skip to main content

H.R. 2264 (103rd): Omnibus Budget Reconciliation Act of 1993


The text of the bill below is as of May 25, 1993 (Reported by House Committee).

Summary of this bill

Source: Wikipedia

The Omnibus Budget Reconciliation Act of 1993 (or OBRA-93) was a federal law that was enacted by the 103rd United States Congress and signed into law by President Bill Clinton. It has also been referred to, unofficially, as the Deficit Reduction Act of 1993. Part XIII, which dealt with taxes and is also called the Revenue Reconciliation Act of 1993.

This summary is from Wikipedia.


HR 2264 RH

Union Calendar No. 57

103d CONGRESS

1st Session

H. R. 2264

[Report No. 103-111]

To provide for reconciliation pursuant to section 7 of the concurrent resolution on the budget for fiscal year 1994.

IN THE HOUSE OF REPRESENTATIVES

May 25, 1993

Mr. SABO, from the Committee on the Budget, reported the following bill; which was committed to the Committee of the Whole House on the State of the Union and ordered to be printed


A BILL

To provide for reconciliation pursuant to section 7 of the concurrent resolution on the budget for fiscal year 1994.

    Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ‘Omnibus Budget Reconciliation Act of 1993’.

SEC. 2. TABLE OF CONTENTS.

    The table of contents is as follows:

TITLE I--COMMITTEE ON AGRICULTURE

TITLE II--COMMITTEE ON ARMED SERVICES

TITLE III--COMMITTEE ON BANKING, FINANCE AND URBAN AFFAIRS

TITLE IV--COMMITTEE ON EDUCATION AND LABOR

TITLE V--COMMITTEE ON ENERGY AND COMMERCE

TITLE VI--COMMITTEE ON FOREIGN AFFAIRS

TITLE VII--COMMITTEE ON THE JUDICIARY

TITLE VIII--COMMITTEE ON MERCHANT MARINE AND FISHERIES

TITLE IX--COMMITTEE ON NATURAL RESOURCES

TITLE X--COMMITTEE ON POST OFFICE AND CIVIL SERVICE

TITLE XI--COMMITTEE ON PUBLIC WORKS

TITLE XII--COMMITTEE ON VETERANS’ AFFAIRS

TITLE XIII--COMMITTEE ON WAYS AND MEANS--SAVINGS

TITLE XIV--COMMITTEE ON WAYS AND MEANS--REVENUES

TITLE I--COMMITTEE ON AGRICULTURE

SEC. 1001. SHORT TITLE AND TABLE OF CONTENTS.

    (a) SHORT TITLE- This title may be cited as the ‘Agricultural Reconciliation Act of 1993’.

    (b) TABLE OF CONTENTS- The table of contents of this title is as follows:

      Sec. 1001. Short title and table of contents.

Subtitle A--Commodity Programs

      Sec. 1101. Wheat program.

      Sec. 1102. Feed grain program.

      Sec. 1103. Upland cotton program.

      Sec. 1104. Rice program.

      Sec. 1105. Dairy program.

      Sec. 1106. Tobacco program.

      Sec. 1107. Sugar program.

      Sec. 1108. Oilseeds program.

      Sec. 1109. Peanut program.

      Sec. 1110. Honey program.

      Sec. 1111. Wool and mohair program.

      Sec. 1112. Conforming amendments to continue deficit reduction activities in crop years after 1995.

Subtitle B--Restructuring of Loan Programs

      Sec. 1201. Restructuring of certain loan programs.

      Sec. 1202. Reorganization of rural development functions.

Subtitle C--Food Stamp Program

      Sec. 1301. Short title.

      Sec. 1302. References to Act.

Chapter 1--Ensuring Adequate Food Assistance

      Sec. 1311. Maximum benefit level.

      Sec. 1312. Helping low-income high school students.

      Sec. 1313. Families with high shelter expenses.

      Sec. 1314. Resource exclusion for earned income tax credits.

      Sec. 1315. Homeless families in transitional housing.

      Sec. 1316. Households benefiting from general assistance vendor payments.

      Sec. 1317. Continuing benefits to eligible households.

      Sec. 1318. Improving the nutritional status of children in Puerto Rico.

Chapter 2--Promoting Self Sufficiency

      Sec. 1321. Income exclusion for education assistance.

      Sec. 1322. Child support payments to nonhousehold members.

      Sec. 1323. Child support exclusion.

      Sec. 1324. Improving access to employment and training activities.

      Sec. 1325. Vehicles needed to seek and continue employment and for household transportation.

      Sec. 1326. Vehicles necessary to carry fuel or water.

      Sec. 1327. Demonstration projects testing resource accumulation.

Chapter 3--Simplifying the Provision of Food Assistance

      Sec. 1331. Simplifying the household definition for households with children and others.

      Sec. 1332. Eligibility of children of parents participating in drug or alcohol treatment programs.

      Sec. 1333. Resources of households with disabled members.

      Sec. 1334. Ensuring adequate funding for the food stamp program.

Chapter 4--Improving Program Integrity

      Sec. 1341. Use and disclosure of information provided by retail food stores and wholesale food concerns.

      Sec. 1342. Additional means of claims collection.

      Sec. 1343. Demonstration projects testing activities directed at street trafficking in coupons.

Chapter 5--Improving Food Stamp Program Management

      Sec. 1351. Clarification of categorical eligibility.

      Sec. 1352. Technical amendments related to electronic benefit transfer.

      Sec. 1353. Disqualification of recipients for trading firearms, ammunition, explosives, or controlled substances for coupons.

      Sec. 1354. Uncapped civil money penalty for trafficking in coupons.

      Sec. 1355. Uncapped civil money penalty for selling firearms, ammunition, explosives, or controlled substances for coupons.

      Sec. 1356. Modifying the food stamp quality control system.

Chapter 6--Uniform Reimbursement Rates

      Sec. 1361. Uniform reimbursement rates.

Chapter 7--Implementation and Effective Dates

      Sec. 1371. Implementation and effective dates.

Subtitle D--Miscellaneous Provisions

      Sec. 1401. Maximum expenditures under market promotion program for fiscal years 1994 through 1998.

      Sec. 1402. Admission, entrance, and recreation fees.

      Sec. 1403. Additional program changes to meet reconciliation requirements.

      Sec. 1404. Environmental conservation acreage reserve program amendments.

      Sec. 1405. Levels of insurance coverage under the Federal Crop Insurance Act.

Subtitle A--Commodity Programs

SEC. 1101. WHEAT PROGRAM.

    (a) FIVE PERCENT REDUCTION IN PAYMENT ACRES-

      (1) REDUCTION- Subsection (c)(1)(C)(ii) of section 107B of the Agricultural Act of 1949 (7 U.S.C. 1445b-3a) is amended by striking ‘85 percent’ and inserting ‘80 percent’.

      (2) APPLICATION OF AMENDMENT- The amendment made by paragraph (1) shall apply beginning with the 1994 crop of wheat.

    (b) CONTINUATION OF DEFICIT REDUCTION ACTIVITIES IN CROP YEARS AFTER 1995-

      (1) AGRICULTURAL ACT OF 1949- Section 107B of the Agricultural Act of 1949 (7 U.S.C. 1445b-3a) is further amended--

        (A) in the section heading, by striking ‘1995’ and inserting ‘1998’;

        (B) in subsections (a)(1), (a)(4)(C), (b)(1), (c)(1)(A), (c)(1)(B)(iii), (e)(1)(G), (e)(3)(A), (e)(3)(C)(iii), (f)(1), and (q), by striking ‘1995’ each place it appears and inserting ‘1998’;

        (C) in the heading of subsection (c)(1)(B)(ii), by striking ‘AND 1995’ and inserting ‘THROUGH 1998’;

        (D) in subsection (c)(1)(B)(ii), by striking ‘and 1995’ and inserting ‘through 1998’; and

        (E) in the heading of subsection (e)(1)(G), by striking ‘1995’ and inserting ‘1998’; and

        (F) in subsection (g)(1), by striking ‘and 1995’ and inserting ‘through 1998’.

      (2) FOOD, AGRICULTURE, CONSERVATION, AND TRADE ACT OF 1990- Title III of the Food, Agriculture, Conservation, and Trade Act of 1990 (Public Law 101-624; 104 Stat. 3382) is amended--

        (A) in section 302 (7 U.S.C. 1379d note), by striking ‘May 31, 1996’ and inserting ‘May 31, 1999’;

        (B) in section 303 (7 U.S.C. 1331 note), by striking ‘1995’ and inserting ‘1998’;

        (C) in section 304 (7 U.S.C. 1340 note), by striking ‘1995’ and inserting ‘1998’; and

        (D) in section 305 (7 U.S.C. 1445a note)--

          (i) in the section heading, by striking ‘1995’ and inserting ‘1998’; and

          (ii) by striking ‘1995’ and inserting ‘1998’.

      (3) FOOD SECURITY WHEAT RESERVE- Section 302(i) of the Food Security Wheat Reserve Act of 1980 (7 U.S.C. 1736f-1(i)) is amended by striking ‘1995’ both places it appears and inserting ‘1998’.

SEC. 1102. FEED GRAIN PROGRAM.

    (a) FIVE PERCENT REDUCTION IN PAYMENT ACRES-

      (1) REDUCTION- Subsection (c)(1)(C)(ii) of section 105B of the Agricultural Act of 1949 (7 U.S.C. 1444f) is amended by striking ‘85 percent’ and inserting ‘80 percent’.

      (2) APPLICATION OF AMENDMENT- The amendment made by paragraph (1) shall apply beginning with the 1994 crop of feed grains.

    (b) CONTINUATION OF DEFICIT REDUCTION ACTIVITIES IN CROP YEARS AFTER 1995-

      (1) AGRICULTURAL ACT OF 1949- Section 105B of the Agricultural Act of 1949 (7 U.S.C. 1444f) is further amended--

        (A) in the section heading, by striking ‘1995’ and inserting ‘1998’;

        (B) in subsections (a)(1), (a)(4)(C), (a)(6), (b)(1), (c)(1)(A), (c)(1)(B)(iii)(I), (c)(1)(B)(iii)(III), (e)(1)(G), (e)(1)(H), (e)(2)(H), (e)(3)(A), (e)(3)(C)(iii), (f)(1), (p)(1), (q)(1), and (r), by striking ‘1995’ each place it appears and inserting ‘1998’;

        (C) in the heading of subsection (c)(1)(B)(ii), by striking ‘AND 1995’ and inserting ‘THROUGH 1998’;

        (D) in subsection (c)(1)(B)(ii), by striking ‘and 1995’ and inserting ‘through 1998’;

        (E) in the headings of subsections (e)(1)(G) and (e)(1)(H), by striking ‘1995’ both places it appears and inserting ‘1998’; and

        (F) in subsection (g)(1), by striking ‘and 1995’ and inserting ‘through 1998’.

      (2) FOOD, AGRICULTURE, CONSERVATION, AND TRADE ACT OF 1990- Section 402 of the Food, Agriculture, Conservation, and Trade Act of 1990 (7 U.S.C. 1444b note) is amended--

        (A) in the section heading, by striking ‘1995’ and inserting ‘1998’; and

        (B) by striking ‘1995’ and inserting ‘1998’.

      (3) RECOURSE LOAN PROGRAM FOR SILAGE- Section 403 of the Food Security Act of 1985 (7 U.S.C. 1444e-1) is amended by striking ‘1996’ and inserting ‘1999’.

SEC. 1103. UPLAND COTTON PROGRAM.

    (a) FIVE PERCENT REDUCTION IN PAYMENT ACRES-

      (1) REDUCTION- Subsection (c)(1)(C)(ii) of section 103B of the Agricultural Act of 1949 (7 U.S.C. 1444-2) is amended by striking ‘85 percent’ and inserting ‘80 percent’.

      (2) APPLICATION OF AMENDMENT- The amendment made by paragraph (1) shall apply beginning with the 1994 crop of upland cotton.

    (b) CONTINUATION OF DEFICIT REDUCTION ACTIVITIES IN CROP YEARS AFTER 1995-

      (1) AGRICULTURAL ACT OF 1949- (A) Section 103(h)(16) of the Agricultural Act of 1949 (7 U.S.C. 1444(h)(16)) is amended by striking ‘1996’ and inserting ‘1999’.

      (B) Section 103B of such Act (7 U.S.C. 1444-2) is further amended--

        (i) in the section heading, by striking ‘1995’ and inserting ‘1998’;

        (ii) in subsections (a)(1), (b)(1), (c)(1)(A), (c)(1)(B)(ii), (e)(3)(A), (f)(1), and (o), by striking ‘1995’ each place it appears and inserting ‘1998’; and

        (iii) in subparagraphs (B)(i), (D)(i), (E)(i), and (F)(i) of subsection (a)(5), by striking ‘1996’ each place it appears and inserting ‘1999’.

      (C) Section 203(b) of such Act (7 U.S.C. 1446d(b)) is amended by striking ‘1995’ and inserting ‘1998’.

      (2) AGRICULTURAL ADJUSTMENT ACT OF 1938- Section 374(a) of the Agricultural Adjustment Act of 1938 (7 U.S.C. 1374(a)) is amended by striking ‘1995’ each place it appears and inserting ‘1998’.

      (3) FOOD, AGRICULTURE, CONSERVATION, AND TRADE ACT OF 1990- Title V of the Food, Agriculture, Conservation, and Trade Act of 1990 (Public Law 101-624; 104 Stat. 3421) is amended--

        (A) in section 502 (7 U.S.C. 1342 note), by striking ‘1995’ and inserting ‘1998’;

        (B) in section 503 (7 U.S.C. 1444 note), by striking ‘1995’ and inserting ‘1998’; and

        (C) in section 505 (7 U.S.C. 1342 note)--

          (i) in the section heading, by striking ‘1996’ and inserting ‘1999’; and

          (ii) by striking ‘1996’ and inserting ‘1999’.

SEC. 1104. RICE PROGRAM.

    (a) FIVE PERCENT REDUCTION IN PAYMENT ACRES-

      (1) REDUCTION- Subsection (c)(1)(C)(ii) of section 101B of the Agricultural Act of 1949 (7 U.S.C. 1441-2) is amended by striking ‘85 percent’ and inserting ‘80 percent’.

      (2) APPLICATION OF AMENDMENT- The amendment made by paragraph (1) shall apply beginning with the 1994 crop of rice.

    (b) CONTINUATION OF DEFICIT REDUCTION ACTIVITIES IN CROP YEARS AFTER 1995- Such section is further amended--

      (1) in the section heading, by striking ‘1995’ and inserting ‘1998’;

      (2) in subsections (a)(1), (a)(3), (b)(1), (c)(1)(A), (c)(1)(B)(iii), (e)(3)(A), (f)(1), and (n), by striking ‘1995’ each place it appears and inserting ‘1998’;

      (3) in subsection (a)(5)(D)(i), by striking ‘1996’ and inserting ‘1999’;

      (4) in the heading of subsection (c)(1)(B)(ii), by striking ‘AND 1995’ and inserting ‘THROUGH 1998’; and

      (5) in subsection (c)(1)(B)(ii), by striking ‘and 1995’ and inserting ‘through 1998’.

SEC. 1105. DAIRY PROGRAM.

    (a) ALLOCATION OF PURCHASE PRICES FOR BUTTER AND NONFAT DRY MILK-

      (1) IN GENERAL- Subsection (c)(3) of section 204 of the Agricultural Act of 1949 (7 U.S.C. 1446e) is amended--

        (A) in the first sentence of subparagraph (A), by striking ‘The Secretary’ and inserting ‘Subject to subparagraph (B), the Secretary’;

        (B) by redesignating subparagraph (B) as subparagraph (C); and

        (C) by inserting after subparagraph (A) the following new subparagraph:

        ‘(B) GUIDELINES- In allocating the rate of price support between the purchase prices of butter and nonfat dry milk under this paragraph, the Secretary may not--

          ‘(i) offer to purchase butter for more than $0.65 per pound; or

          ‘(ii) offer to purchase nonfat dry milk for less than $1.034 per pound.’.

      (2) APPLICATION OF AMENDMENTS- The amendments made by paragraph (1) shall apply with respect to purchases of butter and nonfat dry milk that are made by the Secretary of Agriculture under section 204 of the Agricultural Act of 1949 (7 U.S.C. 1446e) on or after the date of the enactment of this Act.

    (b) REDUCTION IN PRICE RECEIVED- Subsection (h)(2) of such section is amended--

      (1) by striking ‘and’ at the end of subparagraph (A);

      (2) by striking the period at the end of subparagraph (B) and inserting ‘; and’; and

      (3) by adding at the end the following new subparagraph:

        ‘(C) during each of the calendar years 1996 through 1998, 10 cents per hundredweight of milk marketed, which rate shall be adjusted on or before May 1 of each of the calendar years 1996 through 1998 in the manner provided in subparagraph (B).’.

    (c) CONTINUATION OF DEFICIT REDUCTION ACTIVITIES IN FISCAL YEARS AFTER 1995-

      (1) IN GENERAL- Section 204 of the Agricultural Act of 1949 (7 U.S.C. 1446e) is further amended--

        (A) in the section heading, by striking ‘1995’ and inserting ‘1998’;

        (B) in subsections (a), (b), (d)(1)(A), (d)(2)(A), (d)(3), (f), (g)(1), and (k), by striking ‘1995’ each place it appears and inserting ‘1998’; and

        (C) in subsection (g)(2), by striking ‘1994’ and inserting ‘1997’.

      (2) TRANSFER TO MILITARY AND VETERANS HOSPITALS- Subsections (a) and (b) of section 202 of such Act (7 U.S.C. 1446a) are amended by striking ‘1995’ both places it appears and inserting ‘1998’.

      (3) FEDERAL MILK MARKETING ORDERS- Section 101(b) of the Agriculture and Food Act of 1981 (7 U.S.C. 608c note) is amended by striking ‘1995’ and inserting ‘1998’.

      (4) DAIRY INDEMNITY PROGRAM- Section 3 of Public Law 90-484 (7 U.S.C. 450l) is amended by striking ‘1995’ and inserting ‘1998’.

      (5) FOOD SECURITY ACT OF 1985- The Food Security Act of 1985 is amended--

        (A) in section 153 (15 U.S.C. 713a-14), by striking ‘1995’ and inserting ‘1998’; and

        (B) in section 1163 (7 U.S.C. 1731 note), by striking ‘1995’ each place it appears and inserting ‘1998’.

SEC. 1106. TOBACCO PROGRAM.

    (a) TEN PERCENT INCREASE IN MARKETING ASSESSMENT- Subsection (g)(1) of section 106 of the Agricultural Act of 1949 (7 U.S.C. 1445) is amended by striking ‘equal to’ and all that follows through the period and inserting the following: ‘equal to--

      ‘(A) in the case of the 1991 through 1993 crops of tobacco, .5 percent of the national average price support level for each such crop as otherwise provided for in this section; and

      ‘(B) in the case of the 1994 through 1998 crops of tobacco, .55 percent of the national average price support level for each such crop as otherwise provided for in this section.’.

    (b) CONTINUATION OF DEFICIT REDUCTION ACTIVITIES IN FISCAL YEARS AFTER 1995- Such subsection is further amended by striking ‘1995’ and inserting ‘1998’.

    (c) Acreage-Poundage Quotas for Tobacco-

      (1) DEFINITIONS- Subsection (a) of section 317 of the Agricultural Adjustment Act of 1938 (7 U.S.C. 1314c) is amended--

        (A) by inserting ‘DEFINITIONS- ’ after ‘(a)’; and

        (B) by striking paragraphs (2), (3), (4), (5), (6), (7), and (8) and inserting the following new paragraphs:

      ‘(2) FARM ACREAGE ALLOTMENT- The term ‘farm acreage allotment’ for a tobacco farm, other than a new tobacco farm, means the acreage allotment determined by dividing the farm marketing quota by the farm yield.

      ‘(3) FARM YIELD- The term ‘farm yield’ means the yield per acre for a farm determined according to regulations issued by the Secretary and which would be expected to result in a quality of tobacco acceptable to the tobacco trade.

      ‘(4) FARM MARKETING QUOTA-

        ‘(A) IN GENERAL- The term ‘farm marketing quota’ for a farm for a marketing year means a number that is equal to the number of pounds of tobacco determined by multiplying--

          ‘(i) the farm marketing quota for the farm for the previous marketing year (prior to any adjustment for undermarketing or overmarketing); by

          ‘(ii) the national factor.

        ‘(B) ADJUSTMENT- The farm marketing quota determined under subparagraph (A) for a marketing year shall be increased for undermarketing or decreased for overmarketing by the number of pounds by which marketings of tobacco from the farm during the immediate preceding marketing year (if marketing quotas were in effect for that year under the program established by this section) is less than or exceeds the farm marketing quota for such year. Notwithstanding the preceding sentence, the farm marketing quota for a marketing year shall not be increased under this subparagraph for undermarketing by an amount in excess of the farm marketing quota determined for the farm for the immediately preceding year prior to any increase for undermarketing or decrease for overmarketing. If due to excess marketing in the preceding marketing year the farm marketing quota for the marketing year is reduced to zero pounds without reflecting the entire reduction required, the additional reduction shall be made for the subsequent marketing year or years.

      ‘(5) NATIONAL FACTOR- The term ‘national factor’ for a marketing year means a number obtained by dividing--

        ‘(A) the national marketing quota (less the reserve provided for under subsection (e)); by

        ‘(B) the sum of the farm marketing quotas (prior to any adjustments for undermarketing or overmarketing) for the immediate preceding marketing year for all farms for which marketing quotas for the kind of tobacco involved will be determined for such succeeding marketing year.’.

      (2) CONFORMING AMENDMENTS- Such section is further amended--

        (A) in the first sentence of subsection (b), by striking ‘and the national acreage allotment and national average yield goal for the 1965 crop of Flue-cured tobacco,’;

        (B) in the first sentence of subsection (c), by striking ‘and at the same time announce the national acreage allotment and national average yield goal’;

        (C) in subsection (d)--

          (i) in the sixth sentence, by striking ‘, national acreage allotment, and national average yield goal’;

          (ii) in the eighth sentence, by striking ‘, national acreage allotment and national average yield goal’; and

          (iii) in the ninth sentence, by striking ‘, national acreage allotment, and national average goal are’ and inserting ‘is’;

        (D) in subsection (e)--

          (i) in the first sentence, by striking ‘No farm acreage allotment or farm yield shall be established’ and inserting ‘A farm marketing quota and farm yield shall not be established’;

          (ii) in the second sentence, by striking ‘acreage allotment’ both places it appears and inserting ‘marketing quota’;

          (iii) in the second sentence, by striking ‘acreage allotments’ both places it appears and inserting ‘marketing quotas’; and

          (iv) in the last sentence, by striking ‘acreage allotment’ and inserting ‘marketing quota’; and

        (E) in subsection (g)--

          (i) in paragraph (1), by striking ‘paragraph (a)(8)’ and inserting ‘subsection (a)(4)’; and

          (ii) in paragraph (3), by striking ‘subsection (a)(8)’ and inserting ‘subsection (a)(4)’.

      (3) FARM MARKETING QUOTA REDUCTIONS- Subsection (f) of such section is amended to read as follows:

    ‘(f) CAUSES FOR FARM MARKETING QUOTA REDUCTIONS- (1) When an acreage-poundage program is in effect for any kind of tobacco under this section, the farm marketing quota next established for a farm shall be reduced by the amount of such kind of tobacco produced on the farm--

      ‘(A) which was marketed as having been produced on a different farm;

      ‘(B) for which proof of disposition is not furnished as required by the Secretary;

      ‘(C) on acreage equal to the difference between the acreage reported by the farm operator or a duly authorized representative and the determined acreage for the farm; and

      ‘(D) as to which any producer on the farm files, or aids, or acquiesces, in the filing of any false report with respect to the production or marketing of tobacco.

    ‘(2) If the Secretary, through the local committee, finds that no person connected with a farm caused, aided, or acquiesced in any irregularity described in paragraph (1), the next established farm marketing quota shall not be reduced under this subsection.

    ‘(3) The reduction required under this subsection shall be in addition to any other adjustments made pursuant to this section.

    ‘(4) In establishing farm marketing quotas for other farms owned by the owner displaced by acquisition of the owner’s land by any agency, as provided in section 378 of this Act, increases or decreases in such farm marketing quotas as provided in this section shall be made on account of marketings below or in excess of the farm marketing quota for the farm acquired by the agency.

    ‘(5) Acreage allotments and farm marketing quotas determined under this section may (except in the case of kinds of tobacco not subject to section 316) be leased and sold under the terms and conditions in section 316 of this Act, except that any credit for undermarketing or charge for overmarketing shall be attributed to the farm to which transferred.’.

SEC. 1107. SUGAR PROGRAM.

    (a) TEN PERCENT INCREASE IN MARKETING ASSESSMENT- Subsection (i) of section 206 of the Agricultural Act of 1949 (7 U.S.C. 1446g) is amended--

      (1) in paragraph (1), by striking ‘equal to’ and all that follows through the period and inserting the following: ‘equal to--

        ‘(A) in the case of marketings during fiscal years 1992 and 1993, .18 cents per pound of raw cane sugar, processed by the processor from domestically produced sugarcane or sugarcane molasses, that has been marketed (including the transfer or delivery of the sugar to a refinery for further processing or marketing); and

        ‘(B) in the case of marketings during fiscal years 1994 through 1999, .198 cents per pound of raw cane sugar, processed by the processor from domestically produced sugarcane or sugarcane molasses, that has been marketed (including the transfer or delivery of the sugar to a refinery for further processing or marketing).’; and

      (2) in paragraph (2), by striking ‘equal to’ and all that follows through the period and inserting the following: ‘equal to--

        ‘(A) in the case of marketings during fiscal years 1992 and 1993, .193 cents per pound of beet sugar, processed by the processor from domestically produced sugar beets or sugar beet molasses, that has been marketed; and

        ‘(B) in the case of marketings during fiscal years 1994 through 1999, .2123 cents per pound of beet sugar, processed by the processor from domestically produced sugar beets or sugar beet molasses, that has been marketed.’.

    (b) CONTINUATION OF DEFICIT REDUCTION ACTIVITIES IN CROP YEARS AFTER 1995-

      (1) AGRICULTURAL ACT OF 1949- Section 206 of the Agricultural Act of 1949 (7 U.S.C. 1446g) is further amended--

        (A) in the section heading, by striking ‘1995’ and inserting ‘1998’;

        (B) in subsections (a), (c), (d)(1), and (j), by striking ‘1995’ each place it appears and inserting ‘1998’; and

        (C) in paragraphs (1) and (2) of subsection (i), as amended by subsection (a), by striking ‘1996’ both places it appears and inserting ‘1999’.

      (2) AGRICULTURAL ADJUSTMENT ACT OF 1938- Section 359b(a)(1) of the Agricultural Adjustment Act of 1938 (7 U.S.C. 1359bb(a)(1)) is amended by striking ‘1996’ and inserting ‘1999’.

SEC. 1108. OILSEEDS PROGRAM.

    (a) CONTINUATION OF DEFICIT REDUCTION ACTIVITIES IN CROP YEARS AFTER 1995- Section 205 of the Agricultural Act of 1949 (7 U.S.C. 1446f) is amended--

      (1) in the section heading, by striking ‘1995’ and inserting ‘1998’; and

      (2) in subsections (b), (c), (e)(1), and (n), by striking ‘1995’ each place it appears and inserting ‘1998’.

SEC. 1109. PEANUT PROGRAM.

    (a) ASSESSMENT TO COVER UNANTICIPATED LOSSES IN ADMINISTERING THE PROGRAM-

      (1) ADDITIONAL ASSESSMENT- Section 108B of the Agricultural Act of 1949 (7 U.S.C. 1445c-3) is amended--

        (A) by redesignating subsection (h) as subsection (i); and

        (B) by inserting after subsection (g) the following new subsection:

    ‘(h) ADDITIONAL MARKETING ASSESSMENT-

      ‘(1) TWO PERCENT ASSESSMENT- In addition to the marketing assessment required by subsection (g), the Secretary shall also provide for a nonrefundable marketing assessment applicable to each of the 1993 through 1998 crops of peanuts and collected and paid in accordance with this subsection. The assessment shall be on a per pound basis in an amount equal to 2 percent of the national average quota or additional peanut support rate per pound, as applicable, for the applicable crop. No peanuts shall be assessed more than 2 percent of the applicable support rate under this subsection.

      ‘(2) FIRST PURCHASERS- Except as provided under paragraphs (3) and (4), the first purchaser of peanuts shall--

        ‘(A) collect from the producer a marketing assessment equal to 1 percent of the applicable national average support rate times the quantity of peanuts acquired;

        ‘(B) pay, in addition to the amount collected under subparagraph (A), a marketing assessment in an amount equal to 1 percent of the applicable national average support rate times the quantity of peanuts acquired; and

        ‘(C) remit the amounts required under subparagraphs (A) and (B) to the Commodity Credit Corporation in a manner specified by the Secretary.

      ‘(3) OTHER PRIVATE MARKETINGS- In the case of a private marketing by a producer directly to a consumer through a retail or wholesale outlet or in the case of a marketing by the producer outside of the continental United States, the producer shall be responsible for the full amount of the assessment under this subsection and shall remit the assessment by such time as is specified by the Secretary.

      ‘(4) LOAN PEANUTS- In the case of peanuts that are pledged as collateral for a price support loan made under this section, 1/2 of the assessment under this subsection shall be deducted from the proceeds of the loan. The remainder of the assessment shall be paid by the first purchaser of the peanuts as provided in subparagraph (B) of paragraph (2). For purposes of computing net gains on peanuts under this section, the reduction in loan proceeds under this subsection shall be treated as having been paid to the producer.

      ‘(5) RESERVE ACCOUNT-

        ‘(A) ESTABLISHMENT- The Secretary shall establish in the Commodity Credit Corporation a reserve account to be administered by the Secretary for purposes of this section. There shall be deposited in the reserve account for each crop of peanuts an amount equal to--

          ‘(i) the total amount remitted to the Commodity Credit Corporation under paragraphs (2) and (3) as the payment of the marketing assessment applicable to that crop of peanuts under this subsection; and

          ‘(ii) the total amount deducted from the proceeds of a price support loan or paid by first purchasers under paragraph (4) as the payment of the marketing assessment applicable to that crop of peanuts under this subsection.

        ‘(B) USE OF RESERVE ACCOUNT- The Secretary shall use amounts in the reserve account established in this paragraph to cover losses incurred by the Commodity Credit Corporation on the sale or disposal of peanuts.

      ‘(6) APPLICATION OF OTHER PROVISIONS- Paragraphs (2)(B), (5), and (6) of subsection (g) shall apply with respect to the marketing assessment required by this subsection.’.

      (2) EFFECTIVE DATE- The amendments made by paragraph (1) shall take effect 15 days after the date of the enactment of this Act.

    (b) CONTINUATION OF DEFICIT REDUCTION ACTIVITIES IN CROP YEARS AFTER 1995-

      (1) AGRICULTURAL ACT OF 1949- Section 108B of the Agricultural Act of 1949 (7 U.S.C. 1445c-3) is further amended--

        (A) in the section heading, by striking ‘1995’ and inserting ‘1998’;

        (B) in subsections (a)(1), (a)(2), (b)(1), and (g)(1), by striking ‘1995’ each place it appears and inserting ‘1998’; and

        (C) in subsection (i) (as redesignated by subsection (a)(1)(A)), by striking ‘1995’ and inserting ‘1998’.

      (2) AGRICULTURAL ADJUSTMENT ACT OF 1938- Part VI of subtitle B of title III of the Agricultural Adjustment Act of 1938 is amended--

        (A) in section 358-1 (7 U.S.C. 1358-1)--

          (i) in the section heading, by striking ‘1995’ and inserting ‘1998’; and

          (ii) in subsections (a)(1), (b)(1)(A), (b)(1)(B), (b)(2)(A), (b)(2)(C), (b)(3), and (f), by striking ‘1995’ each place it appears and inserting ‘1998’;

        (B) in section 358b (7 U.S.C. 1358b)--

          (i) in the section heading, by striking ‘1995’ and inserting ‘1998’; and

          (ii) in subsection (c), by striking ‘1995’ and inserting ‘1998’;

        (C) in section 358c(d) (7 U.S.C. 1358c(d)), by striking ‘1995’ and inserting ‘1998’; and

        (D) in section 358e (7 U.S.C. 1359a)--

          (i) in the section heading, by striking ‘1995’ and inserting ‘1998’; and

          (ii) in subsection (i), by striking ‘1995’ and inserting ‘1998’.

      (3) FOOD, AGRICULTURE, CONSERVATION, AND TRADE ACT OF 1990- Title VIII of the Food, Agriculture, Conservation, and Trade Act of 1990 (Public Law 101-624; 104 Stat. 3459) is amended--

        (A) in section 801 (104 Stat. 3459), by striking ‘1995’ and inserting ‘1998’;

        (B) in section 807 (104 Stat. 3478), by striking ‘1995’ and inserting ‘1998’; and

        (C) in section 808 (7 U.S.C. 1441 note), by striking ‘1995’ and inserting ‘1998’.

    (c) ASSESSMENT UNDER PEANUT MARKETING AGREEMENT- Section 8b(b)(1) of the Agricultural Adjustment Act (7 U.S.C. 608b(b)(1)), reenacted with amendments by the Agricultural Marketing Agreement Act of 1937, is amended--

      (1) by striking ‘and’ at the end of subparagraph (A);

      (2) by striking the period at the end of subparagraph (B) and inserting ‘; and’; and

      (3) by adding at the end the following new subparagraph:

      ‘(C) any assessment imposed under such agreement shall apply to peanut handlers (as that term is defined by the Secretary) who have not entered into such an agreement with the Secretary in addition to those handlers who have entered into such agreement.’.

    (d) CUSTOMS TREATMENT OF CERTAIN PEANUT PRODUCTS-

      (1) TEMPORARY ADDITIONAL DUTIES- Subchapter I of chapter 99 of the Harmonized Tariff Schedule of the United States is amended by inserting in numerical order the following new headings:

-----------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------
 ‘ 9901.11.10 Peanut paste (provided for in subheading 2007.99.65)  55›/kg No change 55›/kg On or before   7/31/96     
   9901.11.12 Peanut butter (provided for in subheading 2008.11.00) 55›/kg No change 55›/kg On or before   7/31/96  ’. 
-----------------------------------------------------------------------------------------------------------------------
      (2) INCLUSION OF PEANUT BUTTER IN QUOTA- Heading 9904.20.20 of the Harmonized Tariff Schedule of the United States is amended by striking out ‘(except peanut butter)’.

      (3) EFFECTIVE DATES-

        (A) TEMPORARY ADDITIONAL DUTIES- The amendment made by paragraph (1) applies with respect to entries and withdrawals from warehouse for consumption made on or after the 15th day after the date of the enactment of this Act.

        (B) QUOTA AMENDMENT- The amendment made by paragraph (2) applies with respect to entries and withdrawals from warehouse for consumption made after July 31, 1996.

SEC. 1110. HONEY PROGRAM.

    (a) REDUCED SUPPORT RATE- Subsection (a) of section 207 of the Agricultural Act of 1949 (7 U.S.C. 1446h) is amended by striking ‘53.8 cents’ and inserting ‘50 cents’.

