Security Income) (SSI) and other Federal law to require the Social Security Administration to charge States fees for the Federal cost of administering supplemental SSI payments. (Sec. 13252) Amends OMBRA '90 to make permanent the exclusion of State and local relocation assistance from countable income under SSI. (Sec. 13253-13256) Amends SSA title XVI to: (1) deem to be living in a household a spouse or parent of family members on SSI who is absent because of active duty military assignment; (2) exclude hazardous duty pay from countable income; (3) continue SSI benefits to children who are U.S. citizens if they received SSI in the United States and then accompanied their parents on military assignment to a U.S. territory or possession; and (4) extend the SSI definition of disability for children under 18 to any person under age 18. (Sec. 13257) Exempts income of up to $2,000 per year received by individual Indians that is derived from leases on trust or restricted Indian lands in determining eligibility and benefit levels under AFDC (SSA title IV part A) and SSI. Chapter 4: Aid to Families with Dependent Children - Amends SSA title IV part A to: (1) reduce to 50 percent the enhanced Federal matching available for certain categories of State administrative expenses; (2) make optional a State's verification of an individual's immigration status with the Immigration and Naturalization Service through an immigration status verfication system; (3) delay Federal requirements regarding AFDC-UP participation rates; and (4) increase the amount of stepparent earnings disregarded in determining the eligibility and benefit amounts of AFDC recipients and applicants. (Sec. 13263) Amends part F (Job Opportunities and Basic Skills Training Program) (JOBS) to require development of criteria for performance standards in the JOBS program, rather than performance standards themselves. (Sec. 13264) States that the Congress declares: (1) it is the responsibility of the Federal Government to reduce family dependence on income from welfare programs, to assist them toward self-sufficiency, and to increase the living standards of low-income families; and (2) the Federal Government should help welfare recipients and individuals at risk of welfare participation to improve education and job skills, to obtain access to child care and support services, and to take other steps as may assist them to become financially independent. Directs the Secretary to develop welfare participation measures and predictors, and report annually on welfare participation to specified congressional committees. Establishes the Advisory Board on Welfare Participation. (Sec. 13265) Directs the Secretary to provide for a demonstration project offering low-income residents of Milwaukee, Wisconsin, employment, wage supplements, health and child care, and job counseling and training. (Sec. 13266 and 13270) Amends the Family Support Act of 1988 to: (1) delay the requirement for implementation of the Unemployed Parent program in Puerto Rico, Guam, the Virgin Islands, and American Samoa until the limitations on Federal matching payments with respect to AFDC and FCAA maintenance payments are repealed; and (2) extend the authorization for early childhood development projects. (Sec. 13269) Amends OMBRA '87 to extend New York State's Child Assistance Program demonstration. (Sec. 13267) Amends SSA title XI to provide that, with respect to AFDC, one adult member of a household may sign a declaration attesting to the citizenship or satisfactory immigration status of other household members. Chapter 5: Unemployment Insurance - Amends IRC and SSA title III (Unemployment Compensation) to provide for the treatment of short-time compensation programs under which individuals whose workweeks have been reduced by at least ten percent (especially as an alternative to a temporary layoff) are eligible for unemployment compensation, under certain conditions. (Sec. 13275) Amends the Federal-State Extended Unemployment Compensation Act of 1970 to increase the reimbursement rate and repeal special eligibility requirements under the extended unemployment program. (Sec. 13276 and 13277) Amends IRC to extend the current Federal unemployment tax rate and require disclosure of tax information to the Railroad Retirement Board for administration of the Railroad Retirement and Railroad Unemployment Insurance Acts. Chapter 6: Technical Provisions - Makes technical corrections related to the income security and human resources provisions of OMBRAs '89 and '90. (Sec. 13283) Amends SSA title XVI to repeal certain obsolete provisions relating to treatment of the earned income tax credit. Subtitle C: Medicare Program - Chapter 1: Provisions Relating to Part A -Subchapter A: Elimination of Inflation Update for Services Provided under Part A: - Amends SSA title XVIII (Medicare) to eliminate updates for inpatient hospital services and hospice care under Medicare part A in FY 1994 and 1995. (Sec. 13402) Prohibits the Secretary from applying an update factor to the cost limits for skilled nursing facility cost reporting periods beginning in FY 1994 and 1995. Subchapter B: Other Provisions Relating to Part A - Amends SSA title XVIII to, among other things: (1) provide that a change in classification of hospitals from one area to another cannot result in a reduction in the wage index for an urban area if the area has an age index below the rural wage index for the State or if the area is the only urban area in a State with no rural areas; (2) change certain standards for designating metropolitan statistical areas that are used in determining treatment of hospitals in rural counties adjacent to urban areas; (3) require the phase out of payments for day outlier cases starting in FY 1995; (4) authorize appropriations for the Essential Access Community Hospital (EACH) demonstration program; (5) provide for a prospective payment system for outpatient rural primary care hospital services; (6) continue special payments for Medicare-dependent, small rural hospitals for discharges occurring through FY 1994, with reduced payments for certain discharges; (7) allow to participate in Medicare hospitals where the care of patients receiving qualified psychologist services is under a clinical psychologist; (8) require skilled nursing facilities to inform beneficiaries of the hospice benefit under Medicare; (9) reduce the part A premium, on a phase-in basis, for individals with 30 or more quarters of social security coverage (and their spouses); (10) require periodic updating of salary equivalency guidelines for physical therapy and respiratory therapy services; and (11) provide that diagnosis-related group (DRG) window provisions will not apply to hospitals that are not paid on a DRG basis. (Sec. 13414) Amends OMBRA '87 to: (1) reauthorize and extend the rural health transition grant program; and (2) provide that all hospitals classified as regional referral centers on September 30, 1992, shall retain such status through FY 1994. (Sec. 13418) Amends OMBRA '90 to require the Secretary to continue limited-service rural hospital demonstration projects through calendar 1995. (Sec. 13419) Amends OMBRA' 89 to extend the hemophilia pass-through program. (Sec. 13420) Declares that, in the case of a State with a Medicare-approved payment system, no other provision of law shall be construed as preventing the system from providing that payment for covered services be made on the basis of rates provided for under such system. (Sec. 13423) Prohibits the Secretary from taking action to recover certain amounts paid by Medicare to uniformed services treatment facilities in Boston, Baltimore, and Seattle for services provided between October 1, 1986, and December 31, 1989, except to the extent that funds are made available for that purpose under the Department of Defense Appropriations Act, 1993. Requires a report to the Congress on establishment of joint medical facilities among the Department of Defense, the Department of Veterans' Affairs, and other entities. (Sec. 13424 and 13425) Requires the Secretary to: (1) review ]the DRGs assigned to discharges of patients with intractable epilepsy; (2) revise the assignment of discharges to such groups as the Secretary considers appropriate to account for the resource requirements of such patients; and (3) begin collecting data necessary to compute a skilled nursing facility wage index adjustment to the routine service cost limits required under Medicare. Requires the Prospective Payment Assessment Commission to report to the Congress on the impact of applying routine per diem cost limits for skilled nursing facilities on a regional basis. (Sec. 13429) Allows hospitals that have been reclassified from urban to rural as a result of revisions to metropolitan statistical area definitions issued by the Office of Management and Budget on December 28, 1992, to apply to the Medicare Geographic Classification Review Board for reclassification in FY 1994. Chapter 2: Provisions Relating to Part B: Subchapter A: Elimination of Inflation Update - Amends SSA title XVIII part B to eliminate the inflation update for physician and related professional services and other items and services. (Sec. 13432) Freezes payments for enteral and parenteral nutrients, supplies and equipment, rural health clinic, federally qualified health center, and comprehensive outpatient rehabilitation facility services, dialysis services, and other part B items and services. Subchapter B: Physicians' Services - Amends SSA title XVIII part B to, among other things: (1) repeal the OMBRA '90 prohibition on separate payments for EKG interpretations; (2) repeal the reductions in payments to new physicians and practitioners; (3) prohibit changing the methodology in effect as of January 1, 1992, for calculating anesthesia time in the fee schedules; (4) revise requirements with respect to geographic adjustment factors and beneficiary liability for amounts billed above the limiting charge; (5) require pre-payment screening by carriers of unassigned claims submitted by nonparticipating physicians; (6) require the Explanation of Benefits form to contain information on amounts billed in excess of the applicable limiting charge; (7) specify the practitioners who may only bill for services on an assignment-related basis; (8) include antigens prepared by a physician on the physician fee schedule; (9) prohibit the imposition of user fees in specified circumstances in the administration of claims relating to physicians' services; and (10) specify the conditions under which the Secretary can recognize substitute billing arrangements between two physicians. (Sec. 13444) Requires the Secretary to revise and report to specified