Balanced Budget Act of 1997

Summary

TABLE OF CONTENTS: Title I: Committee On Agriculture Title II: Committee On Banking and Financial Services Title III: Committee On Commerce-Nonmedicare Subtitle A: Nuclear Regulatory Commission Annual Charges Subtitle B: Lease of Excess Strategic Petroleum Reserve Capacity Subtitle C: Sale of DOE Assets Subtitle D: Communications Subtitle E: Medicaid Title IV: Committee On Commerce-Medicare Subtitle A: MedicarePlus Program Subtitle B: Prevention Initiatives Subtitle C: Rural Initiatives Subtitle D: Anti-Fraud and Abuse Provisions Subtitle E: Prospective Payment Systems Title V: Committee On Education and the Workforce Subtitle A: TANF Block Grant Subtitle B: Higher Education Programs Subtitle C: Repeal of Smith-Hughes Vocational Education Act Subtitle D: Expansion of Portability and Health Insurance Coverage Title VI: Committee On Government Reform and Oversight Subtitle A: Postal Service Subtitle B: Civil Service Title VII: Committee On Transportation and Infrastructure Title VIII: Committee On Veterans' Affairs Subtitle A: Extension of Temporary Authorities Subtitle B: Other Matters Title IX: Committee On Ways and Means-Nonmedicare Subtitle A: TANF Block Grant Subtitle B: Supplemental Security Income Subtitle C: Child Support Enforcement Subtitle D: Restricting Welfare and Public Benefits for Aliens Subtitle E: Unemployment Compensation Subtitle F: Increase in Public Debt Limit Title X: Committee On Ways and Means-Medicare Subtitle A: MedicarePlus Program Subtitle B: Prevention Initiatives Subtitle C: Rural Initiatives Subtitle D: Anti-Fraud and Abuse Provisions Subtitle E: Prospective Payment Systems Subtitle F: Provisions Relating to Part A Subtitle G: Provisions Relating to Part B Only Subtitle H: Provisions Relating to Parts A and B Balanced Budget Act of 1997 - Title I: Committee on Agriculture - Amends the Food Stamp Act to permit State agencies to provide a specified exemption from the food stamp program (program) work requirement for certain individuals. (Sec. 1002) Obligates specified additional funds for program employment and training programs. Sets forth State allocation and additional payment provisions. (Sec. 1003) Authorizes the use of nongovernmental personnel to make program eligibility determinations. Title II: Committee on Banking and Financial Services - Amends the Balanced Budget Downpayment Act, I to extend permanently certain foreclosure avoidance and borrower assistance provisions under the single family housing mortgage insurance program. (Sec. 2003) Amends the United States Housing Act of 1937 with respect to the section 8 rental assistance program to make certain maximum monthly rent adjustment provisions for certain new and rehabilitated and nonturnover units applicable to FY 1999 and thereafter. Title III: Committee on Commerce--Nonmedicare - Subtitle A: Nuclear Regulatory Commission Annual Charges - Amends the Omnibus Budget Reconciliation Act of 1990 to extend from FY 1998 through FY 2002 the authority of the Nuclear Regulatory Commission to assess and collect user fees and annual charges from licensees. Subtitle B: Lease of Excess Strategic Petroleum Reserve Capacity - Amends the Energy Policy and Conservation Act to authorize the Secretary of Energy to use underutilized Strategic Petroleum Reserve (SPR) facilities to store petroleum product owned by a foreign government. Provides that: (1) such products may be exported without a Federal license; and (2) all attendant agreements shall provide for fees to fully compensate Federal storage and removal costs, including the cost of replacement facilities necessitated as a result of any withdrawals. (Sec. 3101) Instructs the Secretary of Energy (the Secretary) to ensure that such storage agreements do not affect: (1) Federal ability to withdraw, distribute, or sell SPR petroleum in response to an energy emergency; or (2) Federal obligations under the Agreement on an International Energy Program. Makes funds resulting from the leasing of SPR facilities after October 1, 2002, available to the Secretary without further appropriation for petroleum purchases, and for SPR operation and maintenance costs. Subtitle C: Sale of DOE Assets - Instructs the Secretary to sell, during the period FY 1999 through FY 2002, natural and low- enriched uranium that the President has determined is not necessary for national security needs. Prescribes sales terms. Subtitle D: Communications - Amends the Communications Act of 1934 (the Act) to make competitive bidding authority with respect to licenses or construction permits involving exclusive uses of the electromagnetic spectrum inapplicable to such licenses and permits issued by the Federal Communications Commission (FCC) that are: (1) not mutually exclusive; (2) for public safety radio services; (3) for initial licenses or permits assigned to existing terrestrial broadcast licensees for new terrestrial digital television (TV) services; or (4) for public telecommunications services when the application is for channels reserved for noncommercial use. Requires the FCC to provide for the design and conduct of competitive bidding using a contingent combinatorial bidding system that permits prospective bidders to bid on combinations of licenses in a single bid and to enter multiple alternative bids within a single bidding round. Eliminates a requirement for the retention of proceeds from competitive bidding by the FCC's salaries and expenses account. Extends competitive bidding authority through FY 2002. Terminates the FCC's authority to provide preferential treatment in licensing procedures to persons who make significant contributions to the development of a new service or new technology that enhances an existing service on this Act's enactment date (currently, such authority expires on September 30, 1998). Eliminates provisions authorizing random selection in granting spectrum licenses or permits. Directs the FCC, by the end of FY 2002, to permit the assignment by competitive bidding of licenses for the use of bands of frequencies that: (1) individually span at least 25 megahertz (mhz.) unless a combination of smaller bands can be expected to produce greater receipts; (2) in the aggregate span at least 100 mhz.; (3) are located below three gigahertz (ghz.); (4) have not been designated for assignment, identified by the Secretary of Commerce as reallocable frequencies, or allocated for Federal Government use or other specified unlicensed use; and (5) include frequencies at 1,710-1,755 mhz. Requires the FCC to notify the Secretary if it is unable to provide for effective relocation of incumbent licensees to available bands of frequencies and has identified bands suitable for relocation that are allocated for Federal use but could be reallocated pursuant to the National Telecommunications and Information Administration Organization Act. Amends the National Telecommunications and Information Administration Organization Act to direct the Secretary to report to the President, the FCC, and the Congress on recommendations for reallocating frequencies allocated for Federal use under the Communications Act of 1934 to such incumbent licensees. Requires the Secretary to recommend for reallocation for use other than by Federal stations bands of frequencies that: (1) in the aggregate span at least 20 mhz.; (2) individually span at least 20 mhz. unless a combination of smaller bands can be expected to produce greater receipts; and (3) are located below three ghz. Directs the FCC to establish competitive bidding procedures designed to secure winning bids of at least two-thirds of $7.5 billion with respect to bidding for frequencies under this section. (Sec. 3302) Amends the Act to prohibit, under competitive bidding provisions, the renewal of a license authorizing analog TV service beyond the end of 2006. Extends such date if more than five percent of households in a market continue to rely exclusively on over-the-air terrestrial analog TV signals. Requires competitive bidding procedures to be designed to secure winning bids of at least two-thirds of $4 billion in the case of bidding for spectrum of expired analog TV licenses. Prohibits the FCC, in prescribing regulations relating to qualifications of bidders for such spectrum, from: (1) precluding any party from being a qualified bidder for spectrum allocated for any use that includes digital TV service on the basis of the FCC's duopoly rule or newspaper cross-ownership rule; or (2) applying either rule to preclude a successful bidder from using such spectrum for digital TV service. (Sec. 3303) Directs the FCC, no later than January 1, 1998, to allocate on a national, regional, or market basis, from radio spectrum between 746 and 806 mhz.: (1) 24 mhz. for public safety services unless the FCC determines that needs can be met in particular areas with fewer mhz.; and (2) the remainder for commercial purposes to be assigned by competitive bidding. Sets deadlines for the assignment of such licenses and for the commencement of competitive bidding. Requires competitive bidding procedures to be designed to secure winning bids of at least two-thirds of $1.9 billion in the case of bidding under this section. Provides that nothing shall preclude the FCC from assigning frequencies described in this Act by competitive bidding at a later date than required if such delay will better attain the objectives of recovering a fair portion of the value of the public spectrum for the public and avoiding unjust enrichment. Requires the FCC to assure that qualifying low-power TV stations are assigned a frequency below 746 mhz. to permit continued operation. (Sec. 3304) Directs the FCC, by July 1, 1997, to initiate a public inquiry required by the Act regarding competitive bidding systems. Subtitle E: Medicaid - Chapter 1: Flexibility - Amends title XIX (Medicaid) of the Social Security Act (SSA) to authorize States to provide Medicaid benefits (except to special needs children) through managed care entities. (Sec. 3402) Eliminates the (75-25) requirement under SSA title XVIII (Medicare) and title XIX that Medicare and Medicaid beneficiaries constitute less than 75 percent of the membership of a participating health maintenance organization (HMO). (Sec. 3403) Grants States the option of providing Medicaid coverage of primary care case management services without the need for a waiver. (Sec. 3404) Increases from $100,000 to $1 million, indexed annually, the threshold amount for contracts requiring prior approval of the Secretary of Health and Human Services. (Sec. 3405) Requires a Medicaid health plan to cover the length of an inpatient hospital stay as determined medically appropriate by the attending physician (or other attending health care provider as permitted by State law) in consultation with the patient. (Sec. 3411) Repeals "Boren Amendment" provider reimbursement requirements. Requires States to establish a public administrative process for determination of payment rates through publication of proposed rates and a reasonable opportunity for providers, beneficiaries, and other concerned State residents to review and comment. (Sec. 3412) Specifies reductions from 100 percent to 85 percent between FY 1999 through FY 2003 in the percentage of reasonable costs that shall be paid under a State plan for Federally-qualified health center and rural health clinic services (with a special supplemental payment for services furnished under certain managed care contracts). Requires the Comptroller General to report on the impact of such reductions on access to health care for Medicaid beneficiaries and the uninsured served at health centers and rural health clinics, and the ability of such centers and clinics to become integrated in a managed care system. (Sec. 3413) Revises the treatment as broad-based health care related taxes of certain State hospital taxes which currently are not subtracted as revenues from the State share of Medicaid expenditures for purposes of calculating the Federal share of such expenditures. Declares that an exemption from such State hospital tax for certain Federal-tax-exempt hospitals that do not accept Medicaid or Medicare payments (provide free care) shall not disqualify the hospital tax as a broad-based health care related tax (thus allowing continued exclusion of such State hospital tax from the requirement that provider-specific taxes be subtracted from the State share of Medicaid expenditures for purposes of Federal share calculation). (Sec. 3421) Grants States the option to provide for 12-month continuous Medicaid eligibility for children. (Sec. 3422) Requires State Medicaid plan coverage of the Medicare cost-sharing for certain additional low-income Medicare beneficiaries whose income otherwise disqualifies them for specified Medicare benefits. (Sec. 3423) Prescribes criminal penalties for knowingly and willfully, for a fee, counseling or assisting an individual to dispose of assets (including a transfer in trust) in order for that individual to become Medicaid-eligible (fraudulent eligibility). (Sec. 3424) Declares that certain payments in a class settlement of specified cases shall not be considered income or resources in determining Medicaid eligibility. (Sec. 3431) Amends SSA title XVIII to provide for programs of all- inclusive care for the elderly (PACE programs) for individuals age 55 or older who require the level of care required under the State Medicaid plan for coverage of nursing facility services. States that such individuals need not be eligible for Medicare part A benefits, or enrolled under Medicare part B. Specifies eligibility and payment requirements. Limits PACE provider eligibility to public and private non-profit entities; but requires the Secretary to waive such limitations to demonstrate the operation of a PACE program by a private, for-profit entity. (Sec. 3432) Details provisions for the coverage of PACE programs under the Medicare program. (Sec. 3434) Directs the Secretary to study and report to the Congress on the