    (b) PAYMENT LIMITATIONS- Subsection (e)(1) of such section is amended--

      (1) by striking ‘and’ at the end of subparagraph (C);

      (2) by striking subparagraph (D); and

      (3) by adding at the end the following new subparagraphs:

        ‘(D) $125,000 in the 1994 crop year;

        ‘(E) $100,000 in the 1995 crop year;

        ‘(F) $75,000 in the 1996 crop year; and

        ‘(G) $50,000 in each of the 1997 and subsequent crop years.’.

    (c) CONTINUATION OF DEFICIT REDUCTION ACTIVITIES- Subsections (a), (c)(1), and (j) of such section are amended by striking ‘1995’ each place it appears and inserting ‘1998’.

    (d) TERMINATION OF ASSESSMENT- Subsection (i)(1) of such section is amended by striking ‘1995’ and inserting ‘1993’.

SEC. 1111. WOOL AND MOHAIR PROGRAM.

    (a) PAYMENT LIMITATIONS- Section 704(b)(1) of the National Wool Act of 1954 (7 U.S.C. 1783(b)(1)) is amended--

      (1) by striking ‘and’ at the end of subparagraph (C);

      (2) by striking subparagraph (D); and

      (3) by adding at the end the following new subparagraphs:

        ‘(D) $125,000 for the 1994 marketing year;

        ‘(E) $100,000 for the 1995 marketing year;

        ‘(F) $75,000 for 1996 marketing year; and

        ‘(G) $50,000 for each of the 1997 and subsequent marketing years.’.

    (b) MARKETING CHARGES- Section 706 of National Wool Act of 1954 (7 U.S.C. 1785) is amended by inserting after the second sentence the following new sentence: ‘In determining the net sales proceeds and national payment rates for shorn wool and shorn mohair the Secretary shall not deduct marketing charges for commissions, coring, or grading.’.

    (c) CONTINUATION OF DEFICIT REDUCTION ACTIVITIES IN CROP YEARS AFTER 1995- Subsections (a) and (b)(2) of section 703 of the National Wool Act of 1954 (7 U.S.C. 1782) are amended by striking ‘1995’ both places it appears and inserting ‘1998’.

    (d) TERMINATION OF MARKETING ASSESSMENT- Section 704(c) of the National Wool Act of 1954 (7 U.S.C. 1783(c)) is amended by striking ‘1995’ and inserting ‘1992’.

    (e) TECHNICAL AND CONFORMING AMENDMENTS-

      (1) POLICY OF CONGRESS- Section 702 of the National Wool Act of 1954 (7 U.S.C. 1781) is amended--

        (A) by striking ‘, strategic,’ in the first sentence; and

        (B) by striking ‘as a measure of national security and to promote’ and inserting ‘that as a method to promote’.

      (2) ELIMINATION OF OBSOLETE PROVISION- Section 703(b) of the National Wool Act of 1954 (7 U.S.C. 1782(b)) is amended--

        (A) in paragraph (1), by striking ‘paragraphs (2) and (3)’ and inserting ‘paragraph (2)’;

        (B) in paragraph (2), by striking ‘Except as provided in paragraph (3), for’ and inserting ‘For’; and

        (C) by striking paragraph (3).

      (3) ADVERTISING AND SALES PROMOTION PROGRAMS- Section 708 of the National Wool Act of 1954 (7 U.S.C. 1787) is amended--

        (A) by inserting ‘(a)’ after ‘SEC. 708.’; and

        (B) by adding at the end the following new subsection:

    ‘(b)(1) Except as provided in paragraph (2), to the extent that the Secretary determines that the amount of funds that would otherwise be made available under subsection (a) in any marketing year for agreements entered into under such subsection is less than the amount made available under such subsection in the previous marketing year, the difference in such amounts shall be provided from amounts available to support the prices of wool and mohair under section 703 of this title. Any amount provided under this subsection shall be considered to be an expenditure made in connection with payments to producers under this title for purposes of section 705 of this title.

    ‘(2) Paragraph (1) shall not apply if the Secretary determines that any portion of the difference between the amounts made available under subsection (a) between two consecutive marketing years is the result of a per unit reduction in the amount of the assessment imposed under the agreements entered into under such subsection.’.

SEC. 1112. CONFORMING AMENDMENTS TO CONTINUE DEFICIT REDUCTION ACTIVITIES IN CROP YEARS AFTER 1995.

    (a) SUPPLEMENTAL SET-ASIDE AND ACREAGE LIMITATION AUTHORITY- Section 113 of the Agricultural Act of 1949 (7 U.S.C. 1445h) is amended by striking ‘1995’ and inserting ‘1998’.

    (b) DEFICIENCY AND LAND DIVERSION PAYMENTS- Subsections (a)(1), (b), and (c) of section 114 of the Agricultural Act of 1949 (7 U.S.C. 1445j) are amended by striking ‘1995’ each place it appears and inserting ‘1998’.

    (c) DISASTER PAYMENTS- Section 208 of the Agricultural Act of 1949 (7 U.S.C. 1446i) is amended--

      (1) in the section heading, by striking ‘1995’ and inserting ‘1998’;

      (2) in subsection (d), by striking ‘1995’ and inserting ‘1998’.

    (d) MISCELLANEOUS- Title IV of the Agricultural Act of 1949 (7 U.S.C. 1421 et seq.) is amended--

      (1) in section 402(b) (7 U.S.C. 1422(b)), by striking ‘1995’ and inserting ‘1998’;

      (2) in section 403(c) (7 U.S.C. 1423(c)), by striking ‘1995’ and inserting ‘1998’;

      (3) in section 406(b) (7 U.S.C. 1426(b))--

        (A) by striking ‘1995’ each place it appears and inserting ‘1998’; and

        (B) by striking ‘1996’ each place it appears and inserting ‘1999’; and

      (4) in section 408(k)(3) (7 U.S.C. 1428(k)(3)), by striking ‘1995’ and inserting ‘1998’.

    (e) ACREAGE BASE AND YIELD SYSTEM- Title V of the Agricultural Act of 1949 (7 U.S.C. 1461 et seq.) is amended--

      (1) in subsections (c)(3) and (h)(2)(A) of section 503 (7 U.S.C. 1463), by striking ‘1995’ each place it appears and inserting ‘1998’;

      (2) in subsections (b)(1) and (b)(2) of section 505 (7 U.S.C. 1465), by striking ‘1995’ each place it appears and inserting ‘1998’; and

      (3) in section 509 (7 U.S.C. 1469), by striking ‘1995’ and inserting ‘1998’.

    (f) NORMALLY PLANTED ACREAGE- Section 1001 of the Food and Agriculture Act of 1977 (7 U.S.C. 1309) is amended in subsections (a), (b)(1), and (c) by striking ‘1995’ each place it appears and inserting ‘1998’.

    (g) AGRICULTURE AND FOOD ACT OF 1981- Section 1014 of the Agriculture and Food Act of 1981 (7 U.S.C. 4110) is amended by striking ‘1995’ and inserting ‘1998’.

    (h) FOOD SECURITY ACT OF 1985- The Food Security Act of 1985 (Public Law 99-198; 99 Stat. 1354) is amended--

      (1) in section 902(c)(2)(A) (7 U.S.C. 1446 note), by striking ‘1995’ and inserting ‘1998’;

      (2) in paragraphs (1)(A), (1)(B), and (2)(A) of section 1001 (7 U.S.C. 1308), by striking ‘1995’ each place it appears and inserting ‘1998’;

      (3) in section 1001C(a) (7 U.S.C. 1308-3(a)), by striking ‘1995’ both places it appears and inserting ‘1998’;

      (4) in section 1017(b) (7 U.S.C. 1385 note), by striking ‘1995’ and inserting ‘1998’; and

      (5) in section 1019 (7 U.S.C. 1310a), by striking ‘1995’ and inserting ‘1998’.

    (i) OPTIONS PILOT PROGRAM- The Options Pilot Program Act of 1990 (subtitle E of title XI of Public Law 101-624; 104 Stat. 3518; 7 U.S.C. 1421 note) is amended--

      (1) in subsections (a) and (b) of section 1153, by striking ‘1995’ each place it appears and inserting ‘1998’; and

      (2) in section 1154(b)(1)(A), by striking ‘1995’ both places it appears and inserting ‘1998’.

    (j) READJUSTMENT OF SUPPORT LEVELS- Section 1302 of the Agricultural Reconciliation Act of 1990 (7 U.S.C. 1421 note) is amended in subsections (b)(1), (b)(3), and (d)(1)(C) by striking ‘1995’ each place it appears and inserting ‘1998’.

Subtitle B--Restructuring of Loan Programs

SEC. 1201. RESTRUCTURING OF CERTAIN LOAN PROGRAMS.

    (a) LOAN PROGRAMS UNDER THE RURAL ELECTRIFICATION ACT OF 1936-

      (1) INSURED LOAN PROGRAMS- Section 305 of the Rural Electrification Act of 1936 (7 U.S.C. 935) is amended--

        (A) by striking subsections (b) and (d);

        (B) by redesignating subsection (c) as subsection (b); and

        (C) by inserting after subsection (b) (as so redesignated) the following:

    ‘(c) INSURED ELECTRIC LOANS-

      ‘(1) HARDSHIP LOANS-

        ‘(A) IN GENERAL- The Administrator shall make insured electric loans at an interest rate of 5 percent per annum to any applicant therefor who meets each of the following requirements:

          ‘(i) The average revenue per kilowatt-hour sold by the applicant is not less than 120 percent of the average revenue per kilowatt-hour sold by all utilities in the State in which the borrower provides service.

          ‘(ii) The average residential revenue per kilowatt-hour sold by the applicant is not less than 120 percent of the average residential revenue per kilowatt-hour sold by all utilities in the State in which the borrower provides service.

          ‘(iii) The average per capita income of the residents receiving electric service from the applicant is less than the average per capita income of the residents of the State in which the applicant provides service, or the median household income of the households receiving electric service from the applicant is less than the median household income of the households in the State.

        ‘(B) SEVERE HARDSHIP LOANS- The Administrator may make an insured electric loan at an interest rate of 5 percent per annum to an applicant therefor if, in the sole discretion of the Administrator, the applicant has experienced a severe hardship.

        ‘(C) LIMITATION- The Administrator may not make a loan under this paragraph to an applicant for the purpose of furnishing or improving electric service to a consumer located in an urban or urbanized area (as defined by the Bureau of the Census) if the average number of consumers per mile of line of the total electric system of the applicant exceeds 17.

      ‘(2) MUNICIPAL RATE LOANS-

        ‘(A) IN GENERAL- The Administrator shall make insured electric loans, to the extent of qualifying applications therefor, at the interest rate described in subparagraph (B) for the term or terms selected by the applicant pursuant to subparagraph (C).

        ‘(B) INTEREST RATE-

          ‘(i) IN GENERAL- Subject to clause (ii), the interest rate described in this subparagraph on a loan to a qualifying applicant shall be--

            ‘(I) the interest rate determined by the Administrator to be equal to the current market yield on outstanding municipal obligations with remaining periods to maturity similar to the term selected by the applicant pursuant to subparagraph (C), but not greater than the rate determined under section 307(a)(3)(A) of the Consolidated Farm and Rural Development Act which is based on the current market yield on outstanding municipal obligations; plus

            ‘(II) if the applicant for the loan makes an election pursuant to subparagraph (D) to include in the loan agreement the right of the applicant to prepay the loan, a rate equal to the amount by which--

‘(aa) the interest rate on commercial loans for a similar period that afford the borrower such a right; exceeds

‘(bb) the interest rate on commercial loans for such period that do not afford the borrower such a right.

          ‘(ii) MAXIMUM RATE- The interest rate described in this subparagraph on a loan to an applicant therefor shall not exceed 7 percent if--

            ‘(I) the average number of consumers per mile of line of the total electric system of the applicant is less than 5.50; or

            ‘(II)(aa) the average revenue per kilowatt-hour sold by the applicant is more than the average revenue per kilowatt-hour sold by all utilities in the State in which the borrower provides service; and

            ‘(bb) the average per capita income of the residents receiving electric service from the applicant is less than the average per capita income of the residents of the State in which the applicant provides service, or the median household income of the households receiving electric service from the applicant is less than the median household income of the households in the State.

          ‘(iii) EXCEPTION- Clause (ii) shall not apply to a loan to be made to an applicant for the purpose of furnishing or improving electric service to consumers located in an urban or urbanized area (as defined by the Bureau of the Census) if the average number of consumers per mile of line of the total electric system of the applicant exceeds 17.

        ‘(C) LOAN TERM-

          ‘(i) IN GENERAL- Subject to clause (ii), the applicant for a loan under this paragraph may select the term during which the loan is to be repaid, and, at the end of such term (and any succeeding term selected by the applicant under this subparagraph), may renew the loan for another term selected by the applicant.

          ‘(ii) MAXIMUM TERM- Notwithstanding clause (i), the applicant may not select a term that ends more than 35 years after the beginning of the 1st term the applicant selects under clause (i).

        ‘(D) CALL PROVISION- The Administrator shall offer any applicant for a loan under this paragraph the option to include in the loan agreement the right of the applicant to prepay the loan on terms consistent with similar provisions of commercial loans.

      ‘(3) OTHER SOURCE OF CREDIT NOT REQUIRED IN CERTAIN CASES- The Administrator may not require any applicant for a loan made under this subsection who is eligible for a loan under paragraph (1) to obtain a loan from another source as a condition of approving the application for the loan or advancing any amount under the loan.

    ‘(d) INSURED TELEPHONE LOANS-

      ‘(1) HARDSHIP LOANS-

        ‘(A) IN GENERAL- The Administrator shall make insured telephone loans, to the extent of qualifying applications therefor, at an interest rate of 5 percent per annum, to any applicant who meets each of the following requirements:

          ‘(i) The average number of subscribers per mile of line in the service area of the applicant is not more than 4.

          ‘(ii) The applicant is capable of producing net income or margins, after interest payments on the loan applied for, of not less than 100 percent (but not more than 300 percent) of the interest requirements on all of the outstanding and proposed loans of the applicant.

          ‘(iii) The Administrator has approved a telecommunications modernization plan for the State under paragraph (3), and, if the plan was developed by telephone borrowers under this title, the applicant is a participant in the plan.

        ‘(B) AUTHORITY TO WAIVE TIER REQUIREMENT- The Administrator may waive the requirement of subparagraph (A)(ii) in any case in which the Administrator determines (and sets forth the reasons therefor in writing) that the requirement would prevent emergency restoration of the telephone system of the applicant or result in severe hardship to the applicant.

        ‘(C) EFFECT OF LACK OF FUNDS- On request of any applicant who is eligible for a loan under this paragraph for which funds are not available, the applicant shall be considered to have applied for a loan under title IV.

      ‘(2) COST-OF-MONEY LOANS-

        ‘(A) IN GENERAL- The Administrator may make insured telephone loans for the purchase and installation of telephone lines, systems, and facilities (other than buildings used primarily for administrative purposes, vehicles not used primarily in construction, and personal customer premise equipment) directly related to the furnishing, improvement, or extension of rural telecommunications service or the acquisition of a rural telecommunications capability, at an interest rate equal to the then cost of money to the Government of the United States for loans of similar maturity, but not more than 7 percent per annum, to any applicant therefor who meets the following requirements:

          ‘(i) The average number of subscribers per mile of line in the service area of the applicant is not more than 15.

          ‘(ii) The applicant is capable of producing net income or margins, after interest payments on the loan applied for, of not less than 100 percent (but not more than 500 percent) of the interest requirements on all of the outstanding and proposed loans of the applicant.

          ‘(iii) The Administrator has approved a telecommunications modernization plan for the State under paragraph (3), and, if the plan was developed by telephone borrowers under this title, the applicant is a participant in the plan.

        ‘(B) CALL PROVISION- The Administrator shall offer any applicant for a loan under this paragraph the option to include in the loan agreement the right of the applicant to prepay the loan.

        ‘(C) CONCURRENT LOAN AUTHORITY- On request of any applicant for a loan under this paragraph during any fiscal year, the Administrator shall--

          ‘(i) consider the application to be for a loan under this paragraph and a loan under section 408; and

          ‘(ii) if the applicant is eligible therefor, make a loan to the applicant under this paragraph in an amount equal to the amount that bears the same ratio to the total amount of loans for which the applicant is eligible under this paragraph and under section 408, as the amount made available for loans under this paragraph for the fiscal year bears to the total amount made available for loans under this paragraph and under section 408 for the fiscal year.

        ‘(D) EFFECT OF LACK OF FUNDS- On request of any applicant who is eligible for a loan under this paragraph for which funds are not available, the applicant shall be considered to have applied for a loan guarantee under section 306.

      ‘(3) STATE TELECOMMUNICATIONS MODERNIZATION PLANS-

        ‘(A) APPROVAL- If, within 6 months after final regulations are promulgated to carry out this paragraph, the public utility commission of any State develops a telecommunications modernization plan that meets the requirements of subparagraph (B), then the Administrator shall approve the plan for the State. Otherwise, the Administrator shall approve any telecommunications modernization plan for the State that meets such requirements, which is developed by a majority of the borrowers of telephone loans made under this title who are located in the State.

        ‘(B) REQUIREMENTS- A telecommunications modernization plan must, at a minimum, meet the following objectives:

          ‘(i) The plan must provide for the elimination of party line service.

          ‘(ii) The plan must provide for the availability of telecommunications services for improved business, educational, and medical services.

          ‘(iii) The plan must encourage and improve computer networks and information highways for subscribers in rural areas.

          ‘(iv) The plan must provide for--

            ‘(I) subscribers in rural areas to be able to receive through telephone lines--

‘(aa) multiple voices;

‘(bb) video images; and

‘(cc) data at a rate of at least 1,000,000 bits of information per second; and

            ‘(II) the proper routing of information to subscribers.

          ‘(v) The plan must provide for uniform deployment schedules to ensure that advanced services are deployed at the same time in rural and nonrural areas.

        ‘(C) FINALITY OF APPROVAL- A telecommunications modernization plan approved under subparagraph (A) may not subsequently be disapproved.’.

      (2) RURAL TELEPHONE BANK LOAN PROGRAM- Section 408 of the Rural Electrification Act of 1936 (7 U.S.C. 948) is amended--

        (A) in subsection (a)--

          (i) by striking ‘, (1)’ and all that follows through ‘(3)’ and inserting ‘(1) for the purchase and installation of telephone lines, systems, and facilities (other than buildings used primarily for administrative purposes, vehicles not used primarily in construction, and personal customer premise equipment) directly related to the furnishing, improvement, or extension of rural telecommunications service or the acquisition of a rural telecommunications capability, and (2)’; and

          (ii) by striking ‘(2) hereof’ and inserting ‘clause (1)’;

        (B) in subsection (b)--

          (i) by amending paragraph (4) to read as follows:

      ‘(4)(A) The Governor of the telephone bank may make a loan under this section only to an applicant therefor who meets the following requirements:

        ‘(i) The average number of subscribers per mile of line in the service area of the applicant is not more than 15.

        ‘(ii) The applicant is capable of producing net income or margins, after interest payments on the loan applied for, of not less than 100 percent (but not more than 500 percent) of the interest requirements on all of the outstanding and proposed loans of the applicant.

        ‘(iii) The Administrator has approved, under section 305(d)(3), a telecommunications modernization plan for the State in which the applicant is located, and, if the plan was developed by telephone borrowers under title III, the applicant is a participant in the plan.’;

          (ii) in paragraph (8)--

            (I) by inserting ‘(A)’ after ‘(8)’;

            (II) by striking ‘if such prepayment is not made later than September 30, 1988’ and inserting ‘except for any prepayment penalty provided for in a loan agreement entered into before the date of the enactment of the Omnibus Budget Reconciliation Act of 1993’; and

            (III) by adding at the end the following:

      ‘(B) If a borrower prepays part or all of a loan made under this section, then, notwithstanding section 407(b), the Governor of the telephone bank shall--

        ‘(i) use the full amount of the prepayment to repay obligations of the telephone bank issued pursuant to section 407(b) before October 1, 1991, to the extent any such obligations are outstanding; and

        ‘(ii) in repaying such obligations, first repay the advances bearing the greatest rate of interest.’; and

          (iii) by adding at the end the following:

      ‘(9) On request of any applicant for a loan under this section during any fiscal year, the Governor of the telephone bank shall--

        ‘(A) consider the application to be for a loan under this section and a loan under section 305(d)(2); and

        ‘(B) if the applicant is eligible therefor, make a loan to the applicant under this section in an amount equal to the amount that bears the same ratio to the total amount of loans for which the applicant is eligible under this section and under section 305(d)(2), as the amount made available for loans under this section for the fiscal year bears to the total amount made available for loans under this section and under section 305(d)(2) for the fiscal year.

      ‘(10) On request of any applicant who is eligible for a loan under this section for which funds are not available, the applicant shall be considered to have applied for a loan under section 305(d)(2).’; and

        (C) by adding at the end the following:

    ‘(e) Loans and advances made under this section on or after November 5, 1990, shall bear interest at a rate determined under this section, taking into account all assets and liabilities of the telephone bank. This subsection shall not apply to loans obligated before the date of the enactment of this subsection.’.

      (3) FUNDING- Section 314 of such Act (7 U.S.C. 940d) is amended to read as follows:

‘SEC. 314. LIMITATIONS ON AUTHORIZATION OF APPROPRIATIONS.

    ‘(a) IN GENERAL- There are authorized to be appropriated to the Administrator such sums as may be necessary for the cost of loans in the following amounts, for the following purposes and periods of time:

      ‘(1) ELECTRIC HARDSHIP LOANS- For loans under section 305(c)(1)--

        ‘(A) for fiscal year 1994, $125,000,000; and

        ‘(B) for each of fiscal years 1995 through 1998, $125,000,000, increased by the adjustment percentage for the fiscal year.

      ‘(2) ELECTRIC MUNICIPAL RATE LOANS- For loans under section 305(c)(2)--

        ‘(A) for fiscal year 1994, $600,000,000; and

        ‘(B) for each of fiscal years 1995 through 1998, $600,000,000, increased by the adjustment percentage for the fiscal year.

      ‘(3) TELEPHONE HARDSHIP LOANS- For loans under section 305(d)(1)--

        ‘(A) for fiscal year 1994, $125,000,000; and

        ‘(B) for each of fiscal years 1995 through 1998, $125,000,000, increased by the adjustment percentage for the fiscal year.

      ‘(4) TELEPHONE COST-OF-MONEY LOANS- For loans under section 305(d)(2)--

        ‘(A) for fiscal year 1994, $198,000,000; and

        ‘(B) for each of fiscal years 1995 through 1998, $198,000,000, increased by the adjustment percentage for the fiscal year.

    ‘(b) ADJUSTMENT PERCENTAGE DEFINED- As used in subsection (a), the term ‘adjustment percentage’ means, with respect to a fiscal year, the percentage (if any) by which--

      ‘(1) the average of the Consumer Price Index (as defined in section 1(f)(5) of the Internal Revenue Code of 1986) for the 12-month period ending on July 31 of the immediately preceding fiscal year; exceeds

      ‘(2) the average of the Consumer Price Index (as so defined) for the 12-month period ending on July 31, 1993.

    ‘(c) MANDATORY LEVELS- The Administrator shall make insured loans under this title from the Rural Electrification and Telephone Revolving Fund established under section 301, for the purposes, in the amounts, and for the periods of time specified in subsection (a), as provided in advance in appropriations Acts.

    ‘(d) AVAILABILITY OF FUNDS FOR INSURED LOANS- Amounts made available for loans under section 305 are authorized to remain available until expended.’.

      (4) RULE OF INTERPRETATION- Section 309(a) of such Act (7 U.S.C. 939(a)) is amended by adding at the end the following: ‘The preceding sentence shall not be construed to make section 408(b)(2) or 412 applicable to this title.’.

      (5) MISCELLANEOUS AMENDMENTS-

        (A) Section 2 of such Act (7 U.S.C. 902) is amended--

          (i) by inserting ‘(a)’ before ‘The Administrator’;

          (ii) by striking ‘telephone service in rural areas, as hereinafter provided;’ and inserting ‘electric and telephone service in rural areas, as provided in this Act, and for the purpose of assisting electric borrowers to implement demand side management and energy conservation programs’; and

          (iii) by adding at the end the following:

    ‘(b) Not later than January 1, 1994, the Administrator shall issue interim regulations to implement the authority contained in subsection (a) to make loans for the purpose of assisting electric borrowers to implement demand side management and energy conservation programs. If such regulations are not issued by such date, the Administrator shall consider any demand side management program which is approved by a State agency to be eligible for such loans.’

        (B) Section 4 of such Act (7 U.S.C. 904) is amended by inserting ‘and for the furnishing and improving of electric service to persons in rural areas, including by assisting electric borrowers to implement demand side management and energy conservation programs’ after ‘central station service’.

        (C) Section 7 of such Act (7 U.S.C. 907) is amended--

          (i) by inserting ‘(a)’ before ‘The Administrator is’;

          (ii) by designating the 2nd undesignated paragraph as subsection (b); and

          (iii) by adding at the end the following:

    ‘(c) Section 306(b) of the Consolidated Farm and Rural Development Act shall apply to a borrower of a loan under this Act in the same manner in which such section applies to an association referred to in such section.’.

        (D) Section 13 of such Act (7 U.S.C. 913) is amended--

          (i) by inserting ‘, except as provided in section 203(b),’ before ‘shall be deemed to mean any area’; and

          (ii) by striking ‘city, village, or borough having a population in excess of fifteen hundred inhabitants’ and inserting ‘urban or urbanized area, as defined by the Bureau of the Census’.

        (E) Section 203(b) of such Act (7 U.S.C. 923(b)) is amended by striking ‘one thousand five hundred’ and inserting ‘5,000’.

        (F) Section 307 of such Act (7 U.S.C. 937) is amended by adding at the end the following: ‘The Administrator may not request any applicant for an electric loan under this Act to apply for and accept a loan in an amount exceeding 30 percent of the credit needs of the applicant.’.

        (G) Section 406 of such Act (7 U.S.C. 946) is amended by adding at the end the following:

    ‘(i) The Governor of the telephone bank may invest in obligations of the United States the amounts in the account in the Treasury of the United States numbered 12X8139 (known as ‘the RTB Equity Fund’).’.

        (H) Section 18 of such Act (7 U.S.C. 918) is amended--

          (i) by inserting ‘(a) NO CONSIDERATION OF BORROWER’S LEVEL OF GENERAL FUNDS- ’ before ‘The Administrator’; and

          (ii) by adding at the end the following:

    ‘(b) NO LOAN ORIGINATION FEES- The Administrator and the Governor of the telephone bank may not charge any fee or charge not expressly provided in this Act in connection with any loan under this Act.’.

        (I) Title III of such Act (7 U.S.C. 931-940d) is amended by inserting after section 306B the following:

‘SEC. 306C. ELIGIBILITY OF DISTRIBUTION BORROWERS FOR LOANS, LOAN GUARANTEES, AND LIEN ACCOMMODATIONS.

    ‘A distribution borrower not in default on the repayment of any loan made or guaranteed under this Act shall be eligible for a loan, loan guarantee, or lien accommodation under this title. For the purpose of determining such eligibility, a default by a borrower from which a distribution borrower purchases wholesale power shall not be considered a default by the distribution borrower.

‘SEC. 306D. ADMINISTRATIVE PROHIBITIONS APPLICABLE TO ELECTRIC BORROWERS.

    ‘The Administrator may not require prior approval of, impose any requirement, restriction, or prohibition with respect to the operations of, or deny or delay the granting of a lien accommodation to, any electric borrower under this Act whose net worth exceeds 110 percent of the outstanding principal balance on all loans made or guaranteed to the borrower by the Administrator.’.

    (b) EXPANDED ELIGIBILITY FOR LOANS FOR WATER AND WASTE DISPOSAL FACILITIES- Section 306(a)(1) of the Consolidated Farm and Rural Development Act (7 U.S.C. 1926(a)(1)) is amended by inserting after the 1st sentence the following: ‘The Secretary may also make loans to any borrower to whom a loan has been made under the Rural Electrification Act of 1936, for the conservation, development, use, and control of water, and the installation of drainage or waste disposal facilities, primarily serving farmers, ranchers, farm tenants, farm laborers, rural businesses, and other rural residents.’.

    (c) REGULATIONS- Not later than October 1, 1993, the Administrator of the Rural Development Administration shall issue interim final rules to implement the amendments made by this section.

SEC. 1202. REORGANIZATION OF RURAL DEVELOPMENT FUNCTIONS.

    (a) ADMINISTRATION OF RURAL ELECTRIFICATION ACT OF 1936 TRANSFERRED TO THE RURAL DEVELOPMENT ADMINISTRATION-

      (1) IN GENERAL- The Rural Electrification Act of 1936 (7 U.S.C. 901 et seq.) is amended by striking all after the enacting clause that precedes section 2 and inserting the following:

‘SECTION 1. SHORT TITLE; ADMINISTRATION OF ACT.

    ‘(a) SHORT TITLE- This Act may be cited as the ‘Rural Electrification Act of 1936’.

    ‘(b) ADMINISTRATION OF ACT- The Administrator of the Rural Development Administration (in this Act referred to as the ‘Administrator’) shall carry out this Act under the general direction and supervision of the Secretary of Agriculture.’.

      (2) CONFORMING AMENDMENTS-

        (A) Section 3(a) of such Act (7 U.S.C. 903(a)) is amended by striking ‘appointed pursuant to the provisions of this Act’.

        (B) Section 8 of such Act (7 U.S.C. 908) is amended--

          (i) by striking ‘authorized to be appointed by this Act’; and

          (ii) by striking ‘Rural Electrification Administration created by this Act’ and inserting ‘Rural Development Administration’.

        (C) Each of the following provisions of such Act is amended by striking ‘Rural Electrification Administration’ and inserting ‘Rural Development Administration’:

          (i) Section 306A(b) (7 U.S.C. 936a(b)).

          (ii) Section 403(b) (7 U.S.C. 943(b)).

          (iii) Section 404 (7 U.S.C. 944).

          (iv) Section 406(c) (7 U.S.C. 946(c)).

          (v) Section 410(a)(1) (7 U.S.C. 950(a)(1)).

    (b) OTHER FUNCTIONS OF THE RURAL ELECTRIFICATION ADMINISTRATION TRANSFERRED TO THE RURAL DEVELOPMENT ADMINISTRATION- Section 364 of the Consolidated Farm and Rural Development Act (7 U.S.C. 2006f) is amended by adding at the end the following:

    ‘(g) TRANSFER OF FUNCTIONS OF THE RURAL ELECTRIFICATION ADMINISTRATION TO THE RURAL DEVELOPMENT ADMINISTRATION-

      ‘(1) IN GENERAL- All rights, interests, obligations, and duties of the Administrator of the Rural Electrification Administration arising before the date of the enactment of this subsection, from any loan made, insured, or guaranteed by, or other action of, the Rural Electrification Administration shall be vested in the Administrator of the Rural Development Administration.

      ‘(2) REFERENCES- Any reference in any law, regulation, or order in effect immediately before the date of the enactment of this subsection to the Rural Electrification Administration or to the Administrator of the Rural Electrification Administration, is deemed to be a reference to the Rural Development Administration or to the Administrator of the Rural Development Administration, respectively.

      ‘(3) EFFECT ON PENDING PROCEEDINGS AND PARTIES TO SUCH PROCEEDINGS-

        ‘(A) NONABATEMENT OF PROCEEDINGS- This subsection shall not be construed to abate any proceeding commenced by or against the Rural Electrification Administration or the Administrator of the Rural Electrification Administration.

        ‘(B) EFFECT ON PARTIES- If an officer of the Rural Electrification Administration, in the official capacity of such officer, is a party to a proceeding pending on the date of the enactment of this subsection, then such action shall be continued with the Administrator, or other appropriate officer, of the Rural Development Administration substituted or added as a party.

      ‘(4) INCIDENTAL TRANSFERS- The Secretary shall transfer all personnel from the Rural Electrification Administration to the Rural Development Administration, and shall make such determinations as may be appropriate to carry out this subsection.’.

    (c) STRUCTURE OF THE RURAL DEVELOPMENT ADMINISTRATION- Such section 364 (7 U.S.C. 2006f), as amended by subsection (b) of this section, is amended by adding at the end the following:

    ‘(h) STRUCTURE OF THE RURAL DEVELOPMENT ADMINISTRATION-

      ‘(1) DEPUTY ADMINISTRATOR FOR RURAL UTILITIES- The Administrator of the Rural Development Administration shall appoint a Deputy Administrator for Rural Utilities who shall administer--

        ‘(A) the programs authorized by the Rural Electrification Act of 1936; and

        ‘(B) the rural water and waste disposal programs administered by the Rural Development Administration.

      ‘(2) ASSISTANT ADMINISTRATORS- The Administrator of the Rural Development Administration may appoint--

        ‘(A) an Assistant Administrator for the electric programs authorized by the Rural Electrification Act of 1936;

        ‘(B) an Assistant Administrator for the telephone programs authorized by such Act;

        ‘(C) an Assistant Administrator who shall be responsible for--

          ‘(i) rural utility technical engineering standards and specifications; and

          ‘(ii) other utility management and accounting functions assigned by the Administrator; and

        ‘(D) an Assistant Administrator for water and sewer programs.’.

    (d) RURAL ECONOMIC DEVELOPMENT-

      (1) IN GENERAL- Such section 364 (7 U.S.C. 2006f), as amended by subsections (b) and (c) of this section, is amended by adding at the end the following:

    ‘(i) RURAL ECONOMIC DEVELOPMENT- A borrower of a loan or loan guarantee under the Rural Electrification Act of 1936 shall be eligible for assistance under all programs administered by the Rural Development Administration, and the Administrator of the Rural Development Administration shall encourage and facilitate the full participation of such a borrower in such programs.

    ‘(j) TECHNICAL ASSISTANCE UNIT- The Administrator of the Rural Development Administration shall establish a technical assistance unit to provide to borrowers under the programs administered by the Rural Development Administration advice and guidance on community and economic development activities.’.

      (2) CONFORMING REPEAL- Section 11A of the Rural Electrification Act of 1936 (7 U.S.C. 911a) is hereby repealed.

    (e) REGULATIONS- Not later than January 1, 1994, the Administrator of the Rural Development Administration shall issue interim final rules to implement the amendments made by this section.

Subtitle C--Food Stamp Program

SEC. 1301. SHORT TITLE.

    This subtitle may be cited as the ‘Mickey Leland Childhood Hunger Relief Act’.

SEC. 1302. REFERENCES TO THE ACT.

    Except as otherwise provided in this subtitle, references in this subtitle to ‘the Act’ and sections of the Act shall be deemed to be references to the Food Stamp Act of 1977 (7 U.S.C. 2011 et seq.) and the sections of such Act.

CHAPTER 1--ENSURING ADEQUATE FOOD ASSISTANCE

SEC. 1311. MAXIMUM BENEFIT LEVEL.

    Section 3(o) of the Act (7 U.S.C. 2012(o)) is amended by striking ‘(4) through’ and all that follows through the end of the subsection, and inserting the following:

    ‘and (4) on October 1, 1993, and each October 1 thereafter, adjust the cost of such diet to reflect 104 percent of the cost of the thrifty food plan in the preceding June (without regard to adjustments made to such costs in any previous year), as determined by the Secretary, and round the result to the nearest lower dollar increment for each household size.’.