congressional committees on the data necessary to revise geographic indices. Requires the Physician Payment Review Commission to develop criteria for use in redefining the localities used within States for adjusting physicians' fees. (Sec. 13446) Requires the Secretary to develop relative values for the full range of pediatric physicians' services and report to the Congress. Subchapter C: Ambulatory Surgical Center Services - Makes amendments identical to those made above to the Medicare program and OMBRA'90 under subchapter B of chapter 1 of title V of this Act with respect to eye and eye and ear hospitals and intraocular lenses. (Sec. 13452) Requires the Secretary to report to the Congress on the costs to providers of intraocular lenses provided to individuals enrolled under Medicare part B. Subchapter D: Durable Medical Equipment - Makes amendments similar to those made above to the Medicare program and SSA title XI under subchapter C of chapter 1 of title V of this Act with respect to durable medical equipment and kick-backs. (Sec. 13468) Subjects ostomy supplies, tracheostomy supplies, and urologicals to national payment limits. Subchapter E: Other Provisions - Makes amendments similar to those made above to the Medicare program, OMBRA '86, and COMBRA '85 under subchapter E of chapter 1 of title V of this Act with respect to oral cancer drugs and the treatment of certain Indian health programs and facilities as federally-qualified health centers, and the extension of Alzheimer's disease and municipal health service demonstration projects. (Sec. 13471) Amends SSA title XVIII to, among other things: (1) freeze at the 1992 level the conversion factor used to determine payments to medically directed certified registered nurse anesthetists; (2) cap the part B premium penalty for late enrollment for Federal employees who meet certain conditions; and (3) establish statutory definitions for speech language pathologist and audiologists. (Sec. 13473) Provides for uniform coverage of "off-label" drugs used in anti-cancer therapy. Requires a report to specified congressional committees on Medicare coverage of patient care costs associated with clinical trials of new cancer therapies. Subchapter F: Part B Premiums - Duplicates the amendment to the Medicare program made above under subchapter D of chapter 1 of subtitle A of title V of this Act with respect to the monthy Medicare part B premium. Chapter 3: Provisions Relating to Parts A and B -Subchapter A: Elimination of Updates - Amends SSA title XVIII to eliminate updates in payments to hospitals for the direct costs of graduate medical education for cost reporting periods beginning during FY 1994 and 1995. (Sec. 13502) Prohibits the Secretary from providing any update in the cost limits for home health services for cost reporting periods beginning during FY 1994 and 1995. Subchapter B: Medicare Secondary Payer Provisions - Makes amendments similar to those under chapter 2 of subtitle A of title V of this Act with respect to Medicare as secondary payer. Subchapter C: Physician Ownership and Referral - Amends SSA title XVIII to: (1) apply the ban on certain referrals by physicians to all payers, extending it to cover additional specified health services as well as new exceptions; (2) expand current standards used to define a group practice; and (3) provide that Federal law shall not preempt State laws that related to referrals not covered under the ban, or that relate to referrals covered under the ban but are even more restrictive. Subchapter D: Other Provisions - Sets forth measures similar to those under chapters 1 and 2 of subtitle A of title V of this Act with respect to: (1) interest payments on clean claims; (2) payments for erythropoietin; (3) qualified Medicare beneficiary outreach; (4) social health maintenance demonstrations; (5) the second surgical opinion program under SSA title XI; (6) hospice notification; and (7) Medicare capitation payments. (Sec. 13551) Requires the Secretary to redetermine the full-time-equivalent (FTE) resident amount to reflect the amount that would be allowed if the hospital had been liable to pay FICA taxes or make other specified retirement contributions for residents during the base year, but did not make such payments, yet now must do so as a result of OMBRA '90. Amends SSA title XVIII to: (1) provide for adjustments for certain publicly funded family residency programs; (2) extend on a graduated basis to three years (after 1997) the current one-year period following a transplant procedure during which Medicare covers immunosuppressive drug therapy for beneficiaries who have received organ transplants; and (3) provide that user fees imposed under the Clinical Laboratories Improvement Act of 1967 are not subject to the general ban on user fees for determining compliance with any requirement of Medicare. (Sec. 13560) Amends the Balanced Budget and Emergency Deficit Control Act of 1985 (Gramm-Rudman-Hollings Act) to provide that to the extent that appropriations are enacted providing budget authority for Medicare administrative costs above a base level spending in FY 1992 of $1.526 billion, the appropriate discretionary spending limits shall be adjusted to accommodate additional budget authority in FY 1994 and 1995. Chapter 4: Medicare Supplemental Insurance Policies - Amends OMBRA '90 and Medicare to make specified changes to Federal standards respecting the sale and regulation of Medicare supplemental insurance policies. Chapter 5: Treatment of Certain State Health Care Programs - Amends the Employee Retirement Income Security Act of 1974 (ERISA) to provide that: (1) the Hawaii Prepaid Health Care Act will not be preempted by ERISA unless the Secretary of Labor notifies the Governor of Hawaii that certain conditions exist; and (2) State tax laws relating to employee benefit plans will continue to be preempted. Subtitle D: Customs and Trade Provisions - Amends the Tariff Act of 1930 to authorize appropriations for FY 1994 and 1995 for the United States International Trade Commission (ITC). Prohibits use of funds for any special study, requested by the executive branch unless the ITC is reimbursed. (Sec. 13601) Amends the Customs Procedural Reform and Simplification Act of 1978 to authorize appropriations for FY 1994 and 1995 for the United States Customs Service for noncommercial and commercial operations, and the air and marine interdiction programs. Amends the Trade Act of 1974 to authorize appropriations for FY 1994 and 1995 for the Office of the United States Trade Representative. (Sec. 13602) Amends the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) to extend the authority of the Secretary of the Treasury to collect customs user fees through September 30, 1998. (Sec. 13603) Amends the Trade Act of 1974 to remove the Union of Soviet Socialist Republics from the list of countries ineligible for designation as a beneficiary developing country under the Generalized System of Preferences (GSP). Extends duty-free treatment provided under the GSP through September 30, 1994. (Sec. 13604) Extends the worker trade adjustment assistance program (trade adjustment assistance benefits for workers adversely affected by import competition or the relocation of U.S. production facilities abroad), and authorization of appropriations, from FY 1993 through FY 1996. (Sec. 13605) Amends the Omnibus Trade and Competitiveness Act of 1988 to extend the authority of the President, for a specified period of time, to enter into trade agreements with foreign countries for the reduction or elimination of tariff or nontariff barriers if the Uruguay Round of multilateral trade negotiations under the General Agreement on Tariffs and Trade (GATT) has not resulted in such trade agreements by May 31, 1993. Provides that implementing bills involving tariff and nontariff trade agreements shall be effective only if, among other things, the President, at least 120 calendar days (currently, 90 days) before he enters into such an agreement, notifies the Congress of his intention and publishes such intention in the Federal Register. Extends congressional "fast track procedures" to such implementing bills through April 16, 1994. (Sec. 13606) Amends the Federal Trade Act of 1974 to eliminate the East-West Trade Statistics Monitoring System. Subtitle E: Customs Officer Pay Reform - Revises the pay system for United States Customs Service inspectors. (Sec. 13701) Amends the Tariff Act of 1930 to prohibit merchandise or passengers from foreign places, or merchandise being transported from one port to another, from being unladen from carrying vehicles during overtime hours (currently, at night). (Sec. 13702) Authorizes cash awards to customs officers for foreign language proficiency. (Sec. 13703) Amends COBRA to provide for reimbursement of appropriations from the Customs User Fee Account for agency retirement contributions. (Sec. 13704) Amends Federal law with regard to the treatment of certain pay of customs officers for retirement purposes. (Sec. 13705) Revises COBRA congressional reporting requirements respecting Account reimbursements. Requires additional General Accounting Office reports to the Congress on financing of overtime inspectional services through user fees. Title XIV: Revenue Provisions - Revenue Reconciliation Act of 1993 - Subtitle A: Training and Investment Incentives - Part I: Provisions Relating to Education and Training - Makes permanent after June 30, 1992: (1) the tax exclusion of employer-provided educational assistance; and (2) the targeted jobs credit. Allows the use of the targeted jobs credit, with limitations, for the hiring of a qualified participant in an approved school-to-work program. Part II: Investment Incentives - Subpart A: Research Credit - Makes permanent the credit for increasing research activities. Modifies the fixed base percentage of such credit for startup companies for taxable years after 1993. Subpart B: Capital Gain Provisions - Allows a taxpayer other than a corporation to exclude from gross income 50 percent of gain from the sale or exchange of qualified small business stock held for more than five years. Set forth rules and limitations for such exclusion. Treats one-half of such exclusion as an item of tax preference for minimum tax purposes. (Sec. 14114) Allows the rollover of gain from the sale of publicly traded securities into specialized small business investment companies. Subpart C: Modifications to Minimum Tax Depreciation Rules - Modifies the method of determining the depreciation deduction for certain personal property placed in service after 1993. Eliminates the depreciation adjustment for computing adjusted current earnings for such property. Subpart D: Increase in Expense