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151 records in US in 1994
United States · United States Congress · 18 August 1994
Amends the Internal Revenue Code to restore the business meal expense deduction to 80 percent (currently 50 percent) for individuals subject to the hours of service limitations of the Department of Transportation.
United States · United States Congress · 18 August 1994
Declares that any welfare reform legislation that passes the House of Representatives should: (1) result in net savings to the U.S. taxpayer within five years; (2) limit increases in aggregate spending for welfare programs to the rate of inflation; (3) not require any new taxes; (4) not increase the Federal deficit by more than the amount by which it would increase in the absence of the legislation; and (5) not require State or local governments to bear any administrative costs that would not be borne by such governments in the absence of the legislation.
United States · United States Congress · 17 August 1994
TABLE OF CONTENTS: Title I: Family Investment Program and Other Welfare Reform Title II: Improvements in the Collection of Child Support Title III: Welfare Restrictions for Aliens Welfare to Self-Sufficiency Act of 1994 - Title I: Family Investment Program and Other Welfare Reform - Amends part A (Aid to Families with Dependent Children) (AFDC) of title IV of the Social Security Act (SSA) to require State AFDC plans in States without a waiver from the Secretary of Health and Human Services (Secretary) to provide for a program in which the State agency negotiates an agreement with each family on AFDC outlining the steps non-exempt family members must take. Includes among such steps participation in education or job training programs, or in substance abuse treatment or parenting programs, in order to obtain self-sufficiency within a certain period. Requires supplemental services, such as transportation and child care, when necessary for achieving such goal, as well as support and case management when adapting such agreement for changing family circumstances. Requires the State agency to offer such families enrollment in a limited benefit plan under which benefits are suspended after six months, and in which families failing to comply with the agreement are automatically enrolled. (Sec. 101) Requires the Secretaries of Health and Human Services, of Labor, and of Education to ensure appropriate coordination in the planning, development, and operation of the family investment program above and other specified programs, including the JOBS program under SSA title IV part F (Job Opportunities and Basic Skills Training Program) in order to improve departmental services and reduce program overlap and administrative costs. (Sec. 102) Makes numerous miscellaneous amendments to SSA title IV part A. Provides States with various specified options for moving AFDC recipients towards self-sufficiency, including options for: (1) increasing asset limits and disregards for work expenses, earned income, and automobiles; (2) disregarding interest income and certain earned income of new employees and dependent children as well as certain income and resources related to microenterprise and other employment and self-sufficiency initiatives; and (3) requiring certain unemployed parents to participate in job search and training activities. Eliminates the earned income disregard time limitation and various work-related requirements with regard to unemployed parent households. Provides for the inclusion of microenterprise training and activities in the JOBS program, and makes various specified changes with regard to program job searches, work assignments, and grievance procedures. (Sec. 106) Requires pregnant AFDC recipients to participate in the JOBS program. Changes payment formulae for the JOBS program and child care. Increases the JOBS program's authorization. (Sec. 109) Extends transitional child care benefits and the disregards for earned income and child care to non-recipient stepparents. Provides for timely preventive health care for children of AFDC recipients. (Sec. 110) Directs the Secretary to establish wage supplementation demonstration projects for certain AFDC-eligible individuals to provide an incentive to work. Title II: Improvements in the Collection of Child Support - Amends SSA title IV part D (Child Support and Establishment of Paternity) and the Internal Revenue Code to provide for the establishment of a system under which the Internal Revenue Service (IRS) would collect child support via wage withholding and estimated tax payments and disperse it as appropriate. Requires the entire amount of child support owed to be paid to the IRS by the end of the applicable tax year along with the individual's tax return. Subjects delinquent individuals to generally the same penalties applicable to back taxes. (Sec. 203) Gives States the option of periodically making available for publication the identity of individuals at least three months behind in child support payments. Title III: Welfare Restrictions for Aliens - Declares that no AFDC, Medicaid, food stamp, supplemental security income, or Federal unemployment compensation benefits shall be available to an unlawful alien, except pursuant to the Immigration and Nationality Act. (Sec. 301) Requires that any lawful alien receiving any such benefits for 12 months be reported to the Immigration and Naturalization Service (INS) and be treated as a public charge. Requires attribution of a sponsor's or spouse's income and resources to a family preference alien as unearned income and resources until such alien achieves U.S. citizenship. (Sec. 302) Requires State AFDC agencies to provide information on illegal aliens to the INS.
United States · United States Congress · 17 August 1994
Waives points of order against the consideration of the conference report to accompany H.R. 4603 (appropriations for the Departments of Commerce, Justice, and State, the Judiciary, and related agencies).
United States · United States Congress · 17 August 1994
Expresses the sense of the Congress that: (1) trade agreements which promote free trade by reducing trade barriers are free in that they do not exact a cost on U.S. taxpayers by reducing net Federal revenues; and (2) budget rules which inaccurately calculate the revenue impact of trade agreements by ignoring the U.S. growth caused by tariff changes in other countries should not be applied to the General Agreement on Tariffs and Trade implementing legislation in a way that requires increased taxes or program reductions to "offset" expected tariff revenue reductions.
United States · United States Congress · 16 August 1994
TABLE OF CONTENTS: Title I: Improved Access to Affordable Health Care Subtitle A: Increased Availability and Continuity of Health Coverage for Individuals and Their Families Subtitle B: Reform of Health Insurance Subtitle C: Preemption Subtitle D: Health Deduction Fairness Subtitle E: Improved Access to Community Health Services Subtitle F: Improved Access to Rural Health Services Subtitle G: Assistance in Enrolling Uninsured Children in Health Insurance Subtitle H: Medicaid Reform Subtitle I: Remedies and Enforcement with Respect to Group Health Plans Subtitle J: Delivery of Health Care Services to Illegal Immigrants Title II: Health Care Cost Containment and Quality Enhancement Subtitle A: Medical Malpractice Liability Reform Subtitle B: Administrative Cost Savings and Fair Health Information Practices Subtitle C: Deduction for Cost of Catastrophic Health Plan; Medical Savings Accounts Subtitle D: Anti-Fraud Subtitle E: Increased Medicare Beneficiary Choice; Additional Medicare Reforms Subtitle F: Health Care Antitrust Improvements Subtitle G: Encouraging Enforcement Activities of Medical Self-Regulatory Entities Subtitle H: Reform of Clinical Laboratory Requirements for Simple Tests Subtitle I: Miscellaneous Provisions Title III: Long-Term Care Subtitle A: Tax Treatment of Long-Term Care Insurance Subtitle B: Establishment of Federal Standards for Long-Term Care Insurance Subtitle C: Protection of Assets Under Medicaid Through Use of Qualified Long-term Care Insurance Subtitle D: Studies Subtitle E: Volunteer Service Credit Demonstration Projects Affordable Health Care Now Act of 1994 - Title I: Improved Access to Affordable Health Care - Subtitle A: Increased Availability and Continuity of Health Coverage for Individuals and Their Families - Part 1: Required Coverage Options for Eligible Employees, Spouses, and Dependents - Requires each employer to make available to each eligible employee a group health plan under which: (1) coverage of each eligible individual with respect to such employee may be elected on an annual basis; (2) coverage is provided for at least the required coverage specified; and (3) employees may elect to have premiums collected through payroll deduction. Does not require employer contributions to the cost of coverage under such a plan. Provides for the exclusion of: (1) employers who have been employers for less than two years or who have no more than two eligible employees or no more than two eligible employees not covered under any group health plan; and (2) family members under specified circumstances. Specifies that a group health plan shall not be treated as failing to meet the requirements of this Act solely because a period of service by an eligible employee of not more than 60 days is required for coverage. Specifies that the required coverage is standard coverage, except that in the case of a small employer that has not contributed during the previous plan year to the cost of coverage for any eligible employee under any group health plan, the required coverage for the plan year is coverage under a MedAccess standard, MedAccess catastrophic, and MedAccess medisave plan. Requires standard coverage to include at least one option, either a fee-for-service option and if available, a point-of-service option and a managed care option. Provides for a five-year transition for existing group health plans. Part 2: Portability and Nondiscrimination - Prohibits a group health plan from imposing (and an insurer from requiring an employer from imposing through a waiting period for coverage under a plan or similar requirement) a limitation or exclusion of benefits relating to treatment of a preexisting condition if: (1) the condition relates to a condition that was not diagnosed or treated within three months before the date of coverage under the plan; (2) the limitation or exclusion extends over more than six months after the date of coverage, applies to an individual who, as of the date of birth, was covered under the plan, or relates to pregnancy; or (3) an eligible individual has such coverage at the time the individual first became eligible. Specifies that, in the case of an individual who is eligible for coverage under a plan but for a waiting period imposed by the employer, the individual shall be treated as having been covered under the plan as of the earliest date of the beginning of the waiting period. Provides a one-time amnesty period for pre-existing condition exclusions. (Sec. 1012) Requires each group health plan to waive any period applicable to a preexisting condition for similar benefits with respect to an individual to the extent that the individual, prior to enrollment in such plan, was covered for the condition under any other health plan. (Sec. 1013) Prohibits: (1) a multiemployer plan and an exempted multiple employer health plan from canceling or denying renewal of coverage under such a plan for an employer other than for nonpayment of contributions, fraud or other misrepresentation, noncompliance with plan provisions, or because the plan is ceasing to provide any coverage in a geographic area; (2) an insurer from canceling a health insurance plan or denying renewal of coverage other than as prescribed above; and (3) an insurer who terminates the offering of health insurance plans in an area from offering such a plan to any employer in the area until five years after the date of the termination. Part 3: Standards for Managed Care Arrangements and Essential Community Providers - Sets forth requirements for group health plans and insurers that provide health care coverage through managed care arrangements. Requires such arrangements to assure that covered individuals have reasonably prompt access through the entity's provider network to the benefits package and to centers of excellence. (Sec. 1022) Requires the Secretary of Health and Human Services (Secretary) to establish standards for utilization review programs and periodically review and update such standards to reflect changes in the delivery of health care services. Part 4: Enforcement; Effective Dates; Definitions - Makes provisions of the Employee Retirement Income Security Act of 1974 applicable with respect to enforcement of this Act (by the Department of Labor). Amends the Internal Revenue Code (Code) to impose a tax ($100 per day for each individual involved, subject to specified limitations) on the failure of an insurer to comply with the requirements under part 2, unless the Secretary determines that the State has in effect a regulatory enforcement mechanism that provides adequate sanctions. Subtitle B: Reform of Health Insurance - Part I: Marketplace for Small Business - Requires each insurer that makes available a health insurance plan to a small employer in a State to make available to each small employer in the State a MedAccess standard, MedAccess catastrophic, and MedAccess medisave plan, with exceptions for health maintenance organizations (HMOs) and if a State provides for guaranteed availability (rather than guaranteed issue). Requires each insurer that offers a MedAccess plan to a small employer in a State to accept: (1) every small employer in the State that applies for coverage; and (2) every eligible individual who applies for enrollment on a timely basis. Sets forth provisions regarding: (1) special rules for HMOs; (2) timely enrollment requirements; and (3) enrollment of spouses and dependents. Makes such requirements inapplicable in a State that has provided (in accordance with specified standards) a mechanism under which each insurer offering a health insurance plan to a small employer in the State must participate in a program for assigning high-risk small employer groups (or individuals within such a group) among some or all such insurers, if the insurers comply. (Sec. 1102) Defines "MedAccess coverage" as a health insurance plan that: (1) is designed to provide standard coverage with substantial cost-sharing, only catastrophic coverage, or medisave coverage; (2) includes only essential and medically necessary services; (3) meets applicable requirements relating to guaranteed issue; and (4) meets specifies consumer protection standards. Defines "MedAccess standard coverage," "MedAccess catastrophic coverage," and "MedAccess medisave coverage" to mean a MedAccess plan that provides for at least standard coverage, for only catastrophic coverage, or medisave coverage, respectively. Requests the National Association of Insurance Commissioners (NAIC) to submit to the Secretary a set of rules which is sufficient for determining the actuarial value of coverage offered by a plan. Directs the Secretary to certify such set of rules for use under this subtitle if they meet such requirements or establish such a set of rules. Specifies that a health insurance plan is considered to provide: (1) standard coverage if the benefits are determined, in accordance with certified rules of actuarial equivalence, to have a value that is within five percentage points of an established target actuarial value for standard coverage; (2) catastrophic coverage if benefits are available under the plan for a year only to the extent that expenses for covered services in a year exceed a deductible amount that is consistent with a specified requirement for a catastrophic health plan under the Code, and are determined, in accordance with certified actuarial equivalence rules, to have a value that is within five percentage points of an established target actuarial value for catastrophic coverage; and (3) medisave coverage if such plan consists of a catastrophic health plan within the meaning of the Code and a medical savings account. Requests NAIC to submit to the Secretary target actuarial values for standard and catastrophic coverage. Permits NAIC to submit periodic revisions of, and permits the Secretary to revise, the set of rules of actuarial equivalence and target actuarial values where necessary to take into account changes in the relevant types of health benefits provisions, in deductible levels for catastrophic coverage, or in relevant demographic conditions. (Sec. 1103) Directs the Secretary to request NAIC to develop model regulations that specify standards with respect to requirements: (1) that insurers make available MedAccess plans; (2) of guaranteed availability of MedAccess plans to small employers; (3) relating to limits on premiums and certain consumer protections; and (4) relating to limitation of annual premium increases. Requires the Secretary to review such standards and, if NAIC fails to specify standards meeting such requirements, to promulgate standards. Sets forth provisions regarding: (1) the application of MedAccess standards and consumer protection standards by the States; and (2) the Federal role. (Sec. 1104) Sets forth provisions: (1) regarding limits on premium rate variations, including discounts for employer wellness programs; and (2) requiring an insurer, at the time of offering a health insurance plan to a small employer, to fully disclose rating practices for health insurance plans, including rating practices for different populations and benefit designs. (Sec. 1105) Requires the Secretary of Labor to monitor the prevalence and impact of adverse risk selection in the full insured plans made available to small employers resulting from the decision of small employers to self-insure. (Sec. 1106) Directs the Secretary to: (1) request NAIC to develop models for reinsurance or allocation of risk mechanisms for health insurance plans made available to small employers for whom an insurer is at risk of incurring high costs under the plan; and (2) review such models or specify models. Sets forth provisions regarding implementation of reinsurance or allocation of risk mechanisms by the States and the Federal role. Part 2: Marketplace for Individuals - Makes the provisions of Part 1 applicable to insurers offering health insurance coverage to individuals and their dependents. Part 3: Voluntary Health Purchasing Arrangements - Provides for the establishment of voluntary health purchasing arrangements. (Sec. 1124) Requires such arrangements to offer enrollment in health insurance coverage only to: (1) all eligible employees employed by small employers in a service area; and (2) all eligible individuals residing in such area. Part 4: Definitions and Miscellaneous Provisions - Provides definitions for purposes of this subtitle. (Sec. 1134) Requires the Secretary to make annual reports to the Congress on the implementation of this subtitle and the need for additional reforms to assure and expand coverage. (Sec. 1135) Authorizes the Director to conduct: (1) research on the impact of this subtitle on the availability of affordable health coverage for employees and dependents in the small employers group health care coverage market and other specified topics; and (2) demonstration projects relating to such topics. Requires the Director to develop: (1) methods for measuring the relative health risks of eligible individuals in terms of the expected costs of providing benefits under health insurance plans and, in particular, MedAccess plans; and (2) a model for equitably distributing health risks among insurers in the small employer health care coverage market. Authorizes appropriations. Subtitle C: Preemption - Part 1: Scope of State Regulation - Makes inapplicable to a group health plan any State or local law requiring coverage of specific benefits, services, or categories of health care, or services of any class or type of provider of health care. (Sec. 1202) Makes inapplicable any State or local law prohibiting two or more employers from obtaining coverage under a multiple employer welfare arrangement under which all coverage: (1) consists of medical care described under specified provisions of the Employee Retirement Income Security Act of 1974 (ERISA); and (2) is fully insured. (Sec. 1203) Preempts, for a five-year period, State law provisions which restrict: (1) reimbursement rates or selective contracting; (2) differential financing incentives; and (3) utilization review methods. Directs the Comptroller General to study benefits and cost effectiveness of use of managed care in health services delivery and to report to the Congress, including recommendations as to whether such preemption should be extended. Part 2: Multiple Employer Health Benefits Protections - Amends the Employee Retirement Income Security Act of 1974 (ERISA) to provide a limited exemption from certain restrictions on ERISA preemption of State law for health plans maintained by multiple employers subject to certain Federal standards. Relieves such exempted multiple employer health plans of certain restrictions on preemption of State law, and treats them as employee welfare benefit plans. Sets forth exemption procedures, application and eligibility requirements, and additional notice, reporting, and actuarial requirements applicable to exempted multiple employer health plans. Requires multiple employer welfare arrangements providing certain medical care benefits to issue specified disclosures to participating employers. Requires each multiple employer welfare arrangement which is or has been an exempted multiple employer health plan, and under which coverage is not fully insured, to establish certain minimum reserves. Authorizes the Secretary of Labor to permit alternative means of compliance. Sets forth corrective actions, including actions to avoid depletion of reserves and actions in connection with termination of arrangements. Provides for expirations, renewals, suspensions, and revocations of exemptions. Provides for review of actions of the Secretary, including denials of applications and suspensions or revocations of exemptions. Provides for alternative means of distribution of summary plan descriptions. (Sec. 1212) Revises provisions relating to scope of preemption rules, treatment of single employer arrangements, and treatment of certain collectively bargained arrangements. (Sec. 1215) Sets forth special rules for employee leasing healthcare arrangements, providing that they be treated as multiple employer welfare arrangements. (Sec. 1216) Sets forth enforcement provisions relating to multiple employer welfare arrangements and employee leasing healthcare arrangements, including enforcement of filing requirements, actions by States in Federal court, criminal penalties for certain willful misrepresentations, cease activities orders, and responsibility for claims procedures. (Sec. 1217) Sets forth solvency requirements for certain self- insured group health plans. (Sec. 1218) Sets forth filing requirements for multiple employer welfare arrangements providing health benefits. (Sec. 1219) Provides for cooperation between Federal and State authorities, including: (1) agreements for State enforcement of ERISA provisions applicable to multiple employer welfare arrangements which are or have been exempted multiple employer health plans; and (2) enforcement and technical assistance to States with respect to issues involving multiple employer welfare arrangements. (Sec. 1220) Sets forth transitional rules. Part 3: Encouragement of Multiple Employer Arrangements Providing Basic Health Benefits - Amends the Internal Revenue Code to eliminate the commonality of interest or geographic location requirement for tax-exempt trust status in the case of determining whether any multiple employer health plan or insured multiple employer health plan is a voluntary employees' beneficiary association meeting certain requirements, if: (1) such plan provides at least standard coverage consistent with specified provisions of this Act (the Affordable Health Care Now Act of 1994); and (2) in the case of such an insured plan, it meets specified ERISA requirements not preempted by this Act. (Sec. 1222) Amends ERISA to direct the Secretary of Labor to prescribe an alternative method for the filing of a single annual report with respect to all employers participating under a multiple employer welfare arrangement under which all coverage consists of medical care and is fully insured. (Sec. 1223) Sets forth provisions for determining compliance with coverage requirements through multiple employer health arrangements. Subtitle D: Health Deduction Fairness - Amends the Internal Revenue Code to provide for: (1) a permanent extension and an increase in the health insurance tax deduction for self-employed individuals; and (2) a deduction of health insurance premiums for certain previously uninsured individuals. Subtitle E: Improved Access to Community Health Services - Part 1: Increased Authorization for Community and Migrant Health Centers - Directs the Secretary to provide for grants to migrant and community health centers to promote primary health care services for underserved individuals. Allows grants to be used to promote the provision of off-site services, to improve birth outcomes in areas with high infant mortality and morbidity, to establish primary care clinics in areas in need, and for recruitment and training costs of necessary providers and operating costs for unreimbursed services. Authorizes appropriations. Directs the Secretary to conduct a study of the impact of such grants on access to health care, birth outcomes, and the use of emergency room services. Part 2: Grants for Projects for Coordinating Delivery of Services - Amends the Public Health Service Act to authorize the Secretary to make grants to public and nonprofit private entities: (1) to carry out demonstration projects to increase access to outpatient primary health services in specified geographic areas (i.e., areas that are rational areas for the delivery of health services, have a population of not more than 500,000 individuals, and have been designated by the Secretary as areas with a shortage of personal health services or that have a significant number of individuals with low incomes or insufficient health care insurance) through coordinating the delivery of services under Federal, State, local, and private programs; and (2) for developing plans to carry out such projects. Authorizes appropriations. Part 3: Community Health Networks - Sets forth qualifications for community health network arrangements. Subtitle F: Improved Access to Rural Health Services - Part 1: Establishment of Rural Emergency Access Care Hospitals Under Medicare - Amends title XVIII (Medicare) of the Social Security Act (SSA) to provide for: (1) establishment of rural emergency access care hospitals under Medicare; and (2) coverage of and payment for rural emergency access care hospital services under Medicare part B (Supplementary Medical Insurance). Part 2: Rural Medical Emergencies Air Transport - Amends the Public Health Service Act to direct the Secretary to make grants to States to assist in the creation or enhancement of air medical transport systems that provide victims of medical emergencies in rural areas with access to treatments. Sets forth provisions regarding: (1) application and State plan requirements; (2) considerations in awarding grants; (3) State administration and use of grants; (4) the number of grants; and (5) reporting requirements. Authorizes appropriations. Part 3: Emergency Medical Services Amendments - Amends the Public Health Service Act to direct the Secretary to: (1) establish an Office of Emergency Medical Services, headed by a Director; (2) engage in specified emergency medical services activities, including disseminating information obtained in carrying out specified activities to public and private entities, providing technical assistance to State and local agencies, coordinating Department of Health and Human Services (DHHS) activities with those of other Federal agencies; and (3) ensure that such activities are carried out consistent with certain requirements regarding maintaining an adequate number of health professionals with expertise in the provision of services, developing, periodically reviewing, and revising as appropriate guidelines for the provision of such services, appropriately using available technologies, and serving the unique needs of underserved inner-city and rural areas. (Sec. 1522) Authorizes the Secretary to make grants to States for the purpose of improving the availability and quality of emergency medical services through the operation of State offices of emergency medical services, subject to specified matching fund, budgetary, and other requirements. (Sec. 1523) Provides for demonstration projects to establish telecommunications between rural medical facilities and medical facilities with expertise or equipment. Directs the Secretary to ensure that the telecommunications technologies demonstrated include interactive video telecommunications, static video imaging transmitted through the telephone system, and facsimiles transmitted through such system. (Sec. 1524) Authorizes appropriations for: (1) emergency medical services (including for State offices of Emergency Medical Services and for telecommunications demonstrations); and (2) trauma care and certain other activities. Part 4: Additional Rural Health Care Provisions - Authorizes the Secretary to make grants to public and nonprofit private entities to develop health plans to provide services exclusively in rural and frontier areas. Authorizes appropriations. (Sec. 1532) Authorizes the Secretary to make grants to public and nonprofit private hospitals in medically underserved rural communities, and to public and nonprofit outpatient facilities in such communities, to develop or increase capacity to provide primary health services. (Sec. 1533) Authorizes the Secretary to make grants to such entities to conduct research and carry out demonstration projects to develop innovative approaches to the delivery of health care in rural areas, such as the use of telemedicine and mobile delivery units. (Sec. 1534) Authorizes appropriations for the training of rural health professionals other than physicians. Subtitle G: Assistance in Enrolling Uninsured Children in Health Insurance - Amends title XIX (Medicaid) of the Social Security Act (SSA) to provide for the establishment of State premium subsidy programs to assist eligible needy children with premiums for standard health coverage. Subtitle H: Medicaid Reform - Amends SSA title XIX to: (1) provide for the establishment of State health allowance programs under which the State makes payments to an approved group health plan which provides coverage to eligible individuals as an allowance towards the costs of providing the individual with benefits under the plan; (2) modify Federal requirements to allow States more flexibility in contracting for coordinated care services under Medicaid; (3) make changes regarding the period of certain waivers under Medicaid; and (4) reduce the amount of Federal payment adjustments under Medicaid for disproportionate share hospitals. (Sec. 1713) Eliminates the duplicative pediatric immunization program under Medicare. Subtitle I: Remedies and Enforcement with Respect to Group Health Plans - Amends the Employee Retirement Income Security Act of 1974 (ERISA) to set forth claims procedure special rules for group health plans. Directs the Secretary of Labor to establish a mediation program for disputes involving group health plan claims. Requires the Secretary to maintain a list of individuals with expertise to serve as facilitators under such program, and to propose a facilitator for each mediation subject to one objection by each party. Sets forth provisions for participation of attorneys, initiation of mediation, mediation procedures, time limits, costs, legal effect of participation, and confidentiality and admissibility. Sets