SEC. 1312. HELPING LOW-INCOME HIGH SCHOOL STUDENTS.

    Section 5(d)(7) of the Act (7 U.S.C. 2014(d)(7)) is amended by striking ‘who is a student, and who has not attained his eighteenth birthday’ and inserting ‘who is an elementary or secondary school student, and who is 21 years of age or younger’.

SEC. 1313. FAMILIES WITH HIGH SHELTER EXPENSES.

    (a) COMPUTATION- Section 5(e) of the Act (7 U.S.C. 2014(e)) is amended--

      (1) in the fourth sentence by striking ‘: Provided, That the amount’ and all that follows through ‘June 30’; and

      (2) in the fifth sentence by striking ‘under clause (2) of the preceding sentence’.

    (b) LIMITATIONS-

      (1) FISCAL YEAR 1994- Effective on the date of enactment of this Act, section 5(e) of the Act (7 U.S.C. 2014(e)) is amended by inserting after the fourth sentence the following:

    ‘In the 12-month period ending September 30, 1994, such excess shelter expense deduction shall not exceed $214 a month in the 48 contiguous States and the District of Columbia, and shall not exceed, in Alaska, Hawaii, Guam, and the Virgin Islands of the United States, $372, $305, $259, and $158 a month, respectively.’.

      (2) REMOVAL OF CAP- Effective October 1, 1994, section 5(e) of the Act (7 U.S.C. 2014(e)), as amended by paragraph (1), is amended by striking the fifth sentence.

SEC. 1314. RESOURCE EXCLUSION FOR EARNED INCOME TAX CREDITS.

    Section 5(g)(3) of the Act (7 U.S.C. 2014(g)(3)) is amended by adding at the end the following:

    ‘The Secretary shall also exclude from financial resources any earned income tax credits received by any member of the household for a period of 12 months from receipt if such member was participating in the food stamp program at the time the credits were received and participated in such program continuously during the twelve-month period.’.

SEC. 1315. HOMELESS FAMILIES IN TRANSITIONAL HOUSING.

    Section 5(k)(2)(F) of the Act (7 U.S.C. 2014(k)(2)(F)) is amended to read as follows:

      ‘(F) housing assistance payments made to a third party on behalf of the household residing in transitional housing for the homeless;’.

SEC. 1316. HOUSEHOLDS BENEFITING FROM GENERAL ASSISTANCE VENDOR PAYMENTS.

    Section 5(k)(1)(B) of the Act (7 U.S.C. 2014(k)(1)(B)) is amended by striking ‘living expenses’ and inserting ‘housing expenses, not including energy or utility-cost assistance,’.

SEC. 1317. CONTINUING BENEFITS TO ELIGIBLE HOUSEHOLDS.

    Section 8(c)(2)(B) of the Act (7 U.S.C. 2017(c)(2)(B)) is amended by inserting ‘of more than one month in’ after ‘following any period’.

SEC. 1318. IMPROVING THE NUTRITIONAL STATUS OF CHILDREN IN PUERTO RICO.

    Section 19(a)(1)(A) of the Act (7 U.S.C. 2028(a)(1)(A)) is amended by--

      (1) striking ‘$1,091,000,000’ and inserting ‘$1,111,000,000’; and

      (2) striking ‘$1,133,000,000’ and inserting ‘$1,158,000,000’.

CHAPTER 2--PROMOTING SELF SUFFICIENCY

SEC. 1321. INCOME EXCLUSION FOR EDUCATION ASSISTANCE.

    Section 5 of the Act (7 U.S.C. 2014) is amended by--

      (1) amending subsection (d)(3) to read as follows:

      ‘(3) all educational loans on which payment is deferred (including any loan origination fees or insurance premiums associated with such loans), grants, scholarships, fellowships, veterans’ educational benefits, and the like awarded to a household member enrolled at a recognized institution of post-secondary education, at a school for the handicapped, in a vocational education program, or in a program that provides for completion of a secondary school diploma or obtaining the equivalent thereof,’;

      (2) striking ‘, and no portion’ and all that follows through ‘for living expenses,’ in subsection (d)(5); and

      (3) striking subsection (k)(3).

SEC. 1322. CHILD SUPPORT PAYMENTS TO NON-HOUSEHOLD MEMBERS.

    Section 5(d)(6) of the Act (7 U.S.C. 2014(d)6)) is amended by striking the comma at the end and inserting the following--

    ‘: Provided, That child support payments made by a household member to or for a person who is not a member of the household shall be excluded from the income of the household of the person making such payments if such household member was legally obligated to make such payments: Provided further, That the Secretary is authorized to prescribe by regulation the method(s), which may include calculation on a retrospective basis, that State agencies may use to determine the amount of child support excluded,’.

SEC. 1323. CHILD SUPPORT EXCLUSION.

    Section 5 of the Act (7 U.S.C. 2014) is amended--

      (1) in subsection (d)(13)--

        (A) by striking ‘at the option’ and all that follows through ‘subsection (m),’ and inserting ‘(A)’; and

        (B) by adding at the end ‘or (B) the first $50 of any child support payment in the month received if such payment was made by the absent parent in the month when due,’; and

      (2) by striking subsection (m).

SEC. 1324. IMPROVING ACCESS TO EMPLOYMENT AND TRAINING ACTIVITIES.

    (a) DEPENDENT CARE DEDUCTION- Section 5(e) of the Act (7 U.S.C. 2014(e)) is amended in clause (1) of the fourth sentence by--

      (1) striking ‘$160 a month for each dependent’ and inserting ‘$200 a month for a dependent child under 2 years of age and $175 a month for any other dependent’; and

      (2) striking ‘, regardless of the dependent’s age,’.

    (b) REIMBURSEMENTS TO PARTICIPANTS IN EMPLOYMENT AND TRAINING PROGRAMS-

      (1) COSTS OTHER THAN COSTS OF DEPENDENT CARE- Section 6(d)(4)(I)(i)(I) of the Act (7 U.S.C. 2015(d)(4)(I)(i)(I)) is amended by striking ‘, except that’ and all that follows through ‘per month’ and inserting the following--

      ‘(which may include reimbursements for costs of any supportive services of the kinds provided or reimbursed under the State’s plan under part F of title IV of the Social Security Act (42 U.S.C. 681 et seq.)), except that State agencies may establish limits on reimbursements to participants for such costs, which limits may not be less than $25 per month’.

      (2) COSTS OF DEPENDENT CARE- Section 6(d)(4)(I)(i)(II) of the Act (7 U.S.C. 2015(d)(4)(I)(i)(II)) is amended to read as follows--

      ‘(II) the actual costs of such dependent care expenses that are determined by the State agency to be necessary for the participation of an individual in the program (other than an individual who is the caretaker relative of a dependent in a family receiving benefits under part A of title IV of the Social Security Act (42 U.S.C. 601 et seq.) in a local area where an employment, training, or education program under title IV of such Act is in operation, or was in operation, on the date of enactment of the Hunger Prevention Act of 1988) up to any limit set by the State agency (which limit shall not be less than the limit for the dependent care deduction under section 5(e)), but in no event shall such payment or reimbursements exceed the applicable local market rate as determined by procedures consistent with any such determination under the Social Security Act. Individuals subject to the program under this paragraph may not be required to participate if dependent costs exceed the limit established by the State agency under this subclause or other actual costs exceed any limit established under subclause (I).’.

    (c) CONFORMING AMENDMENTS- Section 16(h)(3) of the Act (7 U.S.C. 2025(h)(3)) is amended by--

      (1) striking ‘$25’ and all that follows through ‘dependent care costs)’, and inserting ‘the payment made under section 6(d)(4)(I)(i)(I) and subject to any limits the State has established under such section’; and

      (2) striking ‘representing $160 per month per dependent’ and inserting ‘equal to the payment made under section 6(d)(4)(I)(i)(II) but not more than the applicable local market rate,’.

SEC. 1325. VEHICLES NEEDED TO SEEK AND CONTINUE EMPLOYMENT AND FOR HOUSEHOLD TRANSPORTATION.

    Section 5(g)(2) of the Act (7 U.S.C. 2014(g)(2)) is amended by striking ‘$4,500’ and inserting the following:

    ‘a level set by the Secretary, which shall be $5,500 through September 30, 1994, and which shall be adjusted on each October 1 thereafter to reflect changes in the new car component of the Consumer Price Index for All Urban Consumers published by the Bureau of Labor Statistics for the 12-month period ending on June 30 preceding the date of such adjustment and rounded to the nearest $50’.

SEC. 1326. VEHICLES NECESSARY TO CARRY FUEL OR WATER.

    Section 5(g)(2) of the Act (7 U.S.C. 2014(g)(2)) is amended by adding at the end the following:

    ‘The Secretary shall exclude from financial resources the value of a vehicle that a household depends upon to carry fuel for heating or water for home use when such transported fuel or water is the primary source of fuel or water for the household.’.

SEC. 1327. DEMONSTRATION PROJECTS TESTING RESOURCE ACCUMULATION.

    Section 17 of the Act (7 U.S.C. 2026) is amended by adding at the end the following:

    ‘(k) The Secretary may conduct, under such terms and conditions as the Secretary may prescribe, for a period not to exceed 4 years, demonstration projects to test allowing eligible households to accumulate resources up to $10,000 for later expenditure for a purpose directly related to improving the education, training, or employability (including self employment) of household members, for the purchase of a home for the household, for a change of the household’s residence, or for making major repairs to the household’s home. The Secretary is authorized to pay up to $100,000,000 in food stamp benefits to households participating in such demonstration projects during the period in which such projects are in operation.’.

CHAPTER 3--SIMPLIFYING THE PROVISION OF FOOD ASSISTANCE

SEC. 1331. SIMPLIFYING THE HOUSEHOLD DEFINITION FOR HOUSEHOLDS WITH CHILDREN AND OTHERS.

    Section 3(i) of the Act (7 U.S.C. 2012(i)) is amended--

      (1) in the first sentence--

        (A) by striking ‘(2)’ and inserting ‘or (2)’;

        (B) by striking ‘, or (3) a parent of minor children and that parent’s children’ and all that follows through ‘parents and children, or siblings, who live together’, and inserting the following:

      ‘. Spouses who live together, parents and their children 21 years of age or younger (who are not themselves parents living with their children or married living with their spouses) who live together, and children (excluding foster children) under 18 years of age who live with and are under the parental control of a person other than their parent together with the person exercising parental control’; and

        (C) striking ‘, unless one of ’ and all that follows through ‘disabled member’; and

      (2) in the second sentence by striking ‘clause (1) of the preceding sentence’ and inserting ‘the preceding sentences’.

SEC. 1332. ELIGIBILITY OF CHILDREN OF PARENTS PARTICIPATING IN DRUG OR ALCOHOL ABUSE TREATMENT PROGRAMS.

    Section 3 of the Act (7 U.S.C. 2012) is amended--

      (1) in the last sentence of subsection (i) by inserting ‘, together with their children,’ after ‘narcotics addicts or alcoholics’; and

      (2) in subsection (g)(5) by inserting ‘, and their children,’ after ‘or alcoholics’.

SEC. 1333. RESOURCES OF HOUSEHOLDS WITH DISABLED MEMBERS.

    Section 5(g)(1) of the Act (7 U.S.C. 2014(g)(1)) is amended by striking ‘a member who is 60 years of age or older,’ and inserting ‘an elderly or disabled member,’.

SEC. 1334. ENSURING ADEQUATE FUNDING FOR THE FOOD STAMP PROGRAM.

    Section 18 of the Act (7 U.S.C. 2027) is amended by--

      (1) striking the third and fourth sentences of subsection (a)(1) and inserting the following--

    ‘The Secretary shall, once every 3 months, submit a report to the Committee on Agriculture of the House of Representatives and to the Committee on Agriculture, Forestry, and Nutrition of the Senate setting forth the Secretary’s best estimate of the preceding quarter’s expenditure, including administrative costs, as well as the cumulative totals for the fiscal year. In each quarterly report, the Secretary shall also state whether there is reason to believe that supplemental appropriations will be needed to support the operation of the program through the end of the fiscal year.’; and

      (2) striking subsections (b), (c), and (d) and redesignating subsections (e) and (f) as subsections (b) and (c), respectively.

CHAPTER 4--IMPROVING PROGRAM INTEGRITY

SEC. 1341. USE AND DISCLOSURE OF INFORMATION PROVIDED BY RETAIL FOOD STORES AND WHOLESALE FOOD CONCERNS.

    Section 9(c) of the Act (7 U.S.C. 2018(c)) is amended--

      (1) in the second sentence by inserting after ‘disclosed to and used by’ the following:

    ‘State and Federal law enforcement and investigative agencies for the purposes of administering or enforcing the provisions of this Act or any other Federal or State law and the regulations issued under this Act or such law, and’;

      (2) by inserting after the second sentence the following:

    ‘An officer or employee of an agency described in the preceding sentence who publishes, divulges, discloses, or makes known in any manner or to any extent not authorized by Federal law any information obtained under the authority granted by this subsection shall be subject to section 1905 of title 18 of the United States Code.’; and

      (3) in the last sentence by striking ‘Such purposes shall not exclude’ and inserting the following--

    ‘Such regulations shall establish the criteria to be used by the Secretary to determine that such information is needed. Such regulations shall not prohibit’.

SEC. 1342. ADDITIONAL MEANS OF CLAIMS COLLECTION.

    (a) SAFEGUARDS- Section 11(e)(8) of the Act (7 U.S.C. 2020(e)(8)) is amended by--

      (1) striking ‘and (B)’ and inserting ‘(B)’; and

      (2) striking the semi-colon at the end and inserting the following:

      ‘, and (C) such safeguards shall not prevent the use by, or disclosure of such information, to agencies of the Federal Government (including the United States Postal Service) for purposes of collecting the amount of an overissuance of coupons, as determined under section 13(b) of this Act and excluding claims arising from an error of the State agency, that has not been recovered pursuant to such section, from refunds of Federal taxes as authorized pursuant to section 3720A of title 31 of the United States Code, or from Federal pay (including salaries and pensions) as authorized pursuant to section 5514 of title 5 of the United States Code;’.

    (b) RECOVERY- Section 13 of the Act (7 U.S.C. 2022) is amended by adding the following:

    ‘(d) The amount of an overissuance of coupons (as determined under subsection (b) and except for claims arising from an error of the State agency) that has not been recovered pursuant to such subsection may be recovered from refunds of Federal taxes, as authorized pursuant to section 3720A of title 31 of the United States Code, or from Federal pay (including salaries and pensions) as authorized by section 5514 of title 5 of the United States Code.’.

SEC. 1343. DEMONSTRATION PROJECTS TESTING ACTIVITIES DIRECTED AT STREET TRAFFICKING IN COUPONS.

    Section 17 of the Act (7 U.S.C. 2026) is amended by adding a new subsection (l) at the end thereof as follows--

    ‘(l) The Secretary may use up to $4 million of funds provided in advance in appropriations Acts for projects authorized by this section in Fiscal Year 1994 to conduct projects in which State or local food stamp agencies test innovative ideas for working with State or local law enforcement agencies to investigate and prosecute coupon street trafficking by recipients, buyers, and authorized retail stores.’.

CHAPTER 5--IMPROVING FOOD STAMP PROGRAM MANAGEMENT

SEC. 1351. CLARIFICATION OF CATEGORICAL ELIGIBILITY.

    Effective on the date of enactment of this Act, section 5 of the Act (7 U.S.C. 2014) is amended by--

      (1) striking ‘and the third sentence of section 3(i)’ each place it appears in subsection (a) and inserting the ‘, the third sentence of section 3(i), and section 20(f)’; and

      (2) striking ‘II,’ in subsection (j).

SEC. 1352. TECHNICAL AMENDMENTS RELATED TO ELECTRONIC BENEFIT TRANSFER.

    (a) ELIGIBILITY DISQUALIFICATION OF INDIVIDUALS- Section 6(b)(1)(B) of the Act (7 U.S.C. 2015(b)(1)(B)) is amended by striking ‘or authorization cards’ and inserting ‘, authorization cards, or access devices’.

    (b) ELIGIBILITY DISQUALIFICATION OF RETAIL FOOD STORES AND WHOLESALE FOOD CONCERNS- Section 12(b)(3)(B) of the Act (7 U.S.C. 2021(b)(3)(B)) is amended by--

      (1) striking ‘or authorization cards’ and inserting ‘, authorization cards, or access devices’; and

      (2) striking ‘or cards’ and inserting ‘, cards, or devices’.

SEC. 1353. DISQUALIFICATION OF RECIPIENTS FOR TRADING FIREARMS, AMMUNITION, EXPLOSIVES, OR CONTROLLED SUBSTANCES FOR COUPONS.

    Section 6(b)(1) of the Act (7 U.S.C. 2015(b)(1)) is amended by striking subdivisions (ii) and (iii) and inserting the following:

      ‘(ii) for a period of 1 year upon--

        ‘(I) the second occasion of any such determination; or

        ‘(II) the first occasion of a finding of the trading of a controlled substance (as defined in section 102 of the Controlled Substances Act (21 U.S.C. 802)); and

      ‘(iii) permanently upon--

        ‘(I) the third occasion of any such determination;

        ‘(II) the second occasion of a finding of the trading of a controlled substance (as defined in section 102 of the Controlled Substances Act (21 U.S.C. 802)) for coupons; or

        ‘(III) the first occasion of a finding of the trading of firearms, ammunition, or explosives for coupons.’.

SEC. 1354. UNCAPPED CIVIL MONEY PENALTY FOR TRAFFICKING IN COUPONS.

    Effective on the date of enactment of this Act, section 12(b)(3)(B) of the Act (7 U.S.C. 2021(b)(3)(B)) is amended by striking ‘(except’ and all that follows through ‘) in’, and inserting ‘in’.

SEC. 1355. UNCAPPED CIVIL MONEY PENALTY FOR SELLING FIREARMS, AMMUNITION, EXPLOSIVES, OR CONTROLLED SUBSTANCES FOR COUPONS.

    Effective on the date of enactment of this Act, section 12(b)(3)(C) of the Act (7 U.S.C. 2021(b)(3)(C)) is amended--

      (1) by striking ‘substances (as the term is’ and inserting ‘substance (as’; and

      (2) by striking ‘(except’ and all that follows through ‘) in’, and inserting ‘in’.

SEC. 1356. MODIFYING THE FOOD STAMP QUALITY CONTROL SYSTEM.

    (a) AMENDMENTS- Section 16(c) of the Act (7 U.S.C. 2025(c)) is amended--

      (1) in paragraph (1)(C)--

        (A) by striking ‘payment error tolerance level’ and inserting ‘national performance measure’; and

        (B) by striking ‘equal to’ and all that follows through the period at the end, and inserting the following:

      ‘equal to--

        ‘(i) the product of--

          ‘(I) the value of all allotments issued by the State agency in the fiscal year; times

          ‘(II) the lesser of--

            ‘(aa) the ratio of--

‘(1) the amount by which the State agency’s payment error rate for the fiscal year exceeds the national performance measure for the fiscal year, to

‘(2) the national performance measure for the fiscal year; or

            ‘(bb) one; times

          ‘(III) the amount by which the State agency’s payment error rate for the fiscal year exceeds the national performance measure for the fiscal year.

        ‘(ii) The amount of liability shall not be affected by corrective action under subparagraph (B).’;

      (2) in paragraph (3)(A) by striking ‘60 days (or 90 days at the discretion of the Secretary)’ and inserting ‘120 days’; and

      (3) in paragraph (6) by striking ‘shall be used’ and all that follows through ‘level’ the last place it appears.

    (b) STUDY BY THE OFFICE OF TECHNOLOGY ASSESSMENT- The Office of Technology Assessment shall undertake a study of measurement error, any bias in penalty amounts, extreme value bias, regression formula, and of geographical and temporal uniformity of measurements, in the food stamp program quality control system, and shall report the results and recommendations of such study to the Committee on Agriculture of the House of Representatives and the Committee on Agriculture, Nutrition, and Forestry of the Senate not later than 12 months after the date of enactment of this Act.

    (c) STUDY BY THE SECRETARY OF AGRICULTURE- The Secretary of Agriculture shall conduct a study of major causal factors which contribute to the payment error rate. The Secretary shall also conduct controlled experiments under which various reviewers review identical cases, with the objective of determining the degree of uniformity in quality control error-rate measurements and the extent to which different levels of investment of resources in the review process affect measurement error. The Secretary shall report the results and recommendations (including recommendations as to what measures would best reduce measurement error and increase uniformity of quality control error-rate measurements at reasonable cost) of such study to the Committee on Agriculture of the House of Representatives and the Committee on Agriculture, Nutrition, and Forestry of the Senate not later than 2 years after the date of enactment of this Act.

CHAPTER 6--UNIFORM REIMBURSEMENT RATES

SEC. 1361. UNIFORM REIMBURSEMENT RATES.

    (a) AMENDMENTS- Section 16 of the Act (7 U.S.C. 2025) is amended--

      (1) in subsection (a)--

        (A) by striking ‘and (5)’ and inserting ‘(5)’;

        (B) by inserting before the colon the following--

      ‘, (6) automated data processing and information retrieval systems subject to the conditions set forth in subsection (g), (7) food stamp program investigations and prosecutions, and (8) implementing and operating the immigration status verification system under section 1137(d) of the Social Security Act (42 U.S.C. 1320b-7(d))’; and

        (C) in the proviso by inserting after ‘75 per centum’ the following:

      ‘through June 30, 1994, 70 percent for the 1-year period beginning July 1, 1994, 60 percent for the 1-year period beginning July 1, 1995, and 50 percent for any subsequent period,’;

      (2) in subsection (g)--

        (A) by inserting ‘through June 30, 1995, equal to 60 percent for the 1-year period beginning July 1, 1995, and 50 percent effective July 1, 1996,’ after ‘1991,’; and

        (B) by striking ‘automatic’ and inserting ‘automated’; and

      (3) in subsection (j) by inserting after ‘100 per centum’ the following:

    ‘through June 30, 1994, 70 percent for the 1-year period beginning July 1, 1994, 60 percent for the 1-year period beginning July 1, 1995, and 50 percent for any subsequent period,’.

    (b) APPLICATION OF AMENDMENTS- The reductions in enhanced Federal match rates for administration resulting from the amendments made by subsection (a) shall apply to payments to States for expenditures incurred only after--

      (1) the end of the State fiscal year that ends during 1994; or

      (2) in the case of a State with a State legislature which is not scheduled to have a regular legislative session in 1994, the end of the State fiscal year that ends during 1995;

    without regard to whether or not final regulations tocarry out such amendments have been promulgatedby the Secretary before the end of either of suchState fiscal years.

CHAPTER 7--IMPLEMENTATION AND EFFECTIVE DATES

SEC. 1371. IMPLEMENTATION AND EFFECTIVE DATES.

    (a) GENERAL EFFECTIVE DATE AND IMPLEMENTATION- Except as otherwise provided in this subtitle, this subtitle and the amendments made by this subtitle shall take effect, and shall be implemented beginning on, October 1, 1993.

    (b) SPECIAL EFFECTIVE DATES AND IMPLEMENTATION- (1) Sections 1312, 1315, 1316, 1317, 1322, 1323, 1326, 1331, 1333, and 1353 and the amendments made by such sections shall take effect, and shall be implemented beginning on, July 1, 1994.

    (2) Paragraphs (1) and (3) of section 1356(a) and the amendments made by such paragraphs shall take effect, and shall be implemented beginning on, October 1, 1991.

    (3) Paragraph (2) of section 1356(a) and the amendment made by such paragraph shall take effect, and shall be implemented beginning on, October 1, 1992.

Subtitle D--Miscellaneous Provisions

SEC. 1401. MAXIMUM EXPENDITURES UNDER MARKET PROMOTION PROGRAM FOR FISCAL YEARS 1994 THROUGH 1998.

    (a) LIMITATION- Section 211(c)(1) of the Agricultural Trade Act of 1978 (7 U.S.C. 5641(c)) is amended by striking ‘not less than $200,000,000 for each of the fiscal years 1991 through 1995’ and inserting ‘an amount equal to $147,734,000 for each of the fiscal years 1991 through 1998’.

    (b) APPLICATION OF AMENDMENTS- The amendment made by this section shall apply with respect to fiscal years beginning after September 30, 1993.

SEC. 1402. ADMISSION, ENTRANCE, AND RECREATION FEES.

    (a) AUTHORITY TO IMPOSE FEES-

      (1) ENTRANCE AND ADMISSION FEES- The Secretary of Agriculture may charge admission or entrance fees at National Monuments, National Volcanic Monuments, National Scenic Areas, and areas of concentrated public use administered by the Secretary.

      (2) RECREATION USE FEES- The Secretary may charge recreation use fees at lands administered by the Secretary in connection with the use of specialized outdoor recreation sites, equipment, services, or facilities, including visitors’ centers, picnic tables, boat launching facilities, or campgrounds.

    (b) AMOUNT OF FEES- The amount of the admission, entrance, and recreation fees authorized to be imposed under this section shall be determined by the Secretary.

    (c) DEFINITIONS- For purposes of this section:

      (1) The term ‘area of concentrated public use’ means an area administered by the Secretary that meets each of the following criteria:

        (A) The area is managed primarily for outdoor recreation purposes.

        (B) Facilities and services necessary to accommodate heavy public use are provided in the area.

        (C) The area contains at least one major recreation attraction.

        (D) Public access to the area is provided in such a manner that admission fees can be efficiently collected at one or more centralized locations.

      (2) The term ‘boat launching facility’ includes any boat launching facility regardless of whether specialized facilities or services, such as mechanical or hydraulic boat lifts or facilities, are provided.

      (3) The term ‘campground’ means any campground where a majority of the following amenities are provided, as determined by the Secretary:

        (A) Tent or trailer spaces.

        (B) Drinking water.

        (C) An access road.

        (D) Refuse containers.

        (E) Toilet facilities.

        (F) The personal collection of recreation use fees by an employee or agent of the Secretary.

        (G) Reasonable visitor protection.

        (H) If campfires are permitted in the campground, simple devices for containing the fires.

      (4) The term ‘Secretary’ means the Secretary of Agriculture.

SEC. 1403. ADDITIONAL PROGRAM CHANGES TO MEET RECONCILIATION REQUIREMENTS.

    The Secretary of Agriculture shall consolidate personnel and field, regional, and national offices of agencies within the Department of Agriculture in order to reduce personnel and duplicative overhead expenses as a result of the consolidation such that Department expenditures are reduced by--

      (1) $90,000,000 in fiscal year 1995;

      (2) $97,000,000 in fiscal year 1996;

      (3) $135,000,000 in fiscal year 1997; and

      (4) $178,000,000 in fiscal year 1998.

SEC. 1404. ENVIRONMENTAL CONSERVATION ACREAGE RESERVE PROGRAM AMENDMENTS.

    (a) ENROLLMENT REQUIREMENT-

      (1) CONSERVATION RESERVE PROGRAM-

        (A) IN GENERAL- Section 1231(d) of the Food Security Act of 1985 (16 U.S.C. 3831(d)) is amended--

          (i) by striking ‘the amount of acres specified in section 1230(b)’ and inserting ‘a total of not more than 38,000,000 acres during the 1986 through 1995 calendar years’; and

          (ii) by striking ‘each of calendar years 1994 and 1995’ and inserting ‘the 1995 calendar year’.

        (B) CONFORMING AMENDMENT- Section 1230(b) of such Act (16 U.S.C. 3830(b)) is amended by striking ‘to place in’ and all that follows through ‘acres’.

      (2) WETLANDS RESERVE PROGRAM-

        (A) IN GENERAL- Section 1237(b) of such Act (16 U.S.C. 3837(b)) is amended to read as follows:

    ‘(b) MINIMUM ENROLLMENT- The Secretary shall enroll into the wetlands reserve program--

      ‘(1) a total of not less than 330,000 acres by the end of the 1995 calendar year; and

      ‘(2) a total of not less than 975,000 acres during the 1991 through 2000 calendar years.’.

        (B) CONFORMING AMENDMENT- Section 1237(c) of such Act (16 U.S.C. 3837(c)) is amended by striking ‘1995’ and inserting ‘2000’.

    (b) USE OF COMMODITY CREDIT CORPORATION- Section 1241 of such Act (16 U.S.C. 3841) is amended--

      (1) in subsection (a)--

        (A) by striking ‘(a)(1) During each of the fiscal years ending September 30, 1986, and September 30, 1987’ and inserting ‘(a) During each of the fiscal years 1994 through 2000’; and

        (B) by striking paragraph (2); and

      (2) in subsection (b), by striking ‘(A) through (E)’ and inserting ‘A through E’.

SEC. 1405. LEVELS OF INSURANCE COVERAGE UNDER THE FEDERAL CROP INSURANCE ACT.

    (a) CONVERSION OF PROGRAM TO FOUR LEVELS OF COVERAGE- The Federal Crop Insurance Act is amended--

      (1) in subsection (a) of section 508 (7 U.S.C. 1508)--

        (A) in the first sentence, by striking ‘If sufficient actuarial data are available, as determined by the Board,’ and inserting ‘Subject to section 508B, based on the actuarial and underwriting data available to the Board,’; and

        (B) by striking the fifth, sixth, seventh, eighth, ninth, tenth, fourteenth, fifteenth, and sixteenth sentences; and

      (2) by inserting after section 508A (7 U.S.C. 1508a) the following new section:

‘SEC. 508B. FOUR LEVELS OF CROP INSURANCE COVERAGE.

    ‘(a) FOUR LEVELS OF COVERAGE- In making crop insurance available under section 508 to producers of agricultural commodities grown in the United States, the Corporation shall make available four levels of insurance coverage against losses in yields of the insured commodity:

      ‘(1) LEVEL I- Coverage level I shall be available only to those producers who do not purchase insurance at coverage levels II, III, or IV and shall provide for the indemnification of those producers for losses in yield to the extent that such losses exceed 65 percent of the determined yield of the commodity for the farm, as established under subsection (b).

      ‘(2) LEVELS II, III, AND IV- Coverage levels II, III, and IV shall provide for the indemnification of producers for those losses in yield to the extent that such losses exceed 50, 35, and 25 percent, respectively, of--

        ‘(A) the average proven yield on the farm for a representative period based on the actual production history of the farm, as determined from the producer’s records; or

        ‘(B) if such records are not available or are insufficient, the recorded or appraised average yield of the commodity on the farm for a representative period, subject to such adjustments as the Board may prescribe to ensure that the average yield for farms in the same area, which are subject to the same conditions, are fair and just.

    ‘(b) DETERMINED YIELD- For purposes of subsection (a)(1), the determined yield for a commodity shall be equal to--

      ‘(1) in the case of a crop of any commodity for which the Agricultural Stabilization and Conservation Service establishes a yield for the farm, the yield so established; and

      ‘(2) in the case of a crop of any other commodity, the recorded or appraised average yield of the commodity on the farm for a representative period, subject to such adjustments as the Board may prescribe to ensure that the average yield for farms in the same area, which are subject to the same conditions, are fair and just.

    ‘(c) USE OF ASCS YIELD- If the Agricultural Stabilization and Conservation Service has established a yield for a crop of a commodity for a farm and such yield is higher than the yield determined for the farm under subsection (a)(2) for coverage levels II, III, or IV, the producer may elect to use such higher yield for purpose of coverage levels II, III, and IV. Use of such higher yield shall be subject to an additional premium for the coverage at such a rate as the Board determines appropriate to accurately reflect the increased risk involved and that the Board determines to be actuarially sufficient to cover claims for losses on such insurance and to establish a reasonable reserve against unforeseen losses. No premium subsidy or administrative subsidy may be provided by the Corporation in connection with any additional coverage provided under this subsection.

    ‘(d) PRICE ELECTIONS- The Corporation shall establish a high and low price election for each agricultural commodity for which insurance is available under this title. The high price shall not be less than the projected market price of the commodity. Coverage levels II, III, and IV shall be available to producers at any price election that is equal to or less than the high price election and shall be quoted in terms of dollars per acre coverage that may be purchased. Coverage level I shall be offered only at the low price election.

    ‘(e) COVERAGE AND PRICE INFORMATION- The Corporation shall ensure that each producer is provided accurate and adequate information at the time of application regarding the amount of coverage available at each level of coverage for the commodity to be insured and the cost to the producer for such coverage.

    ‘(f) ANNUAL REPORT- The Corporation shall report annually to the Congress the results of its operations regarding each commodity for which insurance is available under this title. The report shall include for each insured commodity a description of operations under this section at each level of coverage.’.

    (b) PREMIUM PAYMENT- Subsection (e)(3) of section 508 of the Federal Crop Insurance Act (7 U.S.C. 1508) is amended to read as follows:

    ‘(3) For the purpose of encouraging the broadest possible participation in the crop insurance program, the Corporation shall pay--

      ‘(A) with respect to each policy providing for coverage level I, the full amount of the premium for such coverage; and

      ‘(B) with respect to each policy providing for coverage level II, III, or IV, the portion of the premium that is equal to the amount that would have been paid under subparagraph (A) if the producer had elected coverage level I.’.

    (c) REINSURANCE- Subsection (h) of section 508 of the Federal Crop Insurance Act (7 U.S.C. 1508) is amended to read as follows:

    ‘(h) REINSURANCE- The Corporation shall provide reinsurance, to the maximum extent practicable, upon such terms and conditions as the Board may determine to be consistent with subsections (a) and (b) and with sound reinsurance principles promulgated pursuant to the Office of Federal Procurement Policy Act (41 U.S.C. 401, et seq.), which the Board shall modify as necessary to conform to the purposes of this Act, taking into account the expenses of the Corporation paid on its own policies of insurance. Reinsurance shall be provided to insurers including private insurance companies or pools of such companies, reinsurers of such companies, or State or local governmental entities, including any political subdivisions thereof, that insure producers of any agricultural commodity under a plan or plans acceptable to the Corporation. However, in the case of the sale of coverage level I policies only (but not for the processing and adjustment of claims on those policies), contractors of the Corporation shall be paid only $50 per policy, of which $25.50 shall be paid by the policyholder at the time of application and $24.50 shall be paid by the Corporation. Whenever the Corporation provides reinsurance under this subsection to any such insurers, the Corporation shall pay (as provided in subsection (e)) the portion of the producer’s premium for such insurance so reinsured. Insurers of policies on which reinsurance is provided shall make use of licensed private insurance agents and brokers on the same basis as provided for policies of the Corporation under section 507(c)(3) of this title, except that the provisions for compensating agents and brokers from premiums paid by the insured shall not apply. The Corporation shall periodically revise its reinsurance agreement with the reinsured companies to provide for the reinsured companies to bear an increased share of any potential loss under such agreement, in cases in which the financial conditions of the reinsured companies and the availability of private reinsurance so permits.’.

    (d) APPLICATION OF AMENDMENTS- The amendments made by this section shall apply beginning with crops to be harvested in 1995.

TITLE II--COMMITTEE ON ARMED SERVICES

SEC. 2001. LIMITATION ON COST-OF-LIVING ADJUSTMENTS FOR MILITARY RETIREES.