Treatment for Small Business - Increases the dollar limitation on the election to expense certain depreciable small business assets. Part III: Tax-Exempt Bond Provisions - Provides a complete tax exemption (currently a 75 percent tax exemption) for bonds used to finance high-speed intercity rail facilities. (Sec. 14122) Permanently extends the authority to issue qualified small issue bonds to finance manufacturing facilities and farm property. Part IV: Expansion and Simplification of Earned Income Tax Credit - Repeals certain interaction rules with respect to the medical expense deduction, the deduction for health insurance, and the dependent care credit. Revises credit and phaseout percentages for 1994. Part V: Incentives for Investment in Real Estate - Subpart A: Extension of Qualified Mortgage Bonds and Low-Income Housing Credit - Makes permanent: (1) the authority to issue qualified mortgage bonds and qualified mortgage credit certificates; and (2) the low-income housing credit. (Sec. 14142) Provides that assistance under the HOME Investment Partnerships Act should not result in certain buildings being federally subsidized. Subpart B: Modification of Passive Loss Rules - Provides for the treatment of rental real estate activities under the limitations on losses from passive activities. Subpart C: Provisions Relating to Real Estate Investments by Pension Funds - Modifies exceptions to the exclusion of real property acquired by a qualified organization from the meaning of acquisition indebtedness. Makes certain exceptions inapplicable to sales out of foreclosure by a financial institution. (Sec. 14145) Repeals the special rule for publicly traded partnerships with respect to the treatment of unrelated business taxable income. (Sec. 14146) Permits a tax-exempt title-holding company to receive unrelated business taxable income if the unrelated income is incidentally derived from the holding of real property. (Sec. 14147) Excludes from unrelated business taxable income: (1) gains from the sale, exchange, or other disposition of real property acquired from financial institutions that are in conservatorship or receivership; and (2) loan commitment fees and certain option premiums. Provides for the tax treatment of pension fund investments in real estate investment trusts. Subpart D: Discharge of Indebtedness - Excludes from gross income the income from the discharge of qualified real property business indebtedness. Subpart E: Increase in Recovery Period for Nonresidential Real Property - Increases the depreciation recovery period for nonresidential real property. Part VI: Luxury Tax - Repeals the luxury excise tax on boats, aircraft, jewelry, and furs. (Sec. 14162) Modifies the luxury excise tax on automobiles to index the threshold for inflation occurring after 1990 and make such tax applicable to the first retail sale. Exempts from the luxury excise tax parts for accessories installed for use of passenger vehicles by disabled individuals. (Sec. 14163) Extends the current diesel fuel excise tax to diesel fuel used by noncommercial motorboats. Retains such taxes in the General Fund of the Treasury. Part VII: Other Changes - Repeals the tax preferences for the appreciated property charitable deduction. Disallows an adjustment related to the earnings and profits effects of any charitable contribution from being made in computing adjusted current earnings. (Sec. 14171) Requires Secretary of the Treasury to report to specified congressional committees on the development of a procedure for taxpayers to seek an agreement with the Secretary on the value of tangible personal property prior to the donation of such property to a qualifying charitable organization. (Sec. 14172) Amends the Railroad Retirement Solvency Act of 1983 to make permanent the treatment of certain railroad retirement benefits as received under employer plans. (Sec. 14173) Provides for the temporary extension of the deduction of health insurance costs of self-employed individuals. Subtitle B: Revenue Increases - Part I: Provisions Affecting Individuals- Subpart A: Rate Increases - Lowers the tax rates for certain taxpayers and increases the tax rate for certain higher incomes. Imposes a surtax on certain higher incomes. (Sec. 14203) Increases the tentative minimum tax for taxpayers other than corporations. (Sec. 14204) Makes permanent the overall limitation on itemized deductions and the phaseout of personal exemptions for high-income taxpayers. (Sec. 14206) Sets forth provisions to prevent the conversion of ordinary income to capital gain in certain financial transactions. Repeals certain exeptions to market discount rules. Provides for the treatment of purchases of stripped preferred stock after April 30, 1993. Revises methods of: (1) computing the limitation on the deductibility of investment interest; and (2) determining substantial appreciation of partnership inventory items. Subpart B: Other Provisions - Repeals the limitation on the amount of wages subject to the health insurance employment tax. (Sec. 14208) Increases and makes permanent the highest estate and gift tax rate. (Sec. 14209) Reduces the deduction for business meals and entertainment expenses. (Sec. 14210) Disallows a tax deduction for social club membership dues, except for employee recreational expenses. (Sec. 14211) Disallows a deduction as a trade or business expense remuneration to certain employees in excess of $1 million. (Sec. 14212) Reduces the compensation taken into account in determining contributions and benefits under qualified retirement plans. (Sec. 14213) Removes qualified residence sales, purchases, or leases and meals from the deduction for moving expenses. (Sec. 14214) Revises the limitation on using the preceding year's tax to calculate an individual's estimated tax payments. (Sec. 14215) Increases the amount of social security and tier 1 railroad retirement benefits to be included in the gross income of certain taxpayers. Part II: Provisions Affecting Business - Increases the tax rate for corporate income in excess of $10 million and the tax rate on personal service corporations. (Sec. 14222) Denies a tax deduction for lobbying expenses. Subjects lobbying organizations to special reporting requirements. (Sec. 14223) Requires any security which is inventory in the hands of the dealer to be included in inventory at its fair market value. Requires any dealer in securities that holds any security which is not in inventory at the close of any taxable year to: (1) recognize gain or loss as if the security were sold on the last business day of the taxable year; and (2) take into account any such gain or loss for such year (the mark-to-market requirement). (Sec. 14224) Requires taking into account: (1) certain Federal Savings and Loan Insurance Corporation (FSLIC) assistance as compensation for loss; and (2) FSLIC assistance for any debt for determining whether such debt is worthless and the amount of any addition to a reserve for bad debts. (Sec. 14225) Increases the required annual payment for corporations that fail to pay estimated income tax. Modifies the periods for applying such annualization. (Sec. 14226) Limits the Puerto Rico and possession tax credit to 60 percent of the possession corporation's qualified possession wages. (Sec. 14227) Modifies the limitation on corporate deductions for interest paid to related persons to take into account disqualified guarantees of indebtedness and the imposition of a gross basis tax. Part III: Foreign Tax Provisions - Subpart A: Current Taxation of Certain Earnings of Controlled Foreign Corporations - Requires U.S. shareholders of controlled foreign corporations to include in gross income a pro rata share of the corporation's excess passive assets. Modifies the rule on taxation of investment in U.S. property and takes into account excessive passive assets. Requires a report on investments by controlled foreign corporations in U.S property. (Sec. 14233) Excepts from foreign personal holding income dividends attributable to earnings and profits of the distributing corporation accumulated during any period which the person receiving such dividend did not hold such stock. Requires the establishment of an excess limitation account by taxpayers who receive foreign tax credits in a year they receive previously taxed earnings and profits. Subpart B: Allocation of Research and Experimental Expenditures - Reduces the amount allowed as allocation and apportionment of research and experimental expenditures from sources within the United States. Subpart C: Other Provisions - (Sec. 14235) Excludes passive dividends or interest income from foreign oil and gas income. (Sec. 14236) Modifies accuracy-related penalties for tax underpayments. (Sec. 14237) Denies the inclusion of certain contingent interest in the exemption for portfolio interest for nonresident aliens. (Sec. 14238) Authorizes the Secretary of the Treasury to prescribe regulations recharacterizing any multiple-party financing transaction as a transaction directly among any two or more of such parties when appropriate to prevent tax avoidance. Part IV: Energy Tax Provisions - Subpart A: Energy Tax Based on Btu Content - Imposes an excise tax on the following energy products: (1) taxable refined petroleum products removed from a U.S. refinery or terminal entered into the United States for consumption, use, or warehousing, and sold to a nonregistered person; (2) natural gas removed from any U.S. pipeline, entered into the United States for consumption, use, or warehousing, and entered into any nonregistered pipeline; (3) coal received at any facility for use as a fuel at such facility; and (4) the sale of electricity to ultimate users in the United States and the use of electricity which was not subject to such tax. Bases the rate of tax on such products on the applicable Btu factor and content. (Sec. 14241) Provides for refunding certain amounts to ultimate vendors of petroleum used for heating oil and international commercial transportation. Repays certain sums to persons who use petroleum to produce calcined coke. Provides excise tax exemptions for certain uses. Refunds the tax paid by certain users of methane recovered from biomass or coal mining. Imposes a tax on the use of any fossil fuel: (1) in the manufacture or production of a fuel other than at a U.S. refinery; or (2) as a fuel. Imposes a tax on floor stock of taxable fuels held on the date of the tax increase. Allows a credit against such tax. Provides for such tax increases to begin July 1, 1994. Imposes a Btu tax on certain imported products that contain significant levels of direct energy inputs that would be taxable if the products were manufactured in the United States. Imposes a penalty