forth court remedies for participants and beneficiaries with respect to group health plans. Subtitle J: Delivery of Health Care Services to Illegal Immigrants - Directs the Secretary of Health and Human Services to conduct a study of health care to illegal immigrants, including the effect of illegal immigration on health costs and the shifting of health costs. Requires a report to the Congress, with recommendations on appropriate means of: (1) alleviating health problems peculiar to illegal immigrants; (2) financing health care provided to illegal immigrants; and(3) increasing intergovernmental cooperation and coordination of efforts of the United States and other countries to alleviate such health problems and finance such efforts. Title II: Health Care Cost Containment and Quality Enhancement - Subtitle A: Medical Malpractice Liability Reform - Part 1: General Provisions - Makes this subtitle applicable with respect to any medical malpractice liability claim and to any medical malpractice liability action brought in State or Federal court, except a claim or action for damages arising from a vaccine-related injury or death to the extent that title XXI of the Public Health Service Act applies. Sets forth provisions regarding: (1) preemption of State law; (2) effect on sovereign immunity and choice of law or venue; (3) jurisdiction; and (4) effective dates. Part 2: Medical Malpractice and Product Liability Reform - Prohibits a medical malpractice liability action from being brought in any State court during a calendar year unless the relevant claim has been initially resolved (i.e., a decision has been reached on whether the defendant is liable to the plaintiff for damages and on the amount of damages) under a certified alternative dispute resolution (ADR) system or an alternative Federal system. Prohibits a medical malpractice liability action from being brought in Federal court based on diversity of citizenship during a calendar year unless the relevant claim has been initially resolved under such a system in the State whose law applies. Directs the Attorney General to establish an ADR process for tort claims consisting of medical malpractice liability claims brought against the United States under chapter 171 of the Federal judicial code (U.S. Court of Federal Claims). Prohibits a medical malpractice liability action based on such a claim from being brought in any Federal court unless the claim has been initially resolved under such process. Sets forth procedures for filing actions. (Sec. 2012) Limits to $250,000 the amount of noneconomic damages that may be awarded to a claimant and family members in a medical malpractice liability action. Sets limits on punitive damages and on periodic payments for future losses. Reduces damages by any other payments made to compensate an individual for injuries. (Sec. 2013) Set forth provisions regarding: (1) limits on attorney fees and other costs; (2) joint and several liability (generally, liability may be found only for those damages directly attributable to the person's proportionate share of fault or responsibility for the injury); (3) a statute of limitations of seven years; and (4) a uniform standard for determining negligence (the defendant's conduct at the time of providing the health care services was not reasonable). (Sec. 2017) Specifies that in the case of a medical malpractice liability claim relating to services provided during labor or the delivery of a baby, if the health care professional did not previously treat the injured individual for the pregnancy, the trier of fact may not find that the defendant committed malpractice nor assess damages unless the malpractice is proven by clear and convincing evidence. Part 3: Requirements for State Alternative Dispute Resolution Systems - Lists requirements for State ADR systems, including that such a system: (1) applies to all medical malpractice liability claims under the jurisdiction of the courts of that State; (2) requires that a written opinion resolving the dispute be issued within six months after each party against whom the claim is filed has received notice of the claim; (3) is approved by the State or local governments; (4) provides for the transmittal to the State agency responsible for monitoring or disciplining health care professionals and providers of any findings of malpractice; and (5) provides for the regular transmittal of information on disputes resolved under the system to the Administrator for Health Care Policy and Research in a manner that protects the identity of the parties involved. (Sec. 2032) Directs the Secretary, by October 1 of each year, to certify State ADR systems that meet such requirements. Directs the Secretary to establish an alternative Federal ADR system for the resolution of medical malpractice liability claims in States that do not have in effect a certified ADR system. (Sec. 2033) Directs the Secretary, within five years, to submit to the Congress a report describing and evaluating State ADR systems and the alternative Federal system, including: (1) information on the effect of the ADR systems on health care costs, access to health care, and quality of care provided within the State; and (2) to the extent that such report does not provide information on no-fault systems operated by States as ADR systems, an analysis of the feasibility and desirability of establishing a system for resolving medical malpractice liability claims on a no-fault basis. Part 4: Other Provisions Relating to Medical Malpractice Liability - Authorizes a State agency responsible for disciplinary actions for a type of health care practitioner to enter into agreements with State or county professional societies to permit their participation in the licensing of such practitioner and to review any health care malpractice action, claims, or allegation, or other information concerning the practice patterns of any such practitioner. Sets forth agreement requirements. (Sec. 2042) Directs the Secretary to study incentives adopted by State and local governments, insurers, medical societies, and other entities to encourage physicians to volunteer to provide health care services in medically underserved areas. (Sec. 2043) Directs each State to require: (1) each health care professional and health care provider to participate in a risk management program to prevent, and provide early warning of, practices which may result in injuries to patients or endanger patient safety; and (2) each provider of health care professional and provider liability insurance in the State to establish risk management programs or sanction programs of risk management for health care professionals and providers provided by other entities, and require each such professional or provider, as a condition of maintaining insurance, to participate in one such program at least once in each three-year period. (Sec. 2044) Directs the Secretary to make grants: (1) for basic research in the prevention of, and compensation for, injuries resulting from health care professional or provider malpractice and for research of the outcomes of health care procedures; (2) to States to assist in improving their ability to license and discipline health care professionals; and (3) to States and local governments, private nonprofit organizations, and health professional schools for educating the general public about the appropriate use of health care, realistic expectations of medical intervention, and the resources and role of health care professional licensing and disciplinary boards in investigating claims of incompetence or health care malpractice, and for developing programs of faculty training and curricula for educating health care professionals in quality assurance, risk management, and medical injury prevention. Authorizes appropriations. Subtitle B: Administrative Cost Savings and Fair Health Information Practices - Part 1: Administrative Cost Savings - Subpart A: Standards for Data Elements and Transactions - Directs the Secretary to adopt standards and modifications to standards that are: (1) consistent with the objective of reducing the costs of providing and paying for health care; and (2) in use and generally accepted, developed, or modified by the standard-setting organizations accredited by the American National Standard Institute. (Sec. 2104) Directs the Secretary to adopt standards: (1) for data elements of health information; and (2) for transmitting information electronically. Subpart B: Requirements With Respect to Certain Transactions and Information - Specifies standard transactions. Subpart C: Miscellaneous Provisions - Requires the Secretary to establish standards with respect to the operation of health information network services. (Sec. 2124) Authorizes the Secretary to make grants for demonstration projects to promote the development and use of electronically integrated community-based clinical information systems and computerized patient medical records. Subpart D: Assistance to the Secretary - Establishes the Health Care Information Advisory Committee to: (1) assist the Secretary in complying with requirements under this Act; (2) be generally responsible for advising the Secretary and the Congress on the status of the health information network; and (3) make recommendations to correct problems in the network and to refine and improve the network. Part 2: Fair Health Information Practices - Subpart A: Duties of Health Information Trustees - Specifies the duties of health information trustees with respect to inspection of protected health information. (Sec. 2142) Provides a procedure to amend protected health information. Subpart B: Use and Disclosure of Protected Health Information - Sets forth general limitations on the use and disclosure of protected health information by health information trustees. (Sec. 2152) Authorizes a health information trustee to disclose protected health information pursuant to a written authorization by the protected individual. (Sec. 2153) Describes the circumstances under which health information trustees may disclose protected health information to: (1) health plans, health care providers, and oversight agencies; (2) next of kin; (3) public health authorities; (4) health research entities; (5) authorities under emergencies; (6) courts or administrative agencies; (6) law enforcement agencies; (7) entities under subpoenas, warrants, and search warrants; and (8) health information service organizations. Subpart C: Access Procedures and Challenge Rights - Prohibits a government authority from obtaining protected health information about a protected individual from a health information trustee through subpoenas, warrants, and search warrants unless there is probable cause that the information is relevant to the law enforcement inquiry. (Sec. 2172) Establishes challenge procedures to such subpoenas. Subpart D: Miscellaneous Provisions - Restricts the information a health information trustee may disclose when a protected individual pays for health care through a payment card or electronic means. (Sec. 2183) Directs the Secretary to develop standards for electronic documents and communications. (Sec. 2184) Provides for the disclosure of protected health information to affiliated persons and agents and attorneys. (Sec. 2187) Requires States to establish a process for the maintenance of certain protected health information. Subpart E: Enforcement - Provides for civil actions against health information trustees. (Sec. 2192) Authorizes the Secretary to impose a civil money penalty against such trustees for a demonstrated pattern of failure to comply with this subpart. (Sec. 2193) Requires the Secretary to develop an alternative dispute resolution method for resolving claims for civil actions. (Sec. 2194) Amends the Federal criminal code to impose penalties for violations in disclosing and obtaining protected health information. Subpart F: Amendments to Title 5, United States Code - Requires certain Federal agency heads to promulgate rules protecting health information. Subpart G: Regulations, Research, and Education; Effective Dates; Applicability; and Relationship to Other Laws - Requires the Secretary to prescribe regulations to carry out this part not later than July 1, 1996. (Sec. 2197) Makes this part effective on January 1, 1997, except for certain provisions that take effect upon enactment. Subtitle C: Deduction for Cost of Catastrophic Health Plan; Medical Savings Accounts - Amends the Internal Revenue Code to include under the medical expense deduction the portion of such expense attributable to coverage under a catastrophic health plan. (Sec. 2202) Allows individuals a tax deduction for a percentage of contributions made to a medical care savings account established for the benefit of an eligible individual. Allows such deduction whether or not an individual itemizes deductions. Disallows distributions from such accounts as medical expense deductions. Excludes employer contributions to such accounts from employment taxes. Establishes an excise tax for excess contributions to medical care savings accounts. Subtitle D: Anti-Fraud - Directs the Attorney General to establish an all-payer health care fraud and abuse control program. (Sec. 2302) Authorizes additional appropriations for such program and AG investigations of possible health care fraud. (Sec. 2303) Establishes in the Treasury the Anti-Fraud and Abuse Trust Fund for use in preventing anti-fraud and abuse law violations and repaying Medicaid and other beneficiaries for cost-sharing. (Sec. 2311) Amends SSA title XI and the Federal criminal code to: (1) revise current sanctions to provide for, among other things, mandatory exclusion from Medicare and State health care program participation of individuals or entities convicted of a fraud-related felony in connection with the delivery of a health care item or service, and criminal penalties of fines and imprisonment for health care fraud; and (2) authorize the Secretary of Health and Human Services (Secretary) to issue advisory opinions with regard to specified matters, including matters concerning prohibited remuneration and service inducements. (Sec. 2315) Modifies: (1) current limitations under Medicare (SSA title XVIII) on physician self-referral; and (2) effective date exceptions under the Omnibus Budget Reconciliation Act of 1993 for such referrals made for clinical laboratory services. (Sec. 2316) Directs the Comptroller General to study and report to the Congress on the costs of peer review contracts for Medicare HMOs. (Sec. 2332) Amends SSA title XVIII to require the Secretary to issue advisory opinions relating to prohibited referrals under Medicare. Directs the Secretary to issue regulations establishing systems under SSA titles XI and XVIII for the issuance of advisory opinions. Subtitle E: Increased Medicare Beneficiary Choice; Additional Medicare Reforms - Amends SSA title XVIII and the Omnibus Budget Reconciliation Act of 1990 to make specified changes in HMO and Medicare supplemental policy provisions. Imposes mandates on the Secretary in order to afford Medicare beneficiaries additional avenues for choosing health care coverage, including enrollment in private health insurance plans. (Sec. 2411) Extends current rules for computing Medicare part B (Supplementary Medical Insurance) premiums. (Sec. 2412) Amends the Internal Revenue Code to provide for the imposition of a Medicare part B premium tax for high-income Medicare part B beneficiaries. (Sec. 2413) Directs the Secretary to take such steps as necessary to consolidate administration of Medicare parts A (Hospital Insurance) and B. (Sec. 2414) Makes specified extensions with regard to Medicare as secondary payer, including those concerning data matches. Subtitle F: Health Care Antitrust Improvements - Exempts from all antitrust claims an activity relating to the provision of health care services that is: (1) within a "safe harbor" designated by the Attorney General, except for claims for injunctive relief asserted by the Attorney General or the Chair of the Federal Trade Commission in extraordinary circumstances; and (2) specified in and in compliance with the terms of a certificate of review issued by the Attorney General, where the activity occurs while the certificate is in effect, except for claims for injunctive relief. Sets forth provisions regarding the award of attorney fees and costs of suit to the prevailing party in an action based on a claim involving activity found to be exempt. (Sec. 2502) Directs the Attorney General to develop and designate specified safe harbors relating to the following, as well as to such other categories of activities as the Attorney General may designate (subject to specified requirements): (1) joint purchasing of health care services; (2) small hospital mergers; (3) startup and operation of collaborations between State-licensed providers through partial or full integration; (4) standard setting and enforcement activities by medical self-regulatory entities; (5) health care providers collectively supplying non-price medical information to buyers and consumers; (6) health care provider participation in surveys; (7) health care joint ventures' purchase or use of equipment or provision of advanced tertiary care services; (8) provision of market power screens at appropriate levels below which combinations of providers are too small to pose a realistic antitrust threat; (9) joint purchasing arrangements; and (10) good faith negotiations relating to legitimate collaborative activities. Directs the Attorney General to publish notice in the Federal Register soliciting proposals for additional safe harbors. Authorizes the Attorney General to modify or remove a safe harbor following notice and comment upon a determination that the safe harbor does not meet specified criteria. Sets forth criteria in establishing safe harbors, including: (1) the extent to which a competitive or collaborative activity will accomplish an increase in health care access and quality, the establishment of cost efficiencies, and increased ability of health care facilities to provide services in medically underserved areas or to underserved populations; and (2) whether designation as a safe harbor will result in specified desirable outcomes. (Sec. 2503) Directs the Attorney General to issue certificates of review for providers of health care services and to assist persons in applying for such certificates. Sets forth procedures regarding applications for, renovation of, and review of determinations regarding, such certificates. Limits the disclosure of information. (Sec. 2504) Sets forth provisions regarding notifications providing for a reduction in certain penalties under the antitrust laws for health care cooperative ventures. (Sec. 2505) Directs the Attorney General to periodically review the safe harbors, certificates of review, and notifications. (Sec. 2507) Establishes within the Department of Health and Human Services an Office of Health Care Competition Policy. Subtitle G: Encouraging Enforcement Activities of Medical Self- Regulatory Entities - Part 1: Application of the Clayton Act to Medical Self-Regulatory Entities - Provides that no damages, cost of suit, or attorney fee may be recovered under section 4, 4A, or 4C of the Clayton Act, or under any similar State law, except by a State or the United States, from any medical self-regulatory entity as a result of engaging in standard setting or enforcement activities that are: (1) designed to promote the quality of health care provided to patients; and (2) not conducted for purposes of financial gain. Directs the court to award the cost of such a suit, including a reasonable attorney fee, to a substantially prevailing defendant. Part 2: Consultation by Federal Agencies - Requires any Federal agency engaged in the establishment of medical professional standards to consult with appropriate medical societies or associations, specialty boards, or recognized accrediting agencies, if available, in carrying out medical professional standard setting and guidelines or standards relating to the practice of medicine. Subtitle H: Reform of Clinical Laboratory Requirements for Simple Tests - Amends the Public Health Service Act to exempt clinical laboratories performing only simple examinations and procedures from certificate requirements. (Sec. 2703) Directs the Secretary to use existing appropriations to conduct the study relating to the reliability and quality control procedures of clinical laboratory testing programs and the effect of errors in the testing procedures and results on the diagnosis and treatment of patients. (Sec. 2704) Directs the Secretary to revise the membership of the Clinical Laboratory Improvement Advisory Committee to contain a number of practicing physicians proportionate to the number of physician regulated clinical laboratories. Subtitle I: Miscellaneous Provisions - Requires certain Government agencies to refund health benefit contributions for their annuitants. (Sec. 2802) Makes aliens ineligible for social security and Medicaid benefits. (Sec. 2803) Limits the eligibility for social security benefits of certain drug and alcohol addicts. Title III: Long-Term Care - Subtitle A: Tax Treatment of Long-Term Care Insurance - Amends the Internal Revenue Code to provide for the treatment of qualified long-term care insurance as accident and health insurance for purposes of insurance company taxation. (Sec. 3002) Excludes from gross income benefits provided under a long-term care insurance contract. Includes in gross income employer-provided coverage for long-term care services. (Sec. 3003) Includes amounts paid for qualified long-term care services as medical expenses for individual itemized deductions. Includes any parent or grandparent as a dependent for purposes of such expenses. Subtitle B: Establishment of Federal Standards for Long-Term Care Insurance - Amends the Public Health Service Act to mandate the establishment of model Federal standards for long-term care insurance. Prohibits the offering of a long-term care insurance policy in a State unless the State has a regulatory program meeting the requirements of this Act or the policy has been certified by the Secretary of Health and Human Services. Authorizes grants to States for demonstration programs to improve enforcement of the standards. Authorizes appropriations. Imposes on agents selling long-term policies a duty of good faith and fair dealing. Prohibits twisting, high pressure tactics, and cold lead advertising. Mandates minimum financial standards, including income and asset criteria, for advising individuals considering the purchase of a long-term policy. Prohibits sales: (1) to an individual eligible for assistance under title XIX (Medicaid) of the Social Security Act; (2) of duplicate service policies; and (3) of policies that reduce, limit, or coordinate benefits on the basis of eligibility for other coverage or benefits. Provides for: (1) criminal and civil penalties; and (2) agent training and certification. Sets forth additional carrier responsibilities relating to refunding of premiums, mailing of policies, providing information on denials of claims, reporting of information, and limiting compensation to agents for the sale or renewal of policies. Prohibits cancellation or nonrenewal of a long-term care policy except for nonpayment of premium or material misrepresentation. Sets forth continuation and conversion rights for group policies, regulating premiums for converted policies. Requires guaranteed issuance to an individual if the individual meets the minimum medical requirements of the policy. Mandates standards regarding upgraded benefits. Limits cancellation for nonpayment by an incapacitated individual. Requires: (1) subject to exceptions, uniform language and definitions, a uniform format, and at least one standard benefit package; and (2) disclosure of certain matters, including an outline of coverage. Mandates recommendations by the National Association of Insurance Commissioners (NAIC) regarding informing consumers on the long-term economic viability of long-term care insurance carriers. Limits certain conditions on benefits. Requires, if benefits are provided for home health care or community-based services, that certain minimum benefits be provided. Prohibits treating cognitive or mental impairments (including Alzheimer's disease and mental illness) differently from other medical conditions. Limits preexisting condition requirements. Requires: (1) each claimant to have a functional assessment by an individual or entity meeting NAIC qualifications and unconnected to the policy issuer; (2) inflation protection, unless rejected in writing by a policyholder; (3) disclosure of certain premium increases; and (4) nonforfeiture benefits. Prohibits a carrier from contesting a policy or claim based on fraud or misrepresentation unless notice is provided within a time period set by NAIC. Establishes the right of a purchaser to return a policy within a specified period. Defines "long-term care insurance policy," excluding: (1) any basic Medicare supplemental policies; (2) other insurance offered primarily to provide specified types of coverage; and (3) certain life insurance policies. Authorizes grants for programs to provide information, counseling, and assistance regarding the procurement of long-term insurance. Authorizes appropriations. Subtitle C: Protection of Assets Under Medicaid Through Use of Qualified Long-term Care Insurance - Amends the title XIX of the Social Security Act to require State Medicaid plans to disregard some or all of the individual's assets attributable to coverage under a qualified long-term care insurance contract in determining the individual's eligibility for long-term care services. Subtitle D: Studies - Requires the Comptroller General to study the feasibility of: (1) encouraging health care providers to donate their services to homebound patients; and (2) providing heads of households who care for elderly family members in their home with an income tax credit. (Sec. 3303) Requires the Secretary of Health and Human Services to study and report to the Congress on the feasibility of encouraging or requiring the use of a single designated public or nonprofit agency to coordinate, through case management, the provision of long-term care benefits under current Federal, State, and local programs in a geographic area. Subtitle E: Volunteer Service Credit Demonstration Projects - Amends the Older Americans Act of 1965 to require the Commissioner of the Administration on Aging to establish and operate a volunteer service credit demonstration project in each State.
United States · United States Congress · 16 August 1994
Waives points of order against the consideration of the conference report on S. 2182 (authorizing appropriations for FY 1995 for the Department of Defense and defense programs of the Department of Energy).
United States · United States Congress · 12 August 1994
TABLE OF CONTENTS: Title I: Overseas Private Investment Corporation Title II: Trade and Development Agency Title III: Export Promotion Programs Within the International Trade Administration Title IV: Promotion of United States Environmental Exports Title V: International Protection of Intellectual Property Jobs Through Trade Expansion Act of 1994 - Title I: Overseas Private Investment Corporation - Overseas Private Investment Corporation Amendments Act of 1994 - Amends the Foreign Assistance Act of 1961 to revise provisions concerning the Overseas Private Investment Corporation (OPIC). (Sec. 102) Authorizes OPIC to operate its program in a country or an area within a country only if: (1) the United States maintains diplomatic relations with the country; (2) the country or area is a developing country or area, or a country in transition from a nonmarket to market economy; and (3) programs in that country are not prohibited due to human rights violations. Permits OPIC to continue to operate programs in a country which ceases to meet such criteria if the President determines that the operation of such programs would be in the national interest. Raises the ceiling on the per capita income levels of countries established for purposes of granting preferential consideration for, or restricting, OPIC investment projects. Authorizes OPIC to acquire equity securities for purposes of providing capital for projects, subject to limitations on aggregate amounts of equity investment. Requires OPIC to endeavor to dispose of any acquired equity interest within ten years of the date of acquisition. Raises the ceiling on the maximum contingent liability allowed for OPIC insurance and outstanding financing. Authorizes OPIC to transfer amounts from noncredit activities to pay subsidy costs of program levels for the direct loan and guarantee programs. Continues OPIC's authority to issue investment insurance and guarantees through FY 1997. Eliminates OPIC's exemption from Federal taxation. Title II: Trade and Development Agency - Revises provisions regarding the Trade and Development Agency. (Sec. 201) Permits the Agency to provide funding for environmental assessments. Authorizes appropriations for the Agency for FY 1995 and 1996. Title III: Export Promotion Programs Within the International Trade Administration - Amends the Export Administration Amendments Act of 1985 to authorize appropriations for Department of Commerce export promotion programs for FY 1995 and 1996. Title IV: Promotion of United States Environmental Exports - Environmental Export Promotion Act of 1994 - Amends the Export Enhancement Act of 1988 to remove provisions relating to Environmental Export Assistance Officers. (Sec. 402) Directs the Secretary of Commerce to establish the Environmental Technologies Trade Advisory Committee to provide guidance on programs to expand U.S. exports of environmental technologies, goods, and services. Requires the Environmental Trade Promotion Working Group, a subcommittee of the Trade Promotion Coordination Committee (TPCC), to: (1) select five priority countries with the greatest potential for the application of U.S. Government export promotion resources related to environmental exports; and (2) create a plan annually for each such country that sets forth ways to increase such exports to such country. Directs the Secretary to assign a specialist in environmental technologies to the office of the U.S. and Foreign Commercial Service in each of the priority countries. Requires the TPCC to establish international regional initiatives to coordinate the activities of Federal agencies in order to build environmental partnerships between the United States and the geographic regions outside the United States for which such initiatives are established. Provides that such partnerships shall enhance environmental protection and promote sustainable development by using the technical expertise and financial resources of Federal agencies that provide foreign assistance and by expanding U.S. exports of environmental technologies, goods, and services to such regions. Directs the Working Group to maintain a calendar of significant opportunities for U.S. environmental businesses in foreign markets and trade promotion events to be made available to the public. Authorizes the Secretary to provide matching funds for the establishment in the United States of regional environmental business and technology cooperation centers to provide export promotion assistance related to environmental technologies, goods, and services. Title V: International Protection of Intellectual Property - Requires the President, acting through the Administrator of the Agency for International Development, to establish a program of training and technical assistance to assist foreign countries in: (1) developing and strengthening laws and regulations to protect intellectual property; and (2) developing the infrastructure necessary to implement and enforce such laws and regulations.
United States · United States Congress · 11 August 1994
Prohibits any intelligence community construction project in excess of $250,000 from being undertaken in a fiscal year unless such project is specifically: (1) identified as a separate item in the President's annual budget submission to the Congress; and (2) authorized by the Congress.