    Paragraph (2) of section 1401a(b) of title 10, United States Code, is amended to read as follows:

      ‘(2) PRE-AUGUST 1, 1986 MEMBERS-

        ‘(A) GENERAL RULE- The Secretary shall increase the retired pay of each member and former member who first became a member of a uniformed service before August 1, 1986, by the percent (adjusted to the nearest one-tenth of 1 percent) by which--

          ‘(i) the price index for the base quarter of that year, exceeds

          ‘(ii) the base index.

        ‘(B) SPECIAL RULE FOR FISCAL YEARS 1994 THROUGH 1998- In the case of the increases in retired pay that, pursuant to paragraph (1), become effective on December 1 of each of fiscal years 1994, 1995, 1996, 1997, and 1998, the initial month for which each such increase is payable as part of such retired pay shall (notwithstanding such December 1 effective date) be as set forth in the following table:

--First month for which

‘Fiscal year:

--increase is payable:

1994

--April 1994.

1995

--July 1995.

1996

--October 1996.

1997

--January 1998.

1998

--April 1999.

        ‘(C) EXCLUSION OF DISABILITY RETIREES FROM ROLLING COLA- Subparagraph (B) does not apply with respect to the retired pay of a member retired under chapter 61 of this title.’.

SEC. 2002. ELIMINATION OF MILITARY PAY RAISE FOR FISCAL YEAR 1994 AND REDUCTION IN THE AMOUNT OF THE RAISE FOR FISCAL YEARS 1995 THROUGH 1998.

    (a) FISCAL YEAR 1994- During fiscal year 1994, no increase in the rates of basic pay, basic allowance for quarters, or basic allowance for subsistence of members of the uniformed services shall be made or take effect pursuant to section 1009 of title 37, United States Code.

    (b) ONE PERCENT REDUCTION IN SUBSEQUENT FISCAL YEARS- If the General Schedule of compensation for Federal classified employees is increased under section 5303 of title 5, United States Code, as amended by title X of this Act, during fiscal year 1995, 1996, 1997, or 1998, the elements of compensation of members of the uniformed services shall likewise be increased during that fiscal year in the manner provided in section 1009 of title 37, United States Code, based on the corresponding increase under section 5303 of title 5, United States Code (as so amended).

TITLE III--COMMITTEE ON BANKING, FINANCE AND URBAN AFFAIRS

SEC. 3001. NATIONAL DEPOSITOR PREFERENCE.

    (a) IN GENERAL- Section 11(d)(11) of the Federal Deposit Insurance Act (12 U.S.C. 1821(d)(11)) is amended to read as follows:

      ‘(11) Depositor preference-

        ‘(A) IN GENERAL- Subject to section 5(e)(2)(C), amounts realized from the liquidation or other resolution of any insured depository institution by any receiver appointed for such institution shall be distributed to pay claims (other than secured claims to the extent of any such security) in the following order of priority:

          ‘(i) Administrative expenses of the receiver.

          ‘(ii) Any deposit liability of the institution.

          ‘(iii) Any claim of an employee of the institution, other than a senior executive officer (as defined by the Corporation pursuant to section 32(f)), for pay accrued but unpaid as of the date the receiver was appointed for the institution.

          ‘(iv) Any other general or senior liability of the institution (which is not a liability described in clause (v) or (vi)).

          ‘(v) Any obligation subordinated to depositors or other general creditors (which is not an obligation described in clause (vi)).

          ‘(vi) Any obligation to shareholders arising as a result of their status as shareholders (including any depository institution holding company or any shareholder or creditor of such company).

        ‘(B) Effect on state law-

          ‘(i) IN GENERAL- The provisions of subparagraph (A) shall not supersede the law of any State except to the extent such law is inconsistent with the provisions of such subparagraph, and then only to the extent of the inconsistency.

          ‘(ii) PROCEDURE FOR DETERMINATION OF INCONSISTENCY- Upon the Corporation’s own motion or upon the request of any person with a claim described in subparagraph (A)(i) or any State which is submitted to the Corporation in accordance with procedures which the Corporation shall prescribe, the Corporation shall determine whether any provision of the law of any State is inconsistent with any provision of subparagraph (A) and the extent of any such inconsistency.

          ‘(iii) JUDICIAL REVIEW- The final determination of the Corporation under clause (ii) shall be subject to judicial review under chapter 7 of title 5, United States Code.

        ‘(C) ACCOUNTING REPORT- Any distribution by the Corporation in connection with any claim described in subparagraph (A)(vi) shall be accompanied by the accounting report required under paragraph (15)(B).’.

    (b) Technical and Conforming Amendments-

      (1) Section 11(c)(13) of the Federal Deposit Insurance Act (12 U.S.C. 1821(c)(13)) is amended--

        (A) in subparagraph (A), by striking ‘subject to subparagraph (B),’;

        (B) in inserting ‘and’ after the semicolon at the end of subparagraph (A);

        (C) by striking subparagraph (B); and

        (D) by redesignating subparagraph (C) as subparagraph (B).

      (2) Section 11(g)(4) of the Federal Deposit Insurance Act (12 U.S.C. 1921(g)(4)) is amended by striking ‘If the Corporation’ and inserting ‘Subject to subsection (d)(11), if the Corporation’.

    (c) EFFECTIVE DATE- The amendments made by this section shall apply with respect to insured depository institutions for which a receiver is appointed after the date of the enactment of this Act.

SEC. 3002. TRANSFER OF FEDERAL RESERVE SURPLUSES.

    (a) IN GENERAL- The 1st undesignated paragraph of section 7 of the Federal Reserve Act (12 U.S.C. 289) is amended to read as follows:

    ‘(a) Dividends and Surplus Funds of Reserve Banks-

      ‘(1) Stockholder dividends-

        ‘(A) IN GENERAL- After all necessary expenses of a Federal reserve bank have been paid or provided for, the stockholders of the bank shall be entitled to receive an annual dividend of 6 percent on paid-in capital stock.

        ‘(B) DIVIDEND CUMULATIVE- The entitlement to dividends under subparagraph shall be cumulative.

      ‘(2) DEPOSIT OF NET EARNINGS IN SURPLUS FUND- That portion of net earnings of each Federal reserve bank which remains after dividend claims under subparagraph (A) have been fully met shall be deposited in the surplus fund of the bank.

      ‘(3) PAYMENT TO TREASURY- During fiscal years 1994 through 1998, any amount in the surplus fund of any Federal reserve bank in the excess of the amount equal to 3 percent of the total paid-in capital and surplus of the member banks of such bank shall be transferred to the Board for transfer to the Secretary of the Treasury for deposit in the general fund of the Treasury.’.

    (b) ADDITIONAL TRANSFERS FOR FISCAL YEARS 1997 AND 1998-

      (1) IN GENERAL- In addition to the amounts required to be transferred from the surplus funds of the Federal reserve banks pursuant to section 7(a)(3) of the Federal Reserve Act, the Federal reserve banks shall transfer from such surplus funds to the Board of Governors of the Federal Reserve System for transfer to the Secretary of the Treasury for deposit in the general fund of the Treasury, a total amount of $106,000,000 in fiscal year 1997 and a total amount of $107,000,000 in fiscal year 1998.

      (2) ALLOCATION BY FED- Of the total amount required to be paid by the Federal reserve banks under paragraph (1) for fiscal year 1997 or 1998, the Board of Governors of the Federal Reserve System shall determine the amount each such bank shall pay in such fiscal year.

      (3) REPLENISHMENT OF SURPLUS FUND PROHIBITED- No Federal reserve bank may replenish such bank’s surplus fund by the amount of any transfer by such bank under paragraph (1) during the fiscal year for which such transfer is made.

    (c) TECHNICAL AND CONFORMING AMENDMENTS-

      (1) The penultimate undesignated paragraph of section 7 of the Federal Reserve Act (12 U.S.C. 290) is amended by striking ‘The net earnings derived’ and inserting ‘(b) USE OF EARNINGS TRANSFERRED TO THE TREASURY- The net earnings derived’.

      (2) The last undesignated paragraph of section 7 of the Federal Reserve Act (12 U.S.C. 531) is amended by striking ‘Federal reserve banks’ and inserting ‘(c) EXEMPTION FROM TAXATION- Federal reserve banks’.

SEC. 3003. USE OF RETURN DATA FOR INCOME VERIFICATION UNDER CERTAIN HOUSING ASSISTANCE PROGRAMS.

    Section 904 of the Stewart B. McKinney Homeless Assistance Amendments Act of 1988 (42 U.S.C. 3544) is amended as follows:

      (1) CONSENT FORMS- In subsection (b)--

        (A) in the matter preceding paragraph (1), by inserting ‘(including the Indian housing program under title II of the United States Housing Act of 1937)’ before the 1st comma;

        (B) in paragraph (1), by striking ‘and’ at the end;

        (C) in paragraph (2), by striking the period at the end and inserting ‘; and’;

        (D) by inserting after paragraph (2) the following new paragraph:

      ‘(3) sign a consent from approved by the Secretary authorizing the Secretary to request the Commissioner of Social Security and the Secretary of the Treasury to release information pursuant to section 6103(l)(7)(D)(ix) of the Internal Revenue Code of 1986 with respect to such applicant or participant for the sole purpose of the Secretary verifying income information pertinent to the applicant’s or participant’s eligibility or level of benefits.’; and

        (E) in the last sentence, by striking ‘This’ and inserting the following: ‘Except as provided in this subsection, this’.

      (2) APPLICANT AND PARTICIPANT PROTECTIONS- In subsection (c)(2)--

        (A) in subparagraph (A)--

          (i) in the matter preceding clause (i)--

            (I) by inserting after ‘compensation law’ the following: ‘or pursuant to section 6103(i)(7)(D)(ix) of the Internal Revenue Code of 1986 from the Commissioner of Social Security or the Secretary of the Treasury’; and

            (II) by inserting ‘(in the case of information obtained pursuant to such section 303(i))’ before ‘representatives’; and

          (ii) in clause (ii), by inserting ‘or public housing agency’ after ‘owner’ each place it appears;

        (B) in subparagraph (B), by inserting after ‘wages’ each place it appears the following: ‘, other earnings or income,’; and

        (C) in subparagraph (C), by inserting before the second comma the following: ‘at a hearing that provides the basic elements of due process’.

      (3) PENALTY- In subsection (c)(3)--

        (A) in subparagraph (A), by inserting ‘or section 6103(l)(7)(D)(ix) of the Internal Revenue Code of 1986’ after ‘Social Security Act’; and

        (B) in the first sentence of subparagraph (B)--

          (i) by striking clause (i) and inserting the following: ‘(i) a negligent or knowing disclosure of information referred to in this section, section 303(i) of the Social Security Act, or section 6103(l)(7)(D)(ix) of the Internal Revenue Code of 1986 about such person by an officer or employee of any public housing agency or owner (or employee thereof), which disclosure is not authorized by this section, such section 303(i), such section 6103(l)(7)(D)(ix), or any regulation implementing this section, such section 303(i), or such section 6103(l)(7)(D)(ix), or’; and

          (ii) in clause (ii), by inserting ‘such 6103(l)(7)(D)(ix),’ after ‘303(i),’.

      (4) CONFORMING AMENDMENT- The heading of subsection (c) of section 904 of the Stewart B. McKinney Homeless Assistance Amendments Act of 1988 is amended by striking ‘STATE EMPLOYMENT’.

SEC. 3004. GNMA REMIC GUARANTEE FEES.

    Section 306(g)(3) of the National Housing Act (12 U.S.C. 1721(g)(3)) is amended by adding at the end the following new subparagraph:

    ‘(E)(i) Notwithstanding subparagraphs (A) through (D), fees charged for the guaranty of, or commitment to guaranty, multiclass securities backed by a trust or pool of securities or notes guaranteed by the Association under this subsection and other related fees shall be charged by the Association in an amount not to exceed the value, as determined by the Association, of the guarantee or commitment to guarantee. The Association shall take such action as may be necessary to reasonably assure that such portion of the value of the guaranties or commitments to guaranty as the Association determines is appropriate accrues to the benefit of mortgagors under mortgages executed after the date of the enactment of this subparagraph by or upon which such securities or notes are backed.

    ‘(ii) For each Federal fiscal year, the Association shall submit a report to the Congress describing any activities of the Association with respect to guarantying and making commitments to guaranty multiclass securities described in clause (i). The report shall be submitted not later than 90 days after the end of the fiscal year for which the report is made and shall identify the extent of such activities during the fiscal year, the size of each transaction closed during the fiscal year involving such securities, the number of mortgages involved in each such transaction, the amount of the fees charged and earned by the Association for such transactions, and any persons receiving payments for any services provided with respect to any such transactions and the amounts of such payments, and shall include an estimate of the portion of the value of the guarantee or commitment to guarantee accruing to the benefit of mortgagors and a description of any action taken by the Association to ensure such accrual.

    ‘(iii) The Association shall provide for the initial implementation of the program for which fees are charged under the first sentence of clause (i) by notice published in the Federal Register. The notice shall be effective upon publication and shall provide an opportunity for public comment. Not later than 12 months after publication of the notice, the Association shall issue regulations for such program based on the notice, comments received, and the experience of the Association in carrying out the program during such period.’.

SEC. 3005. MUTUAL MORTGAGE INSURANCE FUND PREMIUMS.

    To improve the actuarial soundness of the Mutual Mortgage Insurance Fund under the National Housing Act, the Secretary of Housing and Urban Development shall increase the rate at which the Secretary earns the single premium payment collected at the time of insurance of a mortgage that is an obligation of such Fund (with respect to the rate in effect on the date of the enactment of this Act). In establishing such increased rate, the Secretary shall consider any current audit findings and reserve analyses and information regarding the expected average duration of mortgages that are obligations of such Fund and may consider any other information that the Secretary determines to be appropriate.

TITLE IV--EDUCATION AND LABOR

SEC. 4000. TABLE OF CONTENTS.

    The table of contents of this title is as follows:

TITLE IV--EDUCATION AND LABOR

      Sec. 4000. Table of contents.

Subtitle A--Federal Direct Loan Program

Chapter 1--Amendments to Part D of Title IV of the Higher Education Act of 1965

      Sec. 4001. Short title; references.

      Sec. 4002. Federal Direct Student Loan Program.

Chapter 2--Conforming Amendments

      Sec. 4021. Preserving loan access.

      Sec. 4022. Guaranty agency reserves.

      Sec. 4023. Terms of loans.

      Sec. 4024. Assignment of loans.

      Sec. 4025. Termination of guaranty agency agreements; assumption of guaranty agency functions by the Secretary.

      Sec. 4026. Administrative cost allowance.

      Sec. 4027. Consolidation loans.

      Sec. 4028. Student Loan Marketing Association.

      Sec. 4029. Authority to use optically imaged documents.

      Sec. 4030. Amendment to the Balanced Budget and Emergency Deficit Control Act of 1985.

Chapter 3--Effective Dates; Study

      Sec. 4031. Effective dates.

      Sec. 4032. Study of Internal Revenue Service collection of student loans.

      Sec. 4033. Preference of committee for IRS collection mechanism.

Subtitle B--Cost Sharing by States

      Sec. 4101. Cost sharing by States.

Subtitle C--ERISA Amendments Relating to Group Health Plans

      Sec. 4201. Coordination of ERISA preemption rules with title XIX provisions providing for liability of third parties.

      Sec. 4202. Continued coverage of costs of a pediatric vaccine under group health plans.

      Sec. 4203. Temporary rules governing preemption of certain State laws.

Subtitle A--Federal Direct Loan Program

CHAPTER 1--AMENDMENTS TO PART D OF TITLE IV OF THE HIGHER EDUCATION ACT OF 1965

SEC. 4001. SHORT TITLE; REFERENCES.

    (a) SHORT TITLE- This subtitle may be cited as the ‘Student Loan Reform Act of 1993’.

    (b) REFERENCES- References in this subtitle to ‘the Act’ are references to the Higher Education Act of 1965 (20 U.S.C. 1001 et seq.).

SEC. 4002. FEDERAL DIRECT STUDENT LOAN PROGRAM.

    Part D of title IV of the Act (20 U.S.C. 1087a et seq.) is amended to read as follows:

‘PART D--FEDERAL DIRECT STUDENT LOAN PROGRAM

‘SEC. 451. PURPOSE; PROGRAM AUTHORIZATION.

    ‘(a) PURPOSE- It is the purpose of this part--

      ‘(1) to simplify the delivery of student loans to borrowers and eliminate borrower confusion;

      ‘(2) to provide a variety of repayment plans, including income contingent repayment through the EXCEL Account, to borrowers so that they have flexibility in managing their student loan repayment obligations, and so that those obligations do not foreclose community service-oriented career choices for those borrowers;

      ‘(3) to replace, through an orderly transition, the Federal Family Education Loan Program under part B of this title with the Federal Direct Student Loan Program under this part;

      ‘(4) to avoid the unnecessary cost, to taxpayers and borrowers, and administrative complexity associated with the Federal Family Education Loan Program under part B of this title through the use of a direct student loan program; and

      ‘(5) to create a more streamlined student loan program that can be managed more effectively at the Federal level.

    ‘(b) PROGRAM AUTHORITY- There are hereby made available, in accordance with the provisions of this part, such sums as may be necessary to make loans to all eligible students in attendance at participating institutions of higher education selected by the Secretary (and the eligible parents of such students), to enable such students to pursue their courses of study at such institutions during the period beginning July 1, 1994. Such loans shall be made by participating institutions that have agreements with the Secretary to originate loans, or by alternative originators designated by the Secretary to make loans for students in attendance at participating institutions (and their parents).

‘SEC. 452. FUNDS FOR ORIGINATION OF DIRECT STUDENT LOANS.

    ‘(a) IN GENERAL- The Secretary shall provide, on the basis of the need and the eligibility of students at each participating institution, and parents of such students, for such loans, funds for student and parent loans under this part--

      ‘(1) directly to an institution of higher education that has an agreement with the Secretary under section 454(a) to participate in the direct student loan programs under this part and that also has an agreement with the Secretary under section 454(b) to originate loans under this part, or

      ‘(2) through an alternative originator designated by the Secretary to students and parents of students attending institutions of higher education that have an agreement with the Secretary under section 454(a) but that do not have an agreement with the Secretary under section 454(b).

    ‘(b) FEES FOR ORIGINATION SERVICES-

      ‘(1) FEES FOR INSTITUTIONS- The Secretary shall pay fees to institutions of higher education (or a consortium of such institutions) with agreements under section 454(b), in an amount established by the Secretary, to assist in meeting the costs of loan origination. Such fees--

        ‘(A) shall be paid by the Secretary based on all the loans made under this part to a particular borrower in the same academic year;

        ‘(B) shall be subject to a sliding scale that decreases the amount of such fees as the number of borrowers increases; and

        ‘(C)(i) for academic year 1994-1995, shall not exceed a program-wide average of $10 per borrower for all the loans made under this part in the same academic year; and

        ‘(ii) for succeeding academic years, shall not exceed such average fee as the Secretary shall establish in regulations.

      ‘(2) FEES FOR ALTERNATIVE ORIGINATORS- The Secretary shall pay fees for loan origination services to alternative originators of loans made under this part in an amount established by the Secretary in accordance with the terms of the contract between the Secretary and each such alternative originator.

    ‘(c) NO ENTITLEMENT TO PARTICIPATE OR ORIGINATE- No institution of higher education shall have a right to participate in the programs authorized by this part, to originate loans, or to perform any program function under this part. Nothing in this subsection shall be construed so as to limit the entitlement of an eligible student attending a participating institution (or the eligible parent of such student) to borrow under this part.

‘SEC. 453. SELECTION OF INSTITUTIONS FOR PARTICIPATION AND ORIGINATION.

    ‘(a) PHASE-IN OF PROGRAM-

      ‘(1) GENERAL AUTHORITY- The Secretary shall enter into agreements pursuant to section 454(a) with institutions of higher education to participate in the direct student loan programs under this part, and agreements pursuant to section 454(b) with institutions of higher education to originate loans in such programs, for academic years beginning on or after July 1, 1994. Alternative origination services, through which an entity other than the participating institution at which the student is in attendance originates the loan, shall be provided by the Secretary, through one or more contracts under section 456 or such other means as the Secretary may provide, for students attending participating institutions that do not originate direct student loans under this part. Such agreements for the first year of the program shall, to the extent feasible, be entered into not later than January 1, 1994.

      ‘(2) TRANSITION PROVISIONS- In order to ensure an expeditious but orderly transition from the loan programs under part B of this title to the direct student loan programs under this part, the Secretary shall, in the exercise of his or her discretion, determine the number of institutions with which he or she shall enter into agreements under sections 454 (a) and (b) for any academic year, except that the Secretary shall exercise such discretion so as to achieve the following goals:

        ‘(A) for academic year 1994-1995, loans made under this part shall represent 4 percent of the sum of new student loan volume under this part and part B of this title;

        ‘(B) for academic year 1995-1996, loans made under this part shall represent 25 percent of the sum of new student loan volume under this part and part B of this title;

        ‘(C) for academic year 1996-1997, loans made under this part shall represent 60 percent of the sum of new student loan volume under this part and part B of this title; and

        ‘(D) for academic year 1997-1998, loans made under this part shall represent 100 percent of the sum of new student loan volume under this part and part B of this title.

      ‘(3) CASH MANAGEMENT- The requirements of the Cash Management Improvement Act of 1990 (Public Law 101-453) shall apply to the program under this part only to the extent specified in a schedule established by the Secretaries of Education and the Treasury, except that such schedule shall provide for the application of all such requirements not later than July 1, 1998.

    ‘(b) SELECTION CRITERIA FOR PARTICIPATION-

      ‘(1) APPLICATION- Each institution of higher education desiring to participate in the direct student loan program under this part shall submit an application satisfactory to the Secretary containing such information and assurances as the Secretary may require.

      ‘(2) AGREEMENT- When the program authorized under this part is fully implemented, the Secretary shall enter into agreements under section 454(a) with institutions that submit applications in accordance with paragraph (1).

      ‘(3) TRANSITION SELECTION CRITERIA- Until such full implementation, the Secretary shall select institutions for participation in the direct student loan program under this part, and shall enter into agreements with them under section 454(a), from among those institutions that submit the applications described in paragraph (1), and meet such other eligibility requirements as the Secretary may prescribe, by--

        ‘(A)(i) categorizing such institutions according to anticipated loan volume, length of academic program, and control of the institution; and

        ‘(ii) selecting institutions that are reasonably representative of the respective categories; and

        ‘(B) if needed to carry out the purposes of this part, selecting additional institutions.

    ‘(c) SELECTION CRITERIA FOR ORIGINATION-

      ‘(1) IN GENERAL- The Secretary may enter into a supplemental agreement with an institution (or a consortium of such institutions) that--

        ‘(A) has an agreement under subsection 454(a);

        ‘(B) desires to originate loans under this part; and

        ‘(C) meets the criteria specified in paragraph (2).

      ‘(2) TRANSITION SELECTION CRITERIA- For academic year 1994-1995, the Secretary may approve an institution to originate loans only if such institution--

        ‘(A) made loans under part E of this title in academic year 1993-1994 and did not exceed the applicable maximum default rate under section 464(g) for the most recent fiscal year for which data are available;

        ‘(B) is not on the reimbursement system of payment for any of the programs under subpart 1 or 3 of part A, part C, or part E;

        ‘(C) is not overdue on program or financial reports or audits required under this title;

        ‘(D) is not subject to an emergency action, or a limitation, suspension, or termination under section 428(b)(1)(T), 432(h), or 487(c);

        ‘(E) in the opinion of the Secretary, has not had significant deficiencies identified by the State postsecondary review entity under subpart 1 of part H of this title;

        ‘(F) in the opinion of the Secretary, has not had severe performance deficiencies for any of the programs under this title, including those demonstrated by audits or program reviews submitted or conducted during the 5 calendar years immediately preceding the date of application;

        ‘(G) provides an assurance that it has no delinquent outstanding debts to the United States, unless such debts are being repaid under or in accordance with a repayment arrangement satisfactory to the United States, or the Secretary in his or her discretion determines that the existence or amount of such debts has not been finally determined by the cognizant Federal agency or agencies; and

        ‘(H) meets such other criteria as the Secretary may establish to protect the financial interest of the United States and to promote the purposes of this part.

      ‘(3) REGULATIONS GOVERNING APPROVAL AFTER TRANSITION- For academic year 1995-1996 and subsequent academic years, the Secretary shall publish regulations governing the approval of institutions to originate loans.

    ‘(d) CONSORTIA- Subject to such requirements as the Secretary may prescribe, eligible institutions of higher education with agreements under section 454(a) may apply as consortia to originate loans under this part for students in attendance at such institutions. Such institutions shall each be required to meet the requirements of subsection (c) with respect to loan origination.

‘SEC. 454. AGREEMENTS WITH INSTITUTIONS.

    ‘(a) PARTICIPATION AGREEMENTS- An agreement with any institution of higher education for participation in the direct student loan program under this part shall--

      ‘(1) provide for the establishment and maintenance of a direct student loan program at the institution under which the institution will--

        ‘(A) identify eligible students who seek student financial assistance at such institution in accordance with section 484;

        ‘(B) estimate the need of each such student as required by part F of this title for an academic year, provided that any loan obtained by a student under this part with the same terms (except as otherwise provided in this part) as loans made under section 428A or 428H, or a loan obtained by a parent under this part with the same terms (except as otherwise provided in this part) as loans made under section 428B, or obtained under any State-sponsored or private loan program, may be used to offset the expected family contribution of the student for that year;

        ‘(C) provide a statement that certifies the eligibility of any student to receive a loan under this part that is not in excess of the annual or aggregate limit applicable to the amount of such loan, except that the institution may, in exceptional circumstances specified in regulations prescribed by the Secretary, refuse to certify a statement that permits a student to receive a loan under this part, or certify a loan amount that is less than the student’s determination of need (as determined under part F of this title), if the reason for such action is documented and provided in written form to such student;

        ‘(D) set forth a schedule for disbursement of the proceeds of the loan in installments, consistent with the requirements of section 428G (other than subsection (b)(1) of such section); and

        ‘(E) provide timely and accurate information--

          ‘(i) concerning the status of student borrowers (and students on whose behalf parents borrow under this part) while such students are in attendance at the institution and concerning any new information of which the institution becomes aware for such students (or their parents) after they leave the institution, to the Secretary for the servicing and collecting of loans made under this part; and

          ‘(ii) if the institution does not have an agreement with the Secretary under subsection (b), concerning student eligibility and need, as determined under subparagraphs (A) and (B), to the Secretary as needed for the alternative origination of loans to eligible students and parents in accordance with this part;

      ‘(2) provide assurances that the institution will comply with requirements established by the Secretary relating to student loan information with respect to loans made under this part;

      ‘(3) provide that the institution accepts responsibility and financial liability stemming from its failure to perform its functions pursuant to the agreement;

      ‘(4) provide that students at the institution and their parents (with respect to such students) will not be eligible to participate in the programs under part B of this title for the period during which such institution participates in the direct student loan program under this part;

      ‘(5) provide for the implementation of a quality assurance system, as established by the Secretary, to ensure that the institution is complying with program requirements and meeting program objectives;

      ‘(6) provide that the institution will not charge any fees of any kind, however described, to student or parent borrowers for origination activities or the provision of any information necessary for a student or parent to receive a loan under this part, or any benefits associated with such loan; and

      ‘(7) include such other provisions as the Secretary determines are necessary to protect the interests of the United States and to promote the purposes of this part.

    ‘(b) ORIGINATION- An agreement with any institution of higher education for the origination of loans under this part shall--

      ‘(1) supplement the agreement entered into in accordance with subsection (a);

      ‘(2) include provisions established by the Secretary that are similar to the participation agreement provisions described in paragraphs (1)(E)(ii), (2), (3), (4), (5), (6), and (7) of subsection (a), as modified to relate to the origination of loans by the institution;

      ‘(3) provide that the institution will originate loans to eligible students and parents in accordance with this part; and

      ‘(4) provide that the note or evidence of obligation on the loan shall be the property of the Secretary.

    ‘(c) WITHDRAWAL AND TERMINATION PROCEDURES- The Secretary shall establish procedures by which institutions may withdraw or be terminated from the program under this part.

‘SEC. 455. TERMS AND CONDITIONS OF LOANS.

    ‘(a) IN GENERAL-

      ‘(1) PARALLEL TERMS, CONDITIONS, BENEFITS, AND AMOUNTS- Unless otherwise specified in this part, loans made to borrowers under this part shall have the same terms, conditions, and benefits, and be available in the same amounts, as loans made to borrowers under sections 428, 428A, 428B, and 428H of this title.

      ‘(2) DESIGNATION OF LOANS- Loans made to borrowers under this part that, except as otherwise specified in this part, have the same terms, conditions, and benefits as loans made to borrowers under--

        ‘(A) section 428 shall be known as ‘Federal Direct Student Loans’;

        ‘(B) section 428A shall be known as ‘Federal Direct Supplemental Loans for Students’;

        ‘(C) section 428B shall be known as ‘Federal Direct PLUS Loans’; and

        ‘(D) section 428H shall be known as ‘Federal Direct Unsubsidized Student Loans’.

    ‘(b) INTEREST RATES-

      ‘(1) RATES FOR FDSL AND FDUSL- (A) For Federal Direct Student Loans and Federal Direct Unsubsidized Student Loans made before July 1, 1997, the applicable rate of interest shall, during any 12-month period beginning on July 1 and ending on June 30, be determined on the preceding June 1 and be equal to--

        ‘(i) the bond equivalent rate of 91-day Treasury bills auctioned at the final auction held prior to such June 1; plus

        ‘(ii) 3.1 percent,

      except that such rate shall not exceed 9 percent.

      ‘(B) For Federal Direct Student Loans and Federal Direct Unsubsidized Student Loans made on or after July 1, 1997, the applicable rate of interest shall, during any 12-month period beginning on July 1 and ending on June 30, be determined on the preceding June 1 for all such loans and be equal to--

        ‘(i) the bond equivalent rate of the security with a comparable maturity as established by the Secretary; plus

        ‘(ii) 1 percent,

      except that such rate shall not exceed 9 percent.

      ‘(2) RATES FOR FDSLS- (A) For Federal Direct Supplemental Loans for Students made before July 1, 1997, the applicable rate of interest shall, during any 12-month period beginning on July 1 and ending on June 30, be determined on the preceding June 1 and be equal to--

        ‘(i) the bond equivalent rate of 52-week Treasury bills auctioned at the final auction held prior to such June 1; plus

        ‘(ii) 3.1 percent,

      except that such rate shall not exceed 11 percent.

      ‘(B) For Federal Direct Supplemental Loans for Students made on or after July 1, 1997, the applicable rate of interest shall, during any 12-month period beginning on July 1 and ending on June 30, be determined on the preceding June 1 for all such loans and be equal to--

        ‘(i) the bond equivalent rate of the security with a comparable maturity as established by the Secretary; plus

        ‘(ii) 1.5 percent,

      except that such rate shall not exceed 11 percent.

      ‘(3) RATES FOR FDPLUS- (A) For Federal Direct PLUS loans made before July 1, 1997, the applicable rate of interest shall, during any 12-month period beginning on July 1 and ending on June 30, be determined on the preceding June 1 for loans and be equal to--

        ‘(i) the bond equivalent rate of 52-week Treasury bills auctioned at the final auction held prior to such June 1; plus

        ‘(ii) 3.1 percent,

      except that such rate shall not exceed 10 percent.

      ‘(B) For Federal Direct PLUS loans made on or after July 1, 1997, the applicable rate of interest shall, during any 12-month period beginning on July 1 and ending on June 30, be determined on the preceding June 1 for all such loans and be equal to--

        ‘(i) the bond equivalent rate of the security with a comparable maturity as established by the Secretary; plus

        ‘(ii) 2.1 percent,

      except that such rate shall not exceed 10 percent.

      ‘(4) PUBLICATION- The Secretary shall determine the applicable rates of interest under this subsection after consultation with the Secretary of Treasury and shall publish such rate in the Federal Register as soon as practicable after the date of determination.

    ‘(c) LOAN FEE- For academic years 1994-1995, 1995-1996, and 1996-1997, the Secretary shall charge the borrower of a loan made under this part a loan fee of 5 percent of the principal amount of the loan. For academic years 1997-1998 and succeeding academic years, the Secretary shall charge the borrower of a loan made under this part a loan fee of 3.65 percent of the principal amount of the loan.

    ‘(d) REPAYMENT PLANS-

      ‘(1) DESIGN AND SELECTION- Consistent with criteria established by the Secretary, the Secretary shall offer to a borrower of a loan made under this part a variety of plans for repayment of such loan, including principal and interest on the loan. The borrower shall be entitled to accelerate, without penalty, repayment on his or her loans. The borrower may choose--

        ‘(A) a standard repayment plan, with a fixed annual repayment amount paid over a fixed period of time, consistent with subsection (a)(1) of this section;

        ‘(B) an extended repayment plan, with a fixed annual repayment amount paid over an extended period of time, provided that the borrower annually repays a minimum amount determined by the Secretary, consistent with the requirements of section 428(b)(1)(L);

        ‘(C) a graduated repayment plan, with annual repayment amounts established at two or more graduated levels and paid over a fixed or extended period of time, provided that any of the borrower’s scheduled payments shall not be less than 50 percent, nor more than 150 percent, of what the amortized payment on the amount owed would be if the loan were repaid under the standard repayment plan; and

        ‘(D) except for the borrower of a Federal Direct PLUS Loan, an income contingent repayment plan known as the ‘EXCEL Account,’ with varying annual repayment amounts based on the income of the borrower, paid over an extended period of time, not to exceed a maximum length of time determined by the Secretary.

      ‘(2) SELECTION BY SECRETARY- If a borrower of a loan made under this part does not select a repayment plan described in paragraph (1), the Secretary may provide the borrower with a repayment plan described in subparagraph (A), (B), or (C) of paragraph (1).

      ‘(3) CHANGES IN SELECTIONS- The borrower of a loan made under this part may change his or her selection of a repayment plan under paragraph (1), or the Secretary’s selection of a plan for the borrower under paragraph (2), as the case may be, under such terms and conditions as may be established by the Secretary.

      ‘(4) ALTERNATIVE REPAYMENT PLANS- The Secretary may provide, on a case-by-case basis, an alternative repayment plan to a borrower of a loan under this part who demonstrates to the satisfaction of the Secretary that the terms and conditions of the repayment plans available under paragraph (1) are not adequate to accommodate the borrower’s exceptional circumstances. In designing such alternative repayment plans, the Secretary shall ensure that such plans do not exceed the cost to the Federal Government, as determined on the basis of the present value of future payments by such borrowers, of loans made using the plans available under paragraph (1).

      ‘(5) REPAYMENT AFTER DEFAULT- The Secretary may require any borrower who has defaulted on a loan made under this part to--

        ‘(A) pay all reasonable collection costs associated with such loan; and

        ‘(B) repay the loan pursuant to an EXCEL Account in accordance with subsection (e).