on persons who sell dyed fuel for taxable uses. Subpart B: Modifications to Tax on Diesel Fuel - Imposes an excise tax on diesel fuel. Exempts from such tax diesel fuel: (1) used by trains and intercity, local, or school buses; and (2) which is dyed or marked in accordance in regulations. (Sec. 14242) Provides that the Airport and Airway Trust Fund financing rate does not apply to aviation fuel sold by a producer or importer for use by the purchaser in a nontaxable use. Imposes a civil penalty on persons who use reduced-rate fuel for a taxable use. (Sec. 14243) Imposes a floor stocks tax on any person holding diesel fuel April 1, 1994. Subpart C: Extension of Motor Fuel Tax Rates; Increased Deposits Into Highway Trust Fund - Increases the tax on gasoline and diesel fuels for purposes of the Highway Trust Fund financing rate. Increases the amount to be transferred to the Mass Transit Account from such Fund. Part V: Compliance Provisions - Requires information reporting on payments to corporations for services. (Sec. 14252) Modifies provisions concerning substantial understatement and return-preparer penalties to allow reasonable cause exceptions. (Sec. 14253) Requires certain financial entities (including the Federal Deposit Insurance Corporation, the Resolution Trust Corporation, and the National Credit Union Administration, and their successors or subunits) to file information returns regarding discharges of indebtedness of $600 or more. Part VI: Treatment of Intangibles - Allows an amortization deduction with respect to certain intangible property, including goodwill, that is acquired and held by a taxpayer in connection with the conduct of a trade or business or an activity engaged in for the production of income. Part VII: Miscellaneous Provisions - Establishes substantiation requirements for charitable contributions of $750 or more. (Sec. 14272) Sets forth disclosure requirements for an organization that receives a quid pro quo contribution (payment made partly as a contribution and partly in consideration for goods or services provided to the payor by the donee organization). Imposes a penalty for failure to make such disclosure. (Sec. 14273) Expands the 45-day interest-free period for refunding tax overpayments to all returns, amended returns, and claims for refunds. Provides that if interest is not refunded within 45 days after the taxpayer files an amended return or claim for refund, interest will be paid only for periods after the date on which the return or claim is filed. (Sec. 14274) Denies the business travel expense deduction for spouses, dependents, or others. (Sec. 14275) Increases the withholding rate for supplemental wage payments. Subtitle C: Empowerment Zones and Enterprise Communities - Part I: Empowerment Zones and Enterprise Communities, Etc. - Provides for the designation of 100 tax enterprise communities and ten enpowerment zones between 1993 and 1996: (1) by the Secretary of Housing and Urban Development for urban areas; (2) by the Secretary of Agriculture for rural areas; and (3) by the Secretary of the Interior for Indian reservations. (Sec. 14301) Sets forth eligibility criteria. Makes certain buildings in such communities or zones eligible for the low-income housing credit applicable to buildings in high-cost areas. Provides for the issuance of enterprise zone facility bonds in enterprise communities and enpowerment zones in a manner similar to exempt facility bonds. Excludes enterprise zone facility bonds from the interest deduction limitations on financial institutions. Provides States an additional housing credit ceiling for each zone and community through 1996. Allows a limited empowerment zone employment credit to employers for a percentage of qualified zone wages paid during calendar years 1994 through 2004. Allows businesses a zone resident empowerment savings credit of 50 percent of the qualified savings contributions made by an employer to a defined contribution plan on behalf of a zone employee. Limits the credit amount based on the employee's compensation. Increases the limitation on expensing certain depreciable business assets. Increases the volume cap applicable to enterprise zone facility bonds if the business owners meet specified ownership requirements with regard to abiding in such zones. (Sec. 14302) Allows use of the targeted jobs credit for hiring empowerment zone residents. Part II: Credit for Contributions to Certain Community Development Corporations - Allows a general business tax credit for contributions to selected community development corporations for low-income individuals who are residents of the operational area of the community. Subtitle D: Other Provisions - Part I: Disclosure Provisions - Extends the authority to disclose tax return information to the Department of Veterans Affairs through September 30, 1998. (Sec. 14402) Authorizes the disclosure of certain tax return information to the Department of Education to implement the direct student loan program and to the Department of Housing for income verification. Part II: User Fee Provisions - Requires establishment of a program requiring the payment of user fees for the processing of applications for certificates of alcohol label approval and exemption, formula reviews, and statements of process (including laboratory tests). (Sec. 14412) Removes authority to use the Harbor Maintenance Trust Fund for administrative expenses of certain customs fee collections. (Sec. 14413) Increases the tax on fuel used on commercial transportation on inland waterways. Part III: Public Debt Limit - Increases the public debt limit and repeals the temporary limit on such increase. Part IV: Vaccine Provisions - Makes permanent: (1) the excise tax on certain vaccines; and (2) the authority to pay compensation from the Vaccine Trust Fund under the National Vaccine Injury Compensation Program for certain damages resulting from vaccines administered after September 30, 1988. Directs the Secretary of the Treasury to report to specified congressional committees on uses of such Fund. (Sec. 14431) Imposes a floor stocks tax on taxable vaccines. (Sec. 14432) Requires contribution coverage under group health plans of the costs of pediatric vaccines. (Sec. 14433) Establishes the Childhood Immunization Trust Fund for the entitlement program under the Public Health Service Act.
Bill· HRH.R. 2229 (103rd)open
United States · United States Congress · 20 May 1993
Free Trade With Cuba Act - Amends the Foreign Assistance Act of 1961 to repeal the embargo on trade with Cuba. Prohibits the exercise by the President with respect to Cuba of certain authorities conferred by the Trading With the Enemy Act and exercised on July 1, 1977, as a result of a specified national emergency. Declares that any prohibition on exports to Cuba under the Export Administration Act of 1979 shall cease to be effective. Authorizes the President to impose export controls with respect to Cuba and exercise certain authorities under the International Emergency Economic Powers Act only on account of an unusual and extraordinary threat to U.S. national security that did not exist before enactment of this Act. Repeals the Cuban Democracy Act. Amends the Internal Revenue Code to terminate the denial of the foreign tax credit with respect to Cuba. Authorizes common carriers to install, maintain, and repair telecommunications equipment and facilities in Cuba, and otherwise provide telecommunications services between the United States and Cuba. Prohibits regulation or banning of travel to and from Cuba by U.S. citizens or residents, or of any transactions incident to travel. Directs the U.S. Postal Service to provide direct mail service to and from Cuba. Urges the President to take all necessary steps to conduct negotiations with the Government of Cuba to: (1) settle claims of U.S. nationals against Cuba for the taking of property; and (2) secure protection of internationally recognized human rights.
Bill· HRH.R. 2194 (103rd)open
United States · United States Congress · 19 May 1993
Deems a named individual to be an employee whose transfer from the United States Postal Service to the United States Army Corps of Engineers in March 1985 entitled him to travel, transportation, and relocation expenses.
Bill· HRH.R. 1943 (103rd)referred
United States · United States Congress · 29 April 1993
Free Trade With Cuba Act - Amends the Foreign Assistance Act of 1961 to repeal the embargo on trade with Cuba. Prohibits the exercise by the President with respect to Cuba of certain authorities conferred by the Trading With the Enemy Act and exercised on July 1, 1977, as a result of a specified national emergency. Declares that any prohibition on exports to Cuba under the Export Administration Act of 1979 shall cease to be effective. Authorizes the President to impose export controls with respect to Cuba and exercise certain authorities under the International Emergency Economic Powers Act only on account of an unusual and extraordinary threat to U.S. national security that did not exist before enactment of this Act. Repeals the Cuban Democracy Act. Authorizes common carriers to install, maintain, and repair telecommunications equipment and facilities in Cuba, and otherwise provide telecommunications services between the United States and Cuba. Prohibits regulation or banning of travel to and from Cuba by U.S. citizens or residents, or of any transactions incident to travel. Directs the U.S. Postal Service to provide direct mail service to and from Cuba. Urges the President to take all necessary steps to conduct negotiations with the Government of Cuba to: (1) settle claims of U.S. nationals against Cuba for the taking of property; and (2) secure protection of internationally recognized human rights.
Resolution· HCONRESH.Con.Res. 91 (103rd)open
United States · United States Congress · 29 April 1993
Urges the Citizens' Stamp Advisory Committee of the U.S. Postal Service to recommend to the Postmaster General that a postage stamp be issued honoring Americans held as prisoners of war or listed as missing in action.
Bill· HRH.R. 1911 (103rd)referred
United States · United States Congress · 28 April 1993
Requires the head of each Federal agency (including the U.S. Postal Service) to establish a program under which agency employees shall, under certain circumstances, be reimbursed for expenses incurred in the adoption of a child. Prohibits the denial of a reimbursement from being based on the applicant's marital status.
Law· HRH.R. 1779 (103rd)enacted
United States · United States Congress · 21 April 1993
Designates the U.S. Postal Service facility located at 401 South Washington Street, Chillicothe, Missouri, as the Jerry L. Litton United States Post Office Building.