United States · United States Congress · 9 August 1994
TABLE OF CONTENTS: Title I: Affordable Health Insurance Coverage Subtitle A: Tax Incentives Subtitle B: Premium Assistance Title II: Health Insurance and Delivery Systems Reform Subtitle A: Federal Standards for State Certification Programs Subtitle B: Consolidation of Federal Research Subtitle C: Self-Employed Individual and Small Employer Participation in Federal Employees Health Benefits Plans Subtitle D: Report on Health Care System Title III: Special Assistance for Rural, Frontier and Underserved Urban Areas Subtitle A: Planning, Demonstrations, and Grants Subtitle B: Technical Assistance Grants Subtitle C: Capital Assistance Loans and Loan Guarantees Subtitle D: Increasing Primary Care Providers Subtitle E: Payment Flexibility Subtitle F: Emergency Medical Systems Subtitle G: Studies and Reports Title IV: Long-Term Care Provisions Subtitle A: Long-Term Care Services and Contracts Subtitle B: Tax Treatment of Accelerated Death Benefits Subtitle C: Credit for Personal Assistance Title V: Health Care Providers Subtitle A: Education and Research Subtitle B: Health Care Liability Reform Subtitle C: Health Care Antitrust Improvements Title VI: Administrative Simplification and Privacy Title VII: Enhanced Penalties for Health Care Fraud Subtitle A: All-Payer Fraud and Abuse Control Program Subtitle B: Revisions to Current Sanctions for Fraud and Abuse Subtitle C: Administrative and Miscellaneous Provisions Subtitle D: Amendments to Criminal Law Subtitle E: Amendments to Civil False Claims Act Title VIII: Medicare and Medicaid Subtitle A: Medicare Subtitle B: Medicaid Program Title IX: Department of Veterans Affairs Title I: Affordable Health Insurance Coverage - Subtitle A: Tax Incentives - Amends the Internal Revenue Code to allow a deduction for the qualified health insurance costs of individuals (including self-employed individuals) that provide their own health insurance. (Sec. 111) Allows individuals a tax deduction for contributions made to a medical care savings account established for the benefit of one or more eligible individuals. Limits the amount of such deduction to specified amounts (dependent upon the tax filing category) or the high deductible health plan differential. Allows such deduction whether or not an individual itemizes deductions. (Sec. 112) Excludes employer contributions to medical savings accounts from the gross income of the employee, with a dollar limitation or the high deductible health plan differential. Excludes employer contributions to such accounts from employment taxes. (Sec. 113) Provides for the establishment of medical savings accounts. Sets contribution limitations, including that the individual on whose behalf such contributions are made is covered under a high deductible health plan. Subjects the account beneficiary to taxation as owner of the account. Imposes a penalty for distributions that are not used for qualified medical expenses. Subtitle B: Premium Assistance - Amends title XIX (Medicaid) of the Social Security Act (SSA) to require States with approved Medicaid plans to provide for State programs for furnishing certain low-income families with assistance in regard to certified health plan premiums. Establishes annual limitations on premium assistance spending. Requires the President's budget to include estimates of premium assistance expenditures under Medicare and Medicaid. Title II: Health Insurance and Delivery Systems Reform - Subtitle A: Federal Standards for State Certification Programs - Amends SSA title XIX to require State Medicaid plans to provide for State programs under a new SSA title XXI for certifying insured health plans in the State that meet certain Federal standards and delivery system guidelines developed by the Secretary of Health and Human Services (HHS) incorporating specified requirements pertaining, among other things, to guarantee issue and renewal, preexisting condition exclusions, minimum benefit packages, quality assurance, and access to health care services, as certified health plans. Requires State programs also to provide consumers in the State with comparative value information on the performance of all health plans in each community rating area established in the State. Requires risk adjustment programs. Authorizes appropriations. Requires the Secretary of Labor to develop similar standards and guidelines for Federal certification of self-insured health plans. Provides for: (1) the treatment of certain State laws with regard to health plans; and (2) expanded access to health plans through purchasing cooperatives, the Federal Employee Health Benefits Program in the case of small businesses, and certain multiple employer welfare arrangements maintained by qualified associations; (3) special rules for church, multiemployer, and certain rural cooperative plans; and (4) general employer responsibilities with regard to payroll deductions for certified health plan premiums. Subtitle B: Consolidation of Federal Research - Establishes the Agency for Quality Assurance and Consumer Information within the Department of Health and Human Services. Creates an Administrator for Quality Assurance and Consumer Information to head the Agency. (Sec. 211) Directs the Secretary of Health and Human Services, acting through the Administrator, to consolidate Federal research activities relating to quality and consumer information in health care to enable States to gain access to the results of such research from a central source. Lists current Federal responsibilities to be assumed by the Administrator. Authorizes appropriations. Subtitle C: Self-Employed Individual and Small Employer Participation in Federal Employees Health Benefits Plans - Amends Federal civil service law to require the Office of Personnel Management (OPM) to promulgate regulations applying the Federal Employees Health Benefits Program (FEHBP) to self-employed individuals and businesses employing 50 or fewer employees, allowing required enrollee and Government contributions to be made by the State or small business involved or else be made in full by the self-employed or small business enrollee. (Sec. 221) Extends continued coverage under FEHBP. Requires carriers under FEHBP and the small business health insurance program to submit periodic reports to OPM comparing costs between the programs. (Sec. 222) Prohibits the FEHBP and the program described by this subtitle from being offered exclusively to Members of the Congress and congressional employees. (Sec. 223) Directs the Secretary to study and report to the Congress on nonworker and noncovered employee buy-ins for FEHBP coverage. Subtitle D: Report on Health Care System - Directs the President to report to the Congress on specified aspects of the health care system. Title III: Special Assistance for Rural, Frontier and Underserved Urban Areas - Authorizes States to designate certain rural, frontier, or urban areas as underserved areas based on the lack of access to health plans, quality health providers, and health care facilities. (Sec. 302) Requires the Secretary, upon a State's request, to establish a procedure to certify such areas as underserved areas. Directs the Secretary to give priority in awarding assistance to applicants that serve such areas except with respect to assistance provisions that explicitly direct assistance to areas currently designated as underserved. Subtitle A: Planning, Demonstrations, and Grants - Authorizes the Secretary to conduct a demonstration project and grant program to encourage the development and operation of health networks. Authorizes appropriations. (Sec. 312) Amends title XX (Block Grants to States for Social Services) of the Social Security Act to provide for grants to private entities for developing health networks or health plans to serve underserved areas certified under section 302 of this Act. Authorizes appropriations. (Sec. 313) Amends the Public Health Service Act to establish a program of allotments to States for grants for community-based primary health services to low-income or medically underserved populations. Earmarks funding for such grants. Subtitle B: Technical Assistance Grants - Directs the Secretary to award technical assistance grants to public and private entities for establishing infrastructure for health networks and plans in underserved areas certified under section 302 of this Act. Authorizes appropriations. Subtitle C: Capital Assistance Loans and Loan Guarantees - Directs the Secretary to make loans to health networks, health plans that cover individuals residing in rural, frontier, or urban underserved areas, or health care providers that serve such areas for the capital costs of developing health delivery systems and expanding existing health delivery sites to make health care services available in underserved areas certified under section 302. Subtitle D: Increasing Primary Care Providers - Amends the Internal Revenue Code to: (1) allow a nonrefundable credit for certain primary health services providers for mandatory service periods in health professional shortage areas; and (2) increase the dollar limitation allowed for expensing medical equipment used in such areas. (Sec. 343) Mandates grants to federally qualified health centers (FQHCs) and other entities for providing access to services for medically underserved populations or in high impact areas not currently being served by a FQHC. Authorizes appropriations. (Sec. 345) Authorizes the Secretary to award grants to States for primary health care and social service programs targeted to pregnant women and infants. Authorizes appropriations. (Sec. 346) Amends the Elementary and Secondary Education Act of 1965 to revise provisions regarding the improvement of school health education. Requires the Secretary of Education to award grants to States for local programs of health education and prevention, early health intervention, and health education in pre-schools and elementary schools and to carry out other related activities. Authorizes appropriations. (Sec. 347) Authorizes frontier States (including Alaska, Wyoming, and Montana) to implement proposals to: (1) offer preventive services, including mobile preventive health centers; and (2) participate in demonstration projects to improve recruitment, retention, and training of rural providers. (Sec. 348) Authorizes specified amounts of appropriations for the National Health Service Corps Scholarship Program through FY 2000. (Currently, such sums as necessary are authorized to be appropriated.) Extends the authorization of appropriations for area health education centers through FY 2000. (Sec. 349) Directs the Secretary of Health and Human Services to establish the Interagency Task Force on Rural Telemedicine. (Sec. 350) Requires the Secretary, acting through the Office of Rural Health, to award grants to eligible entities to promote the use of telemedicine to strengthen health care in rural areas. Authorizes appropriations. Subtitle E: Payment Flexibility - Amends SSA title XVIII (Medicare) to: (1) make various specified changes in essential access community hospital (EACH) program provisions, including changes allowing an unlimited number of States to participate in the program, and eliminating grant tie-in requirements for EACH or rural primary care hospital designation. Extends the deadline for development of a prospective payment system (PPS) for inpatient rural primary care hospital services. Provides for the implementation of a PPS for outpatient rural primary care hospital services. Revises the physician staffing requirements for rural primary care hospitals. Authorizes increased appropriations for the EACH program. (Sec. 352) Amends Medicare part A to provide for medical assistance facility and emergency access care hospital demonstration projects for improving access to health care in rural areas. Authorizes appropriations. (Sec. 353) Makes various specified changes with regard to Medicare-dependent, small rural hospitals. (Sec. 354) Provides for expanded coverage for physician assistants and nurse practitioners. Subtitle F: Emergency Medical Systems - Amends the Public Health Service Act to prove for grants to States for systems to transport rural victims of medical emergencies by air. Authorizes appropriations. Subtitle G: Studies and Reports - Amends SSA title VII (Administration) to: (1) provide for the appointment of an Assistant Secretary for Rural Health in the Office of Rural Health Policy; and (2) make administrative changes respecting the Office and duties of the new assistant secretary. (Sec. 372) Requires: (1) the Prospective Parent Assessment Commission to study and report to the Congress on the need for legislation or regulations to ensure that vulnerable populations have adequate access to health plans and health care providers and services; and (2) the Secretary of HHS to study and report to the Congress on expanding the benefits under health plans for individuals residing in rural areas. Title IV: Long-Term Care Provisions - Subtitle A: Long-Term Care Services and Contracts - Amends the Internal Revenue Code to treat qualified long-term care services as medical care for purposes of the medical expense deduction. (Sec. 402) Provides for the treatment long-term care insurance as accident or health insurance. Excludes qualified long-term care insurance contracts from cafeteria plans. (Sec. 406) Sets forth consumer protection provisions to be satisfied by qualified long-term care insurance contracts, including the model regulation and model Act promulgated by the National Association of Insurance Commissioners (NAIC). (Sec. 407) Imposes an excise tax on insurers who fail to meet requirements for long-term care insurance policies. (Sec. 409) Requires NAIC to promulgate standards for the use of uniform language and definitions in such policies, with certain variations permitted. Subtitle B: Tax Treatment of Accelerated Death Benefits - Provides for the exclusion as a death benefit of any amount received under a life insurance contract because such individual is terminally ill. Allows insurance companies to issue accelerated death benefit riders on life insurance contracts. Subtitle C: Credit for Personal Assistance - Allows a tax credit for the cost of personal assistance services required by certain individuals. Describes such individuals as those who, by reason of a medically determinable physical impairment which can be expected to last for a continuous period of not less than 12 months, are unable to engage in any substantial gainful employment activity without personal assistance services appropriate to carry out activities of daily living. Limits the amount of such credit and provides a cost-of- living adjustment. Title V: Health Care Providers - Subtitle A: Education and Research - Amends SSA title XVIII to: (1) require the Director of the Office of Technology Assessment to provide for the appointment of an Advisory Commission on Workforce to develop recommendations and assessments with regard to national health care workforce policy and payment for a report to the Congress. Authorizes appropriations. (Sec. 502) Requires the Secretary of HHS to provide for a consortium demonstration program for testing and evaluating mechanisms for increasing the number of medical students entering primary care practice through the use of funds available for direct graduate medical education (GME) costs. Authorizes appropriations. (Sec. 503) Requires that residency training time spent in nonhospital-owned facilities be counted in determining full-time- equivalent residents for direct and indirect GME payments. (Sec. 504) Amends the Internal Revenue Code to create in the Treasury the National Fund for Medical Research consisting of designated overpayments and cash contributions for use by the National Institutes for Health (NIH) for medical research and construction and acquisition of equipment and facilities for NIH, and for health information communications under the Public Health Service Act. Subtitle B: Health Care Liability Reform - Amends SSA title XI part A to provide for various specified changes with regard to civil actions in State or Federal court for damages arising out of alleged injuries caused by health care providers or payors, including among such changes: (1) limitations on noneconomic damages, attorney contingency fees, and action time frames; (2) requirements for pleading of punitive damages, periodic damage payments, and risk management programs for health care providers; and (3) providing for State health care quality assurance programs funded out of a portion of all punitive damages awarded in the State. Subtitle C: Health Care Antitrust Improvements - Exempts from all antitrust claims an activity relating to the provision of health care services that is: (1) within a "safe harbor" designated by the Attorney General, except for claims for injunctive relief asserted by the Attorney General or the Chair of the Federal Trade Commission in extraordinary circumstances; and (2) specified in and in compliance with the terms of a certificate of review issued by the Attorney General, where the activity occurs while the certificate is in effect, except for claims for injunctive relief. Sets forth provisions regarding the award of attorney fees and costs of suit to the prevailing party in an action based on a claim involving an activity found to be exempt. (Sec. 522) Directs the Attorney General to develop and designate specified safe harbors relating to the following, as well as to such other categories of activities as the Attorney General may designate (subject to specified requirements): (1) joint purchasing of health care services; (2) small hospital mergers; (3) startup and operation of collaborations between State-licensed providers through partial or full integration; (4) standard-setting and enforcement activities by medical self-regulatory entities; (5) health care providers collectively supplying non-price medical information to buyers and consumers; (6) health care provider participation in surveys; (7) health care joint venture's purchase or use of new or existing high technology or costly equipment or the provision of advanced tertiary care services; (8) provision of market power screens at appropriate levels below which combinations of providers are too small to pose a realistic antitrust threat; (9) joint purchasing arrangements; and (10) good faith negotiations relating to legitimate collaborative activities. Directs the Attorney General to publish a notice in the Federal Register soliciting proposals for additional safe harbors. Authorizes the Attorney General to modify or remove a safe harbor following notice and comment upon a determination that the safe harbor does not meet specified required criteria. Sets forth criteria to be considered in establishing safe harbors, including: (1) the extent to which a competitive or collaborative activity will accomplish an increase in health care access and quality, the establishment of cost efficiencies, and increased ability of health care facilities to provide services in medically underserved areas or to underserved populations; and (2) whether designation as a safe harbor will result in specified desirable outcomes. (Sec. 523) Directs the Attorney General to issue certificates of review for providers of health care services and to assist persons in applying for such certificates. Sets forth procedures regarding applications for, revocation of, and review of determinations regarding such certificates. Limits the disclosure of information. (Sec. 524) Sets forth provisions regarding notifications providing for a reduction in certain penalties under the antitrust laws for health care cooperative ventures. (Sec. 525) Directs the Attorney General to: (1) periodically review the safe harbors, certificates of review, and notifications; and (2) publish, and periodically update, specified guidelines intended to promote greater certainty regarding the application of the antitrust laws to activities in the health care market. Title VI: Administrative Simplification and Privacy - Amends SSA title XI to provide for administrative simplification in the health care system including Medicare and Medicaid, by directing the Secretary of HHS to adopt specified standards for: (1) data elements and information transactions to electronic transmission of certain health information; (2) locating and accessing for authorized purposes health information available through the health information network developed through requirements under this title for electronic transmission of such information; and (3) certifying such information networks. Provides penalties for failure to comply with such standards and requirements. Authorizes appropriations. Establishes a Health Care Information Advisory Committee to advise the Secretary of HHS and the Congress on the status of the network. Authorizes appropriations. Directs the Secretary to make grants for electronically integrated demonstration projects for community-based clinical information systems and computerized patient medical records. (Sec. 601) Makes amendments with regard to the Medicare and Medicaid Coverage Data Bank and related identification processes. (Sec. 602) Provides for the establishment of a mechanism for protecting the privacy of individuals with respect to individually identifiable health care information that is created or maintained as part of health treatment, enrollment, payment, testing, or research processes. Establishes civil and criminal penalties for violations of such privacy protections. Authorizes appropriations. Title VII: Enhanced Penalties for Health Care Fraud - Subtitle A: All-Payer Fraud and Abuse Control Program - Directs the Secretary of HHS to establish a program to: (1) coordinate Federal, State, and local law enforcement programs to control fraud and abuse with respect to the delivery of and payment for health care; and (2) perform other specified tasks applicable to controlling health care fraud and abuse. (Sec. 701) Creates in the Treasury the Anti-Fraud and Abuse Trust Fund for use in conjunction with such program. (Sec. 702) Amends SSA title XI to provide for the application of Federal health anti-fraud and abuse sanctions to all fraud and abuse against any health care plan. (Sec. 703) Directs the Secretary of HHS to publish notice in the Federal Register soliciting proposals for certain: (1) safe harbor activities related to payment for health care services; and (2) interpretive rulings and special alerts concerning health care fraud and abuse. (Sec. 704) Directs the Secretary to establish a program through which individuals entitled to Medicare benefits may report to the Secretary on a confidential basis instances of suspected Medicare fraud by program providers. Subtitle B: Revisions to Current Sanctions for Fraud and Abuse - Amends SSA title XI to revise current sanctions for fraud and abuse involving Medicare and State health care programs, providing for: (1) program exclusion for individuals convicted of a felony relating to fraud or the unlawful manufacture or dispensing or a controlled substance; (2) new offenses under civil monetary penalty provisions, such as the offering of inducements to program-eligible individuals and the misuse of health security cards or unique health identifiers; (3) establishment of a minimum period of exclusion for practitioners and persons who fail to meet statutory obligations; (4) intermediate sanctions on eligible HMOs for program violations; and (5) procedures for imposing such sanctions. Subtitle C: Administrative and Miscellaneous Provisions - Directs the Secretary to establish a national health care fraud and abuse data collection program for the reporting by government health care providers, suppliers, and practitioners. Requires program information to be made available to Federal and State governments, subject to a possible fee. Subtitle D: Amendments to Criminal Law - Amends the Federal criminal code to set penalties for knowingly executing a scheme or artifice to: (1) defraud any health care plan in connection with the delivery of, or payment for, health care benefits, items, or services; or (2) obtain, by means of false or fraudulent pretenses, representations, or promises, money or property owned by, or under the custody or control of, any health care plan or person in connection with delivery of or payment for health care benefits. (Sec. 731) Requires the Secretary of the Treasury to deposit into the Anti-Fraud and Abuse Trust Fund an amount equal to criminal fines imposed. (Sec. 732) Makes other specified criminal law changes with regard to forfeitures and injunctive relief with respect to Federal health care offenses and provides for similar deposits into the Anti-Fraud and Abuse Trust Fund. Subtitle E: Amendments to Civil False Claims Act - Makes provisions of the Civil False Claims Act applicable to the use of false records or statements made to a health care plan. Includes within the definition of "claim" for purposes of such Act, a request or demand for money or property which is made or presented to a health care plan. Provides for deposits into the Anti-Fraud and Abuse Trust Fund of amounts equal to penalties and damages imposed under the Civil False Claims Act. Title VIII: Medicare and Medicaid - Subtitle A: Medicare - Directs the Secretary to study and report to the Congress on allowing payment under Medicare for certain Medicare beneficiaries enrolled in either private or other Federal health care plans. (Sec. 802) Revises Medicare provisions on payments to HMOs and competitive medical plans. Directs the Secretary of HHS to establish certain demonstration projects in designated areas for paying such organizations on the basis of a special payment methodology. Amends the Omnibus Budget Reconciliation Act of 1987 to provide for an extension of social health maintenance organizations. (Sec. 803) Amends: (1) the Omnibus Budget Reconciliation Act of 1990 (OMBRA '90) to permit Medicare supplemental policies to be offered in all States; and (2) SSA title XVIII to make technical corrections to provisions on Medicare supplemental policies. (Sec. 811) Makes specified changes with regard to Medicare part A (Hospital Insurance) provisions with regard to: (1) inpatient hospital services updates for PPS hospitals; (2) payment reductions for capital-related costs for inpatient hospital services; (3) payment adjustments for disproportionate share hospitals in participating States; (4) moratoriums on new long-term hospitals; (5) adjustment reductions for indirect medical education; and (6) routine service cost limit reductions for skilled nursing facilities. (Sec. 821) Makes specified changes with regard to Medicare part B (Supplementary Medical Insurance) provisions with regard to: (1) physicians' services updates and payments; (2) establishment of hospital outpatient PPS for hospital outpatient departments; and (3) general Medicare part B premiums. (Sec. 831) Makes specified changes with regard to Medicare parts A and B provisions with regard to: (1) Medicare as secondary payer; and (2) routine cost limit reductions for home health services. Subtitle B: Medicaid Program - Provides for coordination of the Medicaid program with the new health care system established under this Act through such changes as: (1) establishing a cap on payments for certain acute medical services furnished under Medicaid; (2) providing for the integration of certain Medicaid eligibles into the new system; (3) providing for State programs for supplemental benefits; and (4) providing for optional coverage under certified health plans of SSI-eligible individuals. (Sec. 861) Amends SSA title XIX to modify Federal requirements to allow State flexibility in contracting for coordinated care services under Medicaid. (Sec. 871) Amends: (1) Medicaid long-term care provisions, permitting certain demonstration projects and relief from third party liability requirements when cost-effective, among other changes; and (2) the Omnibus Budget Reconciliation Act of 1986 with regard to frail elderly demonstration projects. (Sec. 878) Modifies Medicaid provisions on case management services and home and community-based waivers. (Sec. 881) Makes specified changes in provisions concerning: (1) disproportionate share hospital (DSH) payment adjustments; (2) the Federal medical assistance percentage for certain States; and (3) criteria for determining the amount of disallowances. (Sec. 882) Directs the Secretary to submit recommendations to the Congress on a phased-in elimination of Medicaid DSH payment adjustments. (Sec. 885) Makes technical corrections relating to OMBRA '90 provisions on physicians' services. Title IX: Department of Veterans Affairs - Veterans Health Care Administrative Flexibility Act of 1994 - Expresses as the intent of the Congress that Department of Veterans Affairs health care facilities participate as health care providers recognized under health care reform legislation enacted by the States. Directs the Secretary of Veterans Affairs to provide health care services in a State enacting such reform legislation. Prohibits any State from denying Department participation as a health care provider under such legislation unless the State's chief executive officer certifies that: (1) the benefits to be provided by the Department do not meet the State quality benefits standard; or (2) the location of Department facilities does not meet State proximity requirements. Authorizes the Secretary, in order to facilitate the provision of Department health care services in a manner that is responsive to local market and regulatory conditions, to designate Department health care facilities which shall be exempt from specified Federal regulatory provisions. Allows exempted Department facilities to enter into contracts and agreements for the provision of health care and related services under a State health care reform plan. Exempts such contracts and agreements for less than $250,000 from prior review by the Department's Central Office. Provides for review of contracts or agreements of such amount or greater. Authorizes the Secretary to utilize Department personnel to provide necessary health care services under this title. Provides funding by establishing in the Treasury a Department of Veterans Affairs Health Care Reform Fund, into which shall be deposited certain funds collected by the Secretary from third party payers to defray the costs of providing health care services to veterans. Requires a separate account to be maintained in the Fund for each exempted Department health care facility. Allows exempted Department facilities to expend funds to cover marketing, advertising, legal, acquisition, construction, repair, and renovation costs.