quality and cost of providing PACE program services under Medicare and Medicaid, specifically comparing the costs, quality, and access to services by private, for-profit entities with the costs, quality, and access to services of other PACE providers. (Sec. 3441) Changes from mandatory to discretionary a State's authority to enroll individuals under private group health plans, and pay their premiums. (Sec. 3442) Permits the same co-payments in HMO's as in fee-for- service plans. (Sec. 3443) Repeals: (1) certain physician qualification requirements with respect to services to pregnant women and to children under age 21; and (2) the requirement of prior institutionalization with respect to habilitation services furnished under a waiver for home or community-based services. (Sec. 3445) Provides for benefits for services of physician assistants. (Sec. 3446) Directs the Secretary to provide for a study, and report to the Congress, on the actuarial value of the provision of early and periodic screening, diagnostic, and treatment services under the Medicaid program. (Sec. 3451) Repeals requirements for inspections of the care being provided at mental hospitals and intermediate care facilities for the mentally retarded (ICFS-MR). (Sec. 3452) Authorizes a State, in lieu of terminating a noncompliant ICFS-MR, to establish alternative remedies if the State demonstrates to the Secretary's satisfaction that such alternative remedies are effective in deterring noncompliance and correcting deficiencies. (Sec. 3453) Revises requirements for mechanized claims processing and information retrieval systems. (Sec. 3454) Repeals the requirement for State refund to the Federal Government of any payments received during remediation of a noncompliant nursing facility. (Sec. 3455) Includes the DRUGDEX Information System among the compendia to be used in drug use review for Medicaid payment. (Sec. 3456) Applies certain requirements to the extension of statewide comprehensive research and demonstration projects for which waivers of Medicaid compliance have been granted. (Sec. 3457) Declares that no provision of law shall be construed as preventing any State from allowing determinations of Medicaid eligibility by an entity that is not a State or local government, or by an individual who is not an employee of a State or local government, meeting such qualifications as the State determines. (Sec. 3458) Amends the Omnibus Budget Reconciliation Act of 1989 to extend the moratorium on the treatment of Michigan's Kent Community Hospital Complex and Saginaw Community Hospital as institutions for mental diseases for purposes of Medicaid reimbursement. Chapter 2: Quality Assurance - Amends SSA title XIX to require any State contracting with Medicaid managed care organizations to develop and implement a quality assessment and improvement strategy incorporating certain access standards, monitoring procedures, and other measures. Waives Medicaid HMO requirements for: (1) HMO's with Medicare or MedicarePlus contracts; and (2) HMO's accredited by certain private, nonprofit accrediting organizations. Requires HMO and primary care case management contracts to provide for: (1) submission of care monitoring information to the State agency; (2) maintenance of an internal quality assurance program meeting the Secretary's standards; and (3) effective procedures for resolving grievances between the HMO or primary care case management contractor and enrollees. (Sec. 3462) Requires an HMO to meet solvency standards established by the State for private HMO's, or be State-licensed or -certified as a risk-bearing entity. (Sec. 3463) Provides for: (1) application of the prudent layperson standard for emergency medical condition determinations; (2) prohibition of "gag rule" restrictions against informing patients about their health status or medical care or treatment if the covered health care professional is acting within the lawful scope of practice; (3) various additional specified fraud and abuse protections in managed care; (4) grievances under Medicaid managed care plans; and (5) standards relating to access to obstetrical and gynecological services under Medicaid managed care plans. Chapter 3: Federal Payments - Amends SSA title XIX to require direct State Medicaid payment to disproportionate share hospitals (DSH's) for managed care enrollees. Sets at the FY 1995 level, with specified incremental reductions for high DSH States and other States, the annual DSH allotment through FY 2002. (Sec. 3472) Specifies additional funding for State emergency health services furnished to undocumented aliens. Subtitle F: Child Health Assistance Program (CHAP) - Child Health Assistance Program Act of 1997 - Amends SSA to add a new title XXI (Child Health Assistance Program) (CHAP) in order to provide funds to States to expand the provision of child health care assistance to uninsured, low-income children. Requires a State to submit for the Secretary's approval a child health plan for the use of funds, containing strategic objectives, performance goals, and performance measures. Specifies the benefits to be covered. Allows the use of funds for abortion only if the pregnancy results from rape or incest or if the woman suffers from a physical disorder, illness, or injury that would, as certified by a physician, place her in danger of death unless an abortion is performed. (Sec. 3503) Amends SSA title XIX to provide for an increased Medicaid Federal medical assistance percentage (FMAP) for expanded coverage of targeted low-income children. (Sec. 3504) Authorizes an approved State plan to make Medicaid available to a low-income child during a specified presumptive eligibility period after determination that family income does not exceed a certain level. Title IV: Committee on Commerce - Medicare - Subtitle A: MedicarePlus Program - Chapter 1: MedicarePlus Program - Amends title XVIII (Medicare) of the Social Security Act (SSA) to establish a MedicarePlus program under which each MedicarePlus eligible individual (one entitled to benefits under Medicare part A (Hospital Insurance) and enrolled under Medicare part B (Supplementary Medical Insurance)) is entitled to elect, in accordance with certain procedures, to receive Medicare benefits either through the Medicare fee-for-service program or through a MedicarePlus plan. (Sec. 4001) Outlines the types of MedicarePlus plans that may be available, including: (1) coordinated care plans; (2) plans offered by provider-sponsored organizations; and (3) a combination of MSA (MedicarePlus savings account) plan and contributions to MedicarePlus MSA. Sets forth various special rules regarding, among other things, residence, individuals with end-stage renal disease, and individuals covered under the Federal Employees Health Benefits Program or eligible for veterans or military health benefits. Directs the Secretary of Health and Human Services (HHS) to provide for broad dissemination of coverage option and comparison information to Medicare beneficiaries and prospective Medicare beneficiaries. Directs the Secretary to maintain a toll-free number for inquiries about MedicarePlus options and program operation, as well as an Internet site through which individuals may obtain such information electronically. Requires MedicarePlus organizations to generally accept without restrictions individuals eligible to make an election at any time during which such elections are accepted. Requires the approval of MedicarePlus marketing material and application forms before they are distributed. Outlines benefits and beneficiary protections. Requires each MedicarePlus plan (except MSA plans) to provide those items and services for which benefits are available under Medicare parts A and B and specified additional benefits, as well, at its option, as certain supplemental benefits subject to the Secretary's approval. Prohibits a MedicarePlus organization from denying, limiting, or conditioning coverage or benefits based on any described health status-related factor. Prescribes plan disclosure requirements and an ongoing quality assurance program. Outlines a mechanism for grievances and appeals. Provides for the treatment of services furnished by providers that do not have a contract establishing payment amounts for services furnished to an individual enrolled with a MedicarePlus organization. Requires each MedicarePlus organization to provide the Secretary with information on the extent to which it provides inpatient and outpatient hospital benefits through the use of disproportionate share (DSH) and teaching hospitals. Allows a MedicarePlus organization offering a network plan to enrollees also to offer another plan covering items and services furnished by out-of- network providers. Directs the Secretary to make monthly, advance payments with respect to an individual's coverage to MedicarePlus organizations according to a specified formula. Requires the Secretary to establish separate payment rates for individuals with end-stage renal disease. Directs the Secretary to develop and submit to the Congress a report on a method of risk adjustment of payment rates that accounts for variations in per capita costs based on health status. Sets forth special rules for individuals electing MSA plans. Requires such an individual to establish a MedicarePlus MSA into which the Secretary shall make monthly deposits out of the Medicare trust funds in accordance with prescribed guidelines. Details rules for the submission and charging of premiums by each MedicarePlus organization. Sets limitations on enrollee cost-sharing for basic, additional, and supplemental benefits, except for MSA plans. Requires the Secretary to audit each year the financial records of at least one-third of the MedicarePlus organizations offering MedicarePlus plans. Prohibits a State from imposing a premium tax or similar tax with respect to payments on MedicarePlus plans or the offering of such plans. Sets out organizational and financial requirements for MedicarePlus organizations and provider-sponsored organizations. Directs the Secretary to establish solvency and capital adequacy standards for provider-sponsored organizations, and other standards for MedicarePlus organizations. Prescribes requirements, including minimum enrollment requirements, for contracts between the Secretary and MedicarePlus organizations. Provides for: (1) intermediate sanctions and civil monetary penalties to enforce contract provisions; and (2) procedures for termination of contracts. Directs the Secretary to: (1) study and report to the Congress on the feasibility and impact of removing a certain limitation added by this Act on the eligibility of most individuals medically determined to have end-stage renal disease to enroll in MedicarePlus plans; and (2) report to the Congress on graduate medical education programs operated by MedicarePlus organizations and the extent to which such organizations are providing for payments to DSH and teaching hospitals. (Sec. 4002) Details transitional rules for the current Medicare health maintenance organization (HMO) program, as well as specified conforming changes in the Medicare supplemental health insurance policy (Medigap) program. (Sec. 4006) Amends the Internal Revenue Code to outline special rules for MedicarePlus MSA's. Excludes from gross income any payment by the Secretary to an individual's MedicarePlus MSA. Excludes from qualified deductible medical expenses any amounts paid for the medical care of any individual but the account holder. Prescribes a penalty for distributions from the MedicarePlus MSA not used for qualified medical expenses if the minimum balance is not maintained, with certain exceptions if the account holder becomes disabled or dies. (Sec. 4008) Requires each contract with a MedicarePlus organization and each risk-sharing contract with an eligible organization to provide for an additional payment for Medicare's share of allowable direct graduate medical education (GME) costs incurred by such an organization for an approved medical residency program. Directs the Secretary to provide for specified additional payment amounts, subject to certain annual limits, for each Medicare- dependent, small rural hospital, each PPS-exempt hospital, and each hospital reimbursed under an authorized reimbursement system that has an approved medical residency training program and furnishes services to individuals who are enrolled under a risk-sharing contract with an eligible organization and are entitled to Medicare part A. (Sec. 4009) Directs the Secretary to provide for specified additional payment amounts, subject to certain annual limits, for each Medicare-dependent, small rural hospital and each hospital reimbursed under an authorized reimbursement system that: (1) furnishes services to individuals enrolled under a risk-sharing contract with an eligible organization and entitled to Medicare part A, and to individuals who are enrolled with a MedicarePlus organization; and (2) is, or if it were not reimbursed would qualify as, a DSH. Chapter 2: Integrated Long-Term Care Programs - Amends the Omnibus Budget Reconciliation Act of 1987 to extend the authorities for the social health maintenance organization (SHMO) demonstration project; and the Omnibus Budget Reconciliation Act of 1993 to increase the cap on the number of individuals who may participate in a SHMO demonstration. Directs the Secretary to submit to the Congress a plan for the integration of SHMO health plans and similar plans as an option under the MedicarePlus program. (Sec. 4018) Amends the Consolidated Omnibus Budget Reconciliation Act of 1985 to authorize the Secretary to extend the municipal health service demonstration projects but only with respect to individuals enrolled with such projects before January 1, 1998. Requires the Secretary to work with each such demonstration project to develop a plan (to be submitted to certain congressional committees) for the orderly transition of demonstration projects and project enrollees