Bill· HRH.R. 1785 (103rd)open
United States · United States Congress · 21 April 1993
Deficit Reduction Act of 1993 - Prohibits the annual travel budget for each non-defense executive branch agency (excluding the Postal Service) for FY 1994 from exceeding 90 percent of the budget level available to such agency for FY 1993. Abolishes the Interstate Commerce Commission. Transfers its functions, powers, and duties to the Department of Transportation. Limits the outlays for the legislative branch for FY 1994 to 85 percent of such outlays for FY 1993. Directs the Secretary of the Interior to sell to one or more joint ventures all right, title, and interest of the United States in and to the helium reserves established pursuant to the Helium Act, including facilities and accessories. Limits the administrative and overhead budget (excluding travel expenses) for non-defense executive branch agencies (excluding the Postal Service) for FY 1995 to 99 percent of the budget level available for FY 1994. Repeals the Davis-Bacon Act (an Act which requires that the locally prevailing wage rate be paid to various classes of laborers and mechanics working under federally-financed or federally-assisted contracts for construction, alteration, and repair of public buildings or public works). Eliminates the honey price support and wool and mohair price support programs. Increases rental voucher authority and terminates loan authority for public housing construction. Prohibits the Secretary of Housing and Urban Development from expending or obligating any budget authority for certain special projects. Rescinds such amounts remaining for FY 1993. Amends the United States Housing Act of 1937 to require competitive bidding for public housing modernization activities. Amends the Internal Revenue Code to require the disclosure of tenant income in information returns under housing assistance programs for income-based rent subsidies. Reduces Government contributions to the Thrift Savings Plan. Amends the Communications Act of 1934 to require competitive bidding for the radio spectrum for awarding initial licenses or new construction permits, with exceptions. Authorizes the Federal Communications Commission to consider relative economic values and other public interest benefits in making spectrum allocation decisions among services that are subject to competitive bidding.
Bill· HRH.R. 1392 (103rd)open
United States · United States Congress · 17 March 1993
TABLE OF CONTENTS: Title I: Agriculture Appropriations Title II: Commerce, Justice, and State, the Judiciary, and Related Agencies Appropriations Subtitle A: Department of Commerce Subtitle B: Related Agencies Subtitle C: Department of State Title III: Defense Appropriations Subtitle A: Research, Development, Test and Evaluation Subtitle B: Other Department of Defense Programs Subtitle C: Operations and Maintenance Title IV: Energy and Water Appropriations Subtitle A: Corps of Engineers Subtitle B: Department of Energy Title V: Interior Appropriations Title VI: Transportation Appropriations Title VII: Treasury, Postal Service, and General Government Appropriations Title VIII: Veterans Affairs, Housing and Urban Development, and Independent Agencies Appropriations Subtitle A: Department of Veterans Affairs Subtitle B: Independent Agencies Subtitle C: Department of Housing and Urban Development Title IX: Blue Smoke and Mirrors Spending Priority Reform Act of 1993 - Expresses the sense of the Congress that any money returned to the Treasury as a result of this Act should be deposited in the General Fund to be applied against the Federal budget deficit. Title I: Agriculture Appropriations - Rescinds FY 1993 appropriations to the Department of Agriculture for certain special research grants and for the construction of buildings and facilities of the Cooperative State Research Service which were not authorized, not awarded on a competitive basis, or not subjected to congressional hearings ("unauthorized"). Title II: Commerce, Justice, and State, the Judiciary and Related Agencies Appropriations - Subtitle A: Department of Commerce - Rescinds FY 1993 specified appropriations to: (1) the National Oceanic and Atmospheric Administration; and (2) the International Trade Administration. Subtitle B: Related Agencies - Rescinds FY 1993 appropriations to the Small Business Administration for unauthorized grants for specified miscellaneous projects. Subtitle C: Department of State - Rescinds FY 1993 appropriations to the Department of State for an unauthorized grant for the North/South Center at the University of Miami, Miami, Florida, and certain educational and cultural exchange programs. Title III: Defense Appropriations - Subtitle A: Research, Development, Test and Evaluation - Rescinds unauthorized FY 1993 appropriations made to the Department of Defense for: (1) university grants; (2) electrical vehicle demonstration projects; (3) Army industrial preparedness and manufacturing technology development programs; (4) medical research; (5) naval research, development, testing, and evaluation; and (5) the Space Surveillance Network Improvement Program. Subtitle B: Other Department of Defense Programs - Rescinds FY 1993 appropriations for efforts to prevent brown tree snakes from entering Hawaii from Guam. Subtitle C: Operations and Maintenance - Rescinds FY 1993 appropriations for the following projects: (1) self-powered locks; (2) grants for World University and 1996 Summer Olympics games and World Cup 1994; (3) Army procurement of extended cold weather clothing systems; (4) study of nuclear disposal by the former Soviet Union and for Project Peace; and (5) the Hawaiian Volcano Observatory. Title IV: Energy and Water Appropriations - Subtitle A: Corps of Engineers - Rescinds unauthorized FY 1993 appropriations for funding of surveys and planning activities and construction of water resource projects. Subtitle B: Department of Energy - Rescinds unauthorized FY 1993 appropriations made under the Energy and Water Development Appropriations Act, 1993, for funding certain energy supply, research, and development activities. Title V: Interior Appropriations - Rescinds FY 1993 appropriations for unauthorized funding of: (1) certain National Park System projects; (2) certain construction projects of the U.S. Fish and Wildlife Service; and (3) certain National Forest Service projects. Title VI: Transportation Appropriations - Rescinds FY 1993 appropriations to the Department of Transportation for unauthorized funding of: (1) certain airway science programs; (2) a certain highway research, development, and technology project; (3) certain construction and maintenance projects; (4) certain Federal Highway Administration demonstration projects; and (5) transit planning and research. Title VII: Treasury, Postal Service and General Government Appropriations - Rescinds FY 1993 appropriations to the General Services Administration for certain unauthorized grants for projects funded through the Federal Buildings Fund. Rescinds FY 1993 appropriations to the Office of Personnel Management for the establishment of health promotion and disease prevention programs. Title VIII: Veterans Affairs, Housing and Urban Development, and Independent Agencies Appropriations - Subtitle A: Department of Veterans Affairs - Rescinds FY 1993 appropriations to be Department of Veterans Affairs for unauthorized construction projects. Subtitle B: Independent Agencies - Rescinds 1993 appropriations to: (1) the Environmental Protection Agency for certain unauthorized projects; (2) the Consortium for International Earth Science Information Network; and (3) the National Aeronautics and Space Administration for certain unauthorized research and development projects and construction projects. Subtitle C: Department of Housing and Urban Development - Rescinds FY 1993 appropriations to the Department of Housing and Urban Development for unauthorized funding of certain housing projects and assistance programs. Title IX: Blue Smoke and Mirrors - Expresses the sense of the Congress that, with regard to the appropriations process, "forward funding" tactics should no longer be utilized and Congress should operate within the funding limits prescribed for each fiscal year.
Bill· HRH.R. 1344 (103rd)referred
United States · United States Congress · 16 March 1993
Postal Privacy Act of 1993 - Authorizes the Postal Service to permit its officers or employees to disclose the names and addresses of postal patrons if such disclosure: (1) consists of information relating to a change of address that was obtained on a Postal Service form which informed the patron of how the information would be disclosed and provided a means for the patron to deny disclosure; (2) has not been denied; and (3) would contribute to the efficiency of postal operations.
Law· SS. 464 (103rd)enacted
United States · United States Congress · 25 February 1993
Designates the building in Pulaski, Tennessee, that houses the primary operations of the United States Postal Service as the Ross Bass Post Office Building.
Bill· SS. 460 (103rd)open
United States · United States Congress · 25 February 1993
National Voter Registration Act of 1993 - Requires States to establish procedures with respect to presidential and congressional elections to permit voter registration by: (1) application in person simultaneously with application for a motor vehicle driver's license; (2) mail application; or (3) application in person at designated Federal, State, or nongovernmental office locations. Declares that this Act does not apply to any State that has no voter registration requirement with respect to elections for Federal office, or in which voters may register at the polling place at the time of a general election for Federal office. Amends Federal postal rate law to require the Postal Service to make certain lower postal rates available to State or local election officials who certify that a mailing is in furtherance of this Act. Directs the Federal Election Commission to develop a mail voter registration application form for Federal elections. Provides a private right of action for an individual aggrieved by a violation of this Act. Imposes criminal penalties for specified violations of this Act.
Bill· HRH.R. 733 (103rd)referred
United States · United States Congress · 2 February 1993
Charitable Solicitation Disclosure Act of 1993 - Requires charitable organizations which solicit a contribution by mail to include the following information with such solicitation: (1) the legal name and principal business of the organization; (2) whether it is exempt under the Internal Revenue Code; (3) the purpose of the solicitation and the intended use of the contribution, specifying whether the program or activities for which the contribution will be used are in existence or planned; and (4) the obligation of the organization to furnish a financial report upon the request of the person being solicited. Requires solicitations made in writing to: (1) be presented in readily understandable language; (2) be located in a conspicuous place; and (3) appear in conspicuous and legible type in contrast with other printed matter on the solicitation. Requires solicitations made through audio communication to be clearly audible and in language readily understandable. Requires solicitations made through visual communication to: (1) appear in lettering of sufficient size to be easily read by the viewer; (2) be shown against a background which does not impair the legibility of the communication; and (3) remain in view for a period sufficient to enable the viewer to read the communication. Describes the information to be included in financial reports of organizations which solicit contributions by mail. Requires such organizations to furnish the Postal Service any information it may require to assure compliance with this Act. Describes the types of organizations to which this Act does not apply. Authorizes the Postal Service to issue certain cease and desist orders to organizations that solicit money for a charitable purpose without complying with this Act.
Bill· HJRESH.J.Res. 88 (103rd)referred
United States · United States Congress · 2 February 1993
Requires the U.S. Postal Service to issue a commemorative stamp to honor Dr. Alice Stokes Paul (one of the key leaders of the American suffrage movement).
Bill· SS. 185 (103rd)open
United States · United States Congress · 26 January 1993
Hatch Act Reform Amendments of 1993 - Declares that a Federal employee may take an active part in political management or in political campaigns, except that he or she may not: (1) use official authority or influence for the purpose of interfering with or affecting the result of an election; (2) knowingly solicit, accept, or receive a political contribution from any person, unless such person is a member of the same Federal labor organization or a Federal employee organization with a multicandidate political committee (PAC), such person is not a subordinate employee, and the solicitation is for a contribution to the organization's PAC; (3) run for nomination or election to a partisan political office; or (4) knowingly solicit or discourage the participation in any political activity of any person who has an application for any compensation, grant, contract, ruling, license, permit, or certificate pending before his or her employing office, or who is the subject of, or a participant in, an ongoing audit, investigation, or enforcement action carried out by such employing office. Sets forth special prohibitions for employees of the Federal Election Commission (FEC) who are not presidential appointees. Prohibits any employee (except certain political appointees in specified circumstances) from engaging in political activity: (1) while on duty; (2) in any room or building occupied in the discharge of official duties by a Federal employee or official; (3) while wearing a uniform or official insignia identifying his or her office or position; or (4) while using any vehicle owned or leased by the Government. Authorizes the Office of Personnel Management (OPM) to prescribe regulations permitting employees residing in the immediate vicinity of the District of Columbia in Maryland or Virginia, or in a municipality where the majority of voters are Federal employees, to participate in political management and political campaigns involving their area of residence, if OPM determines that such political participation is in their domestic interest. Requires any employee who has been determined by the Merit Systems Protection Board to have twice violated political activity prohibitions to be removed from his or her position. Prohibits such an employee from holding any position of Federal employment unless elected. Amends the Federal criminal code to make it unlawful for any person to coerce or attempt to coerce any Federal employee to engage or not engage in any political activity. Includes U.S. Postal Service, Postal Rate Commission, and District of Columbia employees within the coverage of this Act.
Law· HRH.R. 588 (103rd)enacted
United States · United States Congress · 26 January 1993
Designates the facility of the U.S. Postal Service located at 20 South Main in Beaver, Utah, as the Abe Murdock United States Post Office Building.
Law· HRH.R. 572 (103rd)enacted
United States · United States Congress · 25 January 1993
Directs the Secretary of the Treasury to pay a specified sum to a named individual in full settlement of all claims against the United States arising out of the sexual assault and molestation of that individual by an employee of the U.S. Postal Service.
Bill· SS. 8 (103rd)open
United States · United States Congress · 21 January 1993
TABLE OF CONTENTS: Title I: Death Penalty Title II: Habeas Corpus Reform Title III: Exclusionary Rule Title IV: Rural Crime and Drug Control Title V: Firearms and Related Amendments Title VI: Juveniles and Gangs Title VII: Terrorism and International Matters Title VIII: Sexual Violence, Child Abuse, and Victims' Rights Title IX: Equal Justice Act Title X: Funding, Grant Programs, and Studies Title XI: Illegal Drugs Title XII: Public Corruption Title XIII: General Provisions Title XIV: Technical Corrections Title XV: Federal Law Enforcement Agencies Title XVI: Federal Prisons Title XVII: Pre-Trial Interrogation Crime Control Act of 1993 - Title I: Death Penalty - Federal Death Penalty Act of 1993 - Amends the Federal criminal code to establish criteria for the imposition of the death penalty for Federal crimes. (Sec. 102) Allows the defendant and the Government to present any information relevant to sentencing (including victim impact statements), but permits evidence to be excluded where its probative value is substantially outweighed by the danger of creating unfair prejudice, confusing the issues, or misleading the jury. Sets forth: (1) procedures for the implementation of, and appeal from, a sentence of death; and (2) provisions regarding the appointment of counsel, deadlines for collateral attacks on judgments imposing a death sentence, and stays of execution. (Sec. 110) Provides for the imposition of the death penalty for various offenses, including: (1) murder committed by prisoners in Federal prisons; (2) murder for hire; (3) murder in the aid of racketeering activity; (4) specified violations of the Controlled Substances Act (CSA); (5) murder of Federal witnesses; (6) rape and child molestation murders; and (7) murders in the District of Columbia. Title II: Habeas Corpus Reform - Subtitle A: General Habeas Corpus Reform - Habeas Corpus Reform Act of 1993 - Amends the Federal judicial code to establish a one-year statute of limitations for habeas corpus actions brought by State prisoners. (Sec. 204) Vests authority to issue certificates of probable cause for appeal of habeas corpus orders exclusively in the courts of appeals. Subtitle B: Death Penalty Litigation Procedures - Death Penalty Litigation Procedures Act of 1993 - Amends the Federal judicial code to set forth special habeas corpus procedures in capital cases. Subtitle C: Equalization of Capital Habeas Corpus Litigation Funding - Amends the Omnibus Crime Control and Safe Streets Act of 1968 (Omnibus Act) to require the Director of the Bureau of Justice Assistance (BJA) to provide grants to the States to support litigation pertaining to Federal habeas corpus petitions in capital cases. Title III: Exclusionary Rule - Amends the Federal criminal code to bar the exclusion of evidence obtained as a result of a search or seizure carried out under circumstances justifying an objectively reasonable belief that it was in conformity with the fourth amendment. Title IV: Rural Crime and Drug Control - Subtitle A: Drug Trafficking in Rural Areas - Amends the Omnibus Act to authorize appropriations for rural law enforcement agencies (LEAs) and increase the base allocation to nonrural States for rural drug enforcement assistance. (Sec. 402) Requires: (1) the Attorney General to establish a Rural Crime and Drug Enforcement Task Force in each Federal judicial district which encompasses significant rural lands, and to cross-designate up to 100 law enforcement officers from specified Federal agencies to enforce provisions of the CSA on non-Federal lands and the Federal criminal code; and (2) the Director of the Federal Law Enforcement Training Center to develop specialized training for rural law enforcement officers. Subtitle B: Rural Drug Prevention and Treatment - Amends the Public Health Service Act to require the Director of the Office for Treatment Improvement to establish a program to provide grants to hospitals, community health centers, and other appropriate entities in developing and implementing projects that provide, or expand the availability of, substance abuse treatment services. Subtitle C: Rural Areas Enhancement - Sets forth provisions regarding: (1) forfeiture of assets seized as a result of investigations initiated by a Rural Drug Enforcement Task Force; and (2) the bringing of criminal charges (including counts involving illegal disposal of hazardous waste and knowing endangerment of the environment) and civil actions (including assessment of environmental and health-related damages) against the operators of clandestine methamphetamine and other dangerous drug laboratories. Title V: Firearms and Related Amendments - Amends the Federal criminal code to establish penalties for smuggling firearms in aid of drug trafficking and for theft of firearms and explosives. (Sec. 503) Increases penalties for: (1) making knowingly false, material statements in connection with the acquisition of a firearm from a licensed dealer; and (2) interstate gun trafficking. (Sec. 504) Authorizes the summary destruction of explosives subject to forfeiture under specified circumstances. Sets forth requirements for reimbursement of the value of destroyed property. (Sec. 506) Prohibits: (1) the receipt of firearms by non-residents of the State in which the transferor resides, unless such receipt is for lawful sporting purposes; (2) transactions involving stolen firearms which have moved in interstate or foreign commerce; and (3) the possession of explosives by felons and specified others. (Sec. 511) Amends: (1) the Internal Revenue Code regarding the disposition of forfeited firearms; and (2) the Federal criminal code regarding the definition of burglary under the Armed Career Criminal Act of 1984. Title VI: Juveniles and Gangs - Anti-Gang and Juvenile Offenders Act of 1993 - Subtitle A: Increased Penalties for Employing Children to Distribute Drugs Near Schools and Playgrounds - Amends the 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. Subtitle B: Antigang Provisions - 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 to States and units of local government to assist them in planning, coordinating, and evaluating projects to reduce the formation or continuation of juvenile gangs and the use and sale of illegal drugs by juveniles. (Sec. 623) Sets penalties for the commission of a felony crime of violence, felony involving a controlled substance, and specified other offenses in, for, or in association with a criminal street gang. Subtitle C: Juvenile Penalties - Amends the Federal criminal code to: (1) add certain firearms offenses to those over which the United States has juvenile delinquency jurisdiction; and (2) provide for the treatment of violent juveniles who commit firearms offenses as adults under certain circumstances. (Sec. 632) Classifies as serious drug offenses for purposes of the Armed Career Criminal Act serious drug offenses committed by juveniles. (Sec. 633) Amends the Omnibus Act to require the Director of the BJA to make grants to States, for use by States and units of local governments, to develop alternatives to incarceration and probation for young offenders which promote reduced recidivism, crime prevention, and victim assistance. Subtitle D: Other Provisions - Includes among permissible uses of drug control and system improvement grants (under the Omnibus Act) programs that address the need for effective bindover systems for the prosecution of violent 16- and 17-year olds in courts with jurisdiction over adults for specified crimes. (Sec. 642) Directs: (1) the Attorney General to develop a national strategy to coordinate gang-related investigations by Federal LEAs, and prepare a report on national gang violence to be submitted to the President and the Congress; and (2) the Director of the Federal Bureau of Investigation (FBI) to acquire and collect information on incidents of gang violence for inclusion in an annual uniform crime report. (Sec. 643) Prohibits a juvenile from being transferred to adult prosecution or a hearing held under section 5037 (disposition after a finding of juvenile delinquency) until any prior juvenile court records have been received by the court or other specified conditions are met. Title VII: Terrorism and International Matters - Repeals the Antiterrorism Act of 1990. Establishes a civil remedy for U.S. nationals (and their survivors or estates) injured, in their person, property, or business, by acts of international terrorism. (Sec. 702) Amends the Federal criminal code to: (1) make it a criminal offense to provide material support to terrorists; and (2) provide for forfeiture of assets used to support terrorists. (Sec. 704) Authorizes the Attorney General to waive immigration admission and other legal requirements and grant permanent resident status for alien witnesses who cooperate with the Government in Federal or State prosecutions. (Sec. 713) Amends the Federal criminal code to: (1) 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; (2) provide for the prosecution of individuals who murder U.S. nationals abroad; and (3) permit FBI access to telephone subscriber information under specified circumstances. Title VIII: Sexual Violence, Child Abuse, and Victims' Rights - Subtitle A: Sexual Violence and Child Abuse - Sexual Assault Prevention Act of 1993 - Chapter 1: Sexual Violence - Subchapter A: Penalties and Remedies - Provides for: (1) pretrial detention in sex offense cases; and (2) the imposition of the death penalty for murders committed by sex offenders. (Sec. 803) Increases penalties for: (1) recidivist sex offenders; and (2) sex offenses against victims below age 16. (Sec. 805) Sets forth provisions regarding: (1) sentencing guideline increases for sex offenses; (2) human immunodeficiency virus testing, penalty enhancement, and cost of testing in sex offense cases; (3) restitution and suspension of Federal benefits; and (4) creation of a civil remedy for victims of sexual violence. Subchapter B: Rules of Evidence, Practice, and Procedure - Amends the Federal Rules of Evidence to allow evidence of similar offenses in criminal or civil sexual assault and child molestation cases. (Sec. 822) Revises the rape victim shield law, including making the past sexual behavior of an alleged victim inadmissible in civil as well as criminal cases. Makes inadmissible evidence to show provocation or invitation by the victim in a sex offense criminal case. (Sec. 824) Sets forth provisions regarding: (1) review of proposed Rules of Professional Conduct for Lawyers in Federal Practice; (2) a victim's right to allocation (to be present, make a statement, and present information) at the sentencing hearing of a defendant convicted of a crime of violence or sexual abuse; and (3) a victim's right of privacy. Subchapter C: Safe Campuses - Directs the Attorney General to provide for a national baseline study on campus sexual assault. Subchapter D: Assistance to States and Localities - Authorizes the Attorney General to make grants to support projects and programs relating to sexual violence, and supplementary grants for States adopting effective laws relating to sexual violence. Chapter 2: Domestic Violence and Offenses Against the Family - Amends the Federal criminal code to: (1) set penalties for noncompliance with child support obligations in interstate cases; and (2) require full faith and credit for protective orders. (Sec. 853) Creates a presumption against child custody for spouse abusers. (Sec. 854) Directs the Attorney General to report to the Congress on: (1) the status of battered women's syndrome as a medical and psychological condition and its effect in criminal trials; (2) the means by which abusive spouses may obtain information concerning the addresses or locations of estranged or former spouses; and (3) problems of recordkeeping of criminal complaints involving domestic violence. (Sec. 857) Authorizes the Attorney General to make grants to support projects and programs relating to domestic violence and other unlawful acts that particularly affect women. Chapter 3: National Task Force on Violence Against Women - Directs the Attorney General to establish a National Task Force on Violence Against Women. Subtitle B: Victims' Rights - Sets forth provisions regarding: (1) restitution and suspension of Federal benefits; and (2) the number of peremptory challenges under the Federal Rules of Criminal Procedure. Subtitle C: National Child Protection Act - National Child Protection Act of 1993 - Provides for: (1) State reporting of child abuse crime information to a national criminal background check system; (2) funding to improve such information; and (3) the withholding of a portion of such funding to States not in compliance with a timetable established under this Act. Subtitle D: Jacob Wetterling Crimes Against Children Registration Act - Jacob Wetterling Crimes Against Children Registration Act - Directs the Attorney General to establish guidelines for State programs requiring any person who is convicted of a criminal offense against a minor to register a current address with a designated State law enforcement agency for ten years after release from prison or being placed on parole or supervised release. Sets forth registration, State compliance, and related requirements. Title IX: Equal Justice Act - Equal Justice Act - Requires that the death penalty and all other penalties be administered by the United States and by every State without regard to the race or color of the defendant or victim. Bars the use of any racial quota or statistical test for the imposition or execution of any penalty. (Sec. 903) Sets forth provisions regarding: (1) safeguards against racial prejudice or bias in criminal courts; and (2) jury instructions and certification, and racial motivation in killings as an aggravating factor, in Federal capital cases. (Sec. 905) Amends specified civil rights provisions to cover conspiracy against rights, and deprivation of rights under color of law, of any person in (currently, inhabitant of) a State, territory, or district. Title X: Funding, Grant Programs, and Studies - Subtitle A: Safer Streets and Neighborhoods - Law Enforcement Enhancement Act of 1993 - Amends the Omnibus Act to: (1) authorize grants to State and local agencies for the hiring of law enforcement personnel; (2) continue the Federal-State funding formula through 1994; and (3) revise the funding formula with respect to the allocation and distribution of funds under formula grants. Subtitle B: Retired Public Safety Officer Death Benefit - Includes retired public safety officers who have died or become permanently and totally disabled as a result of injuries sustained while responding to a fire, rescue, or police emergency among those eligible for death and disability benefits. Subtitle C: Study on Police Officers' Rights - 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. Subtitle D: Cop-on-the-Beat Grants - Cop-on-the-Beat Act of 1993 - Amends the Omnibus Act to authorize the Director of the BJA to make grants to units of local government and community groups to establish or expand cooperative efforts between police and a community for purposes of increasing the police presence in the community. Subtitle E: National Commission to Support Law Enforcement - National Commission to Support Law Enforcement Act - Establishes a National Commission to Support Law Enforcement to study and recommend changes regarding LEAs and law enforcement issues on the Federal, State, and local levels. Subtitle F: Other Provisions - Amends the Omnibus Act to: (1) require the Director of the BJA to establish guidelines and oversee the implementation of family-friendly policies within law enforcement-related offices and divisions in the Department of Justice, identify and evaluate model programs that provide support services to law enforcement personnel and families, and take other specified actions; and (2) authorize the Director to make grants to States and local LEAs to provide family support services to law enforcement personnel. (Sec. 1063) Requires the Bureau of Prisons to notify, in writing and within a specified time frame, the chief law enforcement officer of the State and local jurisdiction in which a prisoner released on supervised release will reside. Title XI: Illegal Drugs - Subtitle A: Drug Testing - Amends the Federal criminal code to require: (1) the Director of the Administrative Office of the U.S. Courts to establish a program of drug testing of criminal defendants on post-conviction release; and (2) the chief probation officer in each district (where feasible) to arrange for the drug testing of such defendants. Requires, as an explicit condition of probation, parole, or supervised release of a defendant involving a felony or a specified violent or drug offense, that the defendant refrain from any unlawful use of a controlled substance and submit to periodic drug tests. Subtitle B: Precursor Chemicals - Chemical Control and Environmental Responsibility Act of 1993 - Amends the CSA to replace references to "listed precursor chemicals" with "list I chemicals" and "listed essential chemicals" with "list II chemicals." (Sec. 1123) Requires every person who manufacturers or distributes, or who proposes to engage in the manufacture or distribution of, a list I chemical to obtain annually a registration issued by the Attorney General. Makes provisions regarding the denial, revocation, and suspension of registration relating to the manufacture, distribution, or dispensation of controlled substances explicitly applicable to list I chemicals. (Sec. 1131) Makes it a felony for a person who possesses a listed chemical with intent that it be used in the illegal manufacture of a controlled substance to manage the listed chemical or waste from such manufacture other than as required under the Solid Waste Disposal Act. (Sec. 1132) Amends the Health Care Quality Improvement Act of 1986 to grant the Attorney General access to information in the National Practitioner Data Bank. Subtitle C: Other Provisions - Sets forth miscellaneous provisions and amends various laws concerning controlled substances. Title XII: Public Corruption - Anti-Corruption Act of 1993 - Amends the Federal criminal code to prescribe criminal penalties to be imposed against anyone who uses any facility of, or affects, interstate or foreign commerce to deprive or defraud the inhabitants of a State or political subdivision of a State of the honest services of a government official or employee, or of a fair and impartially conducted election process. (Sec. 1202) Prescribes criminal penalties to be imposed upon any official, or person selected to be a public official, who, in order to carry out or conceal any scheme or artifice to defraud, discriminates, harasses, or takes adverse action against any employee or official of the United States, or any State or political subdivision. Authorizes such an adversely affected employee or official to obtain relief through a civil action, provided such person did not participate in the scheme or artifice. (Sec. 1203) Amends mail fraud provisions to prohibit the use of any facility of interstate or foreign commerce in the execution of a scheme or artifice to defraud. (Sec. 1204) Sets forth prohibitions regarding narcotics-related public corruption. Title XIII: General Provisions - Subtitle A: Violent Crimes - Sets penalties for attempted: (1) robbery; (2) kidnapping; (3) smuggling; and (4) malicious mischief. (Sec. 1320) Increases penalties for: (1) certain assaults; (2) manslaughter; (3) interstate and foreign travel or transportation in aid of racketeering enterprises; and (4) conspiracy to commit murder for hire. Subtitle B: Civil Rights Offenses - Increases maximum penalties for certain civil rights violations, including damage to religious property. Subtitle C: White Collar and Property Crimes - Establishes penalties for knowingly receiving the proceeds of: (1) a postal robbery; (2) extortion; and (3) a kidnapping. (Sec. 1330) Includes within mail fraud provisions depositing specified matter to be sent by any private or commercial interstate carrier. (Current law applies only to matter sent by the U.S. Postal Service.) (Sec. 1332) Increases penalties for trafficking in counterfeit goods and services. (Sec. 1333) 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 computer 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 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. Creates a civil cause of action for persons suffering damage or loss by virtue of a violation of this Act. Subtitle D: Other Provisions - Sets forth provisions regarding: (1) venue for espionage and related offenses; (2) required reporting by criminal court clerks; and (3) audit requirements for State and local LEAs receiving Federal asset forfeiture funds. (Sec. 1364) 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 the Director of the FBI 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. 1365) Authorizes 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. Title XIV: Technical Corrections - Makes technical corrections to the Omnibus Act, the Federal criminal code, the CSA, and the Foreign Corrupt Practices Act of 1977. Title XV: Federal Law Enforcement Agencies - Federal Law Enforcement Act of 1993 - Authorizes appropriations for the Drug Enforcement Administration, the FBI, the Immigration and Naturalization Service, the U.S. attorneys, the U.S. Marshals Service, the Bureau of Alcohol, Tobacco and Firearms, and the U.S. courts. Title XVI: Federal Prisons - Authorizes appropriations for new prison construction. Title XVII: Pre-Trial Interrogation - Expresses the sense of the Congress that the Attorney General shall instruct all U.S. attorneys, and implement policies consistent therewith, that confessions obtained in conformity with Federal provisions related to such admissibility will be offered into evidence.
Law· SS. 20 (103rd)enacted
United States · United States Congress · 21 January 1993
Government Performance and Results Act of 1993 - Requires executive agency heads to submit to the Director of the Office of Management and Budget (OMB) a strategic plan for performance goals of their agency's program activities. Requires such plan to cover at least a five-year period and to be updated at least every three years. Requires the inclusion of performance plans in the President's budget. Directs the Director to require each agency to prepare annual performance plans covering each program activity in the agency's budget. Requires executive agency heads to report annually to the President and the Congress on program performance for the previous fiscal year, setting forth performance indicators, actual program performance, and a comparison with plan goals for that fiscal year. Specifies the contents of such reports. Authorizes the Director to exempt any agency with annual outlays of $20 million or less from strategic and performance plan reporting requirements. Allows performance plans to include proposals to waive administrative procedural requirements and controls in return for specific individual or organization accountability to achieve a performance goal. Requires the Director of OMB to designate: (1) no fewer than ten agencies (representing a range of Government functions) as pilot projects in performance measurement; (2) no fewer than five agencies (selected from agencies in performance measurement pilot projects) as pilot projects in managerial accountability and flexibility; and (3) no fewer than five agencies (selected from agencies in performance measurement pilot projects) as pilot projects in performance budgeting. Sets forth provisions with respect to strategic and performance planning at the U.S. Postal Service. Directs the Office of Personnel Management to develop a strategic planning and performance measurement training component for its management training.
Bill· SS. 62 (103rd)open
United States · United States Congress · 21 January 1993
Senate Election Reform Act of 1993 - Amends the Federal Election Campaign Act of 1971 to provide for spending limits and benefits for Senate primary, runoff, and general elections. (Sec. 2) Limits personal and election expenditures. Prohibits benefits to a candidate who exceeds specified general and runoff election spending levels. Requires the Secretary to maintain in the Presidential Election Campaign Fund the Senate Account for the deposit of funds for payments to eligible candidates. Establishes criminal penalties for knowing or willful violations of this Act. (Sec. 3) Amends the Internal Revenue Code to increase the amount an individual may designate to the Presidential Election Campaign Fund. (Sec. 4) Amends the Communications Act of 1934 to require a licensee who permits a broadcasting station to broadcast material which either endorses or opposes a Federal candidate to provide equal free time to any eligible candidate opposing the candidate endorsed or to any eligible candidate who was so opposed. Increases the period of time during which the charges made for the use of any broadcast station shall not exceed the lowest unit charge of such station. (Sec. 5) Sets forth reporting requirements for Senate candidates relating to spending limitations, candidacy eligibility, and independent expenditures. Limits the amount that multicandidate political committees (PACs) may contribute to House elections to $100,000 for a general or special election and $25,000 for a runoff election. Limits contributions to Senate elections to ten percent of spending limits established by this Act. (Sec. 7) Provides for the accountability of contributions made by intermediaries or conduits. (Sec. 9) Requires, when independent expenditures are made for television broadcast, showing the name of the person or committee making such expenditure. Requires any type of general public communication to include such statement. (Sec. 11) Includes certain extensions of credit as contributions to a Senate candidate. (Sec. 12) Amends provisions of law regarding the Postal Service to provide for reduced postal rates for eligible Senate candidates. (Sec. 13) Amends the Federal Election Campaign Act of 1971 to require a non-eligible Senate candidate to disclose in advertisements or announcements that such candidate has not agreed to spending limits. (Sec. 14) Repeals the exception which permits a Member of Congress who was such a Member on January 8, 1980, to convert excess campaign contributions to personal use. (Sec. 16) Prohibits a State committee of a political party from making any expenditure in connection with the general election campaign of any presidential candidate affiliated with such party. Subjects to Federal fundraising and expenditure limitations any amount solicited, received, or spent by a national, State, or local committee of a political party, if such amount is solicited, received, or spent in connection with a Federal election. (Sec. 17) Amends the Federal Election Campaign Act of 1971 to revise membership requirements of the Federal Election Commission. (Sec. 18) Increases the period of time preceding an election during which franked mass mail may not be mailed. (Sec. 19) Prohibits a candidate for Congress from having any authorized committee other than his or her principal campaign committee.
Bill· SS. 85 (103rd)referred
United States · United States Congress · 21 January 1993
Financial Services Access Act of 1993 - (Secs. 3-4) Prescribes guidelines under which: (1) each depository institution must offer a basic financial services account under which an account holder may obtain either basic transaction account services or government check cashing account services; and (2) the Board of Governors of the Federal Reserve System (the Board) must develop a model application form for the use of depository institutions offering such accounts. (Secs. 5-6) Sets forth the criteria for basic transaction services accounts and government check cashing services accounts. (Sec. 7) Requires a depository institution to conspicuously disclose the availability of such accounts in its public areas. (Secs. 8-9) Requires certain credit unions to offer basic financial services accounts. Exempts certain depository institutions from the requirements of this Act. (Secs. 10-11) Prescribes guidelines for fraud prevention and administrative enforcement. (Secs. 13-16) Requires a study and report to the Congress by: (1) the Board on the incidence of fraud in connection with government check cashing services; (2) the Secretary of the Treasury on the feasibility of staggering Federal recurring payments; and (3) the Comptroller General on using the Postal Service as a supplemental provider of government check cashing services and on using direct deposit for Federal recurring payments.
Bill· SS. 2 (103rd)referred
United States · United States Congress · 21 January 1993
National Voter Registration Act of 1993 - Requires States to establish procedures with respect to presidential and congressional elections to permit voter registration by: (1) application in person simultaneously with application for a motor vehicle driver's license; (2) mail application; or (3) application in person at designated Federal, State, or nongovernmental office locations. Declares that this Act does not apply to any State that has no voter registration requirement with respect to elections for Federal office, or in which voters may register at the polling place at the time of a general election for Federal office. Amends Federal postal rate law to require the Postal Service to make certain lower postal rates available to State or local election officials who certify that a mailing is in furtherance of this Act. Directs the Federal Election Commission to develop a mail voter registration application form for Federal elections. Provides a private right of action for an individual aggrieved by a violation of this Act. Imposes criminal penalties for specified violations of this Act.