United States · United States Congress · 8 August 1994
TABLE OF CONTENTS: Title I: Community Participation and Human Health Title II: State Roles Title III: Voluntary Response Title IV: Liability and Allocation Title V: Remedy Selection and Cleanup Standards Title VI: Miscellaneous Title VII: Funding Title VIII: Environmental Insurance Resolution Fund Title IX: Taxes Superfund Reform Act of 1994 - Title I: Community Participation and Human Health - Amends the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA or Superfund) to authorize the Administrator of the Environmental Protection Agency (EPA) to make technical assistance grants available to any group of individuals who may be affected by the release or threatened release of hazardous substances or pollutants at any facility on the State Registry or National Priorities List (NPL). (Sec. 101) Requires the President to provide for public participation in significant phases of response activities under CERCLA. Makes all nonprivileged information available to the public throughout all phases of the response action. Directs the President to ensure that the presentation of information on risk is unbiased and informative. (Sec. 102) Requires the President to provide the opportunity for the establishment of a representative public forum, known as a Community Working Group (CWG), to achieve direct, regular, and meaningful consultation with all interested parties throughout all stages of a response action whenever: (1) the President determines such a group will be helpful; or (2) 50 citizens, or at least 20 percent of the population of a locality in which the NPL facility is located, petition for a CWG to be established. Authorizes CWGs to offer recommendations on the anticipated future use of land at an affected facility prior to the selection of a remedy. Establishes a Citizen Information and Access Office within each State to provide information regarding State Registry and NPL sites, citizens' rights, facility records and health data, public meetings, removal and remedial actions, and outreach activities. Authorizes Indian tribes to petition the Administrator to form a body equivalent to such Office. Directs the Administrator to submit a biennial Environmental Justice Study to the Congress. (Sec. 103) Requires the President, in setting priorities for taking remedial action, to: (1) group facilities together, even if they are not adjacent, and score them as a single facility where more than one facility on the State Registry results in hazardous substances exposures to the same population; (2) take into account the use of land or waterways for subsistence, religious, or cultural practices where such use results in additional exposures, in placing facilities on the NPL; (3) conduct interviews with persons affected by the facility and solicit their input in the hazard ranking system evaluation; and (4) place highest priority on facilities with releases of hazardous substances which result in actual ongoing human exposures at levels resulting in demonstrated adverse health effects as identified in specified health assessments. Authorizes the President to take into account any history of exposure to hazardous substances in the community regardless of the source of exposure, in placing facilities on the NPL. Requires the Administrator to: (1) evaluate major urban areas and other areas where environmental justice concerns may warrant special attention; and (2) identify five facilities in each EPA region that are, or should be, on the State Registry and that are likely to warrant inclusion on the NPL. Accords such facilities a priority in evaluation for NPL listing and scoring. (Sec. 109) Requires the Agency for Toxic Substances and Disease Registry (ATSDR) Administrator to develop and distribute educational materials on human health effects of hazardous substances to the public. (Sec. 110) Authorizes the ATSDR Administrator to provide grant or contract assistance to individuals who may be affected by releases or threatened releases when: (1) a public health assessment is conducted at a facility on the NPL; or (2) a release is being evaluated for inclusion on the NPL. Authorizes the ATSDR Administrator, pursuant to such grants or contracts, to provide for health services to communities affected by the release of hazardous substances. (Sec. 113) Permits the EPA Administrator to carry out a demonstration program to assist in the recruitment and training of individuals from areas affected by NPL facilities for employment in remediation activities. Encourages parties conducting response actions under CERCLA to have their contractors train minorities and other disadvantaged persons from the affected community in remediation skills. Title II: State Roles - Authorizes States, pursuant to contracts or cooperative agreements, to apply to the Administrator to take or require: (1) preremedial actions at any non-federally owned or operated facility that is not listed on the NPL; or (2) response actions at non-federally owned or operated NPL facilities or removal actions at any facility proposed for listing on the NPL. Sets forth requirements for State enforcement and allocation of liability. (Sec. 202) Prohibits funding to States for response actions, except for emergency removal actions, unless the affected State provides assurances that it will pay 15 percent of the cost of the action or funding and will assure oversight of any operation and maintenance of response actions. (Sec. 206) Directs the Administrator to study the feasibility of authorizing States to use their own laws to carry out CERCLA in lieu of the Federal program under such Act. (Sec. 207) Authorizes States to apply to the Administrator to exercise the Administrator's authorities with respect to response actions at Federal facilities. Bases approval of transfer of authorities in part on a State's hazardous waste program authorization under the Solid Waste Disposal Act. Continues the existing limitations on transfers of authority from the Administrator to any other person under provisions regarding Federal facilities. Title III: Voluntary Response - Directs the Administrator to establish a program to provide assistance to States to establish and expand voluntary response programs. (Sec. 301) Provides that no portion of a facility subject to a response action plan under a qualified State program shall be proposed for listing on the NPL so long as substantial and continual response activities are being undertaken to complete the response action in a timely fashion. Directs the Administrator to promulgate regulations describing circumstances in which States with qualified programs and the authority to issue permits under Federal environmental statutes may waive permit requirements with respect to approved voluntary response plans under certain conditions. Provides that performance of a voluntary response action shall not constitute an admission of liability under any Federal, State, or local law or regulation or in any private action. Title IV: Liability and Allocation - Authorizes the Administrator to issue administrative subpoenas to require the attendance and testimony of witnesses and production of information regarding response actions. Revises confidentiality requirements with respect to such information and applies confidentiality requirements to contractors. (Sec. 403) Absolves of liability for response actions a person who does not impede a response action or natural resource restoration to the extent liability is based solely on: (1) arrangement, transportation, or acceptance provisions relating to disposal or treatment of hazardous substances and such activities only involved municipal solid waste or sewage sludge possessed by the person and the person is the owner, operator, or lessee of residential property or a small business or small nonprofit organization; (2) such provisions and such activities involved fewer than 55 gallons of liquid materials (or 100 pounds of solid materials) containing hazardous substances, pollutants, or contaminants or such amount as the Administrator may determine; (3) ownership or operation of a vessel or facility and the person is a bona fide prospective purchaser of the facility; (4) ownership and the person acquired the facility by inheritance after disposal of the hazardous substances took place, did not contribute to the release, and exercised due care with respect to such substances; (5) ownership by a Federal, State, or local entity of a road or other right-of-way (other than railroads) over which hazardous substances are transported or on the granting of a license or a permit to conduct business; or (6) actions of a Federal agency in response to a natural disaster. Makes persons who are solely liable under arrangement, transportation, or acceptance provisions regarding disposal or treatment of hazardous substances liable for no more than ten percent of total response costs if such activities only involved municipal solid waste or sewage sludge. Applies such limitation to the aggregate liability of all persons involved. Applies such limitation only if acts or omissions giving rise to liability occurred before the date 36 months after enactment of this Act or the person asserting the limitation participates in a qualified household hazardous waste collection program. Limits the liability of persons who do not impede the performance of a response action or natural resource restoration with respect to a release to the lesser of the fair market value of a vessel or facility or the actual proceeds of the sale of the vessel or facility subject to certain conditions. Provides that a person who owns or operates real property contiguous to property on which there has been a release of a hazardous substance and that may be contaminated shall not be considered an owner or operator, for liability purposes, if such persons: (1) exercised due care with respect to such substance; (2) took precautions against foreseeable acts or omissions that resulted in the release; and (3) did not cause or contribute to the release and provides access to persons authorized to conduct response actions. Authorizes the President to issue assurances of no enforcement action to such person and grant such person protection against cost recovery and contribution actions. Grants the United States a lien, subject to certain conditions, on any facility for which the prospective purchaser is not liable for unrecovered response costs. Provides that no lien shall arise with respect to property: (1) for which the property owner preceding the first bona fide prospective purchaser is not liable or has resolved liability; or (2) where an audit required by an environmental professional gives the purchaser no reason to know of the release of hazardous substances. (Sec. 404) Directs the Administrator to calculate the EPA response action oversight costs for which potentially responsible parties (PRPs) are liable on a national basis as a percentage of total response costs incurred by PRPs (the national oversight rate). Limits the rate to ten percent of total response costs incurred by all PRPs. Provides that when the President responds at facilities on the NPL, liability for pollutants and contaminants shall be identical to that for hazardous substances only if such pollutants and contaminants: (1) constitute an imminent and substantial danger to human health; and (2) are not associated with the production or extraction of any hydrocarbon. Prohibits liability based solely on a person's construction activities at a facility if a person can demonstrate that the activities were carried out in accordance with a contract with the owner or operator and the person is a small business construction contractor. (Sec. 405) Revises contribution provisions to require an action by a PRP against another PRP for recovery of costs to be commenced within the later of: (1) three years after completion of a removal action or within six years after initiation of physical on-site construction of the remedial action; or (2) three years after the date of judgment in any action for recovery or the date of any administrative order or judicial settlement for recovery of costs or damages. (Sec. 406) Provides that a person who has resolved liability to a State or an Indian tribe in an administrative or judicially approved settlement shall not be liable for claims by persons other than the United States regarding response costs or damages addressed in the settlement. Provides the same protection for persons who have resolved liability to the United States. Includes protection against all claims that may be asserted against the settling party for recovery of costs or damages paid by another person if addressed in the settlement, except claims based on contractual indemnification. Limits the right to seek contribution from other parties where: (1) the person asserting the right has waived such right in a settlement; (2) the person from whom the contribution is sought is not liable under CERCLA; or (3) the person from whom the contribution is sought has entered into a final settlement with the United States. Makes any person who commences a contribution action liable to the person against whom the action is brought for all reasonable costs of defending against the claim if the action: (1) is barred for the reasons stated above; (2) is brought against a person who is protected from suits by reason of settlement with the United States; or (3) is brought during a specified moratorium period. (Sec. 408) Provides that response action contractors shall not be liable solely as a result of testing or implementation of alternative or innovative treatment or containment technologies with respect to a response action if use of the technology has been approved by the authorized Federal or State regulatory agency. (Sec. 409) Requires consent decrees pursuant to settlements to require the parties to attempt expeditiously to resolve disagreements concerning implementation of the remedial action informally with Federal and State agencies. Requires such decrees to contain stipulated penalties for violations in an amount of up to $25,000 per day. Waives certain conditions to expand the scope of eligibility for de minimis settlements. Authorizes the Administrator, if a PRP will be paying amounts to the President as part of a settlement for carrying out a response action, to accept ownership of a financial instrument running irrevocably to the benefit of the United States to conduct such response actions. (Sec. 411) Requires (current law authorizes) the President to offer PRPs (currently, any person) who enter into settlement agreements that are in the public interest a final covenant not to sue concerning liability to the United States for response actions or costs, provided that: (1) the settling party agrees to perform a final remedial action for the release that is the subject of the settlement; (2) the remedial action does not provide any hazardous substances will remain at the facility at concentrations above the protective concentration levels established after completion of the final action; (3) the agreement has been reached prior to the commencement of litigation against the settling party; (4) the settling party waives all contribution rights against other PRPs at the facility; (5) the settling party pays a premium that compensates for the risks of remedy failure, unanticipated increases in the cost of any uncompleted action (unless the party is performing the action), and the U.S. litigation risk with respect to persons who have not resolved liability to the United States unless the settlement covers 100 percent of U.S. response costs; and (6) the settlement is otherwise acceptable to the United States. Authorizes the President, for settlements for which covenants are unavailable, to provide any person with a covenant not to sue concerning any liability to the United States if the covenant not to sue is in the public interest. (Sec. 412) Adds the following to the list of conditions that a PRP must meet in order to be eligible for an expedited settlement: (1) liability must be based solely on provisions regarding arrangement, transportation, or acceptance of municipal solid waste or sewage sludge for treatment or disposal; and (2) the PRP must be a natural person, small business, or a municipality that has demonstrated a limited ability to pay response costs. (Sec. 413) Directs the Administrator to initiate the allocation process under this Act for each nonfederally-owned facility on the NPL that involves two or more PRPs: (1) for which the President selects a remedial action on or after February 3, 1994; and (2) for any such action selected before such date if requested by a PRP which has resolved liability to the United States with respect to the remedial action. Authorizes the Administrator to initiate such process for any facility involving two or more PRPs. Makes the allocation process inapplicable to a facility: (1) for which there has been a final settlement, decree, or order that determines all liability or allocated shares of PRPs; or (2) at which all of the PRPs are facility owners or operators. Authorizes the Administrator to initiate a single allocation process for more than one facility. Places a moratorium on the commencement or continuation of liability claims or recovery actions in connection with responses for which allocation is required until 90 days after the issuance of the allocator's report. Sets forth requirements concerning the allocation process, including those for the notification of PRPs and determinations regarding de minimis parties. Provides that de minimis parties that are potentially liable but entitled to expedited settlements shall not be subject to the allocation process unless they fail to settle with the President within 30 days of the offer. Requires the allocation parties to select an allocator from a list provided by the Administrator or from candidates proposed by the parties. Authorizes PRPs, prior to the issuance of the allocator's report, to submit a private allocation for the remedial action to the allocator. Requires the allocator to adopt such report if it meets specified conditions. Directs the allocator to conduct an allocation process culminating in the issuance of a report with a nonbinding, equitable allocation of the percentage shares of responsibility, including the orphan share, within 180 days of the issuance of the final list of parties or the date of the contract for allocation service, whichever is later. Bases allocation shares on the following factors: (1) the amount of hazardous substances contributed by each party; (2) the degree of toxicity and mobility of such substances; (3) the degree of involvement of each party in the generation, transportation, treatment, storage, and disposal of such substances; (4) the degree of care exercised by the party; (5) the cooperation of the party in contributing to the response action; and (6) other factors determined by the Administrator. Sets forth components of orphan shares. Requires shares that the allocator cannot attribute to any party to be distributed among parties, including the orphan share. Authorizes the Administrator and the Attorney General to reject the allocator's report under certain conditions. Permits settling parties to seek a new allocation if there is convincing evidence that the allocator did not have certain information when the report was issued. Includes within settlements based on allocated shares: (1) a waiver of contribution rights against all PRPs for the response action as well as a waiver of rights to challenge any settlement the President enters into with any other PRP; (2) covenants not to sue; (3) a site-specific premium that compensates for the U.S. litigation risk with respect to PRPs who have not resolved liability (unless the settlement covers 100 percent of response costs); (4) contribution protection regarding matters addressed in the settlement; and (5) provisions through which the settling parties shall receive reimbursement from Superfund for response costs incurred in excess of the aggregate of their allocated share and any premia required by the settlement. Lists maximum amounts for premia authorized for litigation risk. Permits the Administrator to modify such amounts. Authorizes the United States to commence actions against liable persons who have not resolved liability following allocation. Sets forth conditions under which a party that performs work in excess of its allocated share may be reimbursed. Limits Superfund financing for reimbursements of costs incurred by parties that are attributable to orphan shares. Authorizes appropriations. Makes Federal agencies named as PRPs subject to the allocation process to the same extent as any other party. Declares that the procedures set forth in this Act shall not be construed to modify the principles of retroactive, strict, joint, and several liability. Provides that persons who are potentially liable solely as response action contractors shall not be named as allocation parties under this section. (Sec. 414) Absolves persons (other than owners or operators) who arranged for the recycling of recyclable material from liability for environmental response actions. Deems transactions involving scrap paper, plastic, glass, textiles, or rubber (other than whole tires) to be arranging for recycling if the person who arranged the transaction demonstrates that the following criteria were met: (1) the recyclable material met a commercial specification grade and a market existed for the material; (2) a substantial portion of the material was made available for use as a feedstock for the manufacture of a new saleable product; (3) the material (or product made from the material) could have been a replacement for a virgin raw material; and (4) with respect to transactions occurring 90 days after this Act's enactment, the person exercised reasonable care to determine that the facility where the material would be managed by another was in compliance with Federal, State, or local environmental laws or regulations. Deems transactions involving scrap metal to be arranging for recycling if the person who arranged the transaction demonstrates that: (1) the criteria for scrap materials were met; (2) he/she complied with applicable standards regarding activities associated with the recycling of scrap metals; and (3) the scrap metal was not melted prior to the transaction. Deems transactions involving spent lead-acid, nickel-cadmium, or other batteries to be arranging for recycling if the person involved demonstrates that: (1) the criteria for scrap materials were met; and (2) he/she complied with applicable Federal environmental standards regarding such batteries. Makes the exemptions from liability under this Act inapplicable if the person: (1) had an objectively reasonable basis to believe at the time of the recycling transaction that the recyclable material would not be recycled or would be burned as fuel or for energy recovery or incineration or that the consuming facility was not in compliance with Federal, State, or local environmental laws or regulations; (2) added hazardous substances to the material for purposes other than processing or recycling; or (3) failed to exercise reasonable care with respect to the management of the material. Makes such exemptions inapplicable if the recyclable material contained polychlorinated biphenyls in excess of 50 parts per million or any new Federal standard. Title V: Remedy Selection and Cleanup Standards - Revises provisions regarding cleanup standards to direct the Administrator to promulgate national goals to be applied at all facilities subject to remedial action under this Act. Requires such goals to be expressed as a single numerical level for chemical carcinogens and noncarcinogens. (Sec. 501) Directs the Administrator to promulgate a national risk protocol for conducting risk assessments under CERCLA. Requires the risk protocol to be used for risk assessment underlying determinations of the need for remedial action, the establishment of protective concentration levels of chemicals, and the evaluation of remedial alternatives. Requires remedial actions to: (1) comply with substantive requirements of Federal, or more stringent State, environmental or facility siting laws; (2) attain any promulgated concentration levels applicable to determining the level of cleanup for such actions; and (3) comply with any other standard under State environmental or facility siting laws that the State demonstrates is consistently applied to remedial actions. States that a goal of this Act is to restore any contaminated groundwater or surface water that may be used for drinking water to: (1) the level of any maximum contaminant level or level goal for the hazardous substance or contaminant that has been established under the Safe Drinking Water Act; and (2) a protective concentration level that attains such goal for any other hazardous substance, pollutant, or contaminant. Requires the achievement of such goal unless the President finds that such goal is technically impracticable from an engineering perspective or, under certain conditions, unreasonably costly. Requires remedial actions for contaminated groundwater (other than that used for drinking water) to attain levels appropriate to the current or anticipated use of such water. Authorizes the President to select a remedial action that does not comply with Federal and State standards subject to certain conditions. (Sec. 502) Revises general rules for remedial actions. Directs the President, in selecting a remedy, to take into account the reasonably anticipated future uses of land at a facility. Provides certain procedures for the remediation of hot spots. Requires the President to establish cost-effective generic remedies for categories of facilities. Sets forth factors to be taken into consideration with respect to selection of response actions for groundwater. (Sec. 504) Removes a condition on the President's authority to acquire property needed to conduct a response action that requires the State in which the property is located to agree to accept transfer of the property when the action is completed. (Sec. 505) Alters the criteria for the continuance of obligations for removal actions to provide that actions shall not continue after $4 million (currently, $2 million) has been obligated or two years (currently, 12 months) have elapsed from the date of initial response to a release or threatened release of hazardous substances. Requires Federal agencies, before the commencement of any non-emergency removal action, to notify the EPA and the State of the planned action and obtain, in the case of facilities listed or proposed for listing on the NPL, concurrence in the planned action from the EPA or the State. (Sec. 506) Authorizes the President, in order to respond to a release of a hazardous substance, to acquire a hazardous substance easement which limits or controls the use of land or other natural resources. Permits easements and notices of property use restrictions to be used whenever institutional controls have been selected as a component of a removal or remedial action. Makes easements enforceable in perpetuity (unless terminated pursuant to this Act) against owners of affected property or persons who acquire interest in, or rights to use, the property. Title VI: Miscellaneous - Makes a Federal agency subject to certain actions required for Federal facilities under CERCLA, with the exception of certain reporting requirements, if the agency owned or operated a facility over which it exercised no regulatory or other control over activities that resulted in a release of a hazardous substance unless: (1) no Federal agency was the primary or sole source or cause of such release; (2) the activities resulting in the release were pursuant to statutory authority and occurred prior to 1976; and (3) the persons primarily responsible for the release are financially viable and capable of performing or financing the response action. (Sec. 605) Authorizes the use of the Superfund to pay up to 50 percent of response costs incurred by a potentially liable party in taking approved actions to achieve response after employing an alternative or innovative technology that fails to achieve the required level of response. (Sec. 606) Includes trusts, estates, or persons who hold title to a vessel or facility or are otherwise affiliated with a vessel or facility in a fiduciary capacity within the definition of "owner or operator" for purposes of determining liability under CERCLA. Limits the personal obligations and liabilities of a fiduciary to the extent to which the assets of the trust or estate are sufficient to indemnify the fiduciary, subject to certain conditions. Excludes from such definition the United States, a Federal agency, or a conservator or receiver appointed by a Federal agency which acquired ownership of a facility or vessel in connection with receivership or conservatorship and forfeiture or seizure authority, provided such entity does not participate in operations that result in a release. (Sec. 608) Directs the Administrator to establish a small business Superfund assistance section within the small business ombudsman office to provide assistance and information regarding CERCLA and the allocation and settlement processes. (Sec. 611) Requires the Administrator to study and report to the Congress on EPA procedures for suspension and debarment of persons and business entities, particularly response action contractors, and to assess the feasibility and cost of creating a nationwide data base to track such persons. (Sec. 613) Directs the Administrator to publish guidelines for a model State program for the training and certification of individuals to perform Phase I Environmental Site Assessments. Establishes the Environmental Certification Board. (Sec. 615) Revises provisions regarding the application of CERCLA to Federal agencies to make such agencies subject to all Federal, State, interstate, and local requirements regarding response actions related to, or management of, hazardous substances, pollutants, and contaminants in the same manner as such requirements apply to nongovernmental entities. Absolves Federal employees of personal liability for civil penalties under Federal or State response laws with respect to acts or omissions within their official duties. Makes such employees subject to criminal sanctions under such laws, but exempts Federal agencies from such sanctions. (Sec. 616) Increases the authorization from Superfund for worker training and education grants. (Sec. 619) Makes States eligible for reimbursement currently available to local governments for emergency response actions. (Sec. 620) Directs the Administrator to study and report to the Congress on the feasibility of instituting a small disadvantaged business goal program for all Federal contracts under CERCLA. Title VII: Funding - Extends the authorization of appropriations to carry out specified Superfund authorities through FY 1999. Title VIII: Environmental Insurance Resolution Fund - Environmental Insurance Resolution and Equity Act of 1994 - Establishes the Environmental Insurance Resolution Fund to provide for the resolution of disputes between certain PRPs and their insurers. (Sec. 805) Authorizes the Fund to decide not to make an offer unless an eligible person has filed and is actively pursuing a claim with an insurer. (Sec. 806) Requires the Fund to make resolution offers to eligible persons equal to the applicable percentage of the lesser of the eligible costs incurred by the persons or the available coverage. Describes applicable percentages based on facility location and size, litigation venues, and State. (Sec. 807) Directs eligible persons that accept Fund resolutions to waive existing and future claims against an insurer for eligible costs. (Sec. 808) Requires the Fund to make pre- and post-resolution payments to eligible persons who accept a resolution. Treats payments made by the Fund to an eligible person as payments made by an insurer. (Sec. 809) Requires the Fund, in cases where an eligible person rejects a resolution offer, litigates a claim against an insurer, and obtains a final judgment against, or enters into a settlement with, the insurer, to reimburse the insurer for the lesser of the amount of the resolution offer or the final judgment or settlement. Authorizes the Fund, in such cases, to reimburse an insurer for unrecovered reasonable costs and legal fees if the resolution offer exceeded such final judgment or settlement. (Sec. 811) Provides that this title acts as a stay of all pending litigation regarding claims for indemnity or arising from insurance coverage for eligible costs. Bars stays of litigation ten years after this Act's enactment with respect to: (1) a person that becomes an eligible person on or after such date; and (2) an eligible person that has not filed a request for a resolution offer and has not rejected an offer before such date. (Sec. 815) Directs the President to report on: (1) the potential liability of the Fund; and (2) the number of non-NPL facilities and their average cleanup cost. (Sec. 817) Terminates the Fund's authority to: (1) accept requests for resolution ten years after this Act's enactment date; and (2) offer resolutions ten years and 180 days after such date. Title IX: Taxes - Amends the Internal Revenue Code to extend the applicability of the environmental tax to tax years before January 1, 2001 (currently, 1996). Extends certain provisions regarding the Superfund financing rate. (Sec. 903) Requires all expenditures of the Resolution Fund to be paid out of fees and assessments imposed by the Internal Revenue Code. Exempts the Fund from Federal, State, and local taxation.
United States · United States Congress · 8 August 1994
Amends the Internal Revenue Code to allow an itemized deduction for qualified adoption expenses, limited to $2,500.
United States · United States Congress · 5 August 1994
Amends the Internal Revenue Code to exclude from gross income awards received under Christa McAuliffe fellowships.
United States · United States Congress · 5 August 1994
Baseline Reform Act of 1994 - Amends the Balanced Budget and Emergency Deficit Control Act of 1985 (Gramm-Rudman-Hollings Act) to declare that the estimated budget outlays submitted to the Congress by the President each year shall not include an inflation adjustment for programs and activities subject to discretionary appropriations. Requires the President's budget to include: (1) estimated expenditures and appropriations for the current year; and (2) a certain comparison of levels of estimated expenditures and proposed appropriations that includes the proposed increase or decrease in spending in percentage terms. Amends the Congressional Budget Act of 1974 to make conforming changes to the development of the concurrent resolution on the budget. Declares that: (1) the starting point for any deliberations in the Committee on the Budget of each House on the budget resolution for the next fiscal year shall be the estimated level of outlays for the current year in each function and subfunction; and (2) any increases or decreases in the congressional budget for the next fiscal year shall be from such estimated levels. Requires the Congressional Budget Office (CBO) to include in reports to budget committees certain current year comparisons and a table on sources of spending growth under current law in total mandatory spending for the budget year and the ensuing four fiscal years. Requires the CBO to include in cost estimates of pending legislation a comparison of prior year spending levels to current year levels. Requires the Comptroller General to report annually to the Congress all programs and activities with permanent appropriations or that fall within a specified definition of spending authority.
United States · United States Congress · 5 August 1994
Full Budget Disclosure Act of 1994 - Amends the Balanced Budget and Emergency Deficit Control Act of 1985 (Gramm-Rudman-Hollings Act) to create: (1) a current policy baseline for projecting current-year spending; and (2) a current funding baseline for projecting spending without any inflation adjustment except for expiring housing contracts. Requires the President's budget to include: (1) estimated expenditures and appropriations for the current year; (2) a certain comparison of levels of estimated expenditures and proposed appropriations that includes the proposed increase or decrease in spending in percentage terms. Amends the Congressional Budget Act of 1974 to make conforming changes to the development of the concurrent resolution on the budget. Requires the Congressional Budget Office (CBO) to include in reports to budget committees certain current year comparisons and a table on sources of spending growth under current law in total mandatory spending for the budget year and the ensuing four fiscal years. Requires the CBO to include in the annual report to the Congress all direct spending programs. Requires the CBO to include in cost estimates of pending legislation a comparison of prior year spending levels to current year levels.
United States · United States Congress · 4 August 1994
School Bus Safety Act - Directs the Secretary of Transportation to prescribe Federal proficiency standards for school bus drivers who are required to possess a commercial driver's license to operate a school bus. Requires the Secretary, in prescribing such standards, to authorize States to establish their own proficiency standards in lieu of the Federal standards if the Secretary determines they are as rigorous as the Federal standards. Requires bus drivers to demonstrate their proficiency in operating a school bus in accordance with either the Federal or State standards. (Sec. 4) Prohibits a local agency from employing a person as a school bus driver until it conducts a criminal background check under procedures that meet the guidelines set forth in the National Child Protection Act of 1993. (Sec. 5) Amends the Intelligent Vehicle-Highway Systems Act of 1991 to require the Secretary, in deciding which projects to fund under such Act, to ensure that one or more operational tests advance the use and reduce the cost of intelligent vehicle-highway system technologies (including hazard warning systems or sensors) that alert school bus drivers of pedestrians or vehicles in, or approaching, the path of a school bus. (Sec. 6) Requires the Secretary to prescribe regulations that require driver seat belts and passenger seat belts, including lap safety belts or other child safety devices meeting applicable Federal safety standards, be installed for each seating position in any newly manufactured school bus. Requires the Secretary to conduct a program to promote the use of seat belts in school buses. (Sec. 7) Requires the Secretary to ensure that each State receiving Federal aid to conduct highway safety programs utilizes a portion of such aid (at least $1 million per fiscal year) to conduct traffic engineering activities to improve the safe operation of school buses. (Sec. 8) Requires the Secretary to begin a rulemaking process to determine the feasibility of certain safety and access requirements for school buses. (Sec. 9) Requires the Secretary in carrying out highway safety research and development projects to provide for the dissemination of information on school bus safety. Authorizes appropriations. (Sec. 10) Requires the Secretary to conduct a study, and report the results to specified congressional committees, on school bus safety. (Sec. 11) Requires the Secretary to: (1) issue a notice of proposed rulemaking with respect to minimum reporting criteria on traffic-related deaths and injuries under State highway safety programs; and (2) issue a final rule establishing such criteria. (Sec. 12) Authorizes appropriations.
United States · United States Congress · 4 August 1994
Amends the Internal Revenue Code to allow a tax credit for contributions made to certain organizations that operate family development program activities to foster positive growth of at-risk youth. Requires such organizations to file information returns relating to such contributions.
United States · United States Congress · 4 August 1994
Amends the Internal Revenue Code by including in the excise tax on bows and arrows any shaft, point, nock, or vane used in the manufacture of an arrow.
United States · United States Congress · 3 August 1994
TABLE OF CONTENTS: Title I: Improved Access to Standardized and Affordable Health Plans Subtitle A: Rules and Definitions of General Applicability Subtitle B: Health Plan Standards Subtitle C: Benefits and Cost-Sharing Subtitle D: Access to Health Plans Subtitle E: Federal Responsibilities Subtitle F: Participating State Responsibilities Subtitle G: Miscellaneous Provisions Title II: New Benefits Subtitle A: Coverage of Outpatient Prescription Drugs in Medicare Subtitle B: Home and Community-Based Services Subtitle C: Long-Term Care Insurance Improvement and Accountability Subtitle D: Life Care Subtitle E: Study and Report Title III: Health Professions Workforce Subtitle A: Workforce Priorities Under Federal Payments Subtitle B: Academic Health Centers Subtitle C: Health Research Initiatives Subtitle D: Core Functions of Public Health Programs; National Initiatives Regarding Preventive Health Subtitle E: Health Services for Medically Underserved Populations Subtitle F: Mental Health; Substance Abuse Subtitle G: Comprehensive School Health Education; School-Related Health Services Subtitle H: Public Health Service Initiative Subtitle I: Additional Provisions Regarding Public Health Subtitle J: Occupational Safety and Health Subtitle K: Full Funding for WIC Subtitle L: Border Health Improvement Title IV: Medicare and Medicaid Subtitle A: Medicare Subtitle B: Medicaid Program Title V: Quality and Consumer Protection Subtitle A: Quality Management and Improvement Subtitle B: Administrative Simplification Subtitle C: Privacy of Health Information Subtitle D: Expanded Efforts to Combat Health Care Fraud and Abuse Affecting Federal Outlay Programs Subtitle E: Medical Liability Reform Subtitle F: Remedies and Enforcement Subtitle G: Repeal of Exemption Title VI: Individual and Employer Subsidies Subtitle A: Individual Premium and Cost-Sharing Assistance Subtitle B: Employer Subsidies Title VII: Revenue Provisions Subtitle A: Financing Provisions Subtitle B: Tax Treatment of Employer-Provided Health Care Subtitle C: Exempt Health Care Organizations Subtitle D: Tax Treatment of Long-Term Care Insurance and Services Subtitle E: Other Revenue Provisions Subtitle F: Graduate Medical Education and Academic Health Centers Trust Fund Title VIII: Other Federal Programs Subtitle A: Indian Health Services Title IX: Workers Compensation Medical Services Title X: Premium Financing Subtitle A: National Health Care Cost and Coverage Commission Subtitle B: Employer and Individual Premium Requirements and Assistance Title XI: Ensuring Health Care Reform Financing Health Security Act - Title I: Improved Access to Standardized and Affordable Health Plans: Subtitle A: Rules and Definitions of General Applicability - Directs each participating State to require that each health plan or long-term care policy issued, sold, offered for sale, or operated in the State shall be certified by the appropriate certifying authority as one of the following: (1) a certified standard health plan; (2) a certified supplemental health benefits plan; or (3) a certified long-term care policy. Applies the following principles to all standard health plans: (1) no standard health plan may discriminate on the basis of medical history, health status, preexisting medical conditions, or genetic predisposition to medical conditions; (2) a standard plan shall offer an annual open enrollment period and accept all eligible individuals for coverage, shall not impose a rider that serves to exclude coverage to an individual, and shall not impose waiting periods before coverage begins; (3) a standard health plan shall ensure that all medically necessary or appropriate services, as defined in the benefits package, are provided; and (4) health benefits coverage shall be portable from one standard health plan to another. (Sec. 1003) States that nothing in this Act shall be construed as prohibiting the following: (1) an individual from purchasing any health care services; (2) an individual from purchasing supplemental insurance to cover health care services not included within the standard benefits package; (3) an individual who is not an eligible individual from purchasing health insurance; (4) employers from providing coverage for benefits in addition to such standard benefits package; or (5) an individual from obtaining health care from any health care provider of such individual's choice. Subtitle B: Health Plan Standards - Sets forth the following standards which a standard health plan must meet: (1) insurance market reform standards; (2) delivery system reform standards; (3) standards for participation in a guaranty fund; (4) standards for the collection and reporting of data; and (5) standards for effective grievance procedures for enrollees. (Sec. 1111) Requires a standard health plan sponsor to: (1) when offering a community-rated standard health plan, offer such plan to any community-rated individual applying for coverage; and (2) when offering an experience-rated standard health plan, offer such plan to any experience-rated indivudal eligible for coverage under the plan through such individuals' experience-rated employer. Defines: (1) a standard health plan as one providing the standard benefits package under subtitle C; (2) a community-rated plan as a plan provided to community-rated individuals; (3) a community-rated individual as one who not an experience-rated individual; (4) an experience-rated plan as a health plan which is a self-insured plan of an experience-rated employer or is an insured health plan which is experience-rated, but which covers only experience-rated individuals; (5) an experience-rated employer as an employer employing more than 500 employees or a multiemployer plan that covers 500 or more employees; and (6) an experience-rated individual as one who is an employee of an experience-rated employer. Requires a community-rated standard health plan to be made available to community-rated individuals throughout the entire community-rating area. Requires a State to be divided into one or more community rating areas in which there must be a minimum of 250,000 individuals residing. Prohibits a metropolitan statistical area in a State from being incorporated into more than one community rating area. Permits a standard health plan sponsor to refuse to renew an individual's plan only for: (1) fraud or materials misrepresentation on the individuals' part; or (2) nonpayment of premiums. (Sec. 1112) Sets forth enrollment process requirements, including the requirement of an annual open enrollment period. (Sec. 1113) Includes in the definition of children, for purposes of coverage, a child who is under 25 years of age or disabled and who is unmarried. (Sec. 1114) Prohibits discrimination based on health status including medical condition, lack of evidence of insurability, or anticipated need for health care services. Prohibits imposing a waiting period before coverage begins. Permits a standard health plan to impose a limitation or exclusion of benefits relating to treatment of a condition based on a preexisting condition if: (1) the condition was diagnosed or treated during the three-month period ending on the day before the date of enrollment; (2) the limitation or exclusion extends for not more than six months; (3) the limitation or exclusion does not apply to an individual who, as of the date of birth, was covered under the plan; or (4) the limitation or exclusion does not relate to pregnancy. (Sec. 1116) Requires a plan to have uniform premiums within a community rating area. (Sec. 1117) Requires each standard health plan to participate in a standard health plan risk adjustment program and a reinsurance program. (Sec. 1118) Sets forth financial solvency requirements. (Sec. 1121) Sets forth provisions concerning: (1) antidiscrimination requirements; (2) quality assurance standards; (3) the consumer grievance process; (4) the issuance of a health security card to each individual enrolled in each standard health plan; (5) information and marketing standards; (6) patient's rights to self-determination in health care; and (7) contracts with purchasing cooperatives. (Sec. 1128) Requires each standard health plan to ensure that all health care providers reimbursed by the plan are authorized under State law to provide applicable services. Requires a plan to ensure that all nonnetwork items and services covered are reasonably available and accessible. Requires covered services to be available to all enrollees throughout the service plan area with reasonable promptness. Requires each plan to establish a program under which participating physicians shall agree to accept the plan's payment schedule as payment in full. States that nothing in this Act shall be construed to: (1) force an individual to receive health care solely through the individual's standard plan; or (2) prohibit any individual from privately contracting with any health care provider and paying for such treatment as agreed to between the individual and the provider. (Sec. 1141) States that nothing in this Act shall be construed as to prevent a standard health plan sponsor from offering and pricing supplemental health benefits plans pursuant to a State certification plan. Applies the same standards to supplemental plans as are applicable to the standard plan concerning issue, availability, enrollment, nondiscrimination, and rating limitation. Sets forth provisions concerning marketing abuses and requirements for cost-sharing plans. Subtitle C: Benefits and Cost-Sharing - Defines a standard benefits package as a benefit package that: (1) provides all the items and services under the categories of health care items and services described in section 1202; (2) provides for at least one of the three cost-sharing schedules established under section 1213 by the National Health Benefits Board; and (3) has an actuarial value that is equivalent to the actuarial value of the benefits package provided by the Blue Cross/Blue Shield Standard Option under the Federal Employees Health Benefits Program as in effect during 1994. Defines an alternative standard benefits package as a benefits package that: (1) provides all the items and services under the categories of health care items and services described in section 1202; (2) provides for the very high deductible cost-sharing schedule established under 1213 by the Board; and (3) has an actuarial value that is less than the actuarial value of the benefits package provided by the Blue Cross/Blue Shield Standard Option as in effect during 1994. (Sec. 1202) Lists the following items and services as categories of medical care to be furnished to health plan enrollees when medically necessary or appropriate: (1) hospital services, including inpatient hospital services, outpatient hospital services, and 24-hour a day hospital emergency services; (2) health professional services, including consultations that are provided in a home, office, or other ambulatory care setting, or an institutional setting and services and supplies furnished as incident to such health professional services; (3) 24-hour a day emergency services and ambulatory medical or surgical services; (4) clinical preventive services, including services for high risk populations, age-appropriate immunizations, tests, and clinician visits furnished consistent with any periodicity schedule specified by the Board; (5) mental illness and substance abuse services, including inpatient, outpatient, residential non-hospital, and intensive non-residential services, for the treatment of mental illness and substance abuse disorders; (6) voluntary comprehensive family planning services, including counseling and education, contraceptive drugs and devices, and services for pregnant women; (7) items and services provided for end of life care (hospice care); (8) home health care and home infusion drug therapy services provided as an alternative to inpatient hospital treatment, treatment in a skilled nursing facility, or treatment in a rehabilitation facility; (9) extended care services described in title XVIII (Medicare) of the Social Security Act, when provided to an inpatient of a skilled nursing facility or a rehabilitation facility and when provided as an alternative to receiving inpatient hospital services; (10) ambulance services; (11) laboratory, radiology, and diagnostic services provided upon prescription to individuals who are not inpatients of a hospital, hospice, skilled nursing facility, or rehabilitation facility; (12) outpatient prescription drugs, blood clotting factors, drugs used for home infusion therapy, biologicals, and accessories and supplies used directly with the above items; (13) outpatient occupational therapy, physical therapy, respiratory therapy, speech-language pathology services, and outpatient audiology services when used to restore or maintain functional capacity or prevent or minimize limitations on physical and cognitive functions as a result of an illness or other health condition, including attaining new functional abilities at an age-appropriate rate; (14) durable medical equipment, prosthetic devices, orthotics and prosthetics, and accessories and supplies used directly with the above equipment or devices; (15) routine eye examinations, diagnosis, and treatment for defects in vision furnished to individuals who are under 22 years of age, including eyeglasses and contact lenses furnished according to a periodicity schedule established by the Board; (16) to individuals under 22 years of age, emergency dental treatment, prevention and diagnosis of dental disease, treatment of dental disease, space maintenance procedures to prevent orthodontic complications, and interceptive orthodontic treatment to prevent severe malocclusion; (17) for individuals who are over 22 years of age, emergency dental treatment, as specified by the Board; (18) routine ear examinations and diagnosis for defects in hearing as part of a physician visit and hearing aids when recommended by a physician or audiologist; and (19) items and services required to provide patient care pursuant to the design of a qualified investigation treatment. (Sec. 1211) Establishes a National Health Benefits Board to: (1) promulgate regulations or establish guidelines as may be necessary to clarify and refine items and services under the categories of health care items and services described in section 1202; (2) establish and update periodicity schedules for the items and services in the categories of health care items and services described in section 1202; and (3) design mental illness substance and abuse services so as to achieve parity with services for other medical conditions. Authorizes the Board to establish: (1) criteria for determinations of medical necessity or appropriateness; (2) procedures for determinations of medical necessity or appropriateness; and (3) regulations or guidelines to be used in determining whether an item or service is medically necessary. Requires the Board to establish cost-sharing schedules to be provided by health plans providing a standard benefits package or an alternative standard benefits package. Authorizes the Board to develop legislative proposals for modifications to the actuarial equivalence provisions of section 1201 and the categories of items and services under section 1202. Authorizes appropriations to the Bord. (Sec. 1217) Sets forth procedures for the congressional consideration of Board proposals. Subtitle D: Access to Health Plans - Requires each employer to make available to each employee the opportunity: (1) in the case of an experience-rated employer, to enroll through the employer in one of at least three certified experience-rated standard health plans; or (2) in the case of a community-rated employer, to enroll in any community-rated plan offered through a purchasing cooperative operating in the community rating area of the employer and, at the employer's option, to enroll in one of at least three community-rated standard health plans. (Sec. 1321) Directs a State, in accordance with specified provisions, to certify health insurance purchasing cooperatives. Requires that each cooperative be chartered under State law and operated as a not-for-profit corporation. Permits a State to establish or sponsor a purchasing cooperative to serve a community rating area. Requires each purchasing cooperative to: (1) negotiate (regarding premiums and marketing fees) with and enter into agreements with standard health plans; (2) enter into agreements with community-rated employers; (3) enroll community-rated employees and community-rated individuals in standard health plans; (4) collect premiums and make payments to standard health plans on behalf of community-rated employers and community-rated individuals; (5) provide for coordination with other purchasing cooperatives; (6) provide comparative information to the public and the participating State on standard health plans offered through the purchasing opperative; (7) have the capability of accepting data from standard health plans; (8) comply with such fiduciary responsibility, financial management, and administrative requirements as the Secretary may establish; and (9) carry out other functions provided for under this title. Prohibits a cooperative from: (1) performing any activity (including review, approval, or enforcement) relating to payment rates for providers; (2) performing any activity (including certification or enforcement) relating to compliance of standard health plans with the requirements of this Act; (3) assuming insurance risk; or (4) performing other activities identified by the State as being inconsistent with the performance of its duties under this Act. (Sec. 1322) Requires a purchasing cooperative to offer all community-rated individuals and community-rated employees residing within the community rating area served by the cooperative the opportunity to enroll in any standard health plan that has entered into an agreement with the cooperative. (Sec. 1324) Directs a purchasing cooperative to charge members a uniform membership fee to cover costs. (Sec. 1331) Requires a purchasing cooperative for a community rating area to offer to enter into an agreement with each community-rated employer that employs individuals in the community rating area and that desires to join the cooperative. (Sec. 1341) Sets forth requirements applicable to the Federal Employees Health Benefits Program. (Sec. 1351) Sets forth rules relating to multiple employer welfare arrangements. Subtitle E: Federal Responsibilities - Directs the Secretary of Health and Human Services to implement all provisions of this Act, subject to stated exceptions, and report annually to the President and the Congress concerning the health care system of this Act. Authorizes appropriations. (Sec. 1411) Requires the Secretary to approve a State health care system for which a plan has been submitted, unless it does not meet applicable requirements. (Sec. 1412) Provides sanctions for participating States not in compliance, including Federal assumption of responsibilities. (Sec. 1422) Provides for Federal assumption of responsibilities in non-participating States. (Sec. 1431) Directs the Secretary to establish premium class and age class factors. (Sec. 1435) Directs the Secretary to develop a risk adjustment and reinsurance methodology. (Sec. 1441) Directs the Secretary to establish minimum capital requirements for workers, as well as additional capital requirements to reflect factors likely to affect the financial stability of a carriers. (Sec. 1461) Directs the Secretary to certify as an essential community provider any health care provider meeting the standards for certification or that is within any of the following categories of providers: (1) covered entities as defined under the Public Health Service Act, school health centers, public or nonprofit hospitals, public and private nonprofit mental health and substance abuse providers, runaway homeless youth centers or transitional living programs for homeless youth, public or nonprofit maternal and child health providers, rural health clinics, and programs of the Indian Health Service shall all be considered category one entities; and (2) Medicare dependent small rural hospitals and children's hospitals shall both be considered category two entities. (Sec. 1463) Directs the Secretary to publish standards for the certification of additional categories of health care providers and organizations as essential community providers. (Sec. 1466) Provides that for essential community providers electing to apply to a health plan, the plan shall either: (1) enter into a provider participation agreement; or (2) enter into an agreement under which the plan makes payments to the provider. (Sec. 1467) Requires the Secretary, within five years of enactment, to submit to the Congress specific recommendations, based on studies, concerning whether, and to what extent, sec. 1466 provisions should continue to apply to some or all essential community providers. Requires the recommendations to be implemented unless a congressional joint resolution disapproving such recommendations is enacted. (Sec. 1481) Sets forth the responsibilities of the Secretary of Labor. (Sec. 1491) Provides that the Office of Rural Health Policy shall be headed by an Assistant Secretary, instead of a Director. Subtitle F: Participating State Responsibilities - Sets forth provisions concerning approval of State plans and certification of standard health plans and supplemental health benefits plans. Requires the Secretary to establish a program for the accreditation, certification, and enforcement (the ACE program) of health plan standards by States. (Sec. 1502) Requires each participating State to be divided into one or more community rating areas. (Sec. 1503) Provides for: (1) open enrollment periods; (2) a risk adjustment program; (3) guaranty funds; and (4) public access sites. (Sec. 1511) Prohibits, as a general rule, any State law from applying to any services provided under a health plan that is not a fee-for-service plan. (Sec. 1512) Provides for the override of restrictive State practice laws. (Sec. 1521) Provides for the continuance of existing Federal law waivers under Medicare, Medicaid, or the Employee Retirement Income Security Act. (Sec. 1522) Sets forth provisions concerning: (1) the Hawaii Prepaid Health Care Act; (2) alternative State provider payment systems; and (3) alternative State hospital services payment systems. (Sec. 1531) Sets forth requirements for State single-payer systems. (Sec. 1541) Provides for the early implementation of comprehensive State programs. Subtitle G: Miscallenous Provisions - Permits a health professional or health facility to deny the provision of an item or service if the professional or facility objects on the basis of religious belief or moral conviction. Prohibits discrimination on the basis of race, national origin, sex, religion, language, income, age, sexual orientation, disability, health status, or anticipated need for health services. Title II: New Benefits - Subtitle A: Coverage of Outpatient Prescription Drugs in Medicare - Amends title XVIII (Medicare) of the Social Security Act to provide for: (1) Medicare coverage of certain outpatient prescription drugs and biologicals as well as home infusion drug therapy services; (2) payment rules and related requirements, such as those pertaining to deductibles, for covered outpatient prescription drugs; (3) manufacturer rebates to the Secretary under Medicare part B (Supplementary Medical Insurance) for covered outpatient prescription drugs; (4) a Prescription Drug Payment Review Commission appointed by the Director of the Congressional Office of Technology Assessment for reporting annually to the Congress on Medicare coverage of outpatient prescription drugs; and (5) the provision of covered outpatient drugs through Medicare drug benefit plans under contract with the Secretary to individuals entitled to benefits under Medicare part A (Hospital Insurance) and enrolled under Medicare part B. Authorizes appropriations. (Sec. 2007) Allows the Secretary, in providing for payments for covered outpatient drugs under Medicare contracts with HMOs and competitive medical plans, to base such payments on classes of enrollees or geographic factors that are different from those otherwise utilized for determining payment. Subtitle B: Home and Community Based Services - Entitles each State with an approved plan for home and community-based services for individuals with disabilities to specified payments. Authorizes appropriations. (Sec. 2111) Amends the Public Health Service Act to direct the Secretary to compile, evaluate, and disseminate information to assist in the replication of successful long-term health care services programs that are aimed at offering care management to hospitalized individuals in need of long-term care so that services to meet individual needs and preferences can be arranged in home and community-based settings as an alternative to long-term nursing home placement. Establishes a related grant program. Authorizes appropriations. Subtitle C: Long-Term Care Insurance Improvement and Accountability - Long-Term Care Insurance Improvement and Accountability Act - Provides for the promulgation of standards and model benefits with respect to long-term care insurance. (Sec. 2211) Prohibits the sale of a long-term care policy unless it meets specified standards. (Sec. 2212) Regulates sales practices and renewal practices for long-term care policies. (Sec. 2215) Establishes benefit standards for long-term care policies. Subtitle D: Life Care - Life Care Act - Amends the Public Health Service Act to add a new title, Title XXVII - Life Care: Public Insurance Program for Nursing Home Care. Directs the Secretary to: (1) establish a voluntary insurance program for individuals 35 yers of age and over to cover the nursing home stays of such individuals; and the nursing home stays of such individuals; and (2) establish a process for enrollment in the Life Care Program. Prohibits the coverage amount from exceeding $90,000. Provides coverage under the title for: (1) nursing care; (2) specified therapy services; (3) medical social work; (4) drugs and appliances; (5) other nursing home facility services; and (6) with respect to the first six months of covered residence in a nursing facility, such room and board costs as are not covered by beneficiary copayment. Subtitle E: Study and Report - Provides for a study on issues relating to appropriate care at the end of life. Title III: Health Professions Workforce - Subtitle A: Workforce Priorities Under Federal Payments - Establishes within the Department of Health and Human Services the National Council on Graduate Medical Education. Directs the Council to ensure that the aggregate number of individuals entering graduate medical education programs does not exceed specified limits. Directs the Council to designate the number of individuals authorized to be enrolled in each specialty. (Sec. 3031) Sets forth provisions concerning Federal formula payments to: (1) qualified entities for the costs of operating approved physician training programs; and (2) academic health centers and other eligible institutions. (Sec. 3061) Sets forth provisions concerning Federal payments to: (1) medical schools; (2) graduate nurse training programs; (3) dental schools; and (4) schools of public health. (Sec. 3081) Authorizes appropriations through FY 2000 for workforce development. Subtitle B: Academic Health Centers - Authorizes grants to: (1) eligible centers for the establishment and operation of information and referral systems to provide the services of such centers to rural health plans; and (2) community-and provider-based health plans for the purpose of providing the services of eligible centers to residents of rural or urban communities who otherwise would not have adequate access to such services. Subtitle C: Health Research Initiatives - Requires 0.25 percent of all premium-related payments made by employers, individuals, and families for coverage under this Act to be used for biomedical and behavioral research and health services research as specified. (Sec. 3221) Authorizes appropriations for a medical technology impact study. Subtitle D: Core Functions of Public Health Programs; National Initiatives Regarding Preventive Health - Authorizes appropriatons for: (1) core functions of public health programs; and (2) national initiatives regarding health promotion and disease prevention. Provides for grants to states for core functions of public health programs. Provides grants for agencies of State or local government and nonprofit organizations for national prevention initiatives. Provides for grants and authorizes appropriations for the development of rural telemedicine. Subtitle E: Health Services for Medically Underserved Populations - Authorizes appropriations for: (1) the development of community health groups and health care sites and services; and (2) the capital costs of the development of community health groups. (Sec. 3402) Authorizes approprations for grants and contracts for enabling and supplemental services. (Sec. 3471) Authorizes appropriations for the National Health Service Corps Program. (Sec. 3481) Provides for payments to hospitals with a low-income utilization rate of not less than 25 percent. Subtitle F: Mental Health; Substance Abuse - Requires each State, as a condition of participation under title I, to integrate the mental illness and substance abuse services of the State and its political subdivisions with the mental illness and substance abuse services offered by health plans pursuant to title I. Authorizes appropriations to States for grants for the development and operation of comprehensive managed mental health and substance abuse programs that are integrated with the health delivery system established under this Act. Subtitle G: Comprehensive School Health Education; School-Related Health Services - Provides for grants to State educational agencies in eligible States to integrate comprehensive school health education in schools within the State, with priority given to those communities in greatest need. Authorizes appropriations. (Sec. 3603) Establishes a Healthy Students-Healthy Schools Interagency Task Force. (Sec. 3681) Authorizes appropriations for grants to State health agencies or local community partnerships for the development and operation of school-related health services. Subtitle H: Public Health Service Initiative - Authorizes appropriations through FY 2004 for specified programs under title III, as well as programs of the Indian Health Service under title VIII. Subtitle I: Additional Provisions Regarding Public Health - Authorizes grants for the purpose of implementing and developing for trainees a curriculum that includes training in identification, treatment, and referral of victims of domestic violence and women's health needs. Subtitle J: Occupational Safety and Health - Directs the Secretary of Health and Human Services and the Secretary of Labor to work together to develop and implement a comprehensive program to expand and coordinate initiatives to prevent occupational injuries and illnesses. Establishes a National Advisory Board for Occupational Injury and Illness Prevention to provide oversight. Authorizes appropriations. Subtitle K: Full Funding for WIC - Amends provisions of the Child Nutrition Act of 1966 concerning the special supplemental food program to authorize to be: (1) appropriated such amounts as are necessary through FY 2000; and (2) made available other specified amounts through FY 2000. Subtitle L: Border Health Improvement - Authorizes the President to conclude an agreement with Mexico to establish a binational commission to be known as the United States - Mexico Border Health Commission to: (1) conduct a needs assessment; (2) develop and implement a plan to carry out actions recommended by the needs assessment; and (3) formulate recommendations to United States and Mexico concerning reimbursement for health care costs. Title IV: Medicare and Medicaid - Subtitle A: Medicare - Amends SSA title XVIII (Medicare) to allow individuals to elect to remain in certain plans. (Sec. 4002) Makes specified changes with regard to eligible organization and Medicare supplemental policy enrollment. (Sec. 4101) Revises provisions relating to Medicare part A and concerned with: (1) various specified hospital and skilled nursing facility payment adjustments for, among other things, capital-related costs for inpatient hospital services and services for low-income patients; (2) the Medicare-dependent, small rural hospital program and the rural health transition grant program; (3) payments for certain multi-campus, rehabilitation, and long-term care hospitals; (4) long-term hospital designation; and (5) indirect medical education payment termination. (Sec. 4111) Replaces the essential access community hospital (EACH) program with a limited service hospital program, prohibiting EACH designations after July 1, 1994, while permitting payment to prior designated EACHs. Authorizes appropriations. Makes part A and B amendments relating to rural primary care hospitals and medical assistance facilities. Repeals provisions for prospective payment systems (PPSs) for rural primary care services. (Sec. 4112) Requires the Secretary to study and report to the Congress with regard to subacute care. (Sec. 4201) Makes specified changes with regard to Medicare part B provisions on: (1) payment for physicians' services, adding limitations on payments relating to inpatient stays in certain hospitals and making various other changes concerning, among other things, service updates, adjustments for volume and intensity, and the performance standard factor; (2) underserved area bonus payments; (3) payments for certain outpatient hospital services and durable medical equipment; (4) eye or eye and ear hospitals; and (5) the general Medicare part B premium. (Sec. 4206) Requires the Secretary to establish: (1) demonstration projects for Medicare State-based performance standard rates of increase; and (2) bidding areas for the competitive acquisition of specified items and services. Provides for a reduction in payment amounts if such competitive acquisition fails to achieve certain savings. (Sec. 4209) Imposes across-the-board co-payments for clinical diagnostic laboratory tests. (Sec. 4212) Provides for expanded coverage for physician assistants and nurse practitioners. Bases payments for physician assistants and certain nurse practitioners on the physician fee schedule. (Sec. 4213) Prohibits nonparticipating physicians and suppliers from receiving payment for items or services provided under Medicare. (Sec. 4214) Requires the Secretary to develop a methodology for implementing a resource-based system for determining practice expense relative value units for each physician's service. (Sec. 4301) Modifies provisions relating to Medicare parts A and B and concerned with: (1) medicare as secondary payer; (2) payments for home health services; and (3) Medicare supplemental policies. (Sec. 4303) Directs the Secretary to use a competitive process to contract with centers of excellence for certain appropriate services (including cataract surgery). (Sec. 4305) Imposes co-payments for home health services. (Sec. 4306) Terminates payments for direct graduate medical education costs attributable to an approved medical residency training program. (Sec. 4307) Amends the Omnibus Budget Reconciliation Act of 1990 to permit Medicare supplemental policies in all States. Subtitle B: Medicaid Program - Amends SSA title XIX (Medicaid) to prohibit a State Medicaid plan from paying for items and services in the standard benefit package described above in title I of this Act, with certain exceptions. (Sec. 4605) Limits State Medicaid expenditures to HMOs to HMOs that are certified as a standard health plan. Revises the 75/25 rule under Medicaid HMO provisions. (Sec. 4611) Modifies national DSH payment limit provisions. Creates a Medicaid part B (Payments to Hospitals Serving Vulnerable Populations). (Sec. 4615) Makes various specified changes with regard to Medicaid long-term care provisions (including provisions on frail elderly demonstration project waivers) as well as with regard to other provisions concerning: (1) Medicaid coverage of certified nurse practitioners and clinical nurse specialist services; and (2) relief from third party liability requirements. Title V: Quality and Consumer Protection - Subtitle A: Quality Management and Improvement - Directs the Secretary of Health and Human Services to establish the National Quality Council to oversee a program of quality management and improvement designed to enhance the quality, appropriateness, and effectiveness of health care services and access to such services. Authorizes appropriations. Subtitle B: Administrative Simplification - States that the purpose of this subtitle is to improve the efficiency and effectiveness of the health care system, including Medicare and Medicaid, by encouraging the development of a health information network through the establishment of standards and requirements for the electronic transmission of certain health information. Provides for standards for data elements and information transactions. Imposes penalties for violators of the standards. Requires standards relating to the form of health security cards issued by health plans and the information needed to be encoded electronically on such cards. Establishes the Health Care Information Advisory Committee. Provides for grants for demonstration projects to promote the development and use of electronically integrated community-based clinical information systems and computerized patient medical records. Repeals provisions of the Social Security Act that established the Medicare and Medicaid Coverage Data Bank. Subtitle C: Privacy of Health Information - States that the purpose of this subtitle is to establish effective mechanisms to protect the privacy of individuals with respect to individually identifiable health care information. Permits the disclosure of health information only in accordance with provisions of this subtitle. Specifies authorized disclosures. Subtitle D: Expanded Efforts to Combat Health Care Fraud and Abuse Affecting Federal Outlay Programs - Directs the Secretary and the Attorney General to establish a joint program to: (1) coordinate Federal, State, and local law enforcement programs to control fraud and abuse affecting Federal outlay programs; (2) conduct investigations and audits relating to the delivery of and payment of health care; and (3) facilitate the enforcement of this subtitle and other statutes applicable to health care fraud and abuse. (Sec. 5302) Establishes the Federal Outlay Program Fraud and Abuse Control Account to be available for carrying out such program. (Sec. 5303) Establishes the HHS Office of Inspector General Asset Forfeiture Proceeds Fund. (Sec. 5304) Authorizes monetary rewards for information relating to a possible prosecution of a Federal health care offfense. (Sec. 5311) Imposes civil penalties for certain violations, including fraud, with respect to certified standard health or long-term care plans or long-term care services. (Sec. 5313) Excludes an individual or entity from participating in any applicable health plan if the individual or entity: (1) is excluded from participation in a public program due to conviction for health care-related crimes or patient abuse; (2) has been convicted under Federal or State law of specified felonies in connection with the delivery of a health care item or service; or (3) has been convicted of a felony relating to the unlawful manufacture, distribution, prescription, or dispensing of a controlled substance. Waives mandatory exclusion if it would significantly harm or pose a risk to public health. Bars payments under a certified standard health plan for the delivery of or payment for any item or service furnished by an excluded individual. (Sec. 5321) Amends the Federal criminal code to provide criminal penalties for fraud, theft, embezzlement, false statements, bribery, and graft in connection with health care. (Sec. 5331) Imposes civil penalties for false claims regarding certified standard health plans or long-term care insurance policies. Subtitle E: Medical Liability Reform - Requires parties to any malpractice action, before the commencement of such action, to participate in a State-based alternative dispute resolution system. Limits attorney's contingency fees. Provides for demonstration projects concerning medical malpractice liability. Authorizes appropriations for such projects. Subtitle F: Remedies and Enforcement - Establishes procedures for the review of health claims, including the review of claims, proceedings in complaint review offices, civil money penalties, the establishment of early resolution programs, mediation proceedings, enforcement of settlement agreements, due process for health care providers, judicial review, civil enforcement, private enforcement rights, consumer protections, discrimination claims, and facial constitutional challenges to invalidate this Act or any provision of this Act. Subtitle G: Repeal of Exemption - Establishes the applicability of the following Acts to the health insurance business: (1) the Sherman Act; (2) the Clayton Act; (3) the Federal Trade Commission Act; and (4) the Robinson-Patman Antidiscrimination Act. Title VI: Individual and Employer Subsidies - Subtitle A: Individual Premium and Cost-Sharing Assistance - Requires a participating State to have in effect a program for furnishing premium assistance and cost-sharing assistance in accordance with the provisions of this subtitle. Sets forth eligibility standards for such assistance. Provides for payments to States furnishing premium assistance. Subtitle B: Employer Subsidies - States that it is the purpose of this subtitle to provide subsidies to eligible employers in providing, or expanding the provision of, health care coverage for the employer's employees. Sets forth provisions concerning the eligibility for and amount of such subsidy. Declares ineligible for such a subsidy: (1) the self-employed; (2) employee leasing firms; and (3) State or local governments. Title VII: Revenue Provisions - Subtitle A: Financing Provisions - Amends the Internal Revenue Code to increase the excise taxes on cigarettes and other tobacco products. Applies such increases to tobacco products manufactured and sold in Puerto Rico. (Sec. 7103) Imposes an excise tax on the manufacture or importation of roll-your-own tobacco. (Sec. 7111) Imposes a tax: (1) on a percentage of premiums received under taxable health insurance policies; and (2) on a percentage of amounts received for health-related administrative services. Imposes on self-insured plans a monthly tax on a percentage of the accident or health coverage expenditures and direct administrative expenditures. (Sec. 7112) Imposes a 25 percent tax on community-rated high cost health plans to be paid by the issuer. Requires the Secretary of Health and Human Services to establish a reference premium for each class of enrollment for community-rated plans within a community rating area. Imposes a 25 percent tax on the excess premium equivalents of an experience-related standard health plan. (Sec. 7121) Provides for the recapture of certain health care subsidies received by high-income individuals. Transfers such amounts to the Supplemental Medical Insurance Trust Fund. (Sec. 7131) Increases the excise tax on certain hollow point and large caliber handgun ammunition. (Sec. 7132) Requires certain shareholders of S corporations and limited partners who materially participate in corporate activities to include their share of income or loss from such corporation when determining net earnings from self-employment. (Sec. 7133) Provides for extending Medicare coverage and applying the hospital insurance tax to all State and local government employees. Subtitle B: Tax Treatment of Employer-Provided Health Care - Declares that on and after January 1, 2004, gross income of an employee includes employer-provided coverage under an accident or health plan which is not permitted coverage. (Sec. 7202) Prohibits health benefits from being provided under cafeteria plans. (Sec. 7203) Increases and makes permanent the deduction for health insurance costs of self-employed individuals. (Sec. 7211) Imposes a tax on employer-provided health benefits that do not meet the requirements for permitted coverage. Subtitle C: Exempt Health Care Organizations - Sets forth qualification and disclosure requirements for tax-exempt health care organizations. (Sec. 7302) Imposes an excise tax on the beneficiary of a taxable inurement and on the management of the participating tax-exempt health care organization. (Sec. 7303) Provides for the treatment of health maintenance organizations, parent organizations, and health insurance purchasing cooperatives as tax-exempt entities. (Sec. 7304) Provides for the taxation as an insurance company other than a life insurance company of certain organizations that provide health insurance and other prepaid health care services. (Sec. 7305) Repeals the special rules for Blue Cross and Blue Shield and similar organizations. (Sec. 7306) Provides a tax exemption for certain qualified high risk insurance pools. (Sec. 7308) Provides for the tax treatment of bonds of certain nonprofit tax-exempt organizations in a manner similar to governmental bonds. Subtitle D: Tax Treatment of Long-Term Care Insurance and Services - Treats qualified long-term care services as medical care for purposes of the medical expense deduction. (Sec. 7402) Provides for the treatment of long-term care insurance as accident and health insurance. (Sec. 7403) Allows accelerated death benefits under life insurance contracts to be paid to terminally ill individuals. Subtitle E: Other Revenue Provisions - Requires the Secretary of the Treasury to submit to specified congressional committees a legislative proposal providing statutory standards for the classification of workers as employees or independent contractors. (Sec. 7502) Increases the penalty for failure to file correct information for returns involving payments for services. (Sec. 7505) Allows a tax credit for certain primary health services providers that practice in health professional shortage areas. (Sec. 7506) Increases the amount allowed to be expensed as a depreciable business asset if such asset is medical equipment. (Sec. 7521) Requires additional reserves for post-retirement medical and life insurance benefits to cover not less than ten years of the working lives of covered employees and to be maintained as separate accounts. (Sec. 7522) Allows a tax credit for the cost of personal assistance services required by certain employed individuals. Limits the amount of such credit and provides a cost-of-living adjustment. Subtitle F: Graduate Medical Education and Academic Health Centers Trust Fund - Establishes the Graduate Medical Education and Academic Health Centers Trust Fund, consisting of the Graduate Medical Education Accountand the Academic Health Centers Account. Provides funding for such trust fund through tax and assessments on insured and self-insured plans and transfers from certain social security trust funds. Title VIII: Other Federal Programs - Subtitle A: Indian Health Service - Makes qualifying Indians eligible for health and supplemental benefits under the Indian Health Service (IHS). (Sec. 8105) Authorizes an IHS program to contract with a health plan to provide health care services to non-Indians. (Sec. 8107) Makes IHS programs eligible for Medicare payments. (Sec. 8109) Directs the Secretary of Health and Human Services to: (1) establish an advisory group to access budget aspects of IHS programs; (2) conduct health service transitional studies and establish a related advisory group; (3) develop a long-term care demonstration program; (4) survey health services available to Indian veterans; and (5) develop new funding methodologies. (Sec. 8118) Authorizes appropriations. Subtitle B: Department of Veterans Affairs - Veterans Health Care Reform Act of 1994 - Allows veterans, individuals currently enrolled in a health plan under the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), and their family members to be enrolled in a Department of Veterans Affairs health plan (VA plan). Requires the Secretary of Veterans Affairs to ensure that each VA plan provides to enrolled individuals the items and services in the standard benefit package under this Act. Allows such plans to offer supplemental health benefits and cost-sharing plans consistent with this Act. Provides a limitation with regard to veterans enrolled with health plans outside the VA. Prohibits the imposition of any plan enrollment charges upon service-connected disabled veterans, veterans receiving disability compensation from the VA, former prisoners of war, veterans of the Mexican border period or World War I, and veterans unable to defray the costs of such care. Allows the Secretary to establish plan charges for other veterans. Deems a VA facility to be a Medicare provider, and a VA health plan to be a Medicare HMO, for purposes of any program administered by the Secretary of Health and Human Services under Medicare (title XXVIII of the Social Security Act). Allows for the recovery of certain care and services provided under a VA plan in the case of an individual who has coverage under another plan. Establishes in the Treasury the Department of Veterans Affairs Health Plan Fund to be used for VA health plan payments and services. Preserves existing benefits for VA facilities not operating within a health plan certified under this Act. Directs the Secretary to organize health plans and operate VA facilities as, or within, health plans under this Act. Preempts conflicting State health plan standards or requirements. Directs the Secretary to designate a health plan director for each VA health plan organized and operated under this subtitle. Authorizes such directors to enter into contracts and agreements for the provision of care and services under the VA plan as well as related services (equipment, maintenance, and repair). Authorizes the Secretary to enter into resource-sharing agreements with other health care plans and providers, health industry organizations, individuals, and other Government departments and agencies. Provides certain administrative and personnel flexibility, as well as expenditure authority, for care and services under a VA plan. Establishes in the Treasury the Veterans Health Care Investment Fund. Authorizes appropriations. Provides specified credits to the Fund for FY 1995 through 1997 for operation of VA health plans. Requires a report from the Secretary to the Congress on the operation of such plans. Authorizes the Secretary to accept and use grants for health care services provided to special populations if used by the VA while operating under a VA health plan. Title IX: Workers Compensation Medical Services - Applies the provisions of subtitle B of title V of this Act to the provision of workers compensation medical services in the same manner as such provisions apply with respect to the provision of services included in the standard benefit package. Requires that, in cases where a workers compensation claim is challenged, a health plan must provide or pay for all medical care in the standard benefit package according to the applicable workers compensation for schedule, until the challenge is adjudicated. Provides for demonstration projects with respect to treatment of work-related injuries and illness. Establishes a Commission on Workers Compensation Medical Services. Title X: Premium Financing - Subtitle A: National Health Care Cost and Coverage Commission - Establishes the National health Care Cost and Coverage Commission to monitor and respond to: (1) trends in health care coverage; and (2) changes in per-capita premiums and other indicators of health care inflation. Provides for congressional consideration of Commission recommendations. Subtitle B: Employer and Indiandual Premium Requirements and Assistance - Requires, with respect to a participating State, each resident U.S. citizen or lawful alien to: (1) enroll in or be covered under a health plan; (2) pay any premium required, consistent with this Act. Excludes individuals covered under an equivalent health care program such as Medicare, Medicaid, a military or veterans health care program, CHAMPUS, the Indian Health Care Improvement Act, or an approved State single-payer system. Provides for a religious exemption. Excludes inmates. Requires employers of 25 or more and employers of less than 25 than make an election, to make health care coverage premium payments on behalf of the employer's qualifying employees. Permits other employers to elect to be treated as community-rated employers. Sets forth provisions for providing for the determination premium payments. Title XI: Ensuring Health Care Reform Financing - States that it is the purpose of this title to ensure that this Act does not result in unanticipated increases in the Federal deficit. States that any entitlement provided by this Act, including premium assistance, shall be subject to the operation of this Act. Requires the President, annually through FY 2004, to issue a health care baseline. Requires the President's budget to include a current health care baseline. Provides that if a baseline exceeds the initial (1995) baseline by more than a specified amount there is to be a proposed order that offsets the excess through a combination of: (1) reductions in premium assistance; (2) reductions in the Medicare deductible for drugs; and (3) reductions in each direct spending program of this Act by a uniform percentage. Requires the eligibility percentage for children and pregnant women to be reduced last. Sets forth provisions in the event of war or low growth. Provides for a Government Accounting Office audit and for additonal reporting requirements by the Office of Management and Budget and the National Health Care Commission.
United States · United States Congress · 3 August 1994
Congressional Accountability Act - Applies, by a specified conditional date, provisions of the following laws to the legislative branch: (1) the Fair Labor Standards Act of 1938; (2) Title VII of the Civil Rights Act of 1964; (3) the Americans With Disabilities Act of 1990; (4) the Age Discrimination in Employment Act of 1967; (5) Titles I and V of the Family and Medical Leave Act of 1993; (6) the Occupational Safety and Health Act of 1970; (7) provisions relating to Federal labor management relations; (8) the Employee Polygraph Protection Act of 1988; (9) the Worker Adjustment and Retraining Notification Act; and (10) the Rehabilitation Act of 1973. Requires that an action to abate a violation of OSHA for which a citation is received take place as soon as possible, but no later than the fiscal year after the citation is issued. (Sec. 4) Establishes in the legislative branch an Office of Compliance to study and report to the Congress on: (1) the application of such laws to the legislative branch; (2) an examination of the procedures used by the instrumentalities to enforce the application of such laws; and (3) a determination as to whether to direct an instrumentality to make improvements in its regulations and procedures so as to assure that they are as effective as those specified in this Act. Authorizes the Office's Board of Directors to direct an instrumentality that has no such procedures to adopt the requisite procedures. Requires the Board to issue regulations governing such applicability which shall be subject to congressional approval. Makes applicable to the legislative branch any provision of Federal law to the extent that it relates to the terms and conditions of employment (including protection from discrimination in personnel actions health and safety of employees, and family and medical leave). (Sec. 5) Directs the Office, on an ongoing basis, to: (1) determine which of such laws should apply to the legislative branch; (2) study the application to the legislative branch of laws enacted after enactment of this Act; and (3) issue regulations to apply such laws to the legislative branch subject to congressional approval. Sets forth House and Senate procedures for bills to implement such regulations. (Sec. 6) Requires the Office to: (1) carry out an education program for Members of Congress and other employing authorities of the legislative branch respecting the laws made applicable to them a program to inform individuals of their rights under such laws and this Act; (3) publish statistics on the use of the Office by congressional employees; and (4) develop a system for the collection of demographic data on the composition of the congressional employees. (Sec. 7) Sets forth procedures for consideration of alleged violations of the laws made applicable to the legislative branch consisting of the following steps: (1) counseling through the Office; (2) mediation with office; (3) formal complaint and hearing by a board; (4) judicial review if a congressional employee is aggrieved by a dismissal, final decision, or an order by the hearing board or if a head of an employing office is aggrieved by a final decision or would be subject to an order issued by such board; and (5) as an alternative to steps 3 and 4, a civil action in a U.S. district court. (Sec. 14) Declares that any intimidation of, or reprisal against, any employee because of the exercise of a right under this Act constitutes an unlawful employment practice that may be remedied in the same manner under this Act as is a violation of law made applicable to the legislative branch. (Sec. 15) Requires all counseling, mediation, and hearings and deliberations of a hearing board to be confidential. Permits the records of hearing boards to be made public if required for judicial review. Authorizes the House Committee on Standards of Official Conduct and the Senate Select Committee on Ethics to have access to the hearing and decisions of the hearing board only after the board has made a decision with respect to the matter. (Sec. 17) Limits a congressional employee to the judicial proceeding provided by this Act to redress prohibited practices. (Sec. 18) Requires the Office to study and report to the Congress on: (1) the ways that public access to information held by the Congress may be improved, streamlined, and made consistent between the House and the Senate; and (2) the application of the Freedom of Information Act and the Right of Privacy Act to the legislative branch.
United States · United States Congress · 3 August 1994
Amends the Catawba Indian Tribe of South Carolina Land Claims Settlement Act of 1993 to provide for the tax treatment of: (1) private funds received as part of the settlement; (2) land conveyances; (3) per capita payments; (4) income from the sale of artifacts; and (5) estate taxes.
United States · United States Congress · 3 August 1994
Waives points of order against the conference report on H.R. 4426 (making appropriations for foreign operations, export financing, and related programs for FY 1995).
United States · United States Congress · 2 August 1994
TABLE OF CONTENTS: Title I: Health Insurance and Delivery Systems Reform Subtitle A: Federal Standards for State Regulatory Programs Subtitle B: Coordination With Other Provisions of Law Title II: Coverage Title III: Premium and Cost-Sharing Assistance Title IV: Administrative Simplification and Privacy Title V: Malpractice and Fraud Subtitle A: Federal Tort Reform Subtitle B: Expanded Efforts to Combat Health Care Fraud and Abuse Affecting Federal Outlay Programs Title VI: Medicare, Medical Education, and Medicaid Subtitle A: Medicare Subtitle B: Medical Education Subtitle C: Home and Community-Based Services Subtitle D: Medicaid Program Title VII: Revenue Provisions Subtitle A: Financing Provisions Subtitle B: Tax Treatment of Employer-Provided Health Care Subtitle C: Deduction for Individuals Purchasing Own Health Insurance Subtitle D: Exempt Organizations Subtitle E: Tax Treatment of Long-Term Care Insurance and Services Subtitle F: Health Care Trust Funds Subtitle G: Other Revenue Provisions Subtitle H: Ensuring Health Care Financing Health Security Act - States that it is the purpose of this Act to achieve universal health insurance coverage through: (1) subsidies for the purchase of health insurance; (2) affordable standardized health insurance; (3) elimination of exclusionary practices by health insurance companies; (4) a permanent National Health Commission for recommending periodically to the Congress how to increase the number of people covered by health insurance; (5) reduction of health costs through more open competitive markets and continued advances in medical education and research; and (6) health care provided under Medicare and Medicaid and health programs of the Departments of Defense and of Veterans Affairs, and the Indian Health Service. Title I: Health Insurance and Delivery Systems Reform - Subtitle A: Federal Standards for State Regulatory Programs - Amends the Social Security Act (SSA) to add a new title XXI under which States are required to establish accreditation, certification, enforcement, and information programs for certifying all health plans and long-term care policies (except multistate self-insured health plans which will be certified by the Secretary of Labor) issued, sold, offered for sale, or operated in the State that meet certain standards incorporating specified requirements, such as those pertaining to community rating, preexisting conditions, and a patient's right to self-determination in health care services, as certified standard, nonstandard, or supplemental health plans or certified long-term care policies in order to participate in Medicaid. (Sec. 101) Requires establishment of such programs also for: (1) enforcing applicable standards for such plans and policies; (2) providing consumers in the State with comparative value information on the performance of all health plans in each community rating area established in the State; (3) designating State health plan service areas for purposes of access to essential community providers, delivery of benefits, and improved access to underserved areas; (4) providing for reinsurance, risk adjustment, and cost-sharing adjustment programs; (5) specifying an annual general enrollment period; (6) providing for a premium approval process for long-term care policies; (7) providing for the certification of workplace wellness programs; (8) enforcing employer responsibilities with regard to employee access to standard plans; (9) oversight of purchasing cooperatives; (10) supporting quality assurances for measuring access to and appropriateness of health care services provided to consumers; (11) supporting development of community health networks and plans; (12) supporting development of community health networks and plans; (13) providing coordination between health plans and automobile medical liability policies; (14) developing remedy and enforcement mechanisms (including early resolution programs) as described for dealing with complaints involving health plans, collecting any civil monetary penalties assessed by the Secretary of Health and Human Services (HHS) under such program, and for handling civil actions brought to invalidate any provision of this Act; and (15) conforming State laws and procedures to the rules regarding fraud and medical malpractice under SSA title XI. Directs the Secretary to initially determine and approve the compliance of such State programs with the Federal guidelines under this new title and periodically review such State programs to determine if they continue to comply with such guidelines. Provides funding for such programs. Sets forth requirements relating to: (1) possessions of the United States; (2) State single-payer systems; and (3) treatment of certain State laws. Directs the Secretary to: (1) develop certification criteria for workplace wellness programs; and (2) certify certain private accreditation entities. Describes the various benefit packages and the categories of items and services included in them (such as mental illness and substance abuse services as well as family planning services and services for pregnant women). Prescribes general cost-sharing under the standard benefits package. Creates in HHS a National Health Benefits Board to: (1) establish cost-sharing schedules to be provided by standard packages; and (2) define the standards to be used by a health plan in determining whether an item or service under certain categories of health care items and services is medically necessary or appropriate for an enrollee in the plan. Outlines the process for congressional consideration of any Board recommendations to modify standard benefit packages and cost-sharing assistance. Authorizes appropriations. Sets forth special provisions relating to abortion and religious beliefs, providing that nothing under this new title shall be construed to require the creation or maintenance of abortion clinics or other abortion providers within a State or any region of a State. Details general employer responsibilities pertaining to payroll deductions and other specified matters in enrolling their employees in certified standard health plans. Lists specific duties of purchasing cooperatives, which include making enrollment information available, enrolling community-rated individuals in certified standard health plans, and collecting and forwarding plan premiums to the plan, as well as specific requirements governing the organization and operation of purchasing cooperatives. Provides for access to standard health benefit plan coverage through qualified association plans. Sets forth special rules for church and multiemployer plans. Requires the Secretary to direct the Agency for Health Care Policy and Research and the Health Care Financing Administration to support and conduct research on the effects of health care reform on health care delivery systems and methods for risk adjustment. Authorizes appropriations. Requires the Secretary to award grants to States or community-based, independent, not-for-profit organizations that have submitted applications to establish demonstration projects that provide certified standard health plans with the technical assistance to implement the results of quality improvement research into medical practice. Directs the Secretary to submit an annual report to the Congress which: (1) reviews the results of the quality improvement research grants; (2) evaluates consumer information programs established by participating States; (3) tracks the evolution of national performance measures and other research; and (4) evaluates State, regional, and national trends on quality of health care. Allows the Secretary to make grants to and enter into contracts with: (1) eligible public or private non-profit consortia for the development of community health groups (i.e. certified community health plans or community health networks); and (2) community health groups for their operation. Authorizes the Secretary to make certain types of financial assistance available to a community health group or isolated rural facility applying for capital assistance. Directs the Secretary to: (1) award grants to eligible entities to establish demonstration projects to promote telemedicine and other uses of the telecommunications network in rural areas; and (2) establish the Interagency Task Force on Rural Telemedicine to, among other things, identify specific uses for telemedicine that have proven to be effective and review the policy of the Health Care Financing Administration relating to reimbursement for telemedicine services. Subtitle B: Coordination With Other Provisions of Law - Eliminates immunity from antitrust suits under provisions commonly known as the McCarran-Ferguson Act with respect to health insurance. (Sec. 112) Elevates the position of the Director of the Office of Rural Health to the position of the Assistant Secretary for Rural Health and expands that official's duties. (Sec. 113) Permits the Secretary of Labor to issue special reporting and disclosure rules for employer group health plans and make other conforming amendments to the Employee Retirement Income Security Act of 1974 (ERISA). Repeals ERISA provisions on multiple employer welfare arrangements. Title II: Coverage - Amends SSA to add a new title XXII under which is established the National Health Care Commission to monitor and respond to: (1) trends in health insurance coverage; and (2) changes in per-capita premiums and other indicators of health care inflation. Requires the Commission to report to the Congress biennially on the status of health insurance coverage in the nation and the national goal of universal coverage. Authorizes appropriations. Provides that if 95 percent of the resident population is not covered by 2002, the Commission shall submit to the Congress an implementing bill which such statutory provisions as the Commission determines are necessary or appropriate to implement recommendations developed by it to achieve that target. Title III: Premium and Cost-Sharing Assistance - Amends SSA title XIX (Medicaid) to require State Medicaid plans to provide for a State program furnishing premium and cost-sharing assistance in accordance with a new Medicaid part B (State Programs for Premium and Cost-Sharing Assistance), which includes a grant program for providing cost-sharing assistance for certain individuals with incomes above 100 percent of the poverty line. Title IV: Administrative Simplification and Privacy - Amends SSA title XI to: (1) delay employer reporting requirements under Medicare and Medicaid Coverage Data Bank provisions; (2) terminate the Bank, effective January 1, 1996; (3) provide for administration simplification in the health care system, including Medicaid and Medicare, through an information network developed according to certain specified data element standards and requirements for electronic transmission and accessing of certain health information; (4) direct the Secretary to establish standards for certifying health information network services as qualified services and for establishing the form of health security cards issued by health plans and the information to be encoded electronically on such cards; (5) provide penalties for failure to comply with data element standards and requirements and for misuse of health security cards and personal health identifiers; (6) provide billing rules for clinical laboratory services; (7) establish the Health Care Information Advisory Committee for advising the Secretary and the Congress with respect to the health information network and network operations; (8) provide for demonstration projects to promote development and use of electronically integrated community-based clinical information systems and computerized patient medical records; (9) provide for privacy of health information; and (10) authorize appropriations. Amends SSA title XVIII (Medicare) to repeal provisions requiring the identification of secondary payer situations. Title V: Malpractice and Fraud - Subtitle A: Federal Tort Reform - Amends SSA title XI to provide for Federal medical malpractice provisions preempting inconsistent State laws (with specified exceptions) for governing malpractice actions brought in State or Federal courts (except with regard to actions arising from a vaccine-related injury or death covered under the Public Health Service Act) without establishing any new basis for bringing malpractice in Federal courts. Requires: (1) States participating under new SSA title XXI to establish alternative dispute resolution procedures for settling medical malpractice claims; and (2) any such claims to have gone through and reached final resolution under such procedures in order for any medical malpractice liability action to be brought with respect to such claim in a participating State. Authorizes the Secretary to provide funds to one or more eligible participating States to establish no-fault medical liability system demonstration projects to replace the common law tort liability system for medical injuries. Authorizes appropriations. Subtitle B: Expanded Efforts to Control Health Care Fraud and Abuse Affecting Federal Outlay Programs - Amends SSA title XI to provide for additional measures for controlling health care fraud and abuse affecting Federal outlay programs, among other means by: (1) mandating a joint program by the Secretary and the Attorney General to coordinate Federal, State, and local law enforcement programs to control fraud and abuse affecting Federal outlay programs; (2) providing qualified immunity to individuals providing information to such officials on health care fraud or abuse; (3) establishing the HHS Office of Inspector General Asset Forfeiture Proceeds Fund, consisting of all proceeds from forfeitures that have been transferred to the HHS Inspector General (IG) from the Department of Justice Asset Forfeiture Fund and available to the IG for investigation expenses; (4) allowing rewards for information leading to possible prosecution for a Federal health care offense; and (5) making revisions with regard to civil monetary penalties for health care fraud and abuse, including increasing such penalties, and with regard to private rights of action and mandatory exclusion from health care program participation. (Sec. 531) Amends Federal criminal code and (Civil False Claims Act) provisions, covering health care fraud as well as theft and embezzlement, false statements, and bribery and graft in connection with health care, and false claims for payments by health plans in order to conform to the changes made above under SSA. Title VI: Medicare, Medical Education, and Medicaid - Subtitle A: Medicare - Amends SSA title XVIII to replace provisions on payments to health maintenance organizations and competitive medical plans with provisions on payments to certain certified standard health plans, modifying provisions with regard to risk-contracting. (Sec. 611) Makes various specified changes in provisions related to Medicare part A (Hospital Insurance) and concerned with: (1) inpatient hospital services updates for prospective payment system hospitals; (2) payment reductions for capital-related costs for inpatient hospital services; (3) disproportionate share payment reductions; (4) payment methodology for rehabilitation and long-term care hospitals; (5) new designations of new long-term hospitals; (6) extension of the freeze on updates to routine service cost limits for skilled nursing facilities; (7) payments for sole community hospitals with teaching programs and multihospital campuses; (8) Medicare-dependent, small rural hospitals; (9) the rural health transition grant program; (10) a new limited service hospital program replacing the essential access community hospital program; (11) rural primary care hospitals and medical assistance facilities; and (12) termination of indirect medical education payments. (Sec. 622) Directs the Secretary to study and report to the Congress on subacute care. (Sec. 631) Makes various specified changes in provisions related to Medicare part B (Supplementary Medical Insurance) and concerned with: (1) updates for physicians' services; (2) volume performance standard rates of increase; (3) limitations on payment for physicians' services relating to inpatient stays in certain hospitals; (4) underserved area bonus payments; (5) development and implementation of resource-based methodology for practice expenses; (6) demonstration projects for Medicare State-based performance standard rate of increase; (7) elimination of formula-driven overpayments for certain outpatient hospital services; (8) eye or eye and ear hospitals; (9) imposition of coinsurance on laboratory services; (10) competition acquisition for items and services and laboratory services; (11) expanded coverage for physician assistants and nurse practitioners; and (12) general part B premiums. (Sec. 651) Makes various specified changes in provisions related to Medicare parts A and B and concerned with: (1) Medicare as secondary payer; (2) physician referral exceptions; (3) Medicare supplemental policies; (4) reductions in routine cost limits for home health services; (5) termination of graduate medical education payments; and (6) extension of social health maintenance organization demonstrations. (Sec. 653) Requires the Secretary to use a competitive process to contract with centers of excellence for cataract surgery and coronary artery by-pass surgery with payment under Medicare to be made for services subject to such contracts on the basis of specified negotiated or all-inclusive rates. (Sec. 659) Requires the Prospective Payment Assessment Commission and the Physician Payment Review Commission to each study and report to the Congress on Medicare spending. (Sec. 660) Directs the Secretary to develop a process to ensure that Medicare claims are submitted first by Medicare, Medicare supplemental policies, and other policies that provide supplemental benefits under Medicare before providers can submit claims to Medicare beneficiaries. Subtitle B: Medical Education - Amends SSA title XVIII to add a new part D (Medical Education) providing Federal payments to: (1) qualified applicants of approved physician and dental training programs and graduate nurse training programs; (2) medical schools for certain costs; and (3) academic health centers and other eligible institutions. Establishes the Graduate Medical Education and Academic Health Centers and Biomedical and Behavioral Research Trust Fund Advisory Committee to study and report to the Congress on operations of the Graduate Medical Education and Academic Health Centers Trust Fund, and the Biomedical and Behavioral Research Trust Fund. Authorizes appropriations. Subtitle C: Home and Community-Based Services - Amends SSA title XIX to add new parts: (1) C (State Programs for Home and Community-Based Services for Individuals with Disabilities) under which each State with an approved plan for home and community-based services for individuals with disabilities can receive Federal payments to provide such services to such individuals; and (2) D (Payments to Hospitals Serving Vulnerable Populations). Subtitle D: Medicaid Program - (Sec. 671) Limits: (1) coverage under Medicaid of items and services covered under the standard benefits package; and (2) State expenditures to certified health plans. Provides that no certified health plan with a Medicaid contract could have more than 50 percent of its enrollment composed of SSI-Medicaid recipients. (Sec. 673) Replaces disproportionate share hospital payment provisions with provisions relating to payments to hospitals serving vulnerable populations. (Sec. 674) Sets forth Medicaid long-term care provisions, including provisions for payments for personal care services and frail elderly services. (Sec. 675) Provides for an increased resource disregard for individuals receiving certain services. (Sec. 676) Increases the number of frail elderly demonstration project waivers. Amends the Omnibus Budget Reconciliation Act of 1986 to provide for the development of waiver protocols and model certification guidelines for an organization operating a demonstration project under such a waiver. (Sec. 677) Eliminates the: (1) requirement of prior institutionalization with respect to habilitation services furnished under a waiver for home or community-based services; and (2) rule regarding availability of beds in certain institutions. (Sec. 679) Provides for Medicaid coverage of all certified nurse practitioner and clinical nurse specialist services. Title VII: Revenue Provisions - Subtitle A: Financing Provisions - Amends the Internal Revenue Code to increase the excise taxes on cigarettes and other tobacco products. Applies such increase to tobacco products manufactured and sold in Puerto Rico. Increases such taxes for a temporary period for the funding of subsidies for children and pregnant women. (Sec. 703) Imposes an excise tax on the manufacture or importation of roll-your-own tobacco. (Sec. 705) Imposes a tax: (1) on a percentage of premiums received under taxable health insurance policies; and (2) on a percentage of amounts received for health-related administrative services. Imposes on self-insured plans a monthly tax on a percentage of the accident or health coverage expenditures and direct administrative expenditures. (Sec. 706) Imposes a 25 percent tax on high cost health plans to be paid by the issuer or the plan sponsor. Makes such tax non-deductible. (Sec. 711) Provides for the recapture of certain health care subsidies received by high-income individuals. Transfers such amounts to the Supplementary Medical Insurance Trust Fund. (Sec. 715) Increases the excise tax on certain hollow point and large caliber handgun ammunition. (Sec. 716) Requires certain shareholders of S corporations and limited partners who materially participate in corporate activities to include their share of income or loss from such corporation when determining net earnings from self-employment. (Sec. 717) Provides for extending Medicare coverage and applying the hospital insurance tax to all State and local government employees. Subtitle B: Tax Treatment of Employer-Provided Health Care - Imposes a tax on employer-provided health benefits that do not meet the requirements for permitted coverage. (Sec. 722) Includes in gross income health insurance coverage provided through flexible spending arrangements. (Sec. 723) Extends the deduction for health insurance costs of self-employed individuals until December 31, 1995. Subtitle C: Deduction for Individuals Purchasing Own Health Insurance - Allows a full deduction for the costs to individuals who purchase their own health insurance. Allows such deduction against the gross income of the individual. Subtitle D: Exempt Organizations - Sets forth qualification and disclosure requirements for tax-exempt health care organizations. (Sec. 742) Imposes an excise tax on the beneficiary of a taxable insurement and on the management of the participating tax-exempt health care organization. (Sec. 743) Provides for the treatment of health maintenance organizations, parent organizations, and health insurance purchasing cooperatives as tax-exempt entities. (Sec. 744) Provides for the taxation as an insurance company other than a life insurance company of certain organizations that provide health insurance and other prepaid health care services. (Sec. 746) Provides a tax exemption for certain qualified high risk insurance pools. (Sec. 748) Provides for the tax treatment of bonds of certain nonprofit tax-exempt organizations in a manner similar to governmental bonds. Subtitle E: Tax Treatment of Long-Term Care Insurance and Services - Treats qualified long-term care services as medical care for purposes of the medical expense deduction. (Sec. 752) Provides for the treatment of long-term care insurance as accident and health insurance. (Sec. 753) Allows accelerated death benefits under life insurance contracts to be paid to terminally ill individuals. Subtitle F: Health Care Trust Funds - Establishes the following trust funds to finance health-related programs: (1) the Health Security Trust Fund; (2) the Graduate Medical Education and Academic Health Centers Trust fund; and (3) the Biomedical and Behavioral Research Trust fund. Provides funding for such Trust Funds through tax and assessments made under this Act. Subtitle G: Other Revenue Provisions - Requires the Secretary of the Treasury to submit to specified congressional committees a legislative proposal providing statutory standards for the classification of workers as employees or independent contractors. (Sec. 772) Increases the penalty for failure to file correct information for returns involving payments for services. (Sec. 775) Allows a tax credit for certain primary health services providers that practice in health professional shortage areas. (Sec. 776) Increases the amount allowed to be expensed as a depreciable business asset if such asset is medical equipment. (Sec. 781) Requires additional reserves for post-retirement medical and life insurance benefits to cover not less than ten years of the working lives of covered employees and to be maintained as separate accounts. (Sec. 783) Allows a tax credit for the cost of personal assistance services required by certain employed individuals. Limits the amount of such credit and provides a cost-of-living adjustment. (Sec. 785) Makes the limit on annual deferrals inapplicable in the case of an individual covered under an excess benefit arrangement maintained by a tax-exempt group medical practice. Subtitle H: Ensuring Health Care Financing - Sets forth provision to ensure that programs under this Act and unanticipated increases in other Federal health spending do not increase the Federal deficit.
United States · United States Congress · 2 August 1994
District of Columbia Government Revenue Bond Delegation Authority Act of 1994 - Amends the District of Columbia Self-Government and Governmental Reorganization Act (the Act) to allow the District of Columbia Council to authorize the issuance of revenue bonds, notes, or other obligations to borrow money to finance, undertakings by District agencies or authorities which operate pursuant to any enterprise fund and other qualified applicants in the areas of sports and entertainment complexes, parking and convention facilities, and elementary and secondary education facilities. Provides for the payment and securing of such bonds, notes, or obligations from available enterprise fund revenues and designated taxes. Authorizes the District Council to delegate to any agency or instrumentality of the District government its authority to issue taxable or tax-exempt revenue bonds, notes, or other obligations to borrow money to finance specified activities. Allows the issued revenue bonds, notes, or other obligations to create a security interest in certain District revenues, including but not limited to designated taxes, as additional security for their payment. Exempts such revenue bonds, notes, or other obligations from the provision that requires prior congressional approval of amounts being obligated or expended by officers or employees of the District government. Provides that fees or revenues to secure revenue bonds shall not be considered as general obligations of the District for purposes of limitations on borrowing and spending by the District government. Permits any Act of the District Council authorizing the issuance of general obligation bonds, general obligation notes, revenue bonds, notes, or other obligations to take effect on the date of enactment of such Act.
United States · United States Congress · 1 August 1994
Job Training Tax Credit Act of 1994 - Amends the Internal Revenue Code to allow a general business tax credit for 20 percent of expenses incurred by reason of the participation of an employee in any job training program funded in whole or in part with Federal funds.
United States · United States Congress · 1 August 1994
Pollution Control Equipment Investment Act of 1994 - Amends the Internal Revenue Code to permit the issuance of tax-exempt bonds for air or water pollution control facilities.
United States · United States Congress · 1 August 1994
Capital Gains Exclusion Expansion Act of 1994 - Amends the Internal Revenue Code to allow a 100 percent exclusion of the gain from the sale or exchange of certain small business stock held for more than ten years.
United States · United States Congress · 1 August 1994
Investment Tax Credit Act of 1994 - Amends the Internal Revenue Code to reinstate the ten-percent investment tax credit for property used as an integral part of manufacturing, production, or extraction or of furnishing transportation, communications, electrical energy, gas, water, and sewage disposal services.
United States · United States Congress · 1 August 1994
Capital Expenditure Expansion Act of 1994 - Amends the Internal Revenue Code to disregard up to $15 million of capital expenditures in applying the provisions permitting a $10 million limit on qualified small issue bonds.
United States · United States Congress · 1 August 1994
S Corporation Investment Act of 1994 - Amends the Internal Revenue Code to increase from 35 to 40 the maximum number of shareholders of an S Corporation (small business corporation). Allows members of a family to be treated as one shareholder. Increases the percentage of permissible passive income. Allows a deduction for payments made to a reinvestment reserve with limitations.
United States · United States Congress · 1 August 1994
Expresses the sense of the House of Representatives that: (1) a more proportionate share of funds appropriated for homeless programs should be appropriated to the Secretary of Veterans Affairs for homeless veterans programs; and (2) funds appropriated for any fiscal year for homeless programs should be administered by all agencies in a proportional manner to aid homeless veterans.
United States · United States Congress · 1 August 1994
Sets forth the rule for the consideration of H.R. 4003 (authorization of appropriations for certain maritime programs of the Department of Transportation).
United States · United States Congress · 29 July 1994
Requires that, for pre-1980 tax years, the Federal income tax deductibility of flight training expenses be determined without considering whether the taxpayer received reimbursement through veterans' educational programs.
United States · United States Congress · 29 July 1994
Foreign Tax Compliance Act of 1994 - Amends the Internal Revenue Code to include in the taxation of controlled foreign corporations income attributable to imported property. Requires the separate application of limitations on the foreign tax credit for imported property income. Expresses the sense of the Congress that deficit reduction should be achieved in part by ending loopholes and enforcement breakdowns that foster the underpayment of taxes on income from cross-border transactions and enable foreign-controlled corporations operating in the United States, and foreign persons investing in the United States, to pay no taxes.
United States · United States Congress · 29 July 1994
Federal Communications Commission Authorization Act of 1994 - Amends the Communications Act of 1934 (the Act) to authorize appropriations for the Federal Communications Commission (FCC) for FY 1994 and 1995. Derives a portion of such appropriations from application and regulatory fees. Repeals provisions regarding reimbursement of FCC travel expenses. Amends the Federal Communications Commission Authorization Act of 1988 to extend the FCC's: (1) authorization to make grants or enter into agreements to utilize the talents of older Americans in FCC programs through FY 1996; and (2) authorization for the relocation of the Hawaii monitoring station through FY 1997. Waives annual equipment inspections for vessels in compliance with the radio provisions of the Safety Convention that are operating solely in waters beyond U.S. jurisdiction, provided that an inspection is performed within 30 days after return to the United States. Revises application fee provisions to require the FCC, beginning in FY 1995, to modify such fees by proportionate increases or decreases so as to result in estimated total collections for the fiscal year equal to the sum of $40 million plus the amount specified in an appropriation Act to be collected, not to exceed necessary FCC expenses. Sets forth a schedule of application fees for personal communications services. Permits the FCC to reject a proposed tariff filing if the filing or any part is patently unlawful. Authorizes the FCC, subject to certain conditions, to require the refund of a portion of any charge by a carrier that results from violation of this Act. Permits the operation of the following radio services without individual licenses: (1) personal radio services; (2) specified aviation radio service on domestic flights; and (3) maritime radio service for ship stations navigated on domestic voyages when such ships are not otherwise required to carry a radio station. Adds a failure to comply with the Act's requirements or FCC rules that imperils the safety of life to the list of offenses for which the FCC may revoke a station license or construction permit. Imposes a forfeiture penalty for such violation. Bars forfeiture proceedings against common carriers to whom the notice of liability is issued five years after the date of the violation.
United States · United States Congress · 29 July 1994
TABLE OF CONTENTS: Title I: Consolidation of Federal Employment Assistance Programs Subtitle A: Block Grants to States Subtitle B: Consolidation and Repeal of Certain Federal Employment Assistance Programs Title II: Notice of Availability of Earned Income Credit Title III: Repeal of Temporary Futa Surtax Employment Enhancement Reform Act - Title I: Consolidation of Federal Employment Assistance Programs - Subtitle A: Block Grants to States - Establishes a block grant program to prepare individuals for employment by increasing their occupational and educational skills. Authorizes the Secretary of Labor to make such grants, for up to five-year periods subject to annual approval and availability of appropriations, to States to provide employment assistance to eligible individuals. Reserves funds for grants to Indian tribes and migrant and seasonal farm worker organizations. (Sec. 103) Allocates such grants to States on the basis of relative numbers of: (1) unemployed in areas of substantial unemployment; (2) excess unemployed; and (3) economically disadvantaged adults. (Sec. 104) Sets forth requirements for applications, use of grants, and conduct of State programs. Requires State programs to provide employment assistance to the following types of eligible individuals: (1) economically disadvantaged and 14 years or older; (2) certain types of dislocated workers; (3) individuals with disabilities; (4) Armed Forces members being separated under other than adverse conditions; (5) unemployed veterans; and (6) displaced homemakers. Requires States to: (1) profile and evaluate individuals to determine the employment assistance services to be provided; (2) notify individuals of other sources of supportive services; (3) provide appropriate employment assistance, within specified limits; (4) monitor rates of individuals successfully obtaining employment after separation from the program, according to specified criteria; and (5) establish one-stop-shop centers throughout the State for program information and profiling and evaluation. Authorizes certain discretionary activities under State programs. (Sec. 107) Directs the Secretary to make biennial determinations of State success in placing individuals in employment. Authorizes reduction or termination of payments when a State has not been successful, and reinstatement or increase of payments when a State implements appropriate modifications of its program. (Sec. 110) Authorizes appropriations. Subtitle B: Consolidation and Repeal of Certain Federal Employment Assistance Programs - Chapter 1: Consolidation of Programs - Amends the Stewart B. McKinney Homeless Assistance Act to eliminate community mental health services demonstration projects for homeless individuals who are chronically mentally ill. (Sec. 112) Amends the Rehabilitation Act of 1973 to add requirements for State collaborative programs of supported employment services for individuals with the most severe disabilities, special recreation activities and services, and projects with industry. Repeals other provisions for special project grants for supported employment programs, special recreational programs, projects with industry, and supported employment services for individuals with severe disabilities. Chapter 2: Repeal of Programs - Repeals Higher Education Act of 1965 provisions for special programs for students whose families are engaged in migrant and seasonal farmwork. (Sec. 122) Repeals: (1) the disabled veterans outreach program and the local veterans employment representative program under Federal law relating to veterans; and (2) the homeless veterans reintegration project under the Stewart B. McKinney Homeless Assistance Act. (Sec. 123) Repeals: (1) the Foster Grandparent and Senior Companion programs under the Domestic Volunteer Service Act; (2) employment and training program provisions under the Food Stamp Act of 1977 (but allowing college students who are parents responsible for care of a dependent child under age 6 to be eligible for the food stamp program); and (3) the older American community service employment program under the Older Americans Act of 1965. (Sec. 124) Repeals the Job Training Partnership Act, except those provisions relating to the Job Corps. Authorizes appropriations for the Job Corps. (Sec. 125) Repeals the Appalachian vocational and other educational facilities and operations program under the Appalachian Regional Development Act of 1965. (Sec. 126) Repeals certain provisions relating to rules for computing the targeted job credit under the Internal Revenue Code. (Sec. 127) Repeals the JOBS (job opportunities and basic skills training) program provisions for recipients of AFDC (aid to families with dependent children) under the Social Security Act. (Sec. 128) Repeals: (1) the Service Members Occupational Conversion and Training Act of 1992; (2) the Adult Education Act; (3) the Carl D. Perkins Vocational and Applied Technology Education Act; (4) the National Literacy Act of 1991; and (5) and the Indian Employment, Training and Related Services Demonstration Act of 1992. (Sec. 133) Repeals special programs relating to adult education for Indians, under the Indian Education Act of 1988. (Sec. 134) Repeals special Social Security Act provisions relating to Indian tribes and JOBS training programs. (Sec. 135) Repeals provisions for for the VISTA Literacy Corps under the Domestic Volunteer Service Act of 1973. (Sec. 136) Repeals: (1) the Wagner-Peyser Act (employment agencies); (2) the adult education for the homeless grants program and the job training for the homeless demonstration grants program under the Stewart B. McKinney Homeless Assistance Act; (3) the trade adjustment assistance for workers program under the Trade Act of 1974; (4) FY 1993 and 1994 authorizations of appropriations for certain grants, as well as certain technical assistance conditions, under the Homeownership and Opportunity through HOPE Act; and (5) the State legalization impact-assistance grants program under the Immigration Reform and Control Act of 1986. Subtitle C: Effective Dates - Sets forth effective dates. Title II: Notice of Availability of Earned Income Credit - Amends the Social Security Act and the Food Stamp Act of 1977 to require that notice of availability of the earned income tax credit be provided to applicants for and former recipients of AFDC, Medicaid, or food stamps. (Sec. 202) Amends the Omnibus Budget Reconciliation Act of 1990 to require printing of a notice of the availability of the earned income tax credit and the dependent care tax credit on W-4 forms for employee withholding exemptions. Title III: Repeal of Temporary FUTA Surtax - Repeals the temporary FUTA (Federal Unemployment Tax Act) surtax under the Internal Revenue Code.
United States · United States Congress · 29 July 1994
Foreign Tax Compliance Act of 1994 - Amends the Internal Revenue Code to include in the taxation of controlled foreign corporations income attributable to imported property. Requires the separate application of limitations on the foreign tax credit for imported property income. Expresses the sense of the Congress that deficit reduction should be achieved in part by eliminating enforcement breakdowns that enable foreign-controlled corporations operating in the United States, and foreign persons investing in the United States, to pay no taxes.
United States · United States Congress · 28 July 1994
Rail-Highway Grade Crossing Safety Act of 1994 - Includes rail-highway crossing closures among the safety projects for which an increased Federal share of construction costs apply. Authorizes any State, after adopting a policy requiring the review of the need for all new public at-grade rail-highway crossings, to use certain authorized funds to provide an incentive payment to a local jurisdiction upon the permanent closing by the jurisdiction of a public at-grade crossing, provided that such payments may not exceed $7,500 and that the funds are matched by an equal payment from the railroad owning the tracks on which the crossing is located. Directs the local jurisdiction receiving funds to use the Federal funds portion of the incentive payment for transportation safety improvements only. Directs the Secretary to establish guidelines to enable States to determine the public benefits and costs resulting from any new rail-highway grade crossings. Revises provisions regarding Operation Lifesaver to require the Secretary of Transportation to set aside $500,000 of funds authorized to be appropriated for the surface transportation program (STP) for a given fiscal year for carrying out a public information and education program to help prevent and reduce motor vehicle accidents, injuries, and fatalities, to improve driver performance at railway-highway crossings, and to help prevent trespassing on rail rights-of-way and resulting injuries and fatalities. Directs that expenditure of any funds in excess of $300,000 be contingent upon receipt of matching funds from nonpublic sources. Requires the Secretary to: (1) set aside $15 million of funds authorized to be appropriated for the STP for a given fiscal year to carry out a program to provide a financial incentive to States that review and implement grade crossing safety improvements on a corridor basis; and (2) issue investment criteria for approving projects.
United States · United States Congress · 28 July 1994
Amends the Internal Revenue Code, with respect to situations in which unearned income of a minor child is taxed as if it were parental income, to not take into account any income attributable to an amount excluded from the gross income of the child by reason of the child receiving a personal injury award.
United States · United States Congress · 27 July 1994
TABLE OF CONTENTS: Title I: Insurance Reform Subtitle A: Reform of Insured Market for Employers and Individuals Subtitle B: ERISA and Internal Revenue Code Requirements Title II: Tax Fairness Title III: Medical Savings Accounts Title IV: Medical Malpractice Title V: Antitrust Reform Title VI: Consumer Information The Prescription for Health Act of 1994 - Title I: Insurance Reforms - Subtitle A: Reform of Insured Market for Employers and Individuals - Part 1: General Reforms - Prohibits an insurer from canceling coverage or denying renewal of coverage of health insurance with respect to an employer or an individual other than: (1) for nonpayment of premiums, fraud or other misrepresentations, or noncompliance with plan provisions; or (2) because the insurer is ceasing to provide any health insurance in the State or, in the case of a health maintenance organization, in a geographic area with respect to employer or individuals, respectively. Prohibits an insurer that terminates the offering of health insurance plans in an area with respect to the market for employers or individuals from offering such a plan to any employer or individual in the area for five years after such termination. (Sec. 102) Bars an insurer from providing for an increase in the premium charged an employer or an individual for health insurance by a percentage that exceeds the percentage change in the premium charged any other employer or individual with the same characteristics, for similar benefits, and for the same area. (Sec. 103) Prohibits an insurer from denying health insurance coverage to any employer or individual, and a sponsor of a group health plan (GHP) from denying coverage to an eligible individual, on the basis of health status or preexisting condition if the employer or individual was covered by health insurance or a GHP for the same condition by another insurer or GHP for a period of not less than 12 months within the 15-month period ending with the month in which the application for coverage is made, with exceptions. Requires an insurer or sponsor of a GHP to waive any period applicable to a preexisting condition under health insurance or a GHP if the employer or individual was covered by such insurance or GHP for the same condition by another insurer or sponsor of a GHP for a period of not less than 12 months within the 15-month period ending with the month in which the application for coverage is made. (Sec. 104) Prohibits the premium charged by an insurer with respect to an employer or an individual covered under health insurance by another insurer for a period of not less than 12 consecutive months from exceeding the greater of the amount charged during the previous rating period or the premium charged to any other employer or individual with the same characteristics, for similar benefits, and for the same area. (Sec. 105) Permits variations in health insurance premiums among employers or individuals based on differences in covered services, age, gender, family composition, geographic area, or group size. (Sec. 106) Requires an insurer, upon request, to fully disclose all actuarial assumptions and methods used in establishing its premiums for health insurance at the time it offers or renews coverage to any employer or individual. (Sec. 107) Subjects any insurer or sponsor of a GHP which fails to comply with the provisions of this part to a civil monetary penalty of $250,000 per individual for each violation. Part 2: State Preemptions - Specifies that no provision of State or local law shall apply: (1) that requires the coverage under health insurance of any insurer of any specific benefits, services, or categories of health care or services of any class or type of provider of health care; and (2) that prohibits two or more employers or groups from obtaining coverage under a multiple health insurance plan. Subtitle B: ERISA and Internal Revenue Code Requirements - Amends the Employee Retirement Income Security Act of 1974 to direct the Secretary of Labor to prescribe: (1) solvency standards for GHPs that are single-employer plans which will ensure that benefits under such plans will be provided in full when due; and (2) rules for monitoring and enforcing compliance with such standards. Requires: (1) the Secretary, in prescribing such solvency standards, to take into consideration the extent to which a plan's potential liabilities are covered by excess or stop-loss coverage; and (2) the plan sponsor of each GHP to take such steps as necessary to ensure that plan assets held for the purpose of complying with such standards are held in trust under the plan and are available solely for such purpose. (Sec. 133) Amends the Internal Revenue Code to provide that the account limit for any qualified asset account for a taxable year is the amount reasonably and actuarially necessary to fund compliance with Federal or State solvency requirements, in the case of an account providing medical benefits, as well as specified claims and administrative costs. Title II: Tax Fairness - Amends the Internal Revenue Code to allow individuals a deduction from gross income for medical expenses attributable to health plan coverage and contributions to a medical savings account. Revises the medical expense deduction to include amounts paid under a health plan or paid to a medical savings account. Makes such deduction inapplicable to participants in a health plan maintained by their employer. Excludes employer contributions to medical savings accounts from employment taxes. Allows an individual tax credit for amounts allocable to FICA taxes used to purchase health plan coverage and to make contributions to medical savings accounts. Makes such credit inapplicable to participants in a health plan maintained by their employer. Title III: Medical Savings Accounts - Establishes tax-exempt medical savings accounts as trusts created to pay the medical expenses of beneficiaries. Title IV: Medical Malpractice - Makes this title applicable to any medical malpractice liability claim (claim) and any medical malpractice liability action (action) brought in State or Federal court, except regarding a claim or action for damages arising from a vaccine-related injury or death to the extent that specified provisions of the Public Health Service Act apply. Sets forth provisions regarding: (1) preemption and negotiated liability; (2) effect on sovereign immunity and choice of law or venue; and (3) Federal court jurisdiction. (Sec. 402) Sets a two-year statute of limitations from the date the alleged injury was, or reasonably should have been, discovered for actions, with an exception for certain minors. (Sec. 403) Makes the liability of each defendant in an action, with respect to economic and noneconomic damages, several only and not joint. Specifies that such a defendant shall be liable only for the amount of such damages allocated to the defendant in direct proportion to such defendant's percentage of fault or responsibility for the claimant's injury. (Sec. 404) Limits to $250,000 the total amount of noneconomic damages that may be awarded to a claimant and the members of the claimant's family for losses resulting from the injury which is the subject of an action. (Sec. 405) Prohibits requiring a defendant, in an action in which the damages awarded for any economic losses to be incurred after the date on which the judgment is entered exceed $100,000, from paying such damages in a single, lump-sum payment. Authorizes the court to require that such a defendant purchase an annuity or fund a reversionary trust to make periodic payments under specified circumstances. Bars a court judgment awarding periodic payments from being reopened at any time to contest, amend, or modify the schedule or amount of payments in the absence of fraud or any other basis under which a party may obtain relief from a final judgment. (Sec. 406) Authorizes a court, as a condition of the initiation of an action, to require an undertaking for the payment of the costs associated with the action, including reasonable attorney fees. Directs the court to require the party against whom the judgment was rendered to pay to the prevailing party costs and fees incurred, with exceptions. (Sec. 407) Specifies that the total amount of damages received by a claimant in an action shall be reduced by any other payment that has been, or will be, made to such claimant to compensate such claimant for an injury that was part of the action. (Sec. 408) Prohibits the award of noneconomic damages regarding any medical product liability claim alleged against a medical product producer if: (1) the drug or device that is the subject of such claim was subject to approval or premarket approval by the Food and Drug Administration (FDA) with respect to the safety of the formulation or performance of the aspect, or the adequacy of the packaging or labeling, of the drug or device, and was approved by the FDA; or (2) the drug or device is generally recognized as safe and effective pursuant to conditions established by the FDA and applicable regulations. Makes an exception in the case of withheld information, misrepresentation, or illegal payment to an FDA official for purposes of securing approval. Title V: Antitrust Reform - Directs the Attorney General to: (1) provide for the development and publication of explicit guidelines on the application of antitrust laws to the activities of health plans; and (2) establish a review process under which the administrator or sponsor of a health plan may submit a request to the Attorney General to obtain a prompt opinion from the Department of Justice on the plan's conformity with the Federal antitrust laws. (Sec. 502) Requires the Attorney General to issue a certificate of public advantage to each eligible health care collaborative activity that complies with specified requirements in effect on or after the expiration of the one-year period that begins on the date of this Act's enactment (thus making such activity and the parties to such activity immune from liability under the antitrust laws for conduct described). Sets forth provisions regarding requirements applicable to the issuance of such certificates. Directs the Attorney General to issue a certificate to an eligible health care collaborative activity upon finding that the benefits are likely to outweigh any reduction in competition likely to result from the activity and that such reduction in competition is reasonably necessary to obtain such benefits. Sets forth provisions regarding: (1) the establishment of criteria and procedures; (2) eligible health care collaborative activity; (3) the review of applications for certificates; (4) revocation of certificates; and (5) judicial review. Title VI: Consumer Information - Requires each hospital, physician, or other health care provider to make available to an individual, before providing any health care item or service in the United States, a list of all applicable fees and charges (and where not readily determinable in advance, the provider may use such estimates as the Secretary of Health and Human Services may permit), with an exception for emergency treatment. Specifies that no individual shall be liable for payment for a health care item or service for which disclosure has not been substantially made in accordance with this title.
United States · United States Congress · 26 July 1994
Extends through FY 1996 the authority of the Secretary of Veterans Affairs to carry out a compensated work therapy and therapeutic transitional housing demonstration program. (Sec. 2) Extends permanently a Department of Veterans Affairs program for the treatment and rehabilitation of veterans for alcohol or drug dependence or abuse disabilities. (Sec. 3) Amends the Stewart B. McKinney Homeless Assistance Act to reauthorize for FY 1995 through 1997 the homeless veterans' reintegration projects established under such Act. (Sec. 4) Authorizes the Secretary to provide care and treatment and rehabilitative services in halfway houses, therapeutic communities, psychiatric residential treatment centers, and other community-based treatment facilities to homeless veterans suffering from chronic mental illness disabilities who are eligible for veterans' medical care. Requires prior approval by the Secretary of the facility providing such care. (Sec. 5) Directs the Secretary to report annually to specified congressional committees on Department activities in assisting homeless veterans during the preceding year. (Sec. 6) Amends the Veterans' Medical Programs Amendments of 1992 to: (1) require the directors of regional Department medical centers or benefits offices to update for each of FY 1995 through 1997 an assessment of the needs of homeless veterans in their region; and (2) require the Secretary to report to specified congressional committees in each of such fiscal years describing such updates. (Sec. 7) Directs the Secretary to carry out a demonstration program at no more than five designated locations under which the Secretary enters into partnerships with community-based homeless service organizations in order to provide services and assistance to homeless veterans. Requires an agreement with a non-Federal entity to carry out a study of the program. Requires the Secretary to report the results of such study to specified congressional committees. (Sec. 8) Amends the Homeless Veterans Comprehensive Service Programs Act of 1992 to: (1) increase from four to 12 the authorized number of centers for the provision of comprehensive services to homeless veterans; and (2) remove a specified funding limitation.
United States · United States Congress · 26 July 1994
Amends the Internal Revenue Code to eliminate the requirement that States pay unemployment compensation on the basis of services performed by election workers if remuneration for a calendar year is expected to be less than $200.
United States · United States Congress · 25 July 1994
Court of Federal Claims Administration Act of 1994 - Amends the Federal judicial code to allow a judge of the U.S. Court of Federal Claims (Court) who is not reappointed to continue in office until a successor is appointed and takes office. (Sec. 3) Grants judges of the Court authority to conduct proceedings in the district courts of territories to the same extent as duly appointed judges of those courts upon request by or on behalf of a territorial court and with the concurrence of the chief judge of the Court and the chief judge of the judicial circuit involved based upon a finding of need. (Sec. 4) Exempts retired judges of the Court from residence restrictions. Provides that the place where a retired judge maintains the actual abode in which such judge customarily lives shall be the judge's official duty station. (Sec. 5) Provides for Court membership on the Judicial Conference of the United States. (Sec. 6) Authorizes the chief judge of the Court to summon the Court judges to a judicial conference annually to consider the business of, and improvements in the administration of justice in, the Court. Directs the Court to provide by its rules or by general order for representation and active participation at such conference by members of the bar. (Sec. 7) Authorizes the chief judge of the Court to recall a formerly disabled judge who retires under the disability provisions of the Court's retirement system if, in the chief judge's view, such judge has recovered sufficiently to render judicial service. (Sec. 8) Grants the Court: (1) the power to grant injunctive and declaratory relief; (2) jurisdiction to render judgment upon any claim by or against, or dispute with, a contractor arising under specified provisions of the Contract Disputes Act of 1978; and (3) ancillary jurisdiction under the Federal Tort Claims Act when a claim is directly related to one otherwise within the Court's jurisdiction. (Sec. 9) Provides that Court judges over age 65 who are on senior status will receive the same treatment as other Federal trial judges on senior status insofar as Social Security taxes and annuity payments are concerned. (Sec. 10) Deems a Court judge to be a judicial officer eligible for coverage under annuity, insurance, and other programs available to other Federal trial judges, including the program for continued Federal life insurance coverage after retirement.
United States · United States Congress · 25 July 1994
TABLE OF CONTENTS: Title I: Authorization of Appropriations for the Nuclear Regulatory Commission Title II: Nuclear Power Plant Safety and Security Nuclear Regulatory Commission Authorization Act for Fiscal Years 1994 and 1995 - Title I: Authorization of Appropriations for the Nuclear Regulatory Commission - Authorizes appropriations for the Nuclear Regulatory Commission (NRC) for FY 1994 and 1995 for salaries and expenses and for the Office of the Inspector General. Prescribes guidelines for allocation and transfer of funds. Title II: Nuclear Power Plant Safety and Security - Amends the Energy Reorganization Act of 1974 to modify the notification requirements for NRC-regulated facilities that contain a defect or otherwise fail to comply with statutory safety requirements (including those leased by the United States Enrichment Corporation). Includes within such notification requirements Department of Energy (DOE) facilities regulated by the NRC and components supplied by DOE to licensees. Amends the Atomic Energy Act of 1954 to: (1) modify the civil monetary penalties for violations of rules, regulations, orders, or licensing requirements; (2) revise from annual to biennial the dateline by which the Advisory Committee on Reactor Safeguards must report to the Congress on reactor safety research; (3) permit NRC licensees and the employees of such licensees' contractors to carry firearms at NRC facilities; (4) authorize the NRC to promulgate regulations regarding the unauthorized introduction of dangerous weapons unto facilities within its licensing purview; (5) impose criminal penalties for the sabotage of NRC-licensed production, utilization, or waste storage facilities under construction; and (6) increase the base level penalty for certain violations of a medical therapy license. Directs the NRC to upgrade the professional requirements for persons licensed to possess nuclear byproduct materials for medical use.
United States · United States Congress · 25 July 1994
Prohibits expenditures by the United States in a fiscal year for land or water acquisition for the National Wildlife Refuge System if the Secretary of the Interior has not made all payments required for the preceding fiscal year to appropriate counties in which any fee area is situated. Makes conforming amendments to the Land and Water Conservation Fund Act. Makes this Act inapplicable to any acquisition the Secretary is obligated to carry out under a contract entered into by the Secretary on or before the enactment of this Act.
United States · United States Congress · 25 July 1994
Civil War Battlefields Preservation Tax Incentives Act of 1994 - Amends the Internal Revenue Code to allow a deduction from the value of a gross estate of the transfer by an heir of a qualified conservation easement on land within a Civil War battlefield site. Provides that the dollar limitation on the valuation of farm and other real property does not apply to property within a Civil War battlefield site. Allows a tax credit of 50 percent of the amount of any qualified Civil War battlefield charitable contribution.
United States · United States Congress · 22 July 1994
TABLE OF CONTENTS: Title I: Prospective Payment System for Nursing Facilities Title II: Subacute Care Continuum Amendments of 1994 Title III: Long-Term Care Tax Clarification Title IV: Long-Term Care Insurance Standards Title V: Financial Eligibility Standards Title VI: Establishment of Program for Home and Community-Based Services for Certain Individuals with Disabilities Title VII: Asset Transfers Quality Care for Life Act of 1994 - Title I: Prospective Payment System for Nursing Facilities - Prospective Payment System for Nursing Facilities Amendments of 1994 - Mandates that payment rates under the Prospective Payment System for Nursing Facilities reflect enumerated objectives. Declares that this Act does not affect the skilled nursing facility benefit under title XVIII (Medicare) of the Social Security Act (SSA). (Sec. 105) Instructs the Secretary of Health and Human Services to: (1) establish a resident classification system which groups residents into classes according to similarity of their assessed condition and required services; and (2) determine payment rates for nursing facilities according to prescribed guidelines. (Sec. 107) Prescribes guidelines for: (1) resident assessment; (2) per diem rate for nursing service costs, administrative and general costs; (3) payment for fee-for-service ancillary services; (4) reimbursement of selected ancillary services including drugs and medical supplies; (5) the per diem rate for property costs; (6) mid-year adjustments; and (7) payment methods for new and low-volume nursing facilities. Title II: Subacute Care Continuum Amendments of 1994 - Subacute Care Continuum Act of 1994 - Provides that SSA shall not be construed as limiting a skilled nursing facility (SNF) from offering subacute care services. Prohibits the Secretary or the States from imposing conditions for such services which restrict SNFs from qualifying based upon their status. (Sec. 203) Instructs the Secretary, regardless of the issuance of final regulations, to: (1) grant an interim exception within 90 days of submission of a request by a SNF providing subacute care services; and (2) establish identical fee schedules for physician visits to a subacute care patient in a SNF or in a hospital. (Sec. 205) Provides coverage under the Medicare program for respiratory therapy services in an SNF. Requires the Secretary to determine and subsequently publish a list of hospital DRGs appropriate for SNFs and the appropriate hospitalizations and copayments and rebase Medicare payments which reflect the lower cost of such care provided in SNFs. (Sec. 207) Expresses the sense of the Congress that: (1) the States are encouraged to develop payment methodologies for nursing facilities which provide subacute care for Medicaid patients; and (2) Federal funding should be available for nursing facilities which provide subacute care to Medicaid patients. Title III: Long-Term Care Tax Clarification - Private Long-Term Care Insurance Incentive Amendments of 1994 - Amends the Internal Revenue Code to: (1) set forth definitions concerning the treatment of long-term care insurance or plans; (2) treat qualified long-term services as medical care; (3) exclude from taxable income policy benefits pertaining to long-term care; (4) permit the offer of certain long-term care insurance contracts in certain employer (cafeteria) plans; (5) include in gross income excessive long-term care benefits; and (6) mandate that qualified long-term care insurance tax reserves be determined by the National Association of Insurance Commissioners. Title IV: Long-Term Care Insurance Standards - Long-Term Care Insurance Standards Amendments of 1994 - Directs the Congress to appoint the National Long-Term Care Insurance Advisory Council to advise it and monitor development of the long-term care insurance market. Authorizes appropriations. (Sec. 402) Amends the Internal Revenue Code to set forth consumer protection provisions regarding long-term care insurance policies. Sets forth tax penalties for non-complying issuers of such policies. (Sec. 404) Declares that insurance policies deemed by a State Insurance Commissioner to be in compliance with this Act and the Internal Revenue Code shall be deemed approved for sale in any other State. Title V: Financial Eligibility Standards - Amends title XIX (Medicaid) of the Social Security Act to delineate the criteria for financial eligibility for nursing facility services. Directs the Secretary to provide grants for State demonstration projects to investigate the coordination of private long-term care insurance benefits and financial eligibility requirements. Title VI: Establishment of Program for Home and Community-Based Services for Certain Individuals with Disabilities - Home and Community-Based Services for Individuals with Disabilities Program Amendments of 1994 - Establishes a program which mandates that States having an approved State plan provide for home and community-based services for eligible individuals with disabilities. (Sec. 602) Increases the amount of an individual's resources which shall be disregarded when determining eligibility for inpatient nursing or intermediate care facilities for the mentally retarded. Title VII: Asset Transfers - Extends from 36 to 60 months the look-back period for asset transfers. Modifies the guidelines for such transfers with respect to the treatment of certain trusts.
United States · United States Congress · 22 July 1994
Congressional Fiscal Responsibility Act of 1994 - Amends the Legislative Reorganization Act of 1946 to reduce the annual salary of a Member of Congress by five percent for FY 1998 and ten percent for FY 1999 through 2001 if the total expenditures of the Federal Government exceed its total receipts for a fiscal year. Requires the reductions to be cumulative and prohibits their total from exceeding 35 percent. Requires such reductions in salary to be disregarded effective as of the first pay period beginning on or after the date the Congress receives a report indicating that total receipts of the Federal Government are greater than or equal to its total expenditures for a fiscal year. Requires restoration of the Member's salary to the level which would then be in effect without enactment of this Act. Mandates such pay adjustments before any other adjustment scheduled to take effect on the same day for the same position. Makes it out of order for the House of Representatives or the Senate to consider any bill or resolution increasing the salary for Members of Congress, with specified exceptions, unless the bill or resolution deals with no subject matter other than a pay increase for members. Requires a recorded vote by the House or Senate in the passage or adoption of such bill or resolution.
United States · United States Congress · 21 July 1994
Makes technical corrections to the Foreign Relations Authorization Act, Fiscal Years 1994 and 1995. Amends the Foreign Service Act of 1980 to exclude certain U.S. citizens hired at posts abroad who are not family members of U.S. Government employees from coverage under Foreign Service grievance provisions. Prohibits the sale or lease of defense articles or services by the U.S. Government to any country or international organization that is known to have sent letters to U.S. firms requesting compliance with, or soliciting information regarding compliance with, the secondary or tertiary (currently, primary or secondary) Arab League boycott unless the President certifies to the appropriate congressional committees that the country or organization does not currently maintain such a policy or practice. Amends the Immigration and Nationality Act to extend the pilot visa waiver program through FY 1995. Authorizes the Secretary of State to transfer a specified amount from the Department of State's Diplomatic and Consular Programs appropriation to appropriations available to the General Services Administration for the purchase of real property for use by the Department of State for its Miami Regional Center. Revives provisions of the United States Information and Educational Exchange Act of 1948 regarding Voice of America.
United States · United States Congress · 21 July 1994
TABLE OF CONTENTS: Title I: Retirement Savings Incentives Subtitle A: Restoration of IRA Deduction Subtitle B: Nondeductible Tax-Free IRAs Title II: Penalty-Free Distributions Title III: Aid to Families With Dependent Children Savings and Investment Incentive Act of 1994 - Title I: Retirement Savings Incentives - Subtitle A: Restoration of IRA Deduction - Amends the Internal Revenue Code to remove the limitation on the deductibility of contributions to individual retirement plans (IRAs) by active participants in employer-maintained plans, thereby restoring the IRA deduction. Provides an inflation adjustment after 1995. Allows certain spouses a full deduction for contributions to an IRA. Makes certain coins and bullion ineligible as collectible investments for purposes of distributions from an IRA. Subtitle B: Nondeductible Tax-Free IRAs - Allows individuals to establish individual retirement plus (IRA plus) accounts with tax treatment similar to that for individual retirement plans. Makes contributions to such accounts nondeductible. Title II: Penalty-Free Distributions - Allows distributions from certain retirement plans without penalty to purchase first homes, pay higher education expenses and financially devastating medical expenses, and assist certain unemployed individuals. Title III: Aid to Families with Dependent Children - Amends part A (Aid to Families with Dependent Children) (AFDC) of title IV of the Social Security Act to exclude from AFDC eligibility determinations certain income and resources that are to be used for education, training, and employability purposes. Requires the Secretary of Health and Human Services to report to the Congress on a revision of the AFDC limit on automobiles in order to increase the employability of AFDC recipients.