to a non-demonstration project health care delivery system. Provides that a demonstration project which does not develop and submit such a transition plan by a certain deadline shall be discontinued as of December 31, 1998. (Sec. 4019) Extends for an additional two years certain Medicare community nursing organization demonstration projects under the Omnibus Budget Reconciliation Act of 1987. Chapter 3: Medicare Payment Advisory Commission - Amends SSA title XVIII to establish the Medicare Payment Advisory Commission (MPAC) to replace the Prospective Payment Assessment Commission and the Physician Payment Review Commission, hereby abolished. Requires the new Commission to review and make recommendations to the Congress about payment policies under Medicare (including certain specific payment-related topics). Authorizes appropriations. Chapter 4: Medigap Protections - Amends SSA title XVIII with respect to the issuer of a Medicare supplemental (Medigap) policy in the case of certain individuals terminated by an employee welfare benefit plan providing supplementary health benefits who seek to enroll under a Medigap policy not later than 63 days after termination or disenrollment. Prohibits the Medigap issuer from: (1) denying or conditioning the issuance or effectiveness of such a policy; (2) discriminating in the pricing of such policy because of health status, claims experience, receipt of health care, or medical condition; or (3) imposing an exclusion of benefits based on a pre-existing condition. (Sec. 4031) Specifies limitations on the imposition of preexisting condition exclusions during the initial open enrollment period in the case of a Medicare supplemental policy issued to an individual who is 65 years of age or older with a certain minimum period of creditable coverage. (Sec. 4032) Directs the Secretary to implement a project to demonstrate the application of, and the consequences of applying, a market-oriented pricing system for the provision of a full range of Medicare benefits in a geographic area. Requires the Secretary to appoint: (1) a national advisory committee to make recommendations concerning the appropriate research design for the project and, taking such recommendations into account, designate the areas in which the project will operate; and (2) an area advisory committee to advise the Secretary on actual project implementation in the area. Directs the Secretary to monitor and report periodically to the Congress on the impact of such projects on the price and quality of, and access to, Medicare covered services, and other relevant factors. Subtitle B: Prevention Initiatives - Outlines various specified new preventive health measures covered under Medicare, namely coverage for: (1) annual screening mammography for women over age 39, while providing for the waiver of the deductible for screening mammography; (2) screening pelvic exams, providing for their payment under the physician fee schedule; (3) prostate cancer screening tests, providing for payment of the prostate-specific antigen (PSA) blood test under the clinical diagnostic laboratory test fee schedules; (4) colorectal cancer screening tests, subject to prescribed frequency and payment limits, which will include a screening barium enema if found by the Secretary to be an appropriate alternative to certain other tests; (5) diabetes outpatient self-management training services, including blood-testing strips (with a ten percent payment reduction after 1997) and glucose monitors as durable medical equipment (DME) for individuals with diabetes; and (4) bone mass measurements for qualified individuals for the purpose of identifying bone mass or detecting bone loss or determining bone quality. (Sec. 4102) Makes certain changes in existing benefits, such as increasing the frequency of coverage of screening pap smears for high risk women and waiving the deductible that applies to such exams. Requires the Secretary to report to the Congress on: (1) the extent to which the use of certain supplemental computer-assisted diagnostic tests in conjunction with pap smears improves the early detection of cervical or vaginal cancer; and (2) the costs implications for coverage of such supplemental tests under Medicare. (Sec. 4105) Directs the Secretary to establish outcome measures, including glysolated hemoglobin (past 90-day average blood sugar levels), for the purpose of evaluating the improvement of the health status of Medicare beneficiaries with diabetes mellitus, with a view to recommending coverage modifications. (Sec. 4107) Extends the Influenza and Pneumococcal Vaccination Campaign carried out by the Health Care Financing Administration (HCFA) in conjunction with the Centers for Disease Control and Prevention and the National Coalition for Adult Immunization. Authorizes appropriations. (Sec. 4108) Directs the Secretary to request the National Academy of Sciences in conjunction with the United States Preventive Services Task Force to and report to the Congress on the expansion or modification of preventive benefits provided to Medicare beneficiaries. Provides funding. Subtitle C: Rural Initiatives - Directs the Secretary to provide for a four-year demonstration project to use eligible health care provider telemedicine networks to apply high-capacity computing and advanced networks to improve primary care and prevent health care complications to Medicare beneficiaries with diabetes mellitus residing in medically underserved rural or inner-city areas. Provides funding. Subtitle D: Anti-Fraud and Abuse Provisions - Revises requirements for mandatory exclusion of certain individuals and entities from participating in Medicare and State health programs. Mandates an ten-year exclusion of any individual for a second health care related conviction, and permanent exclusion for a third health care related conviction. (Sec. 4302) Authorizes the Secretary to refuse to enter into Medicare agreements with individuals or entities convicted of felonies for offenses determined inconsistent with the best interests of program beneficiaries. (Sec. 4303) Requires the annual explanation of Medicare benefits provided to Medicare beneficiaries to include a toll-free telephone number to report Medicare waste, fraud, and abuse. (Sec. 4304) Makes Medicare carriers and fiscal intermediaries liable for reimbursing the Secretary for amounts paid to excluded providers. Makes State agencies liable for reimbursing the Secretary for amounts paid to excluded providers under the Medicaid program. (Sec. 4305) Authorizes the Secretary to exclude from the Medicare program any entity with respect to which a sanctioned person with an ownership or control interest in it transfers such interest in anticipation of (or following) a conviction, assessment, or exclusion against the person, to an immediate family member or member of the household who continues to maintain such an interest. (Sec. 4306) Provides for the imposition of civil monetary penalties for any person who arranges or contracts with an individual or entity that the person knows or should know is excluded from participation in a Federal health care program. (Sec. 4307) Outlines various specified requirements regarding disclosure of information, surety bonds, and advisory opinions regarding certain physician self-referral provisions. Includes surety bond requirements for home health agencies, and provides for the application of disclosure and surety bond requirements to ambulance services and certain clinics. Applies surety bond requirements to comprehensive outpatient rehabilitation facilities (CORF's) and to rehabilitation agencies. (Sec. 4308) Requires any participating entity to disclose to the Secretary its own employer identification numbers and social security account numbers, as well as those of persons with ownership or control interests and subcontractors in which the entity has a five percent or greater interest. Directs the Secretary to report to the Congress on the steps taken to assure the confidentiality of such social security account numbers. (Sec. 4309) Amends SSA title XVIII to direct the Secretary to issue written, binding advisory opinions concerning whether a referral relating to designated health services (other than clinical laboratory services) is prohibited. (Sec. 4310) Provides for: (1) notification of the availability of home health agencies as part of the discharge planning process; and (2) maintenance and disclosure of certain information on post-hospital home health agencies. Amends SSA title XI to provide for public disclosure of certain information on hospital financial interest and referral patterns. Subtitle E: Prospective Payment Systems - Chapter 2 (sic): Payment Under Part B - Eliminates formula-driven overpayments for certain outpatient hospital services. (Sec. 4412) Extends the current reductions in payments for capital-related and other costs of hospital outpatient services. (Sec. 4413) Directs the Secretary to establish a prospective payment system (PPS) for hospital outpatient department services. (Sec. 4421) Establishes payment rates for outpatient therapy services, with certain co-payments imposed for services furnished after 1998. (Sec. 4422) Provides for: (1) payment of CORF services based on fee schedule amounts; and (2) certain interim reductions in payments for ambulance services. Directs the Secretary to establish a prospective fee schedule for payment of such services. (Sec. 4431) Provides that in promulgating regulations to carry out certain provisions with respect to the coverage of ambulance service, the Secretary may include coverage of advanced life support services provided by a paramedic intercept service provider (ALS intercept services) in a rural area if specified conditions are met. (Sec. 4432) Sets out the framework for demonstration projects for coverage of ambulance services under Medicare through contracts with counties or parishes. Chapter 3: Payment Under Parts A and B - Directs the Secretary to establish a PPS for home health services. Subtitle G (sic): Provisions Relating to Part B Only - Chapter 1: Physicians' Services - Revises requirements for the payment of physicians' services, with changes: (1) establishing a single conversion factor for 1998; (2) adding new update provisions; (3) replacing the volume performance standard with sustainable growth rate; (4) adding payment rules for anesthesia services; and (5) phasing-in implementation of resource-based physician practice expense relative value units. (Sec. 4606) Directs the Secretary, for 1999 and 2001, to determine for each hospital: (1) the hospital-specific per discharge relative value according to prescribed guidelines (with a special rule for teaching hospitals); and (2) whether the hospital-specific relative value is projected to be excessive. Requires the Secretary to notify the medical executive committee of each hospital identified as having an excessive hospital-specific relative value of the determinations made with respect to the medical staff. (Sec. 4607) Provides that no x-ray is required for chiropractic services. Directs the Secretary to develop and implement utilization guidelines relating to the coverage of chiropractic services under Medicare part B in cases in which a subluxation has not been demonstrated by x-ray to exist. (Sec. 4608) Provides that effective for electrocardiogram tests performed during 1998, the Secretary shall restore separate payment under Medicare part B for the transportation of electrocardiogram equipment (HCPCS code R0076) based upon the status code and relative value units established for such service as of December 31, 1996. Requires the Comptroller General to report to the Congress on the appropriateness of continuing such payment. Chapter 2: Other Payment Provisions - Provides for a reduction in DME payment amounts and for a payment freeze for parenteral and enteral nutrients, supplies, and equipment. Revises payment rates for oxygen and oxygen equipment, clinical diagnostic laboratory tests, ambulatory surgical services, and drugs and biologicals. (Sec. 4614) Directs the Secretary to divide the United States into up to five regions, and designate a single carrier for each region, for the payment of Medicare part B claims for clinical diagnostic laboratory tests. Requires the Secretary to adopt uniform policies for clinical diagnostic laboratory tests. (Sec. 4617) Provides for Medicare coverage of oral drugs prescribed for use as an acute anti-emetic used as part of an anticancer chemotherapeutic regimen under certain conditions. Sets forth special rules for the payment of such drugs. (Sec. 4618) Revises certain requirements with regard to rural health clinic services, including per-visit payment limits for provider-based clinics, assurance of quality services, and certain staffing and shortage area requirements. (Sec. 4619) Provides for increased Medicare reimbursement for nurse practitioners, clinical nurse specialists, and physician assistants. Repeals certain restrictions on settings applicable to them. (Sec. 4621) Directs the Secretary to: (1) audit a sample of cost reports of renal dialysis providers for 1995 and for each third year thereafter; and (2) develop and implement a method to measure and report quality of renal dialysis services provider under Medicare in order to reduce payments for inappropriate or low quality care. (Sec. 4622) Provides for payment for cochlear implants as customized DME. Chapter 3: Part B Premium - Revises the formula for the monthly Medicare part B premium rate the Secretary promulgates each September for the following calendar year. Requires such rate to equal 50 percent of the monthly actuarial rate for enrollees age 65 and over. Subtitle H: Provisions Relating to Parts A and B - Chapter 1: Provisions Relating to Medicare Secondary Payer - Revises requirements for Medicare as secondary payer. Permits recovery against third party administrators of primary plans. Extends the claims filing period for employer group health plans. Limits beneficiary liability for items and services for which Medicare benefits are incorrectly paid. Chapter 2: Home Health Services - Prohibits the Secretary, in establishing payment limits for cost reporting periods beginning after September 30, 1997, from taking into account any changes in the home health market basket with respect to cost reporting periods beginning on or after July 1, 1994, and before July 1, 1996. (Sec. 4712) Revises requirements for interim payments for home health services. Directs the Secretary to: (1) expand research on a PPS for home health agencies under the Medicare program that ties prospective payments to a unit of service; and (2) study and report to the Congress on the criteria that should be applied in determining whether an individual is homebound for purposes of qualifying for Medicare home health services. (Sec. 4715) Bases the payment for home health services on the location where the service is furnished. (Sec. 4716) Provides for the denial of home health claims based on home health services the frequency and duration of which are in excess of normative guidelines established by the Secretary. (Sec. 4717) Provides that no home health benefits are based solely on drawing blood. (Sec. 4718) Makes Medicare part B the primary payer for certain home health services for an individual entitled to benefits under Medicare part A. Provides for Medicare coverage of post-hospital home health services. Revises requirements for Medicare part B payments with respect to home health services. Provides for the phase-in of additional part B costs in determination of Medicare part B monthly premiums. Directs the Secretary to: (1) report to specified congressional committees on the impact on home health utilization and admissions to hospitals and skilled nursing facilities of Medicare coverage of post- hospital home health services; and (2) further reexamine and report to such committees on this impact one year after the full implementation of the Medicare PPS for home health services. Chapter 3: Baby Boom Generation Medicare Commission - Establishes the Bipartisan Commission on the Effect of the Baby Boom Generation on the Medicare Program to: (1) examine the financial impact on the Medicare program of the significant increase in the number of Medicare-eligible individuals which will occur beginning approximately during 2010 and lasting for approximately 25 years; and (2) make specific recommendations to the Congress respecting a comprehensive approach to preserve the Medicare program for the period during which such individuals are eligible for Medicare. (Sec. 4721) Directs the Commission to report to the Congress its findings and recommendations regarding how to protect and preserve the Medicare program in a financially solvent manner until 2030 (or, if later, throughout the period of projected solvency of the Federal Old- Age and Survivors Insurance Trust Fund). Requires the report to include detailed recommendations for appropriate legislative initiatives on how to accomplish this objective. Authorizes appropriations. Chapter 4: Provisions Relating to Direct Graduate Medical Education - Sets out provisions relating to direct graduate medical education, including: (1) placing a limitation on the number of residents for cost reporting periods beginning after FY 1998; (2) phasing-in a limitation on hospital overhead and supervisory physician component of direct medical education costs; (3) permitting payment to non-hospital providers; and (4) providing incentive payments under plans for voluntary reduction in the number of residents. (Sec. 4735) Directs the Secretary to establish a demonstration project under which the Secretary shall make payments to specified qualifying consortia instead of teaching hospitals. (Sec. 4736) Requires the Medicare Payment Advisory Commission to examine and develop recommendations for the Congress on whether and to what extent Medicare payment policies and other Federal policies regarding teaching hospitals and graduate medical education should be reformed. (Sec. 4737) Provides a special Medicare reimbursement rule for certain combined residency programs. Chapter 5: Other Provisions - Amends SSA title XVIII to direct the Secretary to use a competitive process to contract with specific hospitals or other entities meeting certain quality standards (centers for excellence) for furnishing services related to surgical procedures as well as other services (unrelated to surgical procedures) to hospital inpatients. (Sec. 4742) Establishes a Medicare part B and Medigap special enrollment period for certain military retirees and dependents during which they may enroll without being subject to a Medicare part B late enrollment penalty. (Sec. 4743) Directs the Secretary to establish and operate a two- year demonstration project in two geographic regions under which the Medicare payment for a selected item or service furnished in the region shall be equal to the price determined pursuant to a certain competitive bidding process meeting specified requirements. Subtitle I: Medical Liability Reform - Chapter 1: General Provisions - Sets forth definitions, limitations, preemption mandates, and specified exclusions relating to health care liability actions brought in any State or Federal court. Chapter 2: Uniform Standards for Health Care Liability Actions - Establishes certain uniform standards for such health care liability actions that include: (1) a general statute of limitations of two years after the date on which the claimant discovered or should have discovered the harm that is the subject of the action; (2) a $250,000 limitation on noneconomic damages; and (3) standards for the awarding of punitive damages (clear and convincing evidence of conscious, flagrant indifference to the rights and safety of others). (Sec. 4813) Declares that any alternative dispute resolution system (ADR) used to resolve a health care liability action or claim shall contain provisions relating to such statute of limitations, non- economic damages, punitive damages, and other specified matters which are identical to the relevant provisions of this subtitle. Title V: Committee on Education and the Workforce - Subtitle A: TANF Block Grant - Amends part A (Temporary Assistance for Needy Families) (TANF) of SSA title IV to establish a program of welfare-to-work grants to States. (Sec. 5001) Sets forth requirements relating to State entitlement to non-competitive formula grants under such program and State distribution of such funds among local governments. Provides for competitive grants, based on the likelihood of successful long-term placement of individuals into the work force, for State-approved projects proposed by private industry councils or local governments. Prohibits private industry councils from directly providing services using such grant funds. Provides for such grants to territories and to Indian tribes. Directs the Secretary of Health and Human Services (HHS) to develop a plan to evaluate the use of such grants. (Sec. 5002) Sets forth requirements for: (1) nondisplacement of other workers by participants in work activities under this program; (2) applicable health and safety standards; and (3) grievance procedures with respect to alleged violations of such nondisplacement and health and safety requirements. (Sec. 5003) Exempts teen parents from the limitation on the number of persons who may be treated as engaged in work by reason of participation in a vocational education program. (Sec. 5004) Requires that participants in State welfare-to-work programs receive compensation at the same rates (in accordance with applicable law), including periodic increases, as trainees or employees who are similarly situated in similar occupations by the same employer and who have similar training, experience, and skills. Limits the number of hours per month that an assistance recipient may be required to be assigned to on-the-job-training, and to a work experience or community service position with a public agency or nonprofit organization. (Sec. 5005) Requires reduction of a State's welfare-to-work grant if a State fails to reduce assistance for recipients refusing work without good cause. Subtitle B: Higher Education Programs - Amends the Higher Education Act of 1965 (HEA) with respect to title IV student assistance programs. (Sec. 5101) Directs the Secretary of Education to recall for deposit in the Treasury a specified amount of the reserve funds of State and nonprofit private loan insurance programs held by guaranty agencies on September 1, 2002. Denies the Secretary any authority to direct a guaranty agency to return reserve funds before such date. Requires each guaranty agency, between FY 1998 and 2002, to transfer a certain portion of its required share of the projected recall amount into restricted accounts for investment in U.S. obligations or other similarly low-risk securities. (Sec. 5102) Repeals the requirement that the Secretary pay direct loan origination fees to institutions of higher education. (Sec. 5103) Sets funding levels through FY 2002 for mandatory administrative expenses for the student financial aid programs. Reduces the previously authorized level of appropriations for FY 1998 ($750 million), while authorizing increasing amounts for subsequent fiscal years until the level reaches $750 million for FY 2002. Prescribes a formula for the calculation of administrative cost allowances payable to guaranty agencies. (Sec. 5104) Revises requirements for the Secretary's equitable share of collections to: (1) include collections of payments made on behalf of a borrower, such as payments made to discharge loans to obtain a consolidation loan; and (2) specify the share on consolidated defaulted loans. (Sec. 5105) Extends the HEA title IV student assistance program through FY 2002. Subtitle C: Repeal of Smith-Hughes Vocational Education Act - Repeals the Smith-Hughes Vocational Education Act. Subtitle D: Expansion of Portability and Health Insurance Coverage - Expansion of Portability and Health Insurance Coverage Act of 1997 - Amends the Employee Retirement Income Security Act of 1974 (ERISA) to establish rules governing association health plans, including requirements for: (1) certification; (2) sponsors and boards of trustees, and treatment of franchised networks and collectively bargained plans; (3) participation and coverage of employers and individuals, and of previously uninsured employees; (4) plan documents, contribution rates, and benefit options; (5) maintenance of reserves, excess-stop loss insurance, and solvency indemnification for plans providing health benefits in addition to health insurance coverage; (6) application and related matters, and notice for voluntary termination; (7) corrective actions and mandatory termination; and (8) special rules for church plans. (Sec. 5303) Revises requirements for the treatment of: (1) single employer arrangements; and (2) certain collectively bargained arrangements. (Sec. 5305) Adds requirements relating to association health plans, with respect to: (1) enforcement; and (2) cooperation between Federal and State authorities, and State responsibilities. Title VI: Committee on Government Reform and Oversight - Subtitle A: Postal Service - Repeals provisions authorizing transitional appropriations to the Postal Service. Provides that liabilities of the former Post Office Department to the Employees' Compensation Fund for which appropriations were authorized under such provisions shall remain liabilities payable by the Postal Service. Prohibits payments from being made to the Postal Service Fund pursuant to such provisions for FY 1998. Requires the amount of any such payments that have been made for FY 1998 to be paid from such Fund into the Treasury as miscellaneous receipts before October 1, 1998. Subtitle B: Civil Service - Specifies increases in certain contributions to the Civil Service Retirement System and the Federal Employees Retirement System. (Sec. 6103) Modifies the formula under which the Government contribution for health benefits for a Federal employee or annuitant enrolled in the Federal Employees Health Benefits Program (FEHB) is determined. Title VII: Committee on Transportation and Infrastructure - Extends through FY 2002 the current higher vessel tonnage duties imposed upon foreign vessels entering into U.S. ports. (Sec. 7002) Directs the Administrator of General Services, no earlier than FY 2002, to: (1) sell all U.S. rights and interest to the land and related improvements at Governors Island, New York (granting the right of first refusal to the State of New York and the City of New York); and (2) sell the air rights (currently owned by Amtrak) to the land adjacent to Union Station in Washington, D.C. Directs Amtrak to convey such air rights to the Administrator, for subsequent resale, as a condition of future Federal financial assistance. Title VIII: Committee on Veterans' Affairs - Veterans Reconciliation Act of 1997 - Subtitle A: Extension of Temporary Authorities - Extends through FY 2002 the authority to require certain veterans to make copayments for the receipt of Department of Veterans Affairs health and medical care benefits. Extends through FY 2002: (1) the requirement that veterans pay $2 for each 30-day supply of medication furnished through the Department for the treatment of a non-service-connected disability or condition; and (2) the right of the United States to recover from a veteran the cost of Department care and services provided for certain non-service-connected disabilities. (Sec. 8013) Establishes in the Treasury the Department of Veterans Affairs Medical Care Collections Fund for receipt of amounts recovered or collected by the Department for the provision of certain reimbursable health care and services provided to veterans and their spouses and dependents. Specifies authorized Fund uses. Requires the Secretary to make certain certifications to the Secretary of the Treasury if amounts recovered in the Fund during FY 1998 through 2000 will be more than $25,000 less than the amount contained in the latest congressional baseline estimate for recovery in that fiscal year. Directs the Secretary to submit quarterly reports to the veterans' committees on the operation of such recovery provisions for such fiscal years and the first quarter of FY 2001. Terminates at the end of FY 1997 the Department of Veterans Affairs Medical-Care Cost Recovery Fund. Directs the Secretary to report to the veterans' committees on the implementation of this section. Extends through FY 2002: (1) the authority of the Secretary to obtain information under the Internal Revenue Code for veterans' income verification purposes; (2) a $90 monthly pension limitation for a Medicaid-covered veteran having neither spouse nor child and being furnished domiciliary or nursing home care by the Department; (3) the authority of the Secretary to charge a home loan fee under the veterans' home loan guaranty program; (4) the default procedures applicable to home liquidation sales under the program; and (5) the authority of the Secretary to issue and guarantee the principal and interest on certificates or other securities representing an interest in a pool of mortgage loans made to veterans and guaranteed by the Secretary. Increases the home loan fee rate charged for the purchase from the Department of repossessed homes (homes the loans for which were defaulted by veterans under the home loan guaranty program). Subtitle B: Other Matters - Provides for the rounding down to the next lower dollar of cost-of-living adjustments in veterans' disability compensation and dependency and indemnity compensation rates for FY 1998 through 2002. Allows such adjustments to be no more than the percentage adjustment to social security increases for such year. (Sec. 8022) Revises the notification procedures under which the Secretary may waive all or part of the indebtedness owed by a veteran on account of any loan made to, or assumed or guaranteed by, the Department. Title IX: Committee on Ways and Means--NonMedicare - Subtitle A: TANF Block Grant - Amends part A (Temporary Assistance for Needy Families) (TANF) of SSA title IV to establish a program of welfare-to-work grants to States. (Sec. 9001) Sets forth requirements relating to State entitlement to non-competitive grants under such program and State distribution of such funds among local governments. Provides for competitive grants, based on program effectiveness and other factors, for State-approved projects proposed by private industry councils and local governments. Requires the targeting of at least 65 percent of available funds for such grants to cities with the greatest number of persons with income below the poverty line. Prohibits private industry councils from directly providing services using such grant funds. Sets forth requirements for: (1) nondisplacement of other workers by participants in work activities under this program; (2) applicable health and safety standards; and (3) grievance procedures with respect to alleged violations of such nondisplacement and health and safety requirements. Provides for such grants to outlying areas and to Indian tribes. Directs the Secretary of Health and Human Services (HHS) to: (1) develop a plan to evaluate the use of such grants; and (2) submit interim and final reports to the Congress. (Sec. 9002) Limits to not more than ten percent the portion of TANF block grant funds which a State may use to carry out State programs under SSA title XX block grants to State for social services. (Sec. 9003) Exempts teen parents from the limitation on the number of persons who may be treated as engaged in work by reason of participation in a vocational education program. Increases such limitation from 20 percent to 30 percent of the number of individuals in all families who may be so treated. (Sec. 9004) Limits the number of hours per month that a recipient of assistance may be required to be assigned to a work experience, on- the-job training, or community service position with a public agency or nonprofit organization. Applies Federal and State health and safety standards to the working conditions of participants. Requires the provision of workers' compensation to participants on the same basis as it is provided to other individuals in the State in similar employment. (Sec. 9005) Requires reduction of a State's welfare-to-work grant if the State fails to reduce assistance to recipients refusing work without good cause. Subtitle B: Supplemental Security Income - Amends the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRAWORA) to extend by six months the deadline for certain childhood disability redeterminations under SSA title XVI (Supplemental Security Income) (SSI). (Sec. 9102) Repeals maintenance of effort requirements applicable to optional State programs for supplementation of SSI benefits. (Sec. 9103) Prescribes the schedule of administrative fees the Commissioner of Social Security shall assess each State from FY 1997 through 2003 and after for making optional and mandatory State SSI payments to individuals. Revises requirements for deposit of such fees, directing that a portion be credited to a special fund for FY 1998 and subsequent fiscal years for use in defraying expenses. Authorizes appropriations. Subtitle C: Child Support Enforcement - Amends SSA title III (Unemployment Insurance) with respect to the authority to permit certain redisclosures of wage and claim information for purposes related to the child support enforcement program under SSA title IV part D (Child Support and Establishment of Paternity). Subtitle D: Restricting Welfare and Public Benefits for Aliens - Amends the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 to extend the refugee and asylee eligibility period for Supplemental Security Income (SSI) and Medicaid. Provides a five-year food stamp eligibility period for such aliens. (Sec. 9302) Makes aliens eligible for SSI benefits who were receiving such benefits as of the date of enactment of such Act. Deems Cuban and Haitian entrants and Amerasian immigrants to be "qualified aliens." (Sec. 9303) Provides SSI eligibility for permanent resident aliens who are members of an Indian tribe. (Sec. 9304) Authorizes States to require applicants for State or local benefits to provide eligibility verification. (Sec. 9305) States that an alien who is ineligible for food stamps shall not be eligible for such program based upon SSI eligibility. Authorizes Medicaid eligibility based upon SSI eligibility. Subtitle E: Unemployment Compensation - Declares that no State law definition of a base period shall be considered as meeting the SSA title III (Unemployment Compensation Administration) requirement for a method of administration reasonably calculated to insure full payment of unemployment compensation when due. (Sec. 9402) Amends SSA title IX (Employment Security) to increase the Federal Unemployment Account ceiling. (Sec. 9403) Provides for a special distribution to States of year- end excesses from the Unemployment Trust Fund. (Sec. 9404) Restricts interest-free advances to State accounts in the Unemployment Trust Fund to States which meet or exceed funding goals. (Sec. 9405) Revises the Internal Revenue Code to exempt from the Federal unemployment tax any election officials or election workers whose total annual remuneration for their services is under $1,000. (Sec. 9406) Excludes any service performed by a prison inmate from the definition of employment for unemployment compensation purposes. (Sec. 9407) Exempts from the Federal unemployment tax any services performed for certain income tax-exempt elementary or secondary schools which are operated primarily for religious purposes. (Sec. 9408) Amends SSA title III (Unemployment Compensation Administration) to authorize additional appropriations out of the employment security administration account to carry out State program integrity activities for unemployment compensation, including initial claims review, eligibility review, benefit payments control, and employer liability auditing activities. Subtitle F: Increase in Public Debt Limit - Amends Federal law to provide for an increase in the public debt limit to $5.95 trillion. Title X: Committee on Ways and Means - Medicare - Subtitle A: MedicarePlus Program - Chapter 1: MedicarePlus Program - (This title sets forth provisions generally analogous to those set forth above under title IV of this Act.) Amends title XVIII (Medicare) of the Social Security Act (SSA) to establish a MedicarePlus program under which each MedicarePlus eligible individual (one entitled to benefits under Medicare part A (Hospital Insurance) and enrolled under Medicare part B (Supplementary Medical Insurance)) is entitled to elect, in accordance with certain procedures, to receive Medicare benefits either through the Medicare fee-for-service program or through a MedicarePlus plan. (Sec. 10001) Outlines the types of MedicarePlus plans that may be available, including: (1) coordinated care plans; (2) plans offered by provider-sponsored organizations; and (3) a combination of MSA (MedicarePlus savings account) plan and contributions to MedicarePlus MSA. Sets forth various special rules regarding, among other things, residence, individuals with end-stage renal disease, and individuals covered under the Federal Employees Health Benefits Program or eligible for veterans or military health benefits. Directs the Secretary of Health and Human Services (HHS) to: (1) provide for broad dissemination of coverage option and comparative information to Medicare beneficiaries and prospective Medicare beneficiaries; and (2) maintain a toll-free number for inquiries about MedicarePlus options and program operation, as well as an Internet site through which individuals may obtain such information electronically. Requires a MedicarePlus organization to generally accept without restrictions individuals eligible to make an election at any time during which such elections are accepted. Requires the approval of MedicarePlus marketing material and application forms before they are distributed. Outlines benefits and beneficiary protections. Requires each MedicarePlus plan (except MSA plans) to provide those items and services for which benefits are available under Medicare parts A and B and specified additional benefits, as well as, at its option, certain supplemental benefits, subject to the Secretary's approval. Prohibits a MedicarePlus organization from denying, limiting, or conditioning coverage or benefits based on any described health status-related factor. Prescribes plan disclosure requirements and an ongoing quality assurance program. Outlines a mechanism for grievances and appeals. Provides for the treatment of services furnished by providers that do not have a contract establishing payment amounts for services furnished to an individual enrolled with a MedicarePlus organization (other than under an MSA plan). Requires each MedicarePlus organization to provide the Secretary with information on the extent to which it provides inpatient and outpatient hospital benefits through the use of disproportionate share (DSH) and teaching hospitals. Directs the Secretary to: (1) make monthly, advance payments with respect to an individual's coverage to MedicarePlus organizations according to a specified formula; (2) establish separate payment rules for individuals with end-stage renal disease; and (3) develop and submit to the Congress a report on a method of risk adjustment of payment rates that accounts for variations in per capita costs based on health status. Sets forth special rules for individuals electing MSA plans. Requires such an individual to establish a MedicarePlus MSA into which the Secretary shall make monthly deposits out of the Medicare trust funds in accordance with prescribed guidelines. Sets forth special rules for certain inpatient hospital stays. Details the rules for the submission and charging of premiums by each MedicarePlus organization. Sets limitations on enrollee cost- sharing for basic, additional, and supplemental benefits, except for MSA plans. Requires the Secretary to audit each year the financial records of at least one-third of the MedicarePlus organizations offering MedicarePlus plans. Prohibits a State from imposing a premium tax or similar tax with respect to premiums on MedicarePlus plans or the offering of such plans. Sets forth organizational and financial requirements for MedicarePlus organizations and provider-sponsored organizations. Directs the Secretary to establish solvency and capital adequacy standards for provider-sponsored organizations, and other standards for MedicarePlus organizations and plans. Prescribes requirements, including minimum enrollment requirements, for contracts between the Secretary and MedicarePlus organizations. Provides for: (1) intermediate sanctions and civil monetary penalties to enforce contract provisions; and (2) procedures for termination of contracts. Directs the Secretary to: (1) study and report to the Congress on the feasibility and impact of removing a certain limitation added by this Act on the eligibility of most individuals medically determined to have end-stage renal disease to enroll in MedicarePlus plans; and (2) report to the Congress on graduate medical education programs operated by MedicarePlus organizations and the extent to which such organizations are providing for payments to DSH and teaching hospitals. (Sec. 10002) Details transitional rules for the current Medicare health maintenance organization (HMO) program, as well as specified conforming changes in the Medicare supplemental health insurance policy (Medigap) program. (Sec. 10006) Amends the Internal Revenue Code to outline special rules for MedicarePlus MSA's. Excludes from gross income any payment by the Secretary to an individual's MedicarePlus MSA. Excludes from qualified deductible medical expenses any amounts paid for the medical care of any individual but the account holder. Prescribes a penalty for distributions from the MedicarePlus MSA not used for qualified medical expenses if the minimum balance is not maintained, with certain exceptions if the account holder becomes disabled or dies. Chapter 2: Integrated Long-Term Care Programs - Amends SSA title XVIII to provide for programs of all-inclusive care for the elderly (PACE programs) for individuals age 55 or older who require the level of care required under the State Medicaid plan for coverage of nursing facility services. Specifies benefit and payment requirements. Limits PACE provider eligibility to public and private non-profit entities; but requires the Secretary to waive such limitations to demonstrate the operation of a PACE program by a private, for-profit entity. (Sec. 10012) Amends SSA title XIX (Medicaid) to provide for the establishment of State PACE programs as a State Medicaid option. (Sec. 10014) Directs the Secretary to study and report to the Congress on the quality and cost of providing PACE program services under Medicare and Medicaid, specifically comparing the costs, quality, and access to services by private, for-profit entities under the demonstration projects with the costs, quality, and access to services of other PACE providers. (Sec. 10015) Amends the: (1) Omnibus Budget Reconciliation Act of 1987 to extend the authorities for the social health maintenance organization (SHMO) demonstration project; and (2) Omnibus Budget Reconciliation Act of 1993 to increase the cap on the number of individuals who may participate in a SHMO demonstration. Directs the Secretary to submit to the Congress a plan for the integration of SHMO health plans and similar plans as an option under the MedicarePlus program. (Sec. 10018) Amends the Consolidated Omnibus Budget Reconciliation Act of 1985 to authorize the Secretary to extend the municipal health service demonstration projects but only with respect to individuals enrolled with such projects before January 1, 1998. Requires the Secretary to work with each such demonstration project to develop a plan (to be submitted to certain congressional committees) for the orderly transition of demonstration projects and project enrollees to a non-demonstration project health care delivery system. Provides that a demonstration project which does not develop and submit such a transition plan by a certain deadline shall be discontinued as of December 31, 1998. (Sec. 10019) Extends for an additional two years certain Medicare community nursing organization demonstration projects under the Omnibus Budget Reconciliation Act of 1987. Chapter 3: Medicare Payment Advisory Commission - Amends SSA title XVIII to establish the Medicare Payment Advisory Commission to replace the Prospective Payment Assessment Commission and the Physician Payment Review Commission, hereby abolished. Requires the new Commission to review and make recommendations to the Congress about payment policies under Medicare (including certain specific payment-related topics). Authorizes appropriations. Chapter 4: Medigap Protections - Amends SSA title XVIII with respect to the issuer of a Medicare supplemental (Medigap) policy in the case of certain individuals terminated by an employee welfare benefit plan providing supplementary health benefits who seek to enroll under a Medigap policy not later than 63 days after termination or disenrollment. Prohibits the Medigap issuer from: (1) denying or conditioning the issuance or effectiveness of such a policy; (2) discriminating in the pricing of such policy because of health status, claims experience, receipt of health care, or medical condition; or (3) imposing an exclusion of benefits based on a pre-existing condition. (Sec. 10031) Specifies limitations on the imposition of preexisting condition exclusions during the initial open enrollment period in the case of a Medicare supplemental policy issued to an individual who is 65 years of age or older with a certain minimum period of creditable coverage. (Sec. 10032) Directs the Secretary to implement a project to demonstrate the application of, and the consequences of applying, a market-oriented pricing system for the provision of a full range of Medicare benefits in a geographic area. Requires the Secretary to appoint: (1) a national advisory committee to make recommendations concerning the appropriate research design for the project and, taking such recommendations into account, designate the areas in which the project will operate; and (2) an area advisory committee to advise the Secretary on actual project implementation in the area. Directs the Secretary to monitor and report periodically to the Congress on the impact of such projects on the price and quality of, and access to, Medicare covered services, and other relevant factors. Chapter 5: Tax Treatment of Hospitals Participating in Provider Sponsored Organizations - Amends the Internal Revenue Code to provide that an organization shall not fail to be treated as a tax-exempt charitable organization solely because a hospital which it owns and operates also participates in a provider-sponsored organization, whether or not the provider-sponsored organization is exempt from tax. Provides that any person with a material financial interest in such a provider-sponsored organization shall be treated as a private shareholder or individual with respect to the hospital. Subtitle B: Prevention Initiatives - Outlines various specified new preventive health measures covered under Medicare, namely coverage for: (1) annual screening mammography for women over age 39, while providing for the waiver of the deductible for screening mammography; (2) screening pelvic exams, providing for their payment under the physician fee schedule; (3) prostate cancer screening tests, providing for payment of the prostate-specific antigen (PSA) blood test under the clinical diagnostic laboratory test fee schedules; (4) colorectal cancer screening tests, subject to prescribed frequency and payment limits, which will include a screening barium enema if found by the Secretary to be an appropriate alternative to certain other tests; (5) diabetes outpatient self-management training services, including blood-testing strips (with a ten percent payment reduction after 1997) and glucose monitors as durable medical equipment (DME) for individuals with diabetes; and (4) bone mass measurements for qualified individuals for the purpose of identifying bone mass or detecting bone loss or determining bone quality. (Sec. 10102) Makes certain changes in existing benefits, such as increasing the frequency of coverage of screening pap smears for high risk women and waiving the deductible that applies to such exams. (Sec. 10105) Directs the Secretary to establish outcome measures, including glysolated hemoglobin (past 90-day average blood sugar levels), for the purpose of evaluating the improvement of the health status of Medicare beneficiaries with diabetes mellitus, with a view to recommending coverage modifications. (Sec. 10107) Extends the Influenza and Pneumococcal Vaccination Campaign carried out by the Health Care Financing Administration (HCFA) in conjunction with the Centers for Disease Control and Prevention and the National Coalition for Adult Immunization. Authorizes appropriations. (Sec. 10108) Directs the Secretary to request the National Academy of Sciences, in conjunction with the United States Preventive Services Task Force, to analyze and report to the Congress on the expansion or modification of preventive benefits provided to Medicare beneficiaries. Provides for funding for such analysis. Subtitle C: Rural Initiatives - Replaces the Essential Access Community Hospital (EACH) Program with an optional Medicare Rural Primary Care Hospital Program under which a State may designate one or more facilities as a rural primary care hospital in accordance with prescribed criteria while continuing payment to previously designated EACH's and rural primary care hospitals. Provides for payment under such new program on a reasonable cost basis. Lengthens the maximum period of permitted inpatient rural primary care hospital stay. (Sec. 10202) Amends SSA title XVIII to prohibit denial, on the basis of wage comparisons, of a rural referral center's request for reclassification. Provides that any hospital classified as a rural referral center for FY 1991 shall be classified as such for FY 1998 and each subsequent fiscal year. (Sec. 10203) Amends SSA title XVIII to permit hospital geographic reclassification for purposes of DSH payment adjustments. (Sec. 10204) Makes certain changes with regard to Medicare- dependent, small rural hospitals, including an extension of the current payment methodology. (Sec. 10205) Directs the Secretary of Health and Human Services to publish and use alternative guidelines under which specified disproportionately large hospitals qualify for geographic reclassification for a fiscal year beginning with fiscal year 1998. (Sec. 10206) Sets the floor on the area wage index applicable to hospitals not located in a rural area for discharges occurring on or after October 1, 1997, for purposes of adjusting DRG prospective payment rates for different area wage levels. Directs the Secretary to adjust the area wage indices for certain hospitals to assure that aggregate payments in a fiscal year for the operating costs of inpatient hospital services are not greater or less than those which would have been made in the year if this requirement did not apply. (Sec. 10207) Directs the Secretary to provide for a four-year demonstration project to use eligible health care provider telemedicine networks to apply high-capacity computing and advanced networks to improve primary care and prevent health care complications to Medicare beneficiaries with diabetes mellitus who are residents of medically underserved rural or inner-city areas. Provides funding. Subtitle D: Anti-Fraud and Abuse Provisions - Revises requirements for mandatory exclusion of certain individuals and entities from participating in Medicare and State health programs. Mandates an ten-year exclusion of any individual for a second health care related conviction, and permanent exclusion for a third health care related conviction. (Sec. 10302) Authorizes the Secretary to refuse to enter into Medicare agreements with individuals or entities convicted of felonies for offenses determined inconsistent with the best interests of program beneficiaries. (Sec. 10303) Requires the annual explanation of Medicare benefits provided to Medicare beneficiaries to include a toll-free telephone number to report Medicare waste, fraud, and abuse. (Sec. 10304) Makes Medicare carriers and fiscal intermediaries liable for reimbursing the Secretary for amounts paid to excluded providers. Makes State agencies liable for reimbursing the Secretary for amounts paid to excluded providers under the Medicaid program. (Sec. 10305) Authorizes the Secretary to exclude from the Medicare program any entity with respect to which a sanctioned person with an ownership or control interest in it transfers such interest in anticipation of (or following) a conviction, assessment, or exclusion against the person, to an immediate family member or member of the household who continues to maintain such an interest. (Sec. 10306) Provides for the imposition of civil monetary penalties for: (1) any person who arranges or contracts with an individual or entity that the person knows or should know is excluded from participation in a Federal health care program; and (2) any person that presents or causes to be presented to any State or Federal agency a claim for a medical or other item or service ordered or prescribed by an excluded person and the person furnishing such item or service knows or should have known of such exclusion. (Sec. 10307) Outlines various specified requirements regarding disclosure of information, surety bonds, and advisory opinions regarding certain physician self-referral provisions. Includes surety bond requirements for home health agencies, and provides for the application of disclosure and surety bond requirements to ambulance services and certain clinics. Applies surety bond requirements to comprehensive outpatient rehabilitation facilities (CORF's) and to rehabilitation agencies. (Sec. 10308) Requires any participating entity to disclose to the Secretary its own employer identification numbers and social security account numbers, as well as those of persons with ownership or control interests and subcontractors in which the entity has a five percent or greater interest. Directs the Secretary to report to the Congress on the steps taken to assure the confidentiality of such social security account numbers. (Sec. 10309) Amends SSA title XVIII to direct the Secretary to issue written, binding advisory opinions concerning whether a referral relating to designated health services (other than clinical laboratory services) is prohibited. Subtitle E: Prospective Payment Systems - Chapter 1: Payment Under Part A - Establishes a prospective payment system (PPS) under Medicare for skilled nursing facility (SNF) services and for inpatient rehabilitation hospital services. Provides for consolidated billing of covered SNF services. Requires payment to a SNF of claims for all Medicare part B SNF items and services, identified by code under a uniform coding system specified by the Secretary. Directs the Secretary to establish a thorough medical review process to examine the effects of this Act on the quality of covered SNF services furnished to Medicare beneficiaries. Chapter 2: Payment Under Part B - Eliminates formula-driven overpayments for certain outpatient hospital services. (Sec. 10412) Extends the current reductions in payments for capital-related and other costs of hospital outpatient services. (Sec. 10413) Directs the Secretary to establish a PPS for hospital outpatient department services. (Sec. 10421) Establishes payment rates for outpatient therapy services, with certain co-payments imposed for services furnished after 1998. (Sec. 10422) Provides for: (1) payment of CORF services based on fee schedule amounts; (2) certain interim reductions in payments for ambulance services; and (3) establishment of a prospective fee schedule by the Secretary for payment of such services. (Sec. 10431) Provides that in promulgating regulations to carry out certain provisions with respect to the coverage of ambulance service, the Secretary may include coverage of advanced life support services provided by a paramedic intercept service provider (ALS intercept services) in a rural area if specified conditions are met. (Sec. 10432) Sets out the framework for demonstration projects for coverage of ambulance services under Medicare through contracts with counties or parishes. Chapter 3: Payment Under Parts A and B - Directs the Secretary to establish a PPS for home health services. Eliminates periodic interim payments for home health agencies. Subtitle F: Provisions Relating to Part A - Chapter 1: Payment of PPS Hospitals - Revises requirements for PPS hospital payment updates and capital payments for PPS hospitals. (Sec. 10503) Amends SSA title XVIII to provide for a freeze in DSH payment adjustments for Medicare-dependent, small rural hospitals for FY 1998 and 1999. Directs the Secretary to propose to specified congressional committees a modification of the current qualifying criteria and payment methodology under which DSH's are paid. (Sec. 10504) Amends SSA title XVIII to modify requirements for the valuation of capital assets of a hospital or SNF after a change of ownership. Extends their applicability to the capital assets of service providers, instead of just hospitals or SNF's. (Sec. 10505) Revises requirements for payments to hospitals for inpatient hospital services to: (1) eliminate indirect medical education and DSH payments attributable to outlier payments; (2) provide for a reduction in adjustment for indirect medical education; (3) provide for the treatment of certain transfer cases; and (4) increase the base payment rate for Puerto Rico hospitals. Chapter 2: Payment of PPS Exempt Hospitals - Revises requirements for the payment of PPS exempt hospitals, including those for: (1) payment updates; (2) capital payments; (3) bonus and relief payments; (4) payment and target amount for new providers; (5) rebasing; and (6) treatment of certain long-term care hospitals. (Sec. 10518) Amends SSA title XVIII to eliminate any exemptions from the method for determining the amount of payment to a hospital where events beyond the hospital's control or extraordinary circumstances create a distortion in the increase in costs for a reporting period. Directs the Secretary to publish annually in the Federal Register a report on the total amount of payments to hospitals by reason of any exceptions or adjustments made to the method described above for cost reporting periods ending during the previous fiscal year. Chapter 3: Provisions Related to Hospice Services - Provides for a reduced payment update for hospice services for FY 1998 through 2002. Directs the Secretary to provide for the collection of hospice care program data with respect to the costs of care provided starting in FY 1999. Bases payment for home hospice care on the location where care is furnished. Revises the home hospice care benefit period. Provides for home hospice care coverage of any other items and services specified in a plan. Allows waiver of certain staffing requirements for hospice care programs in non-urbanized areas. Chapter 4: Modification of Part A Home Health Benefit - Provides for modification of the Medicare part A home health benefit for individuals enrolled under Medicare part B to include, for 1998 through 2002, home health services subject to a specified transition reduction and, afterwards, a new post-institutional home health services component for up to 100 visits during a home health spell of illness. Chapter 5: Other Payment Provisions - Requires reductions in Medicare payments for enrollee bad debt. (Sec. 10542) Repeals the termination date to make a permanent extension of the hemophilia passthrough. (Sec. 10543) Eliminates the Medicare part A premium for certain public retirees. Subtitle G: Provisions Relating to Part B Only - Chapter 1: Physicians' Services - Revises requirements for the payment of physicians' services, with changes: (1) establishing a single conversion factor for 1998; (2) adding new update provisions; (3) replacing the volume performance standard with sustainable growth rate; (4) adding payment rules for anesthesia services; and (5) phasing-in implementation of resource-based physician practice expense relative value units. (Sec. 10606) Directs the Secretary, for 1999 and 2001, to determine for each hospital: (1) the hospital-specific per discharge relative value according to prescribed guidelines (with a special rule for teaching hospitals); and (2) whether the hospital-specific relative value is projected to be excessive. Requires the Secretary to notify the medical executive committee of each hospital identified as having an excessive hospital-specific relative value of the determinations made with respect to the medical staff. (Sec. 10607) Provides that no x-ray is required for chiropractic services. (Sec. 10608) Provides that effective for electrocardiogram tests furnished during 1998, the Secretary shall restore separate payment under Medicare part B for the transportation of electrocardiogram equipment (HCPCS code R0076) based upon the status code and relative value units established for such service as of December 31, 1996. Directs the Secretary to determine, taking into account the study of coverage of portable electrocardiogram transportation conducted by the Comptroller General and other relevant information, whether coverage of portable electrocardiogram transportation should be provided under Medicare part B. Chapter 2: Other Payment Provisions - Provides for a reduction in DME payment amounts and for a payment freeze for parenteral and enteral nutrients, supplies, and equipment. Revises payment rates for oxygen and oxygen equipment, clinical diagnostic laboratory tests, ambulatory surgical services, and drugs and biologicals. (Sec. 10614) Directs the Secretary to divide the United States into up to five regions, and designate a single carrier for each region, for the payment of Medicare part B claims for clinical diagnostic laboratory tests. Requires the Secretary to adopt uniform policies for clinical diagnostic laboratory tests. (Sec. 10617) Provides for Medicare coverage of oral drugs prescribed for use as an acute anti-emetic used as part of an anticancer chemotherapeutic regimen under certain conditions. Sets forth special rules for the payment of such drugs. (Sec. 10618) Revises certain requirements with regard to rural health clinic services, including per-visit payment limits for provider-based clinics, assurance of quality services, and certain staffing and shortage area requirements. (Sec. 10619) Provides for increased Medicare reimbursement for nurse practitioners, clinical nurse specialists, and physician assistants. Repeals certain restrictions on settings applicable to them. (Sec. 10621) Directs the Secretary to: (1) audit a sample of cost reports of renal dialysis providers for 1995 and for each third year thereafter; and (2) develop and implement a method to measure and report quality of renal dialysis services provided under Medicare in order to reduce payments for inappropriate or low quality care. Chapter 3: Part B Premium - Revises the formula for the monthly Medicare part B premium rate the Secretary promulgates each September for the following calendar year. Requires such rate to equal 50 percent of the monthly actuarial rate for enrollees age 65 and over. Subtitle H: Provisions Relating to Parts A and B - Chapter 1: Provisions Relating to Medicare Secondary Payer - Revises requirements for Medicare as secondary payer. Permits recovery against third party administrators of primary plans. Extends the claims filing period for employer group health plans. Limits beneficiary liability for items and services for which Medicare benefits are incorrectly paid. Chapter 2: Home Health Services - Provides that, in establishing payment limits for cost reporting periods beginning after September 30, 1997, the Secretary shall not take into account any changes in the home health market basket with respect to cost reporting periods which began on or after July 1, 1994, and before July 1, 1996. (Sec. 10712) Revises requirements for interim payments for home health services. Directs the Secretary to expand research on a PPS for home health agencies under the Medicare program that ties prospective payments to a unit of service. (Sec. 10714) Directs the Secretary to study and report to the Congress on the criteria that should be applied in determining whether an individual is homebound for purposes of qualifying for Medicare home health services. (Sec. 10715) Bases the payment for home health services on the location where the service is furnished. (Sec. 10716) Provides for the denial of home health claims based on home health services the frequency and duration of which are in excess of normative guidelines established by the Secretary. (Sec. 10717) Provides that no home health benefits are based solely on drawing blood. Chapter 3: Baby Boom Generation Medicare Commission - Establishes the Bipartisan Commission on the Effect of the Baby Boom Generation on the Medicare Program to: (1) examine the financial impact on the Medicare program of the significant increase in the number of Medicare-eligible individuals which will occur beginning approximately during 2010 and lasting for approximately 25 years; and (2) make specific recommendations to the Congress respecting a comprehensive approach to preserve the Medicare program for the period during which such individuals are eligible for Medicare. Requires the Commission also to study the feasibility and desirability of establishing: (1) an independent commission on Medicare to make recommendations annually on how best to match the structure of the Medicare program to available funding for the program; (2) an expedited process for congressional consideration of such recommendations; and (3) a default mechanism to enforce congressional spending targets for the program if the Congress fails to approve such recommendations. Directs the Commission to report to the Congress its findings and recommendations regarding how to protect and preserve the Medicare program in a financially solvent manner until 2030 (or, if later, throughout the period of projected solvency of the Federal Old-Age and Survivors Insurance Trust Fund). Requires the report to include detailed recommendations for appropriate legislative initiatives on how to accomplish this objective. Authorizes appropriations. Chapter 4: Provisions Relating to Direct Graduate Medical Education - Sets out provisions relating to direct graduate medical education, including: (1) placing a limitation on the number of residents for cost reporting periods beginning after FY 1998; (2) phasing-in a limitation on hospital overhead and supervisory physician component of direct medical education costs; (3) permitting payment to non-hospital providers; and (4) providing incentive payments under plans for voluntary reduction in the number of residents. (Sec. 10735) Directs the Secretary to establish a demonstration project under which the Secretary shall make payments to specified qualifying consortia instead of teaching hospitals. (Sec. 10736) Requires the Medicare Payment Advisory Commission to examine and develop recommendations for the Congress on whether and to what extent Medicare payment policies and other Federal policies regarding teaching hospitals and graduate medical education should be reformed. (Sec. 10737) Provides a special Medicare reimbursement rule for certain combined residency programs. Chapter 5: Other Provisions - Amends SSA title XVIII to direct the Secretary to use a competitive process to contract with specific hospitals or other entities meeting certain quality standards (centers for excellence) for furnishing services related to surgical procedures as well as other services (unrelated to surgical procedures) to hospital inpatients. (Sec. 10742) Establishes a Medicare part B and Medigap special enrollment period for certain military retirees and dependents during which they may enroll without being subject to a Medicare part B late enrollment penalty. (Sec. 10743) Establishes a Medicare part B special late penalty- free enrollment period for certain disabled workers whose continuous enrollment under a group health plan is involuntarily terminated. (Sec. 10744) Requires that any advance directive is placed in a prominent part of an individual's current medical record. Subtitle I: Medical Liability Reform - Chapter 1: General Provisions - Sets forth definitions, limitations, preemption mandates, and specified exclusions relating to health care liability actions brought in any State or Federal court. Chapter 2: Uniform Standards for Health Care Liability Actions - Establishes certain uniform standards for such health care liability actions that include: (1) a general statute of limitations of two years after the date on which the claimant discovered or should have discovered the alleged injury that is the subject of the action; (2) a $250,000 limitation on noneconomic damages; and (3) standards for the awarding of punitive damages (clear and convincing evidence of specific intent to cause harm or conscious, flagrant indifference to the rights and safety of others). (Sec. 10813) Declares that any alternative dispute resolution system (ADR) used to resolve a health care liability action or claim shall contain provisions relating to such statute of limitations, non- economic damages, punitive damages, and other specified matters which are identical to the relevant provisions of this subtitle.

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Documents

17 official files

• Line item veto by President

  summary · EN · 11 August 1997

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• Public Law (text)

  Public Law · EN · 5 August 1997

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• Public Law (PDF)

  Public Law · EN · 5 August 1997

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• Enrolled Bill (text)

  Enrolled Bill · EN · 31 July 1997

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• Enrolled Bill (PDF)

  Enrolled Bill · EN · 31 July 1997

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• Conference report filed in House

  summary · EN · 30 July 1997

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• Public Print (text)

  Public Print · EN · 26 June 1997

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• Public Print (PDF)

  Public Print · EN · 26 June 1997

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• Received in Senate (text)

  Received in Senate · EN · 25 June 1997

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• Received in Senate (PDF)

  Received in Senate · EN · 25 June 1997

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• Engrossed in House (text)

  Engrossed in House · EN · 25 June 1997

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• Engrossed in House (PDF)

  Engrossed in House · EN · 25 June 1997

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• Engrossed Amendment Senate (text)

  Engrossed Amendment Senate · EN · 25 June 1997

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• Engrossed Amendment Senate (PDF)

  Engrossed Amendment Senate · EN · 25 June 1997

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• Reported in House (text)

  Reported in House · EN · 24 June 1997

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• Reported in House (PDF)

  Reported in House · EN · 24 June 1997

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• Introduced in House

  summary · EN · 24 June 1997

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