    ‘(e) REPAYMENT THROUGH EXCEL ACCOUNTS-

      ‘(1) INFORMATION AND PROCEDURES- The Secretary may obtain such information as is reasonably necessary regarding the income of a borrower (and the borrower’s spouse, if applicable) of a loan made under this part that is, or may be, repaid pursuant to an EXCEL Account for the purpose of determining the annual repayment obligation of the borrower. Return and return information (as defined in section 6103 of the Internal Revenue Code of 1986) may be obtained under the preceding sentence only to the extent authorized by section 6103(l)(13) of such Code. The Secretary shall establish procedures for determining the borrower’s repayment obligation on that loan for such year, and such other procedures as are necessary to implement effectively repayment pursuant to an EXCEL Account.

      ‘(2) REPAYMENT BASED ON ADJUSTED GROSS INCOME- A repayment schedule for a loan made under this part and repaid pursuant to an EXCEL Account shall be based on adjusted gross income (as defined in section 62 of the Internal Revenue Code of 1986, 26 U.S.C. 62) of the borrower or, if the borrower is married and files a Federal income tax return jointly with his or her spouse, on adjusted gross income of the borrower and his or her spouse.

      ‘(3) ADDITIONAL DOCUMENTS- A borrower who chooses, or is required, to repay a loan made under this part pursuant to an EXCEL Account, and for whom adjusted gross income is unavailable or does not reasonably reflect his or her current income, shall provide to the Secretary other documentation of income satisfactory to the Secretary, which documentation the Secretary may use to determine an appropriate repayment schedule.

      ‘(4) REPAYMENT SCHEDULES- EXCEL Account repayment schedules shall be established by the Secretary through regulations and shall require payments measured as a percentage of the appropriate portion of the annual income of the borrower (and the borrower’s spouse, if applicable) as determined by the Secretary.

      ‘(5) CALCULATION OF BALANCE DUE- The balance due on a loan made under this part that is repaid pursuant to an EXCEL Account shall equal the unpaid principal amount of the loan, any accrued interest, and any fees, such as late charges, assessed on such loan. The Secretary may limit by regulation the amount of interest that may be capitalized on such loan, and the timing of any such capitalization.

      ‘(6) NOTIFICATION TO BORROWERS- The Secretary shall establish procedures under which a borrower of a loan made under this part who chooses or is required to repay such loan pursuant to an EXCEL Account is notified of the terms and conditions of such plan, including notification of such borrower--

        ‘(A) that the Internal Revenue Service will disclose to the Secretary tax return information as authorized under section 6103(l)(13) of the Internal Revenue Code of 1986; and

        ‘(B) that if a borrower considers that special circumstances, such as a loss of employment by the borrower or his or her spouse, warrant an adjustment in the borrower’s loan repayment as determined using the information described in subparagraph (A), or the alternative documentation described in paragraph (3), the borrower may contact the Secretary, who shall determine whether such adjustment is appropriate, in accordance with criteria established by the Secretary.

    ‘(f) DEFERMENT-

      ‘(1) EFFECT ON PRINCIPAL AND INTEREST- A borrower of a loan made under this part who meets the requirements described in paragraph (2) shall be eligible for a deferment, during which periodic installments of principal need not be paid, and interest--

        ‘(A) shall not accrue, in the case of a Federal Direct Student Loan or a Federal Direct Consolidation Loan that consolidated only Federal Direct Student Loans, or a combination of such loans and Federal Student Loans for which the student borrower received an interest subsidy under section 428; or

        ‘(B) shall accrue and be capitalized or paid by the borrower, in the case of a Federal Direct Supplemental Loan for Students loan, a Federal Direct PLUS Loan, a Federal Direct Unsubsidized Student Loan, or a Federal Direct Consolidation Loan other than those described in subparagraph (A).

      ‘(2) ELIGIBILITY- A borrower of a loan made under this part shall be eligible for a deferment during any period--

        ‘(A) during which the borrower--

          ‘(i) is pursuing at least a half-time course of study at an eligible institution, as determined by such institution; or

          ‘(ii) is pursuing a course of study pursuant to a graduate fellowship program approved by the Secretary, or pursuant to a rehabilitation training program for individuals with disabilities approved by the Secretary,

        except that no borrower shall be eligible for a deferment under this subparagraph, or a loan made under this part (other than a Federal Direct PLUS Loan, or a Federal Direct Consolidation Loan), while serving in a medical internship or residency program;

        ‘(B) not in excess of 3 years during which the borrower is seeking and unable to find full-time employment; or

        ‘(C) not in excess of 3 years during which the Secretary determines, in accordance with regulations prescribed under section 435(o), that the borrower has experienced or will experience an economic hardship, regardless of the reason for such hardship.

    ‘(g) FEDERAL DIRECT CONSOLIDATION LOANS- A borrower of a loan made under this part may consolidate such loan with the loans described in subsections (a)(4) and (d)(1)(C) of section 428C only under the terms and conditions established by the Secretary under this part. Loans made under this subsection shall be known as ‘Federal Direct Consolidation Loans’.

    ‘(h) BORROWER DEFENSES- Notwithstanding any other provision of State or Federal law, the Secretary shall specify in regulations (except as authorized under section 458(a)) which acts or omissions of an institution of higher education a borrower may assert as a defense to repayment of a loan made under this part, except that in no event may a borrower recover from the Secretary, in any action arising from or relating to a loan made under this part, an amount in excess of the amount such borrower has repaid on such loan.

    ‘(i) OPTICALLY IMAGED DOCUMENTS- Records maintained in accordance with section 484A(c) may be used in any proceeding, as permitted by section 484A(c), with respect to a loan made under this part.

    ‘(j) NONDISCHARGEABILITY IN BANKRUPTCY- Notwithstanding any other provision of law, a loan made under this part shall not be dischargeable in bankruptcy.

‘SEC. 456. CONTRACTS.

    ‘(a) CONTRACTS FOR SUPPLIES AND SERVICES-

      ‘(1) IN GENERAL- The Secretary may award one or more contracts for services and supplies under subsection (b). The entities with which the Secretary may enter into such contracts may include, but are not limited to, agencies with agreements with the Secretary under sections 428(b) and (c), if such agencies are otherwise qualified and comply with the procedures applicable to the award of such contracts.

      ‘(2) EXEMPTION- (A) The Secretary may, through June 30, 1998, award contracts under this section without regard to the requirements in section 303 of the Federal Property and Administrative Services Act of 1949 (41 U.S.C. 253), section 18 of the Office of Federal Procurement Policy Act (41 U.S.C. 416), and section 8(e) of the Small Business Act (15 U.S.C. 637(e)) and the corresponding requirements of the Federal Acquisition Regulations if the Secretary--

        ‘(i) determines in writing, on a case-by-case basis, that the Government’s need for the services and supplies to be provided under the contract is of such an unusual and compelling urgency that sources from which the Secretary solicits bids or proposals must be limited; and

        ‘(ii) notifies the Congress in writing of that determination not more than 30 days after the award of the contract.

      ‘(B) The Secretary may make the determination described in subparagraph (A)(i) if the Secretary determines that exemption from the requirements described in subparagraph (A) is in the public interest and necessary for the orderly transition from the loan programs under part B to the direct student loan programs under this part.

      ‘(C) On and after July 1, 1998, all statutory and regulatory requirements described in subparagraph (A) shall apply to the award of a contract under this section.

    ‘(b) CONTRACTS FOR ORIGINATION, SERVICING, AND DATA SYSTEMS- The Secretary may enter into one or more contracts for--

      ‘(1) the alternative origination of loans to students attending institutions with agreements to participate in the program under this part (or their parents), if such institutions do not have agreements with the Secretary under section 454(b);

      ‘(2) the servicing and collection of loans made under this part;

      ‘(3) the establishment and operation of one or more data systems for the maintenance of records on all loans made under this part;

      ‘(4) services to assist in the orderly transition from the loan programs under part B to the direct student loan programs under this part; and

      ‘(5) such other aspects of the direct student loan programs as the Secretary determines are necessary to ensure the successful operation of the programs.

‘SEC. 457. REPORTS.

    ‘(a) ANNUAL REPORTS- The Secretary shall submit to the Congress not later than July 1, 1993, and each July 1 for the 5 succeeding years an annual report describing the progress and status of the loan program under this part.

    ‘(b) RESEARCH, DEMONSTRATION, AND EVALUATION- The Secretary may use a portion of the funds described in section 459 for research on, or the demonstration or evaluation of, any aspects of the program authorized by this part, including flexible repayment plans.

‘SEC. 458. REGULATORY ACTIVITIES.

    ‘(a) NOTICE IN LIEU OF REGULATIONS FOR FIRST YEAR OF PROGRAM- The Secretary shall publish in the Federal Register whatever standards, criteria, and procedures, consistent with the provisions of this part, the Secretary determines are reasonable and necessary to the successful implementation of the first year of the direct student loan program authorized by this part. Section 431 of the General Education Provisions Act shall not apply to the publication of such standards, criteria, and procedures.

    ‘(b) CLOSING DATE FOR APPLICATIONS FROM INSTITUTIONS- The Secretary shall establish a date not later than October 1, 1993, as the closing date for receiving applications from institutions of higher education desiring to participate in the first year of the direct loan program under this part.

    ‘(c) PUBLICATION OF LIST OF PARTICIPATING INSTITUTIONS AND CONTROL GROUP- Not later than January 1, 1994, the Secretary shall publish in the Federal Register a list of the institutions of higher education selected to participate in the first year of the direct loan program under this part.

‘SEC. 459. FUNDS FOR ADMINISTRATIVE EXPENSES.

    ‘Each fiscal year, there shall be available to the Secretary of Education from funds not otherwise appropriated, funds to be obligated for administrative costs under this part, including the costs of the transition from the loan programs under part B to the direct student loan programs under this part and transition support for the expenses of guaranty agencies in servicing outstanding loans in their portfolios and in guaranteeing new loans, not to exceed $261,000,000 in fiscal year 1994, $346,000,000 in fiscal year 1995, $552,000,000 in fiscal year 1996, $596,000,000 in fiscal year 1997, and $749,000,000 in fiscal year 1998. If in any fiscal year, the Secretary determines that additional funds for administrative expenses are needed as a result of such transition, or the expansion of the direct student loan programs under this part, the Secretary is authorized to use funds available under this section for a subsequent fiscal year for such expenses, except that the total expenditures by the Secretary shall not exceed $2,504,000,000 in fiscal years 1994 through 1998. The Secretary is also authorized to carry over funds available under this section to a subsequent fiscal year.’.

CHAPTER 2--CONFORMING AMENDMENTS

SEC. 4021. PRESERVING LOAN ACCESS.

    (a) PURPOSE- It is the purpose of the amendments made by this section to provide the Secretary with flexible authority as needed to preserve access to student and parent loans under part B of title IV of the Act during the transition from the Federal Family Education Loan Program under such part to the Federal Direct Student Loan Program under part D of such title.

    (b) ADVANCES TO GUARANTY AGENCIES FOR LENDER-OF-LAST RESORT SERVICES-

      (1) AMENDMENT- Section 428(j) of the Act is amended by adding at the end thereof the following new paragraph:

      ‘(4) ADVANCES TO GUARANTY AGENCIES FOR LENDER-OF-LAST RESORT SERVICES DURING TRANSITION TO DIRECT LENDING- (A) In order to ensure the availability of loan capital during the transition from the Federal Family Education Loan program under this part to the Federal Direct Student Loan program under part D of this title, the Secretary is authorized to provide a guaranty agency with additional advance funds in accordance with section 422(c)(7), with such restrictions on the use of such funds as are determined appropriate by the Secretary, in order to ensure that the guaranty agency will make loans as the lender-of-last-resort. Such agency shall make such loans in accordance with this subsection and the requirements of the Secretary.

      ‘(B) Notwithstanding any other provision of this part, a guaranty agency serving as a lender-of-last-resort under this paragraph shall be paid a fee, established by the Secretary, for making such loans in lieu of interest and special allowance subsidies, and shall be required to assign such loans to the Secretary on demand. Upon such assignment, the portion of the advance represented by the loans assigned shall be considered repaid by such guaranty agency.’.

      (2) CONFORMING AMENDMENT- Section 422(c)(7) of the Act is amended by striking ‘to a guaranty agency’ through the end thereof and inserting the following: ‘to a guaranty agency--

        ‘(A) in accordance with section 428(j), in order to ensure that the guaranty agency shall make loans as the lender-of-last-resort during the transition from the Federal Family Education Loan Program under this part to the Federal Direct Student Loan Program under part D of this title; or

        ‘(B) if the Secretary is seeking to terminate the guaranty agency’s agreement, or assuming the guaranty agency’s functions, in accordance with section 428(c)(10)(F)(v), in order to assist the agency in meeting its immediate cash needs, ensure the uninterrupted payment of claims, or ensure that the guaranty agency shall make loans as described in subparagraph (A);’.

    (c) LENDER REFERRAL SERVICES- Section 428(e) of the Act is amended--

      (1) in paragraph (1)--

        (A) by amending the paragraph heading to read as follows: ‘IN GENERAL; AGREEMENTS WITH GUARANTY AGENCIES- ’;

        (B) by inserting the subparagraph designation ‘(A)’ immediately after the paragraph heading;

        (C) by striking ‘in any State’ and inserting ‘with which the Secretary has an agreement under subparagraph (B)’; and

        (D) by adding at the end thereof the following new subparagraph:

      ‘(B)(i) The Secretary may enter into agreements with guaranty agencies that meet standards established by the Secretary to provide lender referral services in geographic areas specified by the Secretary. Such guaranty agencies shall be paid in accordance with paragraph (3) for such services.

      ‘(ii) The Secretary shall publish in the Federal Register whatever standards, criteria, and procedures consistent with the provisions of this part and part D of this title, the Secretary determines are reasonable and necessary to provide lender referral services under this subsection and ensure loan access to student and parent borrowers during the transition from the loan programs under this part to the direct student loan programs under part D of this title. Section 431 of the General Education Provisions Act shall not apply to the publication of such standards, criteria, and procedures.’;

      (2) in paragraph (2)--

        (A) in the matter preceding subparagraph (A), by striking ‘in a State’ and inserting ‘with which the Secretary has an agreement under paragraph (1)(B)’;

        (B) by amending subparagraph (A) to read as follows:

        ‘(A) such student is either a resident of, or is accepted for enrollment in, or is attending, an eligible institution located in a geographic area for which the Secretary (I) determines that loans are not available to all eligible students, and (II) has entered into an agreement with a guaranty agency under paragraph (1)(B) to provide lender referral services; and’;

      (4) in paragraph (3), by striking ‘The’ and inserting ‘From funds available for costs of transition under section 459 of the Act, the’; and

      (5) by striking paragraph (5).

    (d) STUDENT LOAN MARKETING ASSOCIATION- Section 439(q) of the Act is amended--

      (1) in paragraph (1)(A)--

        (A) in the first sentence, by striking ‘the Association or its designated agency may begin making loans’ and inserting ‘the Association or its designated agent shall, subject to the limitations in section 428(j)(3), begin making loans to such eligible borrowers’; and

        (B) by striking the second sentence;

      (2) in paragraph (2)(A), by striking ‘the Association or its designated agent may’ and inserting ‘the Association or its designated agent shall, subject to the limitations in section 428(j)(3),’; and

      (3) in paragraph (3), by striking ‘that--’ through the end thereof and inserting the following: ‘that the conditions that caused the implementation of this subsection have ceased to exist.’.

SEC. 4022. GUARANTY AGENCY RESERVES.

    Section 422 of the Act is amended by adding at the end thereof the following new subsection:

    ‘(g) PRESERVATION OF GUARANTY AGENCY RESERVES-

      ‘(1) AUTHORITY TO RECOVER FUNDS- Notwithstanding any other provision of law, the reserve funds of the guaranty agencies, and any assets purchased with such reserve funds, regardless of who holds or controls the reserves or assets, shall be considered to be the property of the United States to be used in the operation of the program authorized by this part or the program authorized by part D of this title. However, the Secretary may not require the return of all of a guaranty agency reserve funds to the Secretary unless he or she determines that such return is essential to the operation of the program authorized by this part or the program authorized by part D of this title, or to ensure the orderly termination of the guaranty agency’s operations and the liquidation of its assets. The reserves shall be maintained by each guaranty agency to pay program expenses and contingent liabilities, as authorized by the Secretary, except that the Secretary may--

        ‘(A) direct a guaranty agency to return to the Secretary a portion of its reserve fund which the Secretary determines is unnecessary to pay the program expenses and contingent liabilities of the guaranty agency; and

        ‘(B) direct the guaranty agency to require the return, to the guaranty agency or to the Secretary, of any reserve funds or assets held by, or under the control of, any other entity, which the Secretary determines are necessary to pay the program expenses and contingent liabilities of the guaranty agency, or which are required for the orderly termination of the guaranty agency’s operations and the liquidation of its assets.

      ‘(2) TERMINATION PROVISIONS IN CONTRACTS- To ensure that the funds and assets of the guaranty agency are preserved, any contract with respect to the administration of a guaranty agency’s reserve funds, or the administration of any assets purchased or acquired with the reserve funds of the guaranty agency, that is entered into or extended by the guaranty agency, or any other party on behalf of or with the concurrence of the guaranty agency, after the effective date of this provision shall provide that the contract is terminable by the Secretary upon 30 days notice to the contracting parties if the Secretary determines that such contract includes an impermissible transfer of the reserve funds or assets, or is otherwise inconsistent with the terms or purposes of this section.’.

SEC. 4023. TERMS OF LOANS.

    Section 428 of the Act is amended--

      (1) in subsection (b)(1)(D), by striking ‘be subject to’ through the end thereof and inserting the following: ‘be subject to income contingent repayment in accordance with subsection (m);’; and

      (2) in subsection (m)--

        (A) by amending paragraph (1) to read as follows:

      ‘(1) AUTHORITY OF SECRETARY TO REQUIRE- The Secretary may require any borrower who has defaulted on a loan made under this part that is assigned to the Secretary under subsection (c)(8) to repay that loan under an income contingent repayment plan, the terms and conditions of which shall be established by the Secretary and the same as, or similar to, the EXCEL Account established for purposes of part D of this title.’; and

        (B) by striking paragraphs (2) through (4) and inserting the following:

      ‘(2) LOANS FOR WHICH INCOME CONTINGENT REPAYMENT MAY BE REQUIRED- A loan made under this part may be required to be repaid under this subsection if the note or other evidence of the loan has been assigned to the Secretary pursuant to subsection (c)(8).’.

SEC. 4024. ASSIGNMENT OF LOANS.

    Section 428(c)(8) of the Act is amended by--

      (1) inserting the subparagraph designation ‘(A)’ after the paragraph heading;

      (2) striking the second and third sentences; and

      (3) adding at the end thereof the following new subparagraph:

      ‘(B) An orderly transition from the Federal Family Education Loan program under this part to the Federal Direct Student Loan program under part D of this title shall be deemed to be in the Federal fiscal interest, and a guaranty agency shall promptly assign loans to the Secretary under this paragraph upon his or her request.’.

SEC. 4025. TERMINATION OF GUARANTY AGENCY AGREEMENTS; ASSUMPTION OF GUARANTY AGENCY FUNCTIONS BY THE SECRETARY.

    Section 428(c)(10) of the Act is amended--

      (1) in subparagraph (C), by inserting a comma and ‘as appropriate,’ immediately after ‘the Secretary shall’;

      (2) in subparagraph (D)--

        (A) by inserting the clause designation ‘(i)’ after ‘(D)’;

        (B) by striking ‘Each’ and inserting ‘If the Secretary is not seeking to terminate the guaranty agency’s agreement under subparagraph (E), or assuming the guaranty agency’s functions under subparagraph (F), a’;

        (C) by adding at the end thereof the following new clause:

      ‘(ii) If the Secretary is seeking to terminate the guaranty agency’s agreement under subparagraph (E), or assuming the guaranty agency’s functions under subparagraph (F), a management plan described in subparagraph (C) shall include the means by which the Secretary and the guaranty agency shall work together to ensure the orderly termination of the operations, and liquidation of the assets of, the guaranty agency.’;

      (3) in subparagraph (E)--

        (A) in clause (ii), by striking ‘or’ at the end thereof;

        (B) in clause (iii), by striking the period at the end thereof and inserting a semicolon; and

        (C) by adding at the end thereof the following new clauses:

        ‘(iv) the Secretary determines that such action is necessary to protect the Federal fiscal interest;

        ‘(v) the Secretary determines that such action is necessary to ensure the continued availability of loans to student or parent borrowers; or

        ‘(vi) the Secretary determines that such action is necessary to ensure an orderly transition from the loan programs under this part to the direct student loan programs under part D of this title.’;

      (4) in subparagraph (F)--

        (A) in the matter preceding clause (i), by striking ‘Except as provided in subparagraph (G), if’ and inserting ‘If’;

        (B) by amending clause (v) to read as follows:

        ‘(v) provide the guaranty agency with additional advance funds in accordance with section 422(c)(7), with such restrictions on the use of such funds as is determined appropriate by the Secretary, in order to--

          ‘(I) meet the immediate cash needs of the guaranty agency;

          ‘(II) ensure the uninterrupted payment of claims; or

          ‘(III) ensure that the guaranty agency will make loans as the lender-of-last- resort, in accordance with subsection (j)(4);’;

        (C) in clause (vi)--

          (i) by striking ‘and to avoid’ and inserting ‘to avoid’;

          (ii) by striking the period at the end thereof and inserting ‘, and to ensure an orderly transition from the loan programs under this part to the direct student loan programs under part D of this title.’; and

          (iii) by redesignating such clause as clause (vii); and

        (D) by inserting after clause (v) the following new clause:

        ‘(vi) use all funds and assets of the guaranty agency to assist in the activities undertaken in accordance with this subparagraph and take appropriate action to require the return, to the guaranty agency or the Secretary, of any funds or assets provided by the guaranty agency, under contract or otherwise, to any person or organization; or’;

      (5) by striking subparagraph (G);

      (6) by redesignating subparagraphs (H), (I), and (J) as subparagraphs (I), (J), and (K), respectively;

      (7) by inserting after subparagraph (F) the following new subparagraphs:

      ‘(G) Notwithstanding any other provision of Federal or State law, if the Secretary has terminated or is seeking to terminate a guaranty agency’s agreement under subparagraph (E), or has assumed a guaranty agency’s functions under subparagraph (F)--

        ‘(i) such guaranty agency may not file for bankruptcy;

        ‘(ii) no State court may issue any order affecting the Secretary’s actions with respect to such guaranty agency;

        ‘(iii) any contract with respect to the administration of a guaranty agency’s reserve funds, or the administration of any assets purchased or acquired with the reserve funds of the guaranty agency, that is entered into or extended by the guaranty agency, or any other party on behalf of or with the concurrence of the guaranty agency, after the effective date of this provision shall provide that the contract is terminable by the Secretary upon 30 days notice to the contracting parties if the Secretary determines that such contract includes an impermissible transfer of the reserve funds or assets, or is otherwise inconsistent with the terms or purposes of this section; and

        ‘(iv) no provision of State law shall apply to the actions of the Secretary in terminating the operations of a guaranty agency.

      ‘(H) Notwithstanding any other provision of law, the Secretary’s liability for any outstanding liabilities of a guaranty agency (other than outstanding student loan guarantees under this part), the functions of which the Secretary has assumed, shall not exceed the fair market value of the reserves of the guaranty agency, minus any necessary liquidation or other administrative costs.’; and

      (8) in subparagraph (K) (as redesignated by paragraph (6)), by striking ‘system, together’ through the end thereof and inserting the following: ‘system and the progress of the transition from the loan programs under this part to the direct student loan programs under part D of this title.’.

SEC. 4026. ADMINISTRATIVE COST ALLOWANCE.

    Section 428(f)(1) of the Act is amended--

      (1) in subparagraph (A), by striking ‘The Secretary’ and inserting ‘For a fiscal year prior to fiscal year 1994, the Secretary’; and

      (2) in subparagraph (B), by inserting ‘prior to fiscal year 1994’ after ‘any fiscal year’.

SEC. 4027. CONSOLIDATION LOANS.

    Section 428C of the Act is amended--

      (1) by amending subsection (a)(3)(A) to read as follows:

      ‘(3) DEFINITION OF ELIGIBLE BORROWERS- (A) For the purpose of this section, the term ‘eligible borrower’ means a borrower who, at the time of application for a consolidation loan is in repayment status, or in a grace period preceding repayment, or is a delinquent or defaulted borrower who will reenter repayment through loan consolidation.’;

      (2) in subsection (b)--

        (A) in paragraph (1)--

          (i) in subparagraph (A)(ii), by inserting ‘with income-sensitive repayment terms’ after ‘obtain a consolidation loan’;

          (ii) by redesignating subparagraph (E) as subparagraph (F); and

          (iii) by inserting after subparagraph (D) the following new subparagraph:

        ‘(E) that the lender shall offer an income-sensitive repayment schedule, established by the lender in accordance with the regulations of the Secretary, to the borrower of any consolidation loan made by the lender on or after July 1, 1994; and’;

        (B) in paragraph (4), by amending subparagraph (C) to read as follows:

        ‘(C)(i) provides that periodic installments of principal need not be paid, but interest shall accrue and be paid in accordance with clause (ii), during any period for which the borrower would be eligible for a deferral under section 428(b)(1)(M), and that any such period shall not be included in determining the repayment period pursuant to subsection (c)(2) of this section; and

        ‘(ii) provides that interest shall accrue and be paid--

          ‘(I) by the Secretary, in the case of a consolidation loan that consolidated only Federal Stafford Loans for which the student borrower received an interest subsidy under section 428; or

          ‘(II) by the borrower, or capitalized, in the case of a consolidation loan other than one described in subclause (I);’; and

        (C) by adding at the end thereof the following new paragraph:

      ‘(5) DIRECT LOANS- In the event that a borrower is unable to obtain a consolidation loan with income-sensitive repayment terms acceptable to the borrower from a lender with an agreement under subsection (a)(1), the Secretary shall offer any such borrower who applies for it, a direct consolidation loan to be repaid pursuant to an EXCEL Account under part D of this title, except that the Secretary shall not offer such loans if, in his or her judgment, the Department does not yet have the necessary origination and servicing arrangements in place for such loans.’; and

      (3) in subsection (c)--

        (A) in paragraph (1), by amending subparagraphs (B) and (C) to read as follows:

      ‘(B) A consolidation loan made before July 1, 1994, shall bear interest at an annual rate on the unpaid principal balance of the loan that is equal to the greater of--

        ‘(i) the weighted average of the interest rates on the loans consolidated, rounded to the nearest whole percent; or

        ‘(ii) 9 percent.

      ‘(C) A consolidation loan made on or after July 1, 1994, shall bear interest at an annual rate on the unpaid principal balance of the loan that is equal to the weighted average of the interest rates on the loans consolidated, rounded upward to the nearest whole percent.’;

        (B) in paragraph (2)(A)--

          (i) in the matter preceding clause (i), by striking out ‘income sensitive repayment schedules. Such repayment terms’ and inserting in lieu thereof ‘income sensitive repayment schedules, established by the lender in accordance with the regulations of the Secretary. Except as required by such income sensitive repayment schedules, or by the terms of repayment pursuant to an EXCEL Account offered by the Secretary under subsection (b)(5), such repayment terms’;

          (ii) by redesignating clauses (i), (ii), (iii), (iv), and (v) as clauses (ii), (iii), (iv), (v), and (vi), respectively;

          (iii) by inserting immediately preceding clause (ii) (as redesignated by clause (ii)) the following new clause:

        ‘(i) is less than $7,500, then such consolidation loan shall be repaid in not more than 10 years;’; and

          (iv) by adding a period at the end of clause (vi) (as redesignated by clause (ii));

        (C) by striking out suparagraph (B) of paragraph (2); and

        (D) by redesignating subparagraph (C) of paragraph (2) as subparagraph (B); and

        (E) in paragraph (3)(A), by inserting after the subparagraph designation the following: ‘except as required by the terms of repayment pursuant to an EXCEL Account offered by the Secretary under subsection (b)(5),’.

SEC. 4028. STUDENT LOAN MARKETING ASSOCIATION.

    Section 439 of the Act is further amended by adding at the end thereof the following new subsection:

    ‘(s) TRANSITION STUDY- The Secretaries of Education and the Treasury shall prepare a study, to be completed within 6 months of the enactment of this provision, which shall examine alternatives concerning the status, operations, and purposes of the Association during and after the transition from the Federal Family Education Loan program to the Federal Direct Student Loan program. Such study shall--

      ‘(1) consider how best to meet the needs of students and taxpayers;

      ‘(2) reflect the need for the Association to maintain liquidity and perform other functions for the Federal Family Education Loan program during the transition from such program to the Federal Direct Student Loan program under part D of this title, including additional duties as specified by the Secretary of Education or the Secretary of the Treasury;

      ‘(3) consider any appropriate change to part D of title VII, relating to the College Construction Loan Insurance Association; and

      ‘(4) be considered by the Secretaries of Education and the Treasury in developing any legislative proposals concerning any changes to the status of the Association as a Government-sponsored enterprise or its duties under the Federal Family Education Loan program.’.

SEC. 4029. AUTHORITY TO USE OPTICALLY IMAGED DOCUMENTS.

    (a) GENERAL AUTHORITY- Section 484A of the Act is amended--

      (1) in the heading, by adding a semicolon and ‘OPTICALLY IMAGED DOCUMENTS’ after ‘LIMITATIONS’; and

      (2) by adding at the end thereof the following new subsection:

    ‘(c) IN GENERAL- (1) It is the purpose of this subsection to--

      ‘(A) allow the Secretary to use optical imaging technology to store and retrieve documents and records, including promissory notes and repayment agreements, required for the administration of the programs authorized under part D of this title, or for the administration of loans made under part B of this title that have been assigned to the Secretary;

      ‘(B) permit the Secretary to destroy originals of such documents and records, including promissory notes and repayment agreements, after they have been optically imaged, thereby achieving significant savings in storage and retrieval costs; and

      ‘(C) ensure that the Secretary may introduce as evidence in any proceeding with respect to the programs or loans described in subparagraph (A) optically imaged documents and records, including promissory notes and repayment agreements.

    ‘(2) Notwithstanding any other provision of Federal or State law, an optically imaged copy of any document or record, including a promissory note or repayment agreement, may be introduced as evidence in any proceeding with respect to the programs or loans described in paragraph (1)(A) in any Federal or State court, or other tribunal, and such optically imaged copy shall be admissible in any court or tribunal of the United States or any State as if it were the original document or record and have the same force and effect as the original.

    ‘(3) Nothing in this subsection shall be interpreted to preclude the admissibility of a duplicate of a document or record required for the administration of the programs or loans described in paragraph (1)(A) made by a technology other than optical imaging consistent with the Federal Rules of Evidence and section 1732 of title 28 of the United States Code, or applicable State law.

    ‘(4) Nothing in this subsection shall be interpreted to preclude the admissibility of an optically imaged copy of any document or record in a proceeding outside the scope of this subsection consistent with the Federal Rules of Evidence and section 1732 of title 28 of the United States Code, or applicable State law.’.

    (b) PART B AUTHORITY- Section 432 of the Act is amended by adding at the end thereof the following new subsection:

    ‘(q) OPTICALLY IMAGED DOCUMENTS- Records maintained in accordance with section 484A(c) may be used in any proceeding, as permitted by section 484A(c), with respect to a loan that was made under this part and has been assigned to the Secretary.’.

    (c) CONFORMING AMENDMENT- Section 487 of the Act is amended by adding at the end thereof the following new subsection:

    ‘(f) USE OF OPTICALLY IMAGED DOCUMENTS- In any proceeding with respect to a program or activity under part D of this title, or with respect to a loan made under part B of this title that has been assigned to the Secretary, records maintained in accordance with section 484A may be used as provided in that section.’.

SEC. 4030. AMENDMENT TO THE BALANCED BUDGET AND EMERGENCY DEFICIT CONTROL ACT OF 1985.

    The Balanced Budget and Emergency Deficit Control Act of 1985 is amended--

      (1) in section 252(c)(1)(B), by striking ‘guaranteed’;

      (2) in section 256(b)--

        (A) by striking the subsection designation and heading and inserting the following:

    ‘(b) EFFECT OF ORDERS ON STUDENT LOAN PROGRAMS-

      ‘(1) FEDERAL FAMILY EDUCATION LOAN PROGRAM- (A)’;

        (B) by redesignating paragraphs (2) and (3) as subparagraphs (B) and (C), respectively, and by indenting such subparagraphs by an additional 2 ems spaces;

        (C) in paragraph (1)(A) (as redesignated in subparagraph (B)), by striking ‘described in paragraphs (2) and (3)’ and inserting ‘described in subparagraphs (B) and (C)’;

        (D) in paragraph (1)(B) (as redesignated in subparagraph (C)), by redesignating subparagraphs (A) and (B) as clauses (i) and (ii), respectively; and

        (E) by adding at the end thereof the following new paragraph:

      ‘(2) FEDERAL DIRECT STUDENT LOAN PROGRAM- (A) Any reductions that are required to be achieved from the Federal Direct Student Loan program operated under part D of title IV of the Higher Education Act of 1965 as a consequence of an order issued pursuant to section 254, shall be achieved only by the application of the measures described in subparagraph (B).

      ‘(B) For any loan made during the period beginning on the date that an order issued under section 254 takes effect with respect to a fiscal year, and ending at the close of such fiscal year, the loan fee that is authorized to be collected pursuant to section 456(c) of such Act shall be increased by 0.50 percent.’.

CHAPTER 3--EFFECTIVE DATES; STUDY

SEC. 4031. EFFECTIVE DATES.

    (a) IN GENERAL- Except as otherwise provided in this section, the amendments made by this subtitle shall be effective upon enactment.

    (b) INCOME CONTINGENT REPAYMENT- The amendments made by section 4023 of this Act shall be effective for loans made in accordance with section 428 for periods of instruction beginning on or after July 1, 1993, or made on or after July 1, 1993, in the case of loans made in accordance with section 428A, 428B, or 428C of the Act.

    (c) ADMINISTRATIVE COST ALLOWANCE- The amendments made by section 4026 of this Act shall be effective on October 1, 1994.

    (d) CONSOLIDATION LOANS- The amendments made by section 4027 of this Act (other than the amendment made by section 4027(2)(B)) shall be effective for loans made in accordance with section 428C of the Act or after July 1, 1994.

SEC. 4032. STUDY OF INTERNAL REVENUE SERVICE COLLECTION OF STUDENT LOANS.

    (a) GENERAL RULE- The Secretary of Education, in consultation with the Secretary of the Treasury, shall conduct a study of the feasibility of implementing a system for the repayment of Federal student loans through wage withholding or other means involving the Internal Revenue Service. Such study shall include an examination of--

      (1) whether the Internal Revenue Service could implement such a system within its current resources and without adversely affecting the ability of the Internal Revenue Service to collect tax revenues,

      (2) the cumulative impact on voluntary compliance with the tax system of increased disclosure of tax return information and increased Internal Revenue Service involvement in nontax collection activities,

      (3) the anticipated effect on the management of Federal student loan collections and on borrower repayment of such loans, and

      (4) the ability of the Internal Revenue Service to effectively service student loans.

    (b) RECOMMENDATIONS- Not later than the date 6 months after the date of the enactment of this Act, the Secretary of Education shall submit to the Congress a report on the study conducted under subsection (a), together with such legislative recommendations as such Secretary may deem advisable.

SEC. 4033. PREFERENCE OF COMMITTEE FOR IRS COLLECTION MECHANISM.

    It is the sense of the Committee on Education and Labor that--

      (1) the Committee may not, consistent with its jurisdiction under the Rules of the House of Representatives, amend this Act to include provisions providing for the collection of student loans pursuant to the Internal Revenue Code of 1986 using the Internal Revenue Service of the Department of the Treasury;

      (2) the Committee would support the amendment of this Act to include such provisions, as well as amendments to the Higher Education Act of 1965, in the manner proposed by H.R. XXXX as introduced on May 11, 1993; and

      (3) the Committee recommends that the House of Representatives consider and adopt such amendments.

Subtitle B--Cost Sharing by States

SEC. 4101. COST SHARING BY STATES.

    (a) AMENDMENT- Section 428 of the Higher Education Act of 1965 (20 U.S.C. 1001 et seq.) is amended by adding at the end thereof the following new subsection:

    ‘(n) STATE SHARE OF DEFAULT COSTS- (1) In the case of any State in which there are located any institutions of higher education with cohort default rates that exceed 20 percent, such State shall pay to the Secretary an amount equal to--

      ‘(A) the new loan volume attributable to all institutions in the State for the current fiscal year, multiplied by

      ‘(B) the percentage specified in paragraph (2), multiplied by

      ‘(C) the quotient of--

        ‘(i) the sum of the amounts calculated under paragraph (3) for each such institution in the State, divided by

        ‘(ii) the total amount of loan volume attributable to current and former students of institutions located in that State entering repayment in the period used to calculate the cohort default rate.

    ‘(2) For purposes of paragraph (1)(B), the percentage used shall be--

      ‘(A) 12.5 percent for fiscal year 1995;

      ‘(B) 20 percent for fiscal year 1996; and

      ‘(C) 50 percent for fiscal year 1997 and succeeding fiscal years.

    ‘(3) For purposes of paragraph (1)(C)(i), the amount shall be determined by calculating for each institution the amount by which--

      ‘(A) the amount of the loans received for attendance by its current and former students who (i) enter repayment during the fiscal year used for the calculation of the cohort default rate, and (ii) default before the end of the following fiscal year; exceeds

      ‘(B) 20 percent of the loans received for attendance by all the current and former students who enter repayment during the fiscal year used for the calculation of the cohort default rate.

    ‘(4) A State may charge a fee to an institution of higher education that participates in the program under this part and is located in that State according to a fee structure, approved by the Secretary, that is based on the institution’s cohort default rate and the State’s risk of loss under this subsection. Such fee structure shall include a process by which an institution with a high cohort default rate is exempt from any fees under this paragraph if such institution demonstrates to the satisfaction of the State that exceptional mitigating circumstances, as determined by the State and approved by the Secretary, contributed to its cohort default rate.’.

    (b) EFFECTIVE DATE- The amendment made by this section shall be effective on October 1, 1994.

Subtitle C--ERISA Amendments Relating to Group Health Plans

SEC. 4201. COORDINATION OF ERISA PREEMPTION RULES WITH TITLE XIX PROVISIONS PROVIDING FOR LIABILITY OF THIRD PARTIES.

    (a) IN GENERAL- Paragraph (8) of section 514(b) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1144(b)(8)) is amended to read as follows:

    ‘(8)(A) Subsection (a) of this section shall not apply to any State law to the extent necessary to permit the State to comply with the following requirements for the receipt of Federal financial assistance under title XIX of the Social Security Act:

      ‘(i) subparagraphs (A), (B), and (H) of section 1902(a)(25) of such Act (relating to third-party liability) and section 1903(o) of such Act (relating to medicaid as secondary payor), as in effect on October 1, 1993; and

      ‘(ii) sections 1902(a)(45) and 1912 of such Act (relating to assignment of rights of payment), as in effect on May 12, 1993.

    ‘(B) Paragraph (2)(B) shall not apply to any State law to the extent necessary to permit the compliance of the State with any of the requirements described in subparagraph (A).’.

    (b) EFFECTIVE DATE- The amendment made by subsection (a) shall take effect October 1, 1993.

SEC. 4202. CONTINUED COVERAGE OF COSTS OF A PEDIATRIC VACCINE UNDER GROUP HEALTH PLANS.

    (a) IN GENERAL- Part 6 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1161 et seq.) is amended by adding at the end the following new section:

‘SEC. 609. CONTINUED COVERAGE OF COSTS OF A PEDIATRIC VACCINE UNDER GROUP HEALTH PLANS.

    ‘A group health plan may not reduce its coverage of the costs of pediatric vaccines (as defined under section 2162 of the Public Health Service Act) below the coverage it provided as of May 1, 1993.’.

    (b) CONFORMING AMENDMENT- The table of contents in section 1 of such Act is amended by adding after the item relating to section 608 the following new item:

      ‘Sec. 609. Continued coverage of costs of a pediatric vaccine under group health plans.’.

    (c) EFFECTIVE DATE- The amendments made by this section shall apply with respect to plan years beginning after the date of the enactment of this Act.

SEC. 4203. TEMPORARY RULES GOVERNING PREEMPTION OF CERTAIN STATE LAWS.

    Paragraph (5) of section 514(b) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1144(b)(5)) is amended to read as follows:

    ‘(5)(A)(i) Except as provided in clauses (ii) and (iii), subsection (a) shall not apply to the Hawaii Prepaid Health Care Act (Haw. Rev. Stat. Sec. 393-1 through 393-51).

    ‘(ii) Nothing in clause (i) shall be construed to exempt from subsection (a) any State tax law relating to employee benefit plans.

    ‘(iii) Notwithstanding clause (i), parts 1 and 4 of this subtitle, and the preceding sections of this part to the extent they govern matters which are governed by the provisions of such parts 1 and 4, shall supersede the Hawaii Prepaid Health Care Act (as in effect on or after January 14, 1983), but the Secretary may enter into cooperative arrangements under this subparagraph and section 506 with officials of the State of Hawaii to assist them in effectuating the policies of provisions of such Act which are superseded by such parts 1 and 4 and the preceding sections of this part.

    ‘(B)(i) Except as provided in clauses (ii) and (iii), subsection (a) shall not apply to subtitle 2 of title 19 of the Annotated Code of Maryland (relating to the Health Services Cost Review Commission).

    ‘(ii) Nothing in clause (i) shall be construed to exempt from subsection (a)--

      ‘(I) any State tax law relating to employee benefit plans, or

      ‘(II) any amendment of the provision referred to in clause (i) enacted on or after May 12, 1993, to the extent it provides for more than the effective administration of such Act as in effect on such date.

    ‘(iii) Notwithstanding clause (i), parts 1 and 4 of this subtitle, and the preceding sections of this part to the extent they govern matters which are governed by the provisions of such parts 1 and 4, shall supersede the provision referred to in clause (i) (as in effect on or after May 12, 1993), but the Secretary may enter into cooperative arrangements under this subparagraph and section 506 with officials of the State of Maryland to assist them in effectuating the policies of such provision which are superseded by such parts 1 and 4 and the preceding sections of this part.

    ‘(C)(i) Except as provided in clauses (ii) and (iii), subsection (a) shall not apply to the following provisions of the law of the State of Minnesota:

      ‘(I) section 295.52, Minnesota Statutes, as amended in May 1993 by House File 1178 (relating to receipts tax on providers);

      ‘(II) section 19 of article 9 of the Minnesota Health Right Act, as amended in May 1993 by House File 1178 (relating to passthrough of 2 percent gross receipts tax on providers); and

      ‘(III) subdivision 2 of section 3 of article 1 of such Act, article 7 of such Act, and section 1 of article 3 of Minnesota House File 1178 and section 4 and all that follows through the end of such article 3, as enacted in May 1993 (relating to data collection).

    ‘(ii) Nothing in clause (i) shall be construed to exempt from subsection (a)--

      ‘(I) any State tax law relating to employee benefit plans (other than a provision described in clause (i)), and

      ‘(II) any amendment of any provision referred to in clause (i) enacted on or after May 12, 1993, to the extent it provides for more than the effective administration of such provision as in effect on such date.

    ‘(iii) Notwithstanding clause (i), parts 1 and 4 of this subtitle, and the preceding sections of this part to the extent they govern matters which are governed by the provisions of such parts 1 and 4, shall supersede the provisions described in clause (i) (as in effect on or after May 12, 1993), but the Secretary may enter into cooperative arrangements under this subparagraph and section 506 with officials of the State of Minnesota to assist them in effectuating the policies of such provisions which are superseded by such parts 1 and 4 and the preceding sections of this part.

    ‘(D)(i) Except as provided in clauses (ii), (iv), (v), and (vii), subsection (a) shall not apply to the following provisions of the law of the State of New York:

      ‘(I) subdivisions 1(b) and 4(e) of section 2807-c of the Public Health Law (relating to 13 percent surcharge);

      ‘(II) subdivision 1(c) of section 2807-c of the Public Health Law (relating to uniform hospital charges);

      ‘(III) subdivision 2-a of section 2807-c of the Public Health Law (relating to the variable surcharge for HMOs);

      ‘(IV) subdivision 14 of section 2807-c of the Public Health Law (relating to basic percentage allowances for bad debt and charity care);

      ‘(V) subdivision 14-b of section 2807-c of the Public Health Law (relating to health care services allowances);

      ‘(VI) subdivision 14-c of section 2807-c of the Public Health Law (relating to further allowances for financially distressed hospitals); and

      ‘(VII) section 18 of chapter 266 of the laws of 1986, as amended (relating to excess malpractice insurance adjustments).

    ‘(ii) Except as provided in clause (iii), nothing in clause (i) shall be construed to exempt from subsection (a)--

      ‘(I) any State tax law relating to employee benefit plans, or

      ‘(II) any provision referred to in clause (i) to the extent that any law of the State of New York appropriates amounts based on amounts collected by the State under such provision for any purpose other than carrying out the programs established under the provisions described in clause (i).

    ‘(iii) Notwithstanding clause (ii), subsection (a) shall not apply to any provision of the law of the State of New York to the extent that such provision constitutes--

      ‘(I) an HMO surcharge of the type provided for under subdivision 2-a of such section 2807-c (as in effect on February 2, 1993), or

      ‘(II) an allowance, of the type provided for under the provisions referred to in clause (i) (as so in effect), for bad debts, charity care, health care services, or excess malpractice insurance,

    but only if the law of such State appropriates amounts based on and equivalent to amounts collected by the State under such provision solely for the purpose of carrying out one or more programs established under the provisions described in clause (i).

    ‘(iv) Subsection (a) shall apply to any provision of the law of the State of New York to the extent that such provision constitutes a surcharge of the type provided for under subdivisions 1(b) and 4(e) of section 2807-c of the Public Health Law of the State of New York (as in effect on February 2, 1993) unless such provision provides for use of amounts collected under such provision solely for the purpose of carrying out one or more programs established under the provisions described in clause (i).

    ‘(v) Nothing in clause (i) shall be construed to exempt from subsection (a) any amendment of any provision referred to in clause (i) enacted on or after February 2, 1993, to the extent it provides for more than the effective administration of such provisions as in effect on such date, unless such amendment constitutes only a change in the methodology of determining payments to hospitals and would result in--

      ‘(I) a surcharge described in clause (iii)(I) of not more than 9 percent with respect to which the requirements of clause (iii) are met,

      ‘(II) an allowance described in clause (iii)(II) which does not exceed in the aggregate a Statewide average of not more than 10 percent and with respect to which the requirements of clause (iii) are met, or

      ‘(III) a surcharge described in clause (iv) of not more than 13 percent with respect to which the requirements of clause (iv) are met.

    ‘(vi) Subsection (a) shall not apply to any amendment to chapter 2 of the laws of 1988 of the State of New York, as amended, to the extent that such amendment extends the period for which the provisions referred to in clause (i) are in effect.

    ‘(vii) Notwithstanding clause (i), parts 1 and 4 of this subtitle, and the preceding sections of this part to the extent they govern matters which are governed by the provisions of such parts 1 and 4, shall supersede the provisions described in clause (i) (as in effect on or after February 2, 1993), but the Secretary may enter into cooperative arrangements under this subparagraph and section 506 with officials of the State of New York to assist them in effectuating the policies of such provisions which are superseded by such parts 1 and 4 and the preceding sections of this part.

    ‘(viii) The provisions of this subparagraph shall be effective as of February 2, 1993.

    ‘(E) This paragraph shall cease to be effective as of May 12, 1995.’.

TITLE V--COMMITTEE ON ENERGY AND COMMERCE

Subtitle A--Medicare Program

SEC. 5000. REFERENCES IN SUBTITLE; TABLE OF CONTENTS OF SUBTITLE.

    (a) AMENDMENTS TO SOCIAL SECURITY ACT- Except as otherwise specifically provided, whenever in this subtitle an amendment is expressed in terms of an amendment to or repeal of a section or other provision, the reference shall be considered to be made to that section or other provision of the Social Security Act.

    (b) REFERENCES TO OBRA- In this subtitle, the terms ‘OBRA-1986’, ‘OBRA-1987’, ‘OBRA-1989’, and ‘OBRA-1990’ refer to the Omnibus Budget Reconciliation Act of 1986 (Public Law 99-509), the Omnibus Budget Reconciliation Act of 1987 (Public Law 100-203), the Omnibus Budget Reconciliation Act of 1989 (Public Law 101-239), and the Omnibus Budget Reconciliation Act of 1990 (Public Law 101-508), respectively.

    (c) TABLE OF CONTENTS OF SUBTITLE- The table of contents of this subtitle is as follows:

      Sec. 5000. References in subtitle; table of contents of subtitle.

Chapter 1--Provisions Relating to Part B

SUBCHAPTER A--PHYSICIANS’ SERVICES

      Sec. 5001. Reduction in default update for conversion factor for 1994.

      Sec. 5002. Reduction in performance standard rate of increase and increase in maximum reduction permitted in default update.

      Sec. 5003. Classification of primary care services as a separate category of services.

      Sec. 5004. Phased-in reduction in practice expense relative value units for certain services.

      Sec. 5005. Limitation on payment for the anesthesia care team.

      Sec. 5006. Basing payments for anesthesia services on actual time.

      Sec. 5007. Separate payment for interpretation of electrocardiograms.

      Sec. 5008. Payments for new physicians and practitioners.

      Sec. 5009. Geographic adjustment factors for medicare physicians’ services.

      Sec. 5010. Extra-billing limits.

      Sec. 5011. Relative values for pediatric services.

      Sec. 5012. Antigens under physician fee schedule.

      Sec. 5013. Administration of claims relating to physicians’ services.

      Sec. 5014. Miscellaneous and technical corrections.

SUBCHAPTER B--OUTPATIENT HOSPITAL SERVICES AND AMBULATORY SURGICAL SERVICES

      Sec. 5021. Extension of 10 percent reduction in payments for capital-related costs of outpatient hospital services.

      Sec. 5022. Extension of current reduction in payments for other costs of outpatient hospital services.

      Sec. 5023. 1-year freeze in ambulatory surgery rates.

      Sec. 5024. Eye or eye and ear hospitals.

      Sec. 5025. Extension of cap on payments for intraocular lenses.

      Sec. 5026. Miscellaneous and technical corrections.

SUBCHAPTER C--DURABLE MEDICAL EQUIPMENT

      Sec. 5031. Revisions to payment rules for durable medical equipment.

      Sec. 5032. Payment for parenteral and enteral nutrients, supplies, and equipment during 1994.

      Sec. 5033. Treatment of nebulizers and aspirators.

      Sec. 5034. Certification of suppliers.

      Sec. 5035. Prohibition against carrier forum shopping.

      Sec. 5036. Restrictions on certain marketing and sales activities.

      Sec. 5037. Kickback clarification.

      Sec. 5038. Beneficiary liability for noncovered services.

      Sec. 5039. Adjustments for inherent reasonableness.

      Sec. 5040. Payment for surgical dressings.

      Sec. 5041. Payments for tens devices.

      Sec. 5042. Miscellaneous and technical corrections.

SUBCHAPTER D--PART B PREMIUM

      Sec. 5051. Part B premium.

SUBCHAPTER E--OTHER PROVISIONS

      Sec. 5061. Payments for clinical diagnostic laboratory tests.

      Sec. 5062. Treatment of inpatients and provision of diagnostic and therapeutic X-ray services by rural health clinics and Federally qualified health centers.

      Sec. 5063. Application of mammography certification requirements.

      Sec. 5064. Extension of Alzheimer’s disease demonstration.

      Sec. 5065. Oral cancer drugs.

      Sec. 5066. Extension of municipal health service demonstration projects.

      Sec. 5067. Treatment of certain Indian health programs and facilities as Federally-qualified health centers.

      Sec. 5068. Interest payments.

      Sec. 5069. Clarification of coverage of certified nurse-midwife services performed outside the maternity cycle.

      Sec. 5069A. Increase in, and study of, annual cap on amount of medicare payment for outpatient physical therapy and occupational therapy services.

      Sec. 5070. Miscellaneous and technical corrections.

Chapter 2--Provisions Relating to Parts A and B

      Sec. 5071. Elimination of add-on for overhead of hospital-based home health agencies.

      Sec. 5072. Study and report on medicare GME payments.

      Sec. 5073. Medicare as secondary payer.

      Sec. 5074. Extension of self-referral ban to additional specified services.

      Sec. 5075. Reduction in payment for erythropoietin.

      Sec. 5076. Medicare hospital agreements with organ procurement organizations.

      Sec. 5077. Extension of waiver for Watts Health Foundation.

      Sec. 5078. Improved outreach for qualified medicare beneficiaries.

      Sec. 5079. Social health maintenance organizations.

      Sec. 5080. Peer review organizations.

      Sec. 5081. Hospice information to home health beneficiaries.

      Sec. 5082. Health maintenance organizations.

      Sec. 5083. Miscellaneous and technical corrections.

Chapter 3--Provisions Relating to Medicare Supplemental Insurance Policies

      Sec. 5091. Standards for medicare supplemental insurance policies.

CHAPTER 1--PROVISIONS RELATING TO PART B

Subchapter A--Physicians’ Services

SEC. 5001. REDUCTION IN DEFAULT UPDATE FOR CONVERSION FACTOR FOR 1994.

    Section 1848(d)(3)(A) (42 U.S.C. 1395w-4(d)(3)(A)) is amended--

      (1) in clause (i), by striking ‘clause (iii)’ and inserting ‘clauses (iii) and (iv)’, and

      (2) by adding at the end the following new clause:

          ‘(iv) ADJUSTMENT IN PERCENTAGE INCREASE FOR 1994- In applying clause (i) for services (other than primary care services) furnished in 1994, the percentage increase in the appropriate update index shall be reduced by--

            ‘(I) 3 percentage points for surgical services (as defined for purposes of subsection (j)(1)), and

            ‘(II) 2 percentage points for other services.’.

SEC. 5002. REDUCTION IN PERFORMANCE STANDARD RATE OF INCREASE AND INCREASE IN MAXIMUM REDUCTION PERMITTED IN DEFAULT UPDATE.

    (a) REDUCTION IN PERFORMANCE STANDARD FACTOR- Section 1848(f)(2)(B) (42 U.S.C. 1395w-4(f)(2)(B)) is amended--

      (1) by striking ‘and’ at the end of clause (ii), and

      (2) by striking clause (iii) and inserting the following:

          ‘(iii) for 1993 is 2 percentage points,

          ‘(iv) for 1994 is 3 1/2 percentage points, and

          ‘(v) for each succeeding year is 4 percentage points.’.

    (b) INCREASE IN MAXIMUM REDUCTION PERMITTED IN DEFAULT UPDATE- Section 1848(d)(3)(B)(ii) (42 U.S.C. 1395w-4(d)(3)(B)(ii)) is amended--

      (1) in subclause (II), by striking ‘or 1995’, and

      (2) in subclause (III), by striking ‘3’ and inserting ‘5’.

SEC. 5003. CLASSIFICATION OF PRIMARY CARE SERVICES AS A SEPARATE CATEGORY OF SERVICES.

    (a) IN GENERAL- Section 1848(j)(1) (42 U.S.C. 1395w-4(j)(1)) is amended by inserting ‘, primary care services (as defined in section 1842(i)(4)),’ after ‘Secretary)’.

    (b) EFFECTIVE DATE- The amendment made by subsection (a) shall apply--

      (1) to volume performance standard rates of increase established under section 1848(f) of the Social Security Act for fiscal years beginning with fiscal year 1994, and

      (2) to updates in the conversion factors for physicians’ services established under section 1848(d) of such Act for physicians’ services to be furnished in calendar years beginning with 1996.

SEC. 5004. PHASED-IN REDUCTION IN PRACTICE EXPENSE RELATIVE VALUE UNITS FOR CERTAIN SERVICES.

    (a) IN GENERAL- Section 1848(c)(2) (42 U.S.C. 1395w-4(c)(2)) is amended by adding at the end the following new subparagraph:

        ‘(E) REDUCTION IN PRACTICE EXPENSE RELATIVE VALUE UNITS FOR CERTAIN SERVICES-

          ‘(i) IN GENERAL- Subject to clause (ii), the Secretary shall reduce the practice expense relative value units applied to services described in clause (iii) furnished in--

            ‘(I) 1994, by 25 percent of the number by which the number of practice expense relative value units (determined for 1994 without regard to this subparagraph) exceeds the number of work relative value units determined for 1994,

            ‘(II) 1995, by an additional 25 percent of such excess, and

            ‘(III) 1996 and subsequent years, by an additional 25 percent of such excess.

          ‘(ii) FLOOR ON REDUCTIONS- The practice expense relative value units for a physicians’ service shall not be reduced under this subparagraph to a number less than 110 percent of the number of work relative value units.

          ‘(iii) SERVICES COVERED- For purposes of clause (i), the services described in this clause are physicians’ services that are not described in clause (iv) and for which--

            ‘(I) there are work relative value units, and

            ‘(II) the number of practice expense relative value units (determined for 1994) exceeds 110 percent of the number of work relative value units (determined for such year).

          ‘(iv) EXCLUDED SERVICES- For purposes of clause (iii), the services described in this clause are--

            ‘(I) anesthesia services,

            ‘(II) radiology services, and

            ‘(III) services which the Secretary determines at least 75 percent of which are provided under this title in an office setting.’.

    (b) DEVELOPMENT OF RESOURCE-BASED METHODOLOGY FOR PRACTICE EXPENSES-

      (1) The Secretary of Health and Human Services shall develop a methodology for implementing in 1997 a resource-based system for determining practice expense relative value units for each physician’s service.

      (2) The Secretary shall transmit a report by June 30, 1996, on the methodology developed under paragraph (1) to the Committees on Ways and Means and Energy and Commerce of the House of Representatives and the Committee on Finance of the Senate. The report shall include a presentation of data utilized in developing the methodology and an explanation of the methodology.

SEC. 5005. LIMITATION ON PAYMENT FOR THE ANESTHESIA CARE TEAM.

    (a) LIMIT ON PAYMENT TO A PHYSICIAN FOR MEDICAL DIRECTION-

      (1) IN GENERAL- Section 1848(a) (42 U.S.C. 1395w-4(a)), as amended by section 5008(a)(1), is amended by adding at the end the following new paragraph:

      ‘(4) SPECIAL RULE FOR MEDICAL DIRECTION-

        ‘(A) IN GENERAL- With respect to physicians’ services furnished on or after January 1, 1994, and consisting of medical direction of two, three, or four concurrent anesthesia cases, the fee schedule amount to be applied shall not exceed one-half of the amount described in subparagraph (B).

        ‘(B) AMOUNT- The amount described in this subparagraph, for a physician’s medical direction of the performance of anesthesia services, is the following percentage of the fee schedule amount otherwise applicable under this section if the anesthesia services were personally performed by the physician alone:

          ‘(i) For services furnished during 1994, 120 percent.

          ‘(ii) For services furnished during 1995, 115 percent.

          ‘(iii) For services furnished during 1996, 110 percent.

          ‘(iv) For services furnished during 1997, 105 percent.

          ‘(v) For services furnished after 1997, 100 percent.’.

      (2) ELIMINATION OF REDUCTION FOR MEDICAL DIRECTION OF MULTIPLE NURSE ANESTHETISTS- Section 1842(b) (42 U.S.C. 1395u(b)) is amended by striking paragraph (13).

    (b) PAYMENT TO A CERTIFIED REGISTERED NURSE ANESTHETIST FOR MEDICALLY DIRECTED SERVICES- Subparagraph (B) of section 1833(l)(4) (42 U.S.C. 1395l(l)(4)) is amended--

      (1) in clause (i), by inserting ‘and before January 1, 1994,’ after ‘1991,’;

      (2) in clause (ii)--

        (A) by adding ‘and’ at the end of subclause (II),

        (B) by striking the comma at the end of subclause (III) and inserting a period, and

        (C) by striking subclauses (IV) through (VII); and

      (3) by adding at the end the following new clause:

    ‘(iii) In the case of services of a certified registered nurse anesthetist who is medically directed by a physician and that are furnished on or after January 1, 1994, the fee schedule amount shall be one-half of the amount described in section 1848(a)(4)(B) with respect to the physician.’.

SEC. 5006. BASING PAYMENTS FOR ANESTHESIA SERVICES ON ACTUAL TIME.

    (a) PHYSICIANS’ SERVICES- Section 1848(b)(2)(B) (42 U.S.C. 1395w-4(b)(2)(B)) is amended by adding at the end the following: ‘For anesthesia services furnished on or after January 1, 1994, the Secretary may not modify the methodology in effect as of January 1, 1993, for determining the amount of time that may be billed for such services under this section.’.

    (b) SERVICES OF CERTIFIED REGISTERED NURSE ANESTHETISTS- Section 1833(l)(1)(B) (42 U.S.C. 1395l(l)(1)(B)) is amended by adding at the end the following: ‘For anesthesia services furnished on or after January 1, 1994, the Secretary may not modify the methodology in effect as of January 1, 1993, for determining the amount of time that may be billed for such services under this section.’.

SEC. 5007. SEPARATE PAYMENT FOR INTERPRETATION OF ELECTROCARDIOGRAMS.

    (a) IN GENERAL- Paragraph (3) of section 1848(b) (42 U.S.C. 1395w-4(b)) is amended to read as follows:

      ‘(3) TREATMENT OF INTERPRETATION OF ELECTROCARDIOGRAMS- The Secretary--

        ‘(A) shall make separate payment under this section for the interpretation of electrocardiograms performed or ordered to be performed as part of or in conjunction with a visit to or a consultation with a physician, and

        ‘(B) shall adjust the relative values established for visits and consultations under subsection (c) so as not to include relative value units for interpretations of electrocardiograms in the relative value for visits and consultations.’.

    (b) ASSURING BUDGET NEUTRALITY- Section 1848(c)(2) (42 U.S.C. 1395w-4(c)(2)), as amended by section 5004(a); is amended by adding at the end the following new subparagraph:

        ‘(F) BUDGET NEUTRALITY ADJUSTMENTS- The Secretary--

          ‘(i) shall reduce the relative values for all services (other than anesthesia services) established under this paragraph (and, in the case of anesthesia services, the conversion factor established by the Secretary for such services) by such percentage as the Secretary determines to be necessary so that, beginning in 1996, the amendment made by section 5007(a) of the Omnibus Budget Reconciliation Act of 1993 would not result in expenditures under this section that exceed the amount of such expenditures that would have been made if such amendment had not been made, and

          ‘(ii) shall reduce the amounts determined under subsection (a)(2)(B)(ii)(I) by such percentage as the Secretary determines to be required to assure that, taking into account the reductions made under clause (i), the amendment made by section 5007(a) of the Omnibus Budget Reconciliation Act of 1993 would not result in expenditures under this section in 1994 that exceed the amount of such expenditures that would have been made if such amendment had not been made.’.

    (c) CONFORMING AMENDMENTS- Section 1848 (42 U.S.C. 1395w-4) is amended--

      (1) in subsection (a)(2)(B)(ii)(I), by inserting ‘and as adjusted under subsection (c)(2)(F)(ii)’ after ‘for 1994’;

      (2) in subsection (c)(2)(A)(i), by adding at the end the following: ‘Such relative values are subject to adjustment under subparagraph (F)(i).’; and

      (3) in subsection (i)(1)(B), by adding at the end ‘including adjustments under subsection (c)(2)(F),’.

    (d) EFFECTIVE DATE- The amendments made by this section shall apply to services furnished on or after January 1, 1994.

SEC. 5008. PAYMENTS FOR NEW PHYSICIANS AND PRACTITIONERS.

    (a) EQUAL TREATMENT OF NEW PHYSICIANS AND PRACTITIONERS- (1) Section 1848(a) (42 U.S.C. 1395w-4(a)) is amended by striking paragraph (4).

    (2) Section 1842(b)(4) (42 U.S.C. 1395u(b)(4)) is amended by striking subparagraph (F).

    (b) BUDGET NEUTRALITY ADJUSTMENT- Notwithstanding any other provision of law, the Secretary of Health and Human Services shall reduce the following values and amounts for 1994 (to be applied for that year and subsequent years) by such uniform percentage as the Secretary determines to be required to assure that the amendments made by subsection (a) will not result in expenditures under part B of title XVIII of the Social Security Act in 1994 that exceed the amount of such expenditures that would have been made if such amendments had not been made:

      (1) The relative values established under section 1848(c) of such Act for services (other than anesthesia services) and, in the case of anesthesia services, the conversion factor established under section 1848 of such Act for such services.

      (2) The amounts determined under section 1848(a)(2)(B)(ii)(I) of such Act.

      (3) The prevailing charges or fee schedule amounts to be applied under such part for services of a health care practitioner (as defined in section 1842(b)(4)(F)(ii)(I) of such Act, as in effect before the date of the enactment of this Act).

    (c) CONFORMING AMENDMENTS- Section 1848 (42 U.S.C. 1395w-4), as amended by section 5007(c), is amended--

      (1) in subsection (a)(2)(B)(ii)(I), by inserting ‘and section 5008(b) of the Omnibus Budget Reconciliation Act of 1993’ after ‘(c)(2)(F)(ii)’;

      (2) in subsection (c)(2)(A)(i), by inserting ‘and section 5008(b) of the Omnibus Budget Reconciliation Act of 1993’ after ‘under subparagraph (F)(i)’; and

      (3) in subsection (i)(1)(B), by inserting ‘and section 5008(b) of the Omnibus Budget Reconciliation Act of 1993’ after ‘under subsection (c)(2)(F)’.

    (d) EFFECTIVE DATE- The amendments made by subsection (a) shall apply to services furnished on or after January 1, 1994.

SEC. 5009. GEOGRAPHIC ADJUSTMENT FACTORS FOR MEDICARE PHYSICIANS’ SERVICES.

    (a) REQUIRING CONSULTATION WITH REPRESENTATIVES OF PHYSICIANS IN REVIEWING GEOGRAPHIC ADJUSTMENT FACTORS- Section 1848(e)(1)(C) (42 U.S.C. 1395w-4(e)(1)(C)) is amended by striking ‘shall review’ and inserting ‘shall, in consultation with appropriate representatives of physicians, review’.

    (b) USE OF MOST RECENT DATA IN GEOGRAPHIC ADJUSTMENT- Section 1848(e)(1) (42 U.S.C. 1395w-4(e)(1)) is amended by adding at the end the following new subparagraph:

        ‘(D) USE OF RECENT DATA- In establishing indices and index values under this paragraph, the Secretary shall use the most recent data available relating to practice expenses, malpractice expenses, and physician work effort in different fee schedule areas.’.

    (c) DEADLINE FOR INITIAL REVIEW AND REVISION- The Secretary of Health and Human Services shall first review and revise geographic adjustment factors under section 1848(e)(1)(C) of the Social Security Act by not later than January 1, 1995.

    (d) REPORT ON REVIEW PROCESS- Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services shall study and report to the Committee on Finance of the Senate and the Committee on Ways and Means and the Committee on Energy and Commerce of the House of Representatives on--

      (1) the data necessary to review and revise the indices established under section 1848(e)(1)(A) of the Social Security Act, including--

        (A) the shares allocated to physicians’ work effort, practice expenses (other than malpractice expenses), and malpractice expenses;

        (B) the weights assigned to the input components of such shares; and

        (C) the index values assigned to such components;

      (2) any limitations on the availability of data necessary to review and revise such indices at least every three years;

      (3) ways of addressing such limitations, with particular attention to the development of alternative data sources for input components for which current index values are based on data collected less frequently than every three years; and

      (4) the costs of developing more accurate and timely data.

SEC. 5010. EXTRA-BILLING LIMITS.

    (a) ENFORCEMENT AND UNIFORM APPLICATION-

      (1) ENFORCEMENT- Paragraph (1) of section 1848(g) (42 U.S.C. 1395w-4(g)) is amended to read as follows:

      ‘(1) LIMITATION ON ACTUAL CHARGES-

        ‘(A) IN GENERAL- In the case of a nonparticipating physician or nonparticipating supplier or other person (as defined in section 1842(i)(2)) who does not accept payment on an assignment-related basis for a physician’s service furnished with respect to an individual enrolled under this part, the following rules apply:

          ‘(i) APPLICATION OF LIMITING CHARGE- No person may bill or collect an actual charge for the service in excess of the limiting charge described in paragraph (2) for such service.

          ‘(ii) NO LIABILITY FOR EXCESS CHARGES- No person is liable for payment of any amounts billed for the service in excess of such limiting charge.

          ‘(iii) CORRECTION OF EXCESS CHARGES- If such a physician, supplier, or other person bills, but does not collect, an actual charge for a service in violation of clause (i), the physician, supplier, or other person shall reduce on a timely basis the actual charge billed for the service to an amount not to exceed the limiting charge for the service.

          ‘(iv) REFUND OF EXCESS COLLECTIONS- If such a physician, supplier, or other person collects an actual charge for a service in violation of clause (i), the physician, supplier, or other person shall provide on a timely basis a refund to the individual charged in the amount by which the amount collected exceeded the limiting charge for the service. The amount of such a refund shall be reduced to the extent the individual has an outstanding balance owed by the individual to the physician.

        ‘(B) SANCTIONS- If a physician, supplier, or other person--

          ‘(i) knowingly and willfully bills or collects for services in violation of subparagraph (A)(i) on a repeated basis, or

          ‘(ii) fails to comply with clause (iii) or (iv) of subparagraph (A) on a timely basis,

        the Secretary may apply sanctions against the physician, supplier, or other person in accordance with paragraph (2) of section 1842(j). In applying this subparagraph, paragraph (4) of such section applies in the same manner as such paragraph applies to such section and any reference in such section to a physician is deemed also to include a reference to a supplier or other person under this subparagraph.

        ‘(C) TIMELY BASIS- For purposes of this paragraph, a correction of a bill for an excess charge or refund of an amount with respect to a violation of subparagraph (A)(i) in the case of a service is considered to be provided ‘on a timely basis’, if the reduction or refund is made not later than 30 days after the date the physician, supplier, or other person is notified by the carrier under this part of such violation and of the requirements of subparagraph (A).’.

      (2) UNIFORM APPLICATION OF EXTRA-BILLING LIMITS TO PHYSICIANS’ SERVICES-

        (A) IN GENERAL- Section 1848(g)(2)(C) (42 U.S.C. 1395w-4(g)(2)(C)) is amended by inserting ‘or for nonparticipating suppliers or other persons’ after ‘nonparticipating physicians’.

        (B) CONFORMING DEFINITION- Section 1842(i)(2) (42 U.S.C. 1395u(i)(2)) is amended--

          (i) by striking ‘, and the term’ and inserting ‘; the term’, and

          (ii) by inserting before the period at the end the following: ‘; and the term ‘nonparticipating supplier or other person’ means a supplier or other person (excluding a provider of services) that is not a participating physician or supplier (as defined in subsection (h)(1))’.

      (3) ADDITIONAL CONFORMING AMENDMENTS- Section 1848 (42 U.S.C. 1395w-4) is amended--

        (A) in subsection (a)(3)--

          (i) by inserting ‘AND SUPPLIERS’ after ‘PHYSICIANS’,

          (ii) by inserting ‘or a nonparticipating supplier or other person’ after ‘nonparticipating physician’, and

          (iii) by adding at the end the following: ‘In the case of physicians’ services (including services which the Secretary excludes pursuant to subsection (j)(3)) of a nonparticipating physician, supplier, or other person for which payment is made under this part on a basis other than the fee schedule amount, the payment shall be based on 95 percent of the payment basis for such services furnished by a participating physician, supplier, or other person.’;

        (B) in subsection (g)(1)(A), as amended by subsection (a), in the matter before clause (i), by inserting ‘(including services which the Secretary excludes pursuant to subsection (j)(3))’ after ‘a physician’s service’;

        (C) in subsection (g)(2)(D), by inserting ‘(or, if payment under this part is made on a basis other than the fee schedule under this section, 95 percent of the other payment basis)’ after ‘subsection (a)’;

        (D) in subsection (g)(3)(B)--

          (i) by inserting after the first sentence the following: ‘No person is liable for payment of any amounts billed for such a service in violation of the previous sentence.’, and

          (ii) in the last sentence, by striking ‘previous sentence’ and inserting ‘first sentence’;

        (E) in subsection (h)--

          (i) by inserting ‘or nonparticipating supplier or other person furnishing physicians’ services (as defined in section 1848(j)(3))’ after ‘physician’ the first place it appears,

          (ii) by inserting ‘, supplier, or other person’ after ‘physician’ the second place it appears, and

          (iii) by inserting ‘, suppliers, and other persons’ after ‘physicians’ the second place it appears; and

        (F) in subsection (j)(3), by inserting ‘, except for purposes of subsections (a)(3), (g), and (h)’ after ‘tests and’.

    (b) CLARIFICATION OF MANDATORY ASSIGNMENT RULES FOR CERTAIN PRACTITIONERS-

      (1) IN GENERAL- Section 1842(b) (42 U.S.C. 1395u(b)), as amended by section 5014(e), is amended by adding at the end the following new paragraph:

    ‘(18)(A) Payment for any service furnished by a practitioner described in subparagraph (C) and for which payment may be made under this part on a reasonable charge or fee schedule basis may only be made under this part on an assignment-related basis.

    ‘(B) A practitioner described in subparagraph (C) or other person may not bill (or collect any amount from) the individual or another person for any service described in subparagraph (A), except for deductible and coinsurance amounts applicable under this part. No person is liable for payment of any amounts billed for such a service in violation of the previous sentence. If a practitioner or other person knowingly and willfully bills (or collects an amount) for such a service in violation of such sentence, the Secretary may apply sanctions against the practitioner or other person in the same manner as the Secretary may apply sanctions against a physician in accordance with section 1842(j)(2) in the same manner as such section applies with respect to a physician. Paragraph (4) of section 1842(j) shall apply in this subparagraph in the same manner as such paragraph applies to such section.

    ‘(C) A practitioner described in this subparagraph is any of the following:

      ‘(i) A physician assistant, nurse practitioner, or clinical nurse specialist (as defined in section 1861(aa)(5)).

      ‘(ii) A certified registered nurse anesthetist (as defined in section 1861(bb)(2)).

      ‘(iii) A certified nurse-midwife (as defined in section 1861(gg)(2)).

      ‘(iv) A clinical social worker (as defined in section 1861(hh)(1)).

      ‘(v) A clinical psychologist (as defined by the Secretary for purposes of section 1861(ii)).

    ‘(D) For purposes of this paragraph, a service furnished by a practitioner described in subparagraph (C) includes any services and supplies furnished as incident to the service as would otherwise be covered under this part if furnished by a physician or as incident to a physician’s service.’.

      (2) CONFORMING AMENDMENTS-

        (A) Section 1833 (42 U.S.C. 1395l) is amended--

          (i) in subsection (l)(5), by striking subparagraph (B) and redesignating subparagraph (C) as subparagraph (B);

          (ii) by striking subsection (p); and

          (iii) in subsection (r), by striking paragraph (3) and redesignating paragraph (4) as paragraph (3).

        (B) Section 1842(b)(12) (42 U.S.C. 1395u(b)(12)) is amended by striking subparagraph (C).

    (c) INFORMATION ON EXTRA-BILLING LIMITS-

      (1) PART OF EXPLANATION OF MEDICARE BENEFITS- Section 1842(h)(7) (42 U.S.C. 1395u(h)(7)) is amended--

        (A) by striking ‘and’ at the end of subparagraph (B),

        (B) in subparagraph (C), by striking ‘shall include’,

        (C) in subparagraph (C), by striking the period at the end and inserting ‘, and’, and

        (D) by adding at the end the following new subparagraph:

      ‘(D) in the case of services for which the billed amount exceeds the limiting charge imposed under section 1848(g), information regarding such applicable limiting charge (including information concerning the right to a refund under section 1848(g)(1)(A)(iv)).’.

      (2) DETERMINATIONS BY CARRIERS- Subparagraph (G) of section 1842(b)(3) (42 U.S.C. 1395u(b)(3)) is amended to read as follows:

      ‘(G) will, for a service that is furnished with respect to an individual enrolled under this part, that is not paid on an assignment-related basis, and that is subject to a limiting charge under section 1848(g)--

        ‘(i) determine, prior to making payment, whether the amount billed for such service exceeds the limiting charge applicable under section 1848(g)(2);

        ‘(ii) notify the physician, supplier, or other person periodically (but not less often than once every 30 days) of determinations that amounts billed exceeded such applicable limiting charges; and

        ‘(iii) provide for prompt response to inquiries of physicians, suppliers, and other persons concerning the accuracy of such limiting charges for their services;’.

    (d) REPORT ON CHARGES IN EXCESS OF LIMITING CHARGE- Section 1848(g)(6)(B) (42 U.S.C. 1395w-4(g)(6)(B)) is amended by inserting ‘the extent to which actual charges exceed limiting charges, the number and types of services involved, and the average amount of excess charges and’ after ‘report to the Congress’.

    (e) MISCELLANEOUS AND TECHNICAL AMENDMENTS- Section 1833 (42 U.S.C. 1395l) is amended--

      (1) in subsection (a)(1), as amended by section 5070(e)(2)--

        (A) by striking ‘and’ before ‘(O)’, and

        (B) by inserting before the semicolon at the end the following: ‘, and (P) with respect to services described in clauses (i), (ii) and (iv) of section 1861(s)(2)(K), the amounts paid are subject to the provisions of section 1842(b)(12)’; and

      (2) in subsection (h)(5)(D)--

        (A) by striking ‘paragraphs (2) and (3)’ and by inserting ‘paragraph (2)’, and

        (B) by adding at the end the following: ‘Paragraph (4) of such section shall apply in this subparagraph in the same manner as such paragraph applies to such section.’.

    (f) EFFECTIVE DATES-

      (1) ENFORCEMENT AND UNIFORM APPLICATION; MISCELLANEOUS AND TECHNICAL AMENDMENTS- The amendments made by subsections (a) and (e) shall apply to services furnished on or after the date of the enactment of this Act; except that the amendments made by subsection (a) shall not apply to services of a nonparticipating supplier or other person furnished before January 1, 1994.

      (2) PRACTITIONERS- The amendments made by subsection (b) shall apply to services furnished on or after January 1, 1994.

      (3) EOMBS- The amendments made by subsection (c)(1) shall apply to explanations of benefits provided on or after January 1, 1994.

      (4) CARRIER DETERMINATIONS- The amendments made by subsection (c)(2) shall apply to contracts as of January 1, 1994.

      (5) REPORT- The amendment made by subsection (d) shall apply to reports for years beginning with 1994.

SEC. 5011. RELATIVE VALUES FOR PEDIATRIC SERVICES.

    (a) IN GENERAL- The Secretary of Health and Human Services shall fully develop, by not later than July 1, 1994, relative values for the full range of pediatric physicians’ services which are consistent with the relative values developed for other physicians’ services under section 1848(c) of the Social Security Act. In developing such values, the Secretary shall conduct such refinements as may be necessary to produce appropriate estimates for such relative values.

    (b) STUDY-

      (1) IN GENERAL- The Secretary shall conduct a study of the relative values for pediatric and other services to determine whether there are significant variations in the resources used in providing similar services to different populations. In conducting such study, the Secretary shall consult with appropriate organizations representing pediatricians and other physicians and physical and occupational therapists.

      (2) REPORT- Not later than July 1, 1994, the Secretary shall submit to Congress a report on the study conducted under paragraph (1). Such report shall include any appropriate recommendations regarding needed changes in coding or other payment policies to ensure that payments for pediatric services appropriately reflect the resources required to provide these services.

SEC. 5012. ANTIGENS UNDER PHYSICIAN FEE SCHEDULE.

    (a) IN GENERAL- Section 1848(j)(3) (42 U.S.C. 1395w-4(j)(3)) is amended by inserting ‘(2)(G),’ after ‘(2)(D),’.

    (b) EFFECTIVE DATE- The amendment made by subsection (a) shall apply to services furnished on or after January 1, 1994.

SEC. 5013. ADMINISTRATION OF CLAIMS RELATING TO PHYSICIANS’ SERVICES.

    (a) LIMITATION ON CARRIER USER FEES- Section 1842(c) (42 U.S.C. 1395u(c)) is amended by adding at the end the following new paragraph:

    ‘(4) Neither a carrier nor the Secretary may impose a fee under this title--

      ‘(A) for the filing of claims related to physicians’ services,

      ‘(B) for an error in filing a claim relating to physicians’ services or for such a claim which is denied,

      ‘(C) for any appeal under this title with respect to physicians’ services,

      ‘(D) for applying for (or obtaining) a unique identifier under subsection (r), or

      ‘(E) for responding to inquiries respecting physicians’ services or for providing information with respect to medical review of such services.’.

    (b) CLARIFICATION OF PERMISSIBLE SUBSTITUTE BILLING ARRANGEMENTS-

      (1) IN GENERAL- Clause (D) of section 1842(b)(6) (42 U.S.C. 1395u(b)(6)) is amended to read as follows: ‘(D) payment may be made to a physician for physicians’ services (and services furnished incident to such services) furnished by a second physician to patients of the first physician if (i) the first physician is unavailable to provide the services; (ii) the services are furnished pursuant to an arrangement between the two physicians that (I) is informal and reciprocal, or (II) involves per diem or other fee-for-time compensation for such services; (iii) the services are not provided by the second physician over a continuous period of more than 60 days; and (iv) the claim form submitted to the carrier for such services includes the second physician’s unique identifier (provided under the system established under subsection (r)) and indicates that the claim meets the requirements of this clause for payment to the first physician’.

      (2) EFFECTIVE DATE- The amendment made by paragraph (1) shall apply to services furnished on or after the first day of the first month beginning more than 60 days after the date of the enactment of this Act.

SEC. 5014. MISCELLANEOUS AND TECHNICAL CORRECTIONS.

    (a) OVERVALUED PROCEDURES (SECTION 4101 OF OBRA-1990)- (1) Section 1842(b)(16)(B)(iii) (42 U.S.C. 1395u(b)(16)(B)(iii)) is amended--

      (A) by striking ‘, simple and subcutaneous’,

      (B) by striking ‘; small’ and inserting ‘and small’,

      (C) by striking ‘treatments;’ the first place it appears and inserting ‘and’,

      (D) by striking ‘lobectomy;’,

      (E) by striking ‘enterectomy; colectomy; cholecystectomy;’,

      (F) by striking ‘; transurerethral resection’ and inserting ‘and resection’, and

      (G) by striking ‘sacral laminectomy;’.

    (2) Section 4101(b)(2) of OBRA-1990 is amended--

      (A) in the matter before subparagraph (A), by striking ‘1842(b)(16)’ and inserting ‘1842(b)(16)(B)’, and

      (B) in subparagraph (B)--

        (i) by striking ‘, simple and subcutaneous’,

        (ii) by striking ‘(HCPCS codes 19160 and 19162)’ and inserting ‘(HCPCS code 19160)’, and

        (iii) by striking all that follows ‘(HCPCS codes 92250’ and inserting ‘and 92260).’.

    (b) RADIOLOGY SERVICES (SECTION 4102 OF OBRA-1990)- (1) Section 1834(b)(4) (42 U.S.C. 1395m(b)(4)) is amended by redesignating subparagraphs (E) and (F) as subparagraphs (F) and (G), respectively.

    (2) Section 1834(b)(4)(D) (42 U.S.C. 1395m(b)(4)(D)) is amended--

      (A) in the matter before clause (i), by striking ‘shall be determined as follows:’ and inserting ‘shall, subject to clause (vii), be reduced to the adjusted conversion factor for the locality determined as follows:’,

      (B) in clause (iv), by striking ‘LOCAL ADJUSTMENT- Subject to clause (vii), the conversion factor to be applied to’ and inserting ‘ADJUSTED CONVERSION FACTOR- The adjusted conversion factor for’,

      (C) in clause (vii), by striking ‘under this subparagraph’, and

      (D) in clause (vii), by inserting ‘reduced under this subparagraph by’ after ‘shall not be’.

    (3) Section 4102(c)(2) of OBRA-1990 is amended by striking ‘radiology services’ and all that follows and inserting ‘nuclear medicine services.’.

    (4) Section 4102(d) of OBRA-1990 is amended by striking ‘new paragraph’ and inserting ‘new subparagraph’.

    (5) Section 1834(b)(4)(E) (42 U.S.C. 1395m(b)(4)(E)) is amended by inserting ‘RULE FOR CERTAIN SCANNING SERVICES- ’ after ‘(E)’.

    (6) Section 1848(a)(2)(D)(iii) (42 U.S.C. 1395w-4(a)(2)(D)(iii)) is amended by striking ‘that are subject to section 6105(b) of the Omnibus Budget Reconciliation Act of 1989’ and by striking ‘provided under such section’ and inserting ‘provided under section 6105(b) of the Omnibus Budget Reconciliation Act of 1989’.

    (c) ANESTHESIA SERVICES (SECTION 4103 OF OBRA-1990)- (1) Section 4103(a) of OBRA-1990 is amended by striking ‘REDUCTION IN FEE SCHEDULE’ and inserting ‘REDUCTION IN PREVAILING CHARGES’.

    (2) Section 1842(q)(1)(B) (42 U.S.C. 1395u(q)(1)(B)) is amended--

      (A) in the matter before clause (i), by striking ‘shall be determined as follows:’ and inserting ‘shall, subject to clause (iv), be reduced to the adjusted prevailing charge conversion factor for the locality determined as follows:’, and

      (B) in clause (iii), by striking ‘Subject to clause (iv), the prevailing charge conversion factor to be applied in’ and inserting ‘The adjusted prevailing charge conversion factor for’.

    (d) ASSISTANTS AT SURGERY (SECTION 4107 OF OBRA-1990)- (1) Section 4107(c) of OBRA-1990 is amended by inserting ‘(a)(1)’ after ‘subsection’.

    (2) Section 4107(a)(2) of OBRA-1990 is amended by adding at the end the following: ‘In applying section 1848(g)(2)(D) of the Social Security Act for services of an assistant-at-surgery furnished during 1991, the recognized payment amount shall not exceed the maximum amount specified under section 1848(i)(2)(A) of such Act (as applied under this paragraph in such year).’.

    (e) TECHNICAL COMPONENTS OF DIAGNOSTIC SERVICES (SECTION 4108 OF OBRA-1990)- Section 1842(b) (42 U.S.C. 1395u(b)) is amended by redesignating paragraph (18), as added by section 4108(a) of OBRA-1990, as paragraph (17) and, in such paragraph, by inserting ‘, tests specified in paragraph (14)(C)(i),’ after ‘diagnostic laboratory tests’.

    (f) STATEWIDE FEE SCHEDULES (SECTION 4117 OF OBRA-1990)- Section 4117 of OBRA-1990 is amended--

      (1) in subsection (a)--

        (A) by striking ‘(a) IN GENERAL- ’, and

        (B) by striking ‘, if the’ and all that follows through ‘1991, ’; and

      (2) by striking subsections (b), (c), and (d).

    (g) STUDY OF AGGREGATION RULE FOR CLAIMS OF SIMILAR PHYSICIAN SERVICES (SECTION 4113 OF OBRA-1990)- Section 4113 of OBRA-1990 is amended--

      (1) by inserting ‘of the Social Security Act’ after ‘1869(b)(2)’; and

      (2) by striking ‘December 31, 1992’ and inserting ‘December 31, 1993’.

    (h) OTHER MISCELLANEOUS AND TECHNICAL AMENDMENTS- (1) The heading of section 1834(f) (42 U.S.C. 1395m(f)) is amended by striking ‘FISCAL YEAR’.

    (2)(A) Section 4105(b) of OBRA-1990 is amended--

      (i) in paragraph (2), by striking ‘amendments’ and inserting ‘amendment’, and

      (ii) in paragraph (3), by striking ‘amendments made by paragraphs (1) and (2)’ and inserting ‘amendment made by paragraph (1)’.

    (B) Section 1848(f)(2)(C) (42 U.S.C. 1395w-4(f)(2)(C)) is amended by inserting ‘PERFORMANCE STANDARD RATES OF INCREASE FOR FISCAL YEAR 1991- ’ after ‘(C)’.

    (C) Section 4105(d) of OBRA-1990 is amended by inserting ‘PUBLICATION OF PERFORMANCE STANDARD RATES- ’ after ‘(d)’.

    (3) Section 1842(b)(4)(F) (42 U.S.C. 1395u(b)(4)(F)) is amended--

      (A) in clause (i), by striking ‘prevailing charge’ the first place it appears and inserting ‘customary charge’; and

      (B) in clause (ii)(III), by striking ‘second, third, and fourth’ and inserting ‘first, second, and third’.

    (4) Section 1842(b)(4)(F)(ii)(I) (42 U.S.C. 1395u(b)(4)(F)(ii)(I)) is amended by striking ‘respiratory therapist,’.

    (5) Section 4106(c) of OBRA-1990 is amended by inserting ‘of the Social Security Act’ after ‘1848(d)(1)(B)’.

    (6) Section 4114 of OBRA-1990 is amended by striking ‘patients’ the second place it appears.

    (7) Section 1848(e)(1)(C) (42 U.S.C. 1395w-4(e)(1)(C)) is amended by inserting ‘date of the’ after ‘since the’.

    (8) Section 4118(f)(1)(D) of OBRA-1990 is amended by striking ‘is amended’.

    (9) Section 4118(f)(1)(N)(ii) of OBRA-1990 is amended by striking ‘subsection (f)(5)(A)’ and inserting ‘subsection (f)(5)(A))’.

    (10) Section 1845(e) (42 U.S.C. 1395w-1(e)) is amended--

      (A) by striking paragraph (2); and

      (B) by redesignating paragraphs (3), (4), and (5) as paragraphs (2), (3), and (4).

    (11) Section 4118(j)(2) of OBRA-1990 is amended by striking ‘In section’ and inserting ‘Section’.

    (12)(A) Section 1848(i)(3) (42 U.S.C. 1395w-4(i)(3)) is amended by striking the space before the period at the end.

    (B) Section 1834(a)(10)(B) (42 U.S.C. 1395m(a)(10)(B)) is amended by striking ‘as such provisions apply to physicians’ services and physicians and a reasonable charge under section 1842(b)’.

    (i) OTHER CORRECTIONS- (1) Effective on the date of the enactment of this Act, section 6102(d)(4) of OBRA-1989 is amended by striking all that follows the first sentence.

    (2) Effective for payments for fiscal years beginning with fiscal year 1994, section 1842(c)(1) (42 U.S.C. 1395u(c)(1)) is amended--

      (A) in subparagraph (A), by striking ‘(A) Any contract’ and inserting ‘Any contract’; and

      (B) by striking subparagraph (B).

    (j) EFFECTIVE DATE- Except as provided in subsection (i), the amendments made by this section and the provisions of this section shall take effect as if included in the enactment of OBRA-1990.

Subchapter B--Outpatient Hospital Services and Ambulatory Surgical Services

SEC. 5021. EXTENSION OF 10 PERCENT REDUCTION IN PAYMENTS FOR CAPITAL-RELATED COSTS OF OUTPATIENT HOSPITAL SERVICES.

    Section 1861(v)(1)(S)(ii)(I) (42 U.S.C. 1395x(v)(1)(S)(ii)(I)) is amended by striking ‘fiscal year 1992, 1993, 1994, or 1995’ and inserting ‘fiscal years 1992 through 1998’.

SEC. 5022. EXTENSION OF CURRENT REDUCTION IN PAYMENTS FOR OTHER COSTS OF OUTPATIENT HOSPITAL SERVICES.

    Section 1861(v)(1)(S)(ii)(II) (42 U.S.C. 1395x(v)(1)(S)(ii)(II)) is amended by striking ‘1991’ and all that follows and inserting ‘1991 through 1998.’.

SEC. 5023. 1-YEAR FREEZE IN AMBULATORY SURGERY RATES.

    The Secretary of Health and Human Services shall not provide for any update in the amounts of payment described in paragraphs (2)(A) and (2)(B) of section 1833(i)(2) of the Social Security Act that otherwise would occur in fiscal year 1994.

SEC. 5024. EYE OR EYE AND EAR HOSPITALS.

    (a) IN GENERAL- Section 1833(i) (42 U.S.C. 1395l(i)) is amended--

      (1) in paragraph (3)(B)(ii)--

        (A) by striking ‘the last sentence of this clause’ and inserting ‘paragraph (4)’, and

        (B) by striking the last sentence; and

      (2) by inserting after paragraph (3) the following new paragraph:

    ‘(4)(A) In the case of a hospital that--

      ‘(i) makes application to the Secretary and demonstrates that it specializes in eye services or eye and ear services (as determined by the Secretary),

      ‘(ii) receives more than 30 percent of its total revenues from outpatient services, and

      ‘(iii) on October 1, 1987--

        ‘(I) was an eye specialty hospital or an eye and ear specialty hospital, or

        ‘(II) was operated as an eye or eye and ear unit (as defined in subparagraph (B)) of a general acute care hospital which, on the date of the application described in clause (i), operates less than 20 percent of the beds that the hospital operated on October 1, 1987, and has sold or otherwise disposed of a substantial portion of the hospital’s other acute care operations,

    the cost proportion and ASC proportion in effect under subclauses (I) and (II) of paragraph (3)(B)(ii) for cost reporting periods beginning in fiscal year 1988 shall remain in effect for cost reporting periods beginning on or after October 1, 1988, and before January 1, 1995.

    ‘(B) For purposes of this subparagraph (A)(iii)(II), the term ‘eye or eye and ear unit’ means a physically separate or distinct unit containing separate surgical suites devoted solely to eye or eye and ear services.’.

    (b) EFFECTIVE DATE- The amendments made by subsection (a) shall apply to portions of cost reporting periods beginning on or after January 1, 1994.

SEC. 5025. EXTENSION OF CAP ON PAYMENTS FOR INTRAOCULAR LENSES.

    (a) IN GENERAL- Section 4151(c)(3) of OBRA-1990 is amended by striking ‘December 31, 1992’ and inserting ‘December 31, 1994’.

    (b) EFFECTIVE DATE- The amendment made by subsection (a) shall be effective as if included in the enactment of OBRA-1990.

SEC. 5026. MISCELLANEOUS AND TECHNICAL CORRECTIONS.

    (a) PAYMENT AMOUNTS FOR SERVICES FURNISHED IN AMBULATORY SURGICAL CENTERS- (1)(A) Section 1833(i)(2)(A)(i) (42 U.S.C. 1395l(i)(2)(A)(i)) is amended by striking the comma at the end and inserting the following: ‘, as determined in accordance with a survey (based upon a representative sample of procedures and facilities) taken not later than January 1, 1995, and every 5 years thereafter, of the actual audited costs incurred by such centers in providing such services,’.

    (B) Section 1833(i)(2) (42 U.S.C. 1395l(i)(2)) is amended--

      (i) in the second sentence of subparagraph (A) and the second sentence of subparagraph (B), by striking ‘and may be adjusted by the Secretary, when appropriate,’; and

      (ii) by adding at the end the following new subparagraph:

    ‘(C) Notwithstanding the second sentence of subparagraph (A) or the second sentence of subparagraph (B), if the Secretary has not updated amounts established under such subparagraphs with respect to facility services furnished during a fiscal year (beginning with fiscal year 1996), such amounts shall be increased by the percentage increase in the consumer price index for all urban consumers (U.S. city average) as estimated by the Secretary for the 12-month period ending with the midpoint of the fiscal year involved.’.

    (C) The second sentence of section 1833(i)(1) (42 U.S.C. 1395l(i)(1)) is amended by striking the period and inserting the following: ‘, in consultation with appropriate trade and professional organizations.’.

    (2) Section 4151(c)(3) of OBRA-1990 is amended by striking ‘for the insertion of an intraocular lens’ and inserting ‘for an intraocular lens inserted’.

    (b) ADJUSTMENTS TO PAYMENT AMOUNTS FOR NEW TECHNOLOGY INTRAOCULAR LENSES- (1) Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services (in this subsection referred to as the ‘Secretary’) shall develop and implement a process under which interested parties may request review by the Secretary of the appropriateness of the reimbursement amount provided under section 1833(i)(2)(A)(iii) of the Social Security Act with respect to a class of new technology intraocular lenses. For purposes of the preceding sentence, an intraocular lens may not be treated as a new technology lens unless it has been approved by the Food and Drug Administration.

    (2) In determining whether to provide an adjustment of payment with respect to a particular lens under paragraph (1), the Secretary shall take into account whether use of the lens is likely to result in reduced risk of intraoperative or postoperative complication or trauma, accelerated postoperative recovery, reduced induced astigmatism, improved postoperative visual acuity, more stable postoperative vision, or other comparable clinical advantages.

    (3) The Secretary shall publish notice in the Federal Register from time to time (but no less often than once each year) of a list of the requests that the Secretary has received for review under this subsection, and shall provide for a 30-day comment period on the lenses that are the subjects of the requests contained in such notice. The Secretary shall publish a notice of his determinations with respect to intraocular lenses listed in the notice within 90 days after the close of the comment period.

    (4) Any adjustment of a payment amount (or payment limit) made under this subsection shall become effective not later than 30 days after the date on which the notice with respect to the adjustment is published under paragraph (3).

Subchapter C--Durable Medical Equipment

SEC. 5031. REVISIONS TO PAYMENT RULES FOR DURABLE MEDICAL EQUIPMENT.

    (a) BASING NATIONAL PAYMENT LIMITS ON MEDIAN OF LOCAL PAYMENT AMOUNTS-

      (1) INEXPENSIVE AND ROUTINELY PURCHASED ITEMS; ITEMS REQUIRING FREQUENT AND SUBSTANTIAL SERVICING- (A) Paragraphs (2)(C)(i)(II) and (3)(C)(i)(II) of section 1834(a) (42 U.S.C. 1395m(a)) are each amended--

        (i) by striking ‘1992’ the first place it appears and inserting ‘1992, 1993, and 1994’; and

        (ii) by striking ‘1992’ the second place it appears and inserting ‘the year’.

      (B) Paragraphs (2)(C)(ii) and (3)(C)(ii) of section 1834(a) (42 U.S.C. 1395m(a)) are each amended--

        (i) by striking ‘and’ at the end of subclause (I);

        (ii) by redesignating subclause (II) as (IV); and

        (iii) by inserting after subclause (I) the following new subclauses:

            ‘(II) for 1992 and 1993, the amount determined under this clause for the preceding year increased by the covered item update for such subsequent year,

            ‘(III) for 1994, the local payment amount determined under clause (i) for such item or device for that year, except that the national limited payment amount may not exceed 100 percent of the median of all local payment amounts determined under such clause for such item for that year and may not be less than 85 percent of the median of all local payment amounts determined under such clause for such item or device for that year, and’.

      (2) MISCELLANEOUS DEVICES AND ITEMS- Section 1834(a)(8) (42 U.S.C. 1395m(a)(8)) is amended--

        (A) in subparagraph (A)(ii)(III), by striking ‘1992’ and inserting ‘1992, 1993, and 1994’; and

        (B) in subparagraph (B)--

          (i) by striking ‘and’ at the end of clause (i),

          (ii) by redesignating clause (ii) as (iv), and

          (iii) by inserting after clause (i) the following new clauses:

          ‘(ii) for 1992 and 1993, the amount determined under this subparagraph for the preceding year increased by the covered item update for such subsequent year;

          ‘(iii) for 1994, the local purchase price computed under subparagraph (A)(ii) for the item for the year, except that such national limited purchase price may not exceed 100 percent of the median of all local purchase prices computed for the item under such subparagraph for the year and may not be less than 85 percent of the median of all local purchase prices computed under such subparagraph for the item for the year; and’.

      (3) OXYGEN AND OXYGEN EQUIPMENT- Section 1834(a)(9) (42 U.S.C. 1395m(a)(9)) is amended--

        (A) in subparagraph (A)(ii)(II), by striking ‘1991 and 1992’ and inserting ‘1991, 1992, 1993, and 1994’; and

        (B) in subparagraph (B)--

          (i) by striking ‘and’ at the end of clause (i),

          (ii) by redesignating clause (ii) as (iv), and

          (iii) by inserting after clause (i) the following new clauses:

          ‘(ii) for 1992 and 1993, the amount determined under this subparagraph for the preceding year increased by the covered item update for such subsequent year;

          ‘(iii) for 1994, the local monthly payment rate computed under subparagraph (A)(ii) for the item for the year, except that such national limited monthly payment rate may not exceed 100 percent of the median of all local monthly payment rates computed for the item under such subparagraph for the year and may not be less than 85 percent of the median of all local monthly payment rates computed for the item under such subparagraph for the year; and’.

    (b) PAYMENT FOR PROSTHETIC DEVICES AND ORTHOTICS AND PROSTHETICS-

      (1) IN GENERAL- Section 1834(h)(2) (42 U.S.C. 1395m(h)(2)) is amended--

        (A) in subparagraph (A)(ii)(II), by striking ‘1992 or 1993’ and inserting ‘1992, 1993, or 1994’;

        (B) in subparagraph (B)(ii), by striking ‘each subsequent year’ and inserting ‘1993’;

        (C) in subparagraph (C)(iv), by striking ‘regional purchase price computed under subparagraph (B)’ and inserting ‘national limited purchase price computed under subparagraph (E)’;

        (D) in subparagraph (D)(ii), by striking ‘a subsequent year’ and inserting ‘1993’; and

        (E) by adding at the end the following new subparagraph:

        ‘(E) COMPUTATION OF NATIONAL LIMITED PURCHASE PRICE- With respect to the furnishing of a particular item in a year, the Secretary shall compute a national limited purchase price--

          ‘(i) for 1994, equal to the local purchase price computed under subparagraph (A)(ii)(II) for the item for the year, except that such national limited purchase price may not exceed 100 percent of the median of all local purchase prices for the item computed under such subparagraph for the year, and may not be less than 85 percent of the median of all local purchase prices for the item computed under such subparagraph for the year; and

          ‘(ii) for each subsequent year, equal to the amount determined under this subparagraph for the preceding year increased by the applicable percentage increase for such subsequent year.’.

      (2) EXCEPTION FOR CERTAIN ITEMS- Section 1834(h) (42 U.S.C. 1395m(h)), as amended by paragraph (1), is further amended--

        (A) in paragraph (1)(B), by striking ‘subparagraph (C),’ and inserting ‘subparagraphs (C) and (F),’; and

        (B) by adding at the end of paragraph (2) the following new subparagraph:

        ‘(F) EXCEPTION FOR CERTAIN ITEMS- Payment for ostomy supplies, tracheostomy supplies, and urologicals shall be made in accordance with subparagraphs (B) and (C) of section 1834(a)(2).’.

    (c) EFFECTIVE DATE- The amendments made by this section shall apply to items furnished on or after January 1, 1994.

SEC. 5032. PAYMENT FOR PARENTERAL AND ENTERAL NUTRIENTS, SUPPLIES, AND EQUIPMENT DURING 1994.

    In determining the amount of payment under part B of title XVIII of the Social Security Act during 1994, the charges determined to be reasonable with respect to parenteral and enteral nutrients, supplies, and equipment may not exceed the charges determined to be reasonable with respect to such nutrients, supplies, and equipment during 1993.

SEC. 5033. TREATMENT OF NEBULIZERS AND ASPIRATORS.

    (a) IN GENERAL- Section 1834(a)(3)(A) (42 U.S.C. 1395m(a)(3)(A)) is amended by striking ‘ventilators, aspirators, IPPB machines, and nebulizers’ and inserting ‘ventilators and IPPB machines’.

    (b) PAYMENT FOR ACCESSORIES RELATING TO NEBULIZERS AND ASPIRATORS- Section 1834(a)(2)(A) (42 U.S.C. 1395m(a)) is amended--

      (1) by striking ‘or’ at the end of clause (i),

      (2) by adding ‘or’ at the end of clause (ii), and

      (3) by inserting after clause (ii) the following new clause:

          ‘(iii) which is an accessory used in conjunction with a nebulizer or aspirator,’.

    (c) EFFECTIVE DATE- The amendments made by this section shall apply to items furnished on or after January 1, 1994.

SEC. 5034. CERTIFICATION OF SUPPLIERS.

    (a) REQUIREMENTS-

      (1) IN GENERAL- Section 1834 (42 U.S.C. 1395m) is amended by adding at the end the following new subsection:

    ‘(i) REQUIREMENTS FOR SUPPLIERS OF MEDICAL EQUIPMENT AND SUPPLIES-

      ‘(1) ISSUANCE AND RENEWAL OF SUPPLIER NUMBER-

        ‘(A) PAYMENT- Except as provided in subparagraph (C), no payment may be made under this part after October 1, 1994, for items furnished by a supplier of medical equipment and supplies unless such supplier obtains (and renews at such intervals as the Secretary may require) a supplier number.

        ‘(B) STANDARDS FOR POSSESSING A SUPPLIER NUMBER- A supplier may not obtain a supplier number unless--

          ‘(i) for medical equipment and supplies furnished on or after October 1, 1994, and before January 1, 1996, the supplier meets standards prescribed by the Secretary; and

          ‘(ii) for medical equipment and supplies furnished on or after January 1, 1996, the supplier meets revised standards prescribed by the Secretary (in consultation with representatives of suppliers of medical equipment and supplies, carriers, and consumers) that shall include requirements that the supplier--

            ‘(I) comply with all applicable State and Federal licensure and regulatory requirements;

            ‘(II) maintain a physical facility on an appropriate site;

            ‘(III) have proof of appropriate liability insurance; and

            ‘(IV) meet such other requirements as the Secretary may specify.

        ‘(C) EXCEPTION FOR ITEMS FURNISHED AS INCIDENT TO A PHYSICIAN’S SERVICE- Subparagraph (A) shall not apply with respect to medical equipment and supplies furnished as an incident to a physician’s service.

        ‘(D) PROHIBITION AGAINST MULTIPLE SUPPLIER NUMBERS- The Secretary may not issue more than one supplier number to any supplier of medical equipment and supplies unless the issuance of more than one number is appropriate to identify subsidiary or regional entities under the supplier’s ownership or control.

        ‘(E) PROHIBITION AGAINST DELEGATION OF SUPPLIER DETERMINATIONS- The Secretary may not delegate (other than by contract under section 1842) the responsibility to determine whether suppliers meet the standards necessary to obtain a supplier number.

      ‘(2) CERTIFICATES OF MEDICAL NECESSITY-

        ‘(A) STANDARDIZED CERTIFICATES- Not later than October 1, 1994, the Secretary shall, in consultation with carriers under this part, develop one or more standardized certificates of medical necessity (as defined in subparagraph (C)) for medical equipment and supplies for which the Secretary determines that such a certificate is necessary.

        ‘(B) PROHIBITION AGAINST DISTRIBUTION BY SUPPLIERS OF CERTIFICATES OF MEDICAL NECESSITY-

          ‘(i) IN GENERAL- Except as provided in clause (ii), a supplier of medical equipment and supplies may not distribute to physicians or to individuals entitled to benefits under this part for commercial purposes any completed or partially completed certificates of medical necessity on or after October 1, 1994.

          ‘(ii) EXCEPTION FOR CERTAIN BILLING INFORMATION- Clause (i) shall not apply with respect to a certificate of medical necessity for any item that is not contained on the list of potentially overused items developed by the Secretary under subsection (a)(15)(A) to the extent that such certificate contains only information completed by the supplier of medical equipment and supplies identifying such supplier and the beneficiary to whom such medical equipment and supplies are furnished, a description of such medical equipment and supplies, any product code identifying such medical equipment and supplies, and any other administrative information (other than information relating to the beneficiary’s medical condition) identified by the Secretary. In the event a supplier provides a certificate of medical necessity containing information permitted under this clause, such certificate shall also contain the fee schedule amount and the supplier’s charge for the medical equipment or supplies being furnished prior to distribution of such certificate to the physician.

          ‘(iii) PENALTY- Any supplier of medical equipment and supplies who knowingly and willfully distributes a certificate of medical necessity in violation of clause (i) is subject to a civil money penalty in an amount not to exceed $1,000 for each such certificate of medical necessity so distributed. The provisions of section 1128A (other than subsections (a) and (b)) shall apply to civil money penalties under this subparagraph in the same manner as they apply to a penalty or proceeding under section 1128A(a).

        ‘(C) DEFINITION- For purposes of this paragraph, the term ‘certificate of medical necessity’ means a form or other document containing information required by the Secretary to be submitted to show that a covered item is reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

    ‘(3) COVERAGE AND REVIEW CRITERIA-

        ‘(A) DEVELOPMENT AND ESTABLISHMENT- Not later than January 1, 1996, the Secretary, in consultation with representatives of suppliers of medical equipment and supplies, individuals enrolled under this part, and appropriate medical specialty societies, shall develop and establish uniform national coverage and utilization review criteria for 200 items of medical equipment and supplies selected in accordance with the standards described in subparagraph (B). The Secretary shall publish the criteria as part of the instructions provided to fiscal intermediaries and carriers under this part and no further publication, including publication in the Federal Register, shall be required.

        ‘(B) STANDARDS FOR SELECTING ITEMS SUBJECT TO CRITERIA- The Secretary may select an item for coverage under the criteria developed and established under subparagraph (A) if the Secretary finds that--

          ‘(i) the item is frequently purchased or rented by beneficiaries;

          ‘(ii) the item is frequently subject to a determination that such item is not medically necessary; or

          ‘(iii) the coverage or utilization criteria applied to the item (as of the date of the enactment of this subsection) is not consistent among carriers.

        ‘(C) ANNUAL REVIEW AND EXPANSION OF ITEMS SUBJECT TO CRITERIA- The Secretary shall annually review the coverage and utilization of items of medical equipment and supplies to determine whether items not included among the items selected under subparagraph (A) should be made subject to uniform national coverage and utilization review criteria, and, if appropriate, shall develop and apply such criteria to such additional items.

      ‘(4) DEFINITION- The term ‘medical equipment and supplies’ means--

        ‘(A) durable medical equipment (as defined in section 1861(n));

        ‘(B) prosthetic devices (as described in section 1861(s)(8));

        ‘(C) orthotics and prosthetics (as described in section 1861(s)(9));

        ‘(D) surgical dressings (as described in section 1861(s)(5));

        ‘(E) such other items as the Secretary may determine; and

        ‘(F) for purposes of paragraphs (1) and (3)--

          ‘(i) home dialysis supplies and equipment (as described in section 1861(s)(2)(F)), and

          ‘(ii) immunosuppressive drugs (as described in section 1861(s)(2)(J)).’.

      (2) CONFORMING AMENDMENT- Effective October 1, 1994, paragraph (16) of section 1834(a) (42 U.S.C. 1395m(a)) is repealed.

    (b) REPORT ON EFFECT OF UNIFORM CRITERIA ON UTILIZATION OF ITEMS- Not later than July 1, 1996, the Secretary shall submit a report to the Committee on Ways and Means and the Committee on Energy and Commerce of the House of Representatives and the Committee on Finance of the Senate analyzing the impact of the uniform criteria established under section 1834(i)(3)(A) of the Social Security Act (as added by subsection (a)) on the utilization of items of medical equipment and supplies by individuals enrolled under part B of the medicare program.

    (c) USE OF COVERED ITEMS BY DISABLED BENEFICIARIES-

      (1) IN GENERAL- The Secretary of Health and Human Services, in consultation with representatives of suppliers of durable medical equipment under part B of the medicare program and individuals entitled to benefits under such program on the basis of disability, shall conduct a study of the effects of the methodology for determining payments for items of such equipment under such part on the ability of such individuals to obtain items of such equipment, including customized items.

      (2) REPORT- Not later than one year after the date of the enactment of this Act, the Secretary shall submit a report to Congress on the study conducted under paragraph (1), and shall include in the report such recommendations as the Secretary considers appropriate to assure that disabled medicare beneficiaries have access to items of durable medical equipment.

    (d) CRITERIA FOR TREATMENT OF ITEMS AS PROSTHETICS DEVICES OR ORTHOTICS AND PROSTHETICS- Not later than one year after the date of the enactment of this Act, the Secretary of Health and Human Services shall submit a report to the Committees on Ways and Means and Energy and Commerce of the House of Representatives and the Committee on Finance of the Senate describing prosthetic devices or orthotics and prosthetics covered under part B of the medicare program that do not require individualized or custom fitting and adjustment to be used by a patient. Such report shall include recommendations for an appropriate methodology for determining the amount of payment for such items under such program.

SEC. 5035. PROHIBITION AGAINST CARRIER FORUM SHOPPING.

    (a) IN GENERAL- Section 1834(a)(12) (42 U.S.C. 1395m(a)(12)) is amended to read as follows:

      ‘(12) USE OF CARRIERS TO PROCESS CLAIMS-

        ‘(A) DESIGNATION OF REGIONAL CARRIERS- The Secretary may designate, by regulation under section 1842, one carrier for one or more entire regions to process all claims within the region for covered items under this section.

        ‘(B) PROHIBITION AGAINST CARRIER SHOPPING- (i) No supplier of a covered item may present or cause to be presented a claim for payment under this part unless such claim is presented to the appropriate regional carrier (as designated by the Secretary).

        ‘(ii) For purposes of clause (i), the term ‘appropriate regional carrier’ means the carrier having jurisdiction over the geographic area that includes the permanent residence of the patient to whom the item is furnished.’.

    (b) EFFECTIVE DATE- The amendment made by subsection (a) shall apply to items furnished on or after October 1, 1993.

    (c) CLARIFICATION OF AUTHORITY TO DESIGNATE CARRIERS FOR OTHER ITEMS AND SERVICES- Nothing in this subsection or the amendment made by this subsection may be construed to restrict the authority of the Secretary of Health and Human Services to designate regional carriers or modify claims jurisdiction rules with respect to items or services under part B of the medicare program that are not covered items under section 1834(a) of the Social Security Act or prosthetic devices or orthotics and prosthetics under section 1834(h) of such Act.

SEC. 5036. RESTRICTIONS ON CERTAIN MARKETING AND SALES ACTIVITIES.

    (a) PROHIBITING UNSOLICITED TELEPHONE CONTACTS FROM SUPPLIERS OF DURABLE MEDICAL EQUIPMENT TO MEDICARE BENEFICIARIES-

      (1) IN GENERAL- Section 1834(a) (42 U.S.C. 1395m(a)) is amended by adding at the end the following new paragraph:

      ‘(17) PROHIBITION AGAINST UNSOLICITED TELEPHONE CONTACTS BY SUPPLIERS-

        ‘(A) IN GENERAL- A supplier of a covered item under this subsection may not contact an individual enrolled under this part by telephone regarding the furnishing of a covered item to the individual (other than a covered item the supplier has already furnished to the individual) unless--

          ‘(i) the individual gives permission to the supplier to make contact by telephone for such purpose; or

          ‘(ii) the supplier has furnished a covered item under this subsection to the individual during the 15-month period preceding the date on which the supplier contacts the individual for such purpose.

        ‘(B) PROHIBITING PAYMENT FOR ITEMS FURNISHED SUBSEQUENT TO UNSOLICITED CONTACTS- If a supplier knowingly contacts an individual in violation of subparagraph (A), no payment may be made under this part for any item subsequently furnished to the individual by the supplier.

        ‘(C) EXCLUSION FROM PROGRAM FOR SUPPLIERS ENGAGING IN PATTERN OF UNSOLICITED CONTACTS- If a supplier knowingly contacts individuals in violation of subparagraph (A) to such an extent that the supplier’s conduct establishes a pattern of contacts in violation of such subparagraph, the Secretary shall exclude the supplier from participation in the programs under this Act, in accordance with the procedures set forth in subsections (c), (f), and (g) of section 1128.’.

      (2) REQUIRING REFUND OF AMOUNTS COLLECTED FOR DISALLOWED ITEMS- Section 1834(a) (42 U.S.C. 1395m(a)), as amended by paragraph (1), is amended by adding at the end the following new paragraph:

      ‘(18) REFUND OF AMOUNTS COLLECTED FOR CERTAIN DISALLOWED ITEMS-

        ‘(A) IN GENERAL- If a nonparticipating supplier furnishes to an individual enrolled under this part a covered item for which no payment may be made under this part by reason of paragraph (17)(B), the supplier shall refund on a timely basis to the patient (and shall be liable to the patient for) any amounts collected from the patient for the item, unless--

          ‘(i) the supplier establishes that the supplier did not know and could not reasonably have been expected to know that payment may not be made for the item by reason of paragraph (17)(B), or

          ‘(ii) before the item was furnished, the patient was informed that payment under this part may not be made for that item and the patient has agreed to pay for that item.

        ‘(B) SANCTIONS- If a supplier knowingly and willfully fails to make refunds in violation of subparagraph (A), the Secretary may apply sanctions against the supplier in accordance with section 1842(j)(2).

        ‘(C) NOTICE- Each carrier with a contract in effect under this part with respect to suppliers of covered items shall send any notice of denial of payment for covered items by reason of paragraph (17)(B) and for which payment is not requested on an assignment-related basis to the supplier and the patient involved.

        ‘(D) TIMELY BASIS DEFINED- A refund under subparagraph (A) is considered to be on a timely basis only if--

          ‘(i) in the case of a supplier who does not request reconsideration or seek appeal on a timely basis, the refund is made within 30 days after the date the supplier receives a denial notice under subparagraph (C), or

          ‘(ii) in the case in which such a reconsideration or appeal is taken, the refund is made within 15 days after the date the supplier receives notice of an adverse determination on reconsideration or appeal.’.

    (b) CONFORMING AMENDMENT- Section 1834(h)(3) (42 U.S.C. 1395m(h)(3)) is amended by striking ‘Paragraph (12)’ and inserting ‘Paragraphs (12) and (17)’.

    (c) EFFECTIVE DATE- The amendments made by subsections (a) and (b) shall apply to items furnished after the expiration of the 60-day period that begins on the date of the enactment of this Act.

SEC. 5037. KICKBACK CLARIFICATION.

    (a) IN GENERAL- Section 1128B(b)(3)(B) (42 U.S.C. 1320a-7b(b)(3)(B)) is amended by inserting before the semicolon the following: ‘(except that in the case of a contract supply arrangement between any entity and a supplier of medical supplies and equipment (as defined in section 1834(i)(4), but not including items described in subparagraph (F) of such section), such employment shall not be considered bona fide to the extent that it includes tasks of a clerical and cataloging nature in transmitting to suppliers assignment rights of individuals eligible for benefits under part B of title XVIII, or performance of warehousing or stock inventory functions)’.

    (b) EFFECTIVE DATE- The amendment made by subsection (a) shall apply with respect to services furnished on or after the first day of the first month that begins after the expiration of the 60-day period beginning on the date of the enactment of this Act.

SEC. 5038. BENEFICIARY LIABILITY FOR NONCOVERED SERVICES.

    (a) UNASSIGNED CLAIMS-

      (1) IN GENERAL- Section 1834(i) (42 U.S.C. 1395m(i)), as added by section 5034(a)(1), is amended--

        (A) by redesignating paragraph (4) as paragraph (5), and

        (B) by inserting after paragraph (3) the following new paragraph:

      ‘(4) LIMITATION ON PATIENT LIABILITY- If a supplier of medical equipment and supplies (as defined in paragraph (5))--

        ‘(A) furnishes an item or service to a beneficiary for which no payment may be made by reason of paragraph (1);

        ‘(B) furnishes an item or service to a beneficiary for which payment is denied in advance under subsection (a)(15); or

        ‘(C) furnishes an item or service to a beneficiary for which payment is denied under section 1862(a)(1);

      any expenses incurred for items and services furnished to an individual by such a supplier not on an assigned basis shall be the responsibility of such supplier. The individual shall have no financial responsibility for such expenses and the supplier shall refund on a timely basis to the individual (and shall be liable to the individual for) any amounts collected from the individual for such items or services. The provisions of subsection (a)(18) shall apply to refunds required under the previous sentence in the same manner as such provisions apply to refunds under such subsection.’.

      (2) CONFORMING AMENDMENT- Section 1128B(b)(3)(B) (42 U.S.C. 1320a-7b(b)(3)(B)), as amended by section 5037(a), is amended by striking ‘1834(i)(4)’ and inserting ‘1834(i)(5)’.

    (b) ASSIGNED CLAIMS- Section 1879 (42 U.S.C. 1395pp) is amended by adding at the end the following new subsection:

    ‘(h) If a supplier of medical equipment and supplies (as defined in section 1834(i)(4))--

      ‘(1) furnishes an item or service to a beneficiary for which no payment may be made by reason of section 1834(i)(1); or

      ‘(2) furnishes an item or service to a beneficiary for which payment is denied in advance under section 1834(a)(15);

    any expenses incurred for items and services furnished to an individual by such a supplier on an assignment-related basis shall be the responsibility of such supplier. The individual shall have no financial responsibility for such expenses and the supplier shall refund on a timely basis to the individual (and shall be liable to the individual for) any amounts collected from the individual for such items or services. The provisions of section 1834(a)(18) shall apply to refunds required under the previous sentence in the same manner as such provisions apply to refunds under such section.’.

    (c) EFFECTIVE DATE- The amendments made by this section shall apply to items or services furnished on or after October 1, 1994.

SEC. 5039. ADJUSTMENTS FOR INHERENT REASONABLENESS.

    (a) ADJUSTMENTS MADE TO FINAL PAYMENT AMOUNTS-

      (1) IN GENERAL- Section 1834(a)(10)(B) (42 U.S.C. 1395m(a)(10)(B)) is amended by adding at the end the following: ‘In applying such provisions to payments for an item under this subsection, the Secretary shall make adjustments to the payment basis for the item described in paragraph (1)(B) if the Secretary determines (in accordance with such provisions and on the basis of prices and costs applicable at the time the item is furnished) that such payment basis is not inherently reasonable.’.

      (2) EFFECTIVE DATE- The amendment made by paragraph (1) shall take effect on the date of the enactment of this Act.

    (b) ADJUSTMENT REQUIRED FOR CERTAIN ITEMS-

      (1) IN GENERAL- In accordance with section 1834(a)(10)(B) of the Social Security Act (as amended by subsection (a)), the Secretary of Health and Human Services shall determine whether the payment amounts for the items described in paragraph (2) are not inherently reasonable, and shall adjust such amounts in accordance with such section if the amounts are not inherently reasonable.

      (2) ITEMS DESCRIBED- The items referred to in paragraph (1) are decubitus care equipment, transcutaneous electrical nerve stimulators, and any other items considered appropriate by the Secretary.

SEC. 5040. PAYMENT FOR SURGICAL DRESSINGS.

    (a) IN GENERAL- Section 1834 (42 U.S.C. 1395m), as amended by section 5034(a)(1), is amended by adding at the end the following new subsection:

    ‘(j) PAYMENT FOR SURGICAL DRESSINGS-

      ‘(1) IN GENERAL- Payment under this subsection for surgical dressings (described in section 1861(s)(5)) shall be made in a lump sum amount for the purchase of the item in an amount equal to 80 percent of the lesser of--

        ‘(A) the actual charge for the item; or

        ‘(B) a payment amount determined in accordance with the methodology described in subparagraphs (B) and (C) of subsection (a)(2) (except that in applying such methodology, the national limited payment amount referred to in such subparagraphs shall be initially computed based on local payment amounts using average reasonable charges for the 12-month period ending December 31, 1992, increased by the covered item updates described in such subsection for 1993 and 1994)

      ‘(2) EXCEPTIONS- Paragraph (1) shall not apply to surgical dressings that are--

        ‘(A) furnished as an incident to a physician’s professional service; or

        ‘(B) furnished by a home health agency.’.

    (b) CONFORMING AMENDMENT- Section 1833(a)(1) (42 U.S.C. 1395l(a)(1)), as amended by sections 5070(e)(2) and 5010(e)(1), is amended--

      (1) by striking ‘and’ before ‘(P)’, and

      (2) by inserting before the semicolon at the end the following: ‘, and (Q) with respect to surgical dressings, the amounts paid shall be the amounts determined under section 1834(j)’.

    (c) EFFECTIVE DATE- The amendments made by this section shall apply to items furnished on or after January 1, 1994.

SEC. 5041. PAYMENTS FOR TENS DEVICES.

    (a) IN GENERAL- Section 1834(a)(1)(D) (42 U.S.C. 1395m(a)(1)(D)) is amended by striking ‘15 percent’ the second place it appears and inserting ‘45 percent’.

    (b) EFFECTIVE DATE- The amendment made by subsection (a) shall apply to items furnished on or after January 1, 1994.

SEC. 5042. MISCELLANEOUS AND TECHNICAL CORRECTIONS.

    (a) UPDATES TO PAYMENT AMOUNTS- Subparagraph (A) of section 1834(a)(14) (42 U.S.C. 1395m(a)(14)) is amended to read as follows:

        ‘(A) for 1991 and 1992, the percentage increase in the consumer price index for all urban consumers (U.S. city average) for the 12-month period ending with June of the previous year reduced by 1 percentage point; and’.

    (b) TREATMENT OF POTENTIALLY OVERUSED ITEMS AND ADVANCED DETERMINATIONS OF COVERAGE- (1) Effective on the date of the enactment of this Act, section 1834(a)(15) (42 U.S.C. 1395m(a)(15)) is amended to read as follows:

      ‘(15) SPECIAL TREATMENT FOR POTENTIALLY OVERUSED ITEMS-

        ‘(A) DEVELOPMENT OF LIST OF ITEMS BY SECRETARY- The Secretary shall develop and periodically update a list of items for which payment may be made under this subsection that are potentially overused, and shall include in such list seat-lift mechanisms, transcutaneous electrical nerve stimulators, motorized scooters, decubitus care mattresses, and any such other item determined by the Secretary to be potentially overused on the basis of any of the following criteria--

          ‘(i) the item is marketed directly to potential patients;

          ‘(ii) the item is marketed with an offer to potential patients to waive the costs of coinsurance associated with the item or is marketed as being available at no cost to policyholders of a medicare supplemental policy (as defined in section 1882(g)(1));

          ‘(iii) the item has been subject to a consistent pattern of overutilization; or

          ‘(iv) a high proportion of claims for payment for such item under this part may not be made because of the application of section 1862(a)(1).

        ‘(B) ITEMS SUBJECT TO SPECIAL CARRIER SCRUTINY- Payment may not be made under this part for any item contained in the list developed by the Secretary under subparagraph (A) unless the carrier has subjected the claim for payment for the item to special scrutiny or has followed the procedures described in paragraph (11)(C) with respect to the item.’.

    (2) Effective January 1, 1994, section 1834(a)(11) (42 U.S.C. 1395m(a)) is amended by adding at the end the following new subparagraph:

        ‘(C) CARRIER DETERMINATIONS FOR CERTAIN ITEMS IN ADVANCE- A carrier shall determine in advance whether payment for an item may not be made under this subsection because of the application of section 1862(a)(1) if--

          ‘(i) the item is a customized item (other than inexpensive items specified by the Secretary); or

          ‘(ii) the item is a specified covered item under subparagraph (B).’.

    (3) Effective for standards applied for contract years beginning after the date of the enactment of this Act, section 1842(c) (42 U.S.C. 1395u(c)), as amended by section 5013(a), is amended by adding at the end the following new paragraph:

    ‘(5) Each contract under this section which provides for the disbursement of funds, as described in subsection (a)(1)(B), shall require the carrier to meet criteria developed by the Secretary to measure the timeliness of carrier responses to requests for payment of items described in section 1834(a)(11)(C).’.

    (4) Section 1834(h)(3) (42 U.S.C. 1395m(h)(3)) is amended by striking ‘paragraph (10) and paragraph (11)’ and inserting ‘paragraphs (10) and (11)’.

    (c) STUDY OF VARIATIONS IN DURABLE MEDICAL EQUIPMENT SUPPLIER COSTS-

      (1) COLLECTION AND ANALYSIS OF SUPPLIER COST DATA- The Administrator of the Health Care Financing Administration shall, in consultation with appropriate organizations, collect data on supplier costs of durable medical equipment for which payment may be made under part B of the medicare program, and shall analyze such data to determine the proportions of such costs attributable to the service and product components of furnishing such equipment and the extent to which such proportions vary by type of equipment and by the geographic region in which the supplier is located.

      (2) DEVELOPMENT OF GEOGRAPHIC ADJUSTMENT INDEX; REPORTS- Not later than January 1, 1995--

        (A) the Administrator shall submit a report to the Committees on Energy and Commerce and Ways and Means of the House of Representatives and the Committee on Finance of the Senate on the data collected and the analysis conducted under paragraph (1), and shall include in such report the Administrator’s recommendations for a geographic cost adjustment index for suppliers of durable medical equipment under the medicare program and an analysis of the impact of such proposed index on payments under the medicare program; and

        (B) the Comptroller General shall submit a report to the Committees on Energy and Commerce and Ways and Means of the House of Representatives and the Committee on Finance of the Senate analyzing on a geographic basis the supplier costs of durable medical equipment under the medicare program.

    (d) OXYGEN RETESTING- Section 1834(a)(5)(E) (42 U.S.C. 1395m(a)(5)(E)) is amended by striking ‘55’ and inserting ‘56’.

    (e) OTHER MISCELLANEOUS AND TECHNICAL AMENDMENTS- (1) Section 4152(a)(3) of OBRA-1990 is amended by striking ‘amendment made by subsection (a)’ and inserting ‘amendments made by this subsection’.

    (2) Section 4152(c)(2) of OBRA-1990 is amended by striking ‘1395m(a)(7)(A)’ and inserting ‘1395m(a)(7)’.

    (3) Section 1834(a)(7)(A)(iii)(II) (42 U.S.C. 1395m(a)(7)(A)(iii)(II)) is amended by striking ‘clause (v)’ and inserting ‘clause (vi)’.

    (4) Section 1834(a)(7)(C)(i) (42 U.S.C. 1395m(a)(7)(C)(i)) is amended by striking ‘or paragraph (3)’.

    (5) Section 1834(a)(3) (42 U.S.C. 1395m(a)(3)) is amended by striking subparagraph (D).

    (6) Section 4153(c)(1) of OBRA-1990 is amended by striking ‘1834(a)’ and inserting ‘1834(h)’.

    (7) Section 4153(d)(2) of OBRA-1990 is amended by striking ‘Reconiliation’ and inserting ‘Reconciliation’.

    (8)(A) Section 1834(a) (42 U.S.C. 1395m(a)) is amended by striking paragraph (6).

    (B) Section 1834(a) (42 U.S.C. 1395m(a)) is amended--

      (i) in subparagraphs (A) and (B) of paragraph (1), by striking ‘(2) through (7)’ each place it appears and inserting ‘(2) through (5) and (7)’;

      (ii) in paragraph (7), by striking ‘(2) through (6)’ and inserting ‘(2) through (5)’;

      (iii) in paragraph (8), by striking ‘paragraphs (6) and (7)’ each place it appears in the matter preceding subparagraph (A) and in subparagraph (C) and inserting ‘paragraph (7)’; and

      (iv) in paragraph (8)(A)(i), by striking ‘described--’ and all that follows and inserting ‘described in paragraph (7) equal to the average of the purchase prices on the claims submitted on an assignment-related basis for the unused item supplied during the 6-month period ending with December 1986.’.

    (9) The amendments made by this subsection shall take effect as if included in the enactment of OBRA-1990.

Subchapter D--Part B Premium

SEC. 5051. PART B PREMIUM.

    Section 1839(e) (42 U.S.C. 1395r(e)) is amended--

      (1) in paragraph (1)(A), by inserting ‘and for each month in 1996 and 1997’ after ‘January 1991’, and

      (2) in paragraph (2), by striking ‘1991’ and inserting ‘1998’.

Subchapter E--Other Provisions

SEC. 5061. PAYMENTS FOR CLINICAL DIAGNOSTIC LABORATORY TESTS.

    (a) LOWER CAP- Section 1833(h)(4)(B) (42 U.S.C. 1395l(h)(4)(B)) is amended--

      (1) by striking ‘and’ at the end of clause (iii),

      (2) in clause (iv), by inserting ‘and before January 1, 1994,’ after ‘1990,’,

      (3) by striking the period at the end of clause (iv) and inserting ‘, and’, and

      (4) by adding at the end the following:

      ‘(v) after December 31, 1993, is equal to 76 percent of the median of all the fee schedules established for that test for that laboratory setting under paragraph (1).’.

    (b) TWO PERCENT UPDATE FOR 1994 THROUGH 1998- Section 1833(h)(2)(A)(ii)(III) (42 U.S.C. 1395l(h)(2)(A)(ii)(III)) is amended by striking ‘1991, 1992, and 1993’ and inserting ‘1991 through 1998’.

SEC. 5062. TREATMENT OF INPATIENTS AND PROVISION OF DIAGNOSTIC AND THERAPEUTIC X-RAY SERVICES BY RURAL HEALTH CLINICS AND FEDERALLY QUALIFIED HEALTH CENTERS.

    (a) TREATMENT OF INPATIENTS- Section 1861(aa) (42 U.S.C. 1395x(aa)) is amended--

      (1) in paragraph (1), in the matter following subparagraph (C), by striking ‘as an outpatient’ and inserting ‘as a patient’;

      (2) in paragraph (2)(A), by striking ‘furnishing to outpatients’ and inserting ‘furnishing to patients’; and

      (3) in paragraph (3), in the matter following subparagraph (B), by striking ‘as an outpatient’ and inserting ‘as a patient’.

    (b) TREATMENT OF DIAGNOSTIC AND THERAPEUTIC X-RAY SERVICES- Section 1861(aa) (42 U.S.C. 1395x(aa)) is further amended--

      (1) in paragraph (1)(A), by inserting ‘(i)’ after ‘(A)’ and by adding at the end the following: ‘and (ii) diagnostic and therapeutic x-ray services,’, and

      (2) in paragraph (2)(A), by striking ‘(A)’ and inserting ‘(A)(i)’.

    (c) CONFORMING AMENDMENT- Section 1862(a)(14) (42 U.S.C. 1395y(a)(14)) is amended by striking ‘and services of a certified registered nurse anesthetist’ and inserting ‘services of a certified registered nurse anesthetist, rural health clinic services, and Federally-qualified health center services’.

    (d) EFFECTIVE DATE- The amendments made by this section shall take effect on January 1, 1994, and shall apply to services furnished on or after such date.

SEC. 5063. APPLICATION OF MAMMOGRAPHY CERTIFICATION REQUIREMENTS.

    (a) SCREENING MAMMOGRAPHY- Section 1834(c) (42 U.S.C. 1395m(c)) is amended--

      (1) in paragraph (1)(B), by striking ‘meets the quality standards established under paragraph (3)’ and inserting ‘is conducted by a facility that has a certificate (or provisional certificate) issued under section 354 of the Public Health Service Act’;

      (2) in paragraph (1)(C)(iii), by striking ‘paragraph (4)’ and inserting ‘paragraph (3)’;

      (3) by striking paragraph (3); and

      (4) by redesignating paragraphs (4) and (5) as paragraphs (3) and (4).

    (b) DIAGNOSTIC MAMMOGRAPHY- Section 1861(s)(3) (42 U.S.C. 1395x(s)(3)) is amended by inserting ‘and including diagnostic mammography if conducted by a facility that has a certificate (or provisional certificate) issued under section 354 of the Public Health Service Act’ after ‘necessary’.

    (c) CONFORMING AMENDMENTS- (1) Section 1862(a)(1)(F) (42 U.S.C. 1395y(a)(1)(F)) is amended by striking ‘or which does not meet the standards established under section 1834(c)(3)’ and inserting ‘or which is not conducted by a facility described in section 1834(c)(1)(B)’.

    (2) Section 1863 (42 U.S.C. 1395z) is amended by striking ‘or whether screening mammography meets the standards established under section 1834(c)(3),’.

    (3) The first sentence of section 1864(a) (42 U.S.C. 1395aa(a)) is amended by striking ‘, or whether screening mammography meets the standards established under section 1834(c)(3)’.

    (4) The third sentence of section 1865(a) (42 U.S.C. 1395bb(a)) is amended by striking ‘1834(c)(3),’.

    (d) EFFECTIVE DATE- The amendments made by this section shall apply to mammography furnished by a facility on and after the first date that the certificate requirements of section 354(b) of the Public Health Service Act apply to such mammography conducted by such facility.

SEC. 5064. EXTENSION OF ALZHEIMER’S DISEASE DEMONSTRATION.

    Section 9342 of OBRA-1986, as amended by section 4164(a)(2) of OBRA-1990, is amended--

      (1) in subsection (c)(1), by striking ‘4 years’ and inserting ‘5 years’; and

      (2) in subsection (f)--

        (A) by striking ‘$55,000,000’ and inserting ‘$60,000,000’, and

        (B) by striking ‘$3,000,000’ and inserting ‘$5,000,000’.

SEC. 5065. ORAL CANCER DRUGS.

    (a) COVERAGE OF CERTAIN SELF-ADMINISTERED ANTICANCER DRUGS- Section 1861(s)(2) (42 U.S.C. 1395(s)(2)), as amended by section 5070(f)(7)(B), is amended--

      (1) by striking ‘and’ at the end of subparagraph (N);

      (2) by adding ‘and’ at the end of subparagraph (O); and

      (3) by adding at the end the following new subparagraph:

      ‘(P) an oral drug (which is approved by the Federal Food and Drug Administration) prescribed for use as an anticancer chemotherapeutic agent for a given indication, and containing an active ingredient (or ingredients), which is the same indication and active ingredient (or ingredients) as a drug which the carrier determines would be covered pursuant to subparagraph (A) or (B) if the drug could not be self-administered;’.

    (b) EFFECTIVE DATE- The amendments made by this section shall apply to items furnished on or after January 1, 1994.

SEC. 5066. EXTENSION OF MUNICIPAL HEALTH SERVICE DEMONSTRATION PROJECTS.

    Section 9215 of the Consolidated Omnibus Budget Reconciliation Act of 1985, as amended by section 6135 of OBRA-1989, is amended--

      (1) by striking ‘December 31, 1993’ and inserting ‘December 31, 1997’, and

      (2) in the second sentence, by inserting after ‘beneficiary costs,’ the following: ‘costs to the medicaid program and other payors, access to care, outcomes, beneficiary satisfaction, utilization differences among the different populations served by the projects,’.

SEC. 5067. TREATMENT OF CERTAIN INDIAN HEALTH PROGRAMS AND FACILITIES AS FEDERALLY-QUALIFIED HEALTH CENTERS.

    (a) IN GENERAL- Section 1861(aa)(4) (42 U.S.C. 1395x(aa)(4)) is amended--

      (1) by striking ‘or’ at the end of subparagraph (B);

      (2) by striking the period at the end of subparagraph (C) and inserting ‘; or’; and

      (3) by adding at the end the following new subparagraph:

      ‘(D) is an outpatient health program or facility operated by a tribe or tribal organization under the Indian Self-Determination Act or by an urban Indian organization receiving funds under title V of the Indian Health Care Improvement Act.’.

    (b) EFFECTIVE DATE- The amendment made by subsection (a) shall take effect as if included in the enactment of section 4161(a)(2)(C) of OBRA-1990.

SEC. 5068. INTEREST PAYMENTS.

    (a) IN GENERAL- Section 1842(c)(2)(B)(ii)(IV) of the Social Security Act shall be applied with respect to paper claims received in the 9-month period beginning January 1, 1993, by substituting ‘27 calendar days’ for ‘24 calendar days’ and ‘17 calendar days’.

    (b) PROHIBITING PAYMENT OF INTEREST DURING MANDATORY PAYMENT DELAY PERIOD- Section 1842(c)(2)(C) (42 U.S.C. 1395u(c)(2)(C)) is amended by adding at the end the following: ‘Notwithstanding any other provision of law, no interest may be paid with respect to a claim pursuant to the preceding sentence within any period following the submission of the claim during which no payment may be issued, mailed, or otherwise transmitted with respect to the claim.’.

SEC. 5069. CLARIFICATION OF COVERAGE OF CERTIFIED NURSE-MIDWIFE SERVICES PERFORMED OUTSIDE THE MATERNITY CYCLE.

    (a) IN GENERAL- Section 1861(gg)(2) (42 U.S.C. 1395x(gg)(2)) is amended by striking ‘, and performs services’ and all that follows and inserting a period.

    (b) EFFECTIVE DATE- The amendment made by subsection (a) shall apply to services furnished on or after January 1, 1994.

SEC. 5069A. INCREASE IN, AND STUDY OF, ANNUAL CAP ON AMOUNT OF MEDICARE PAYMENT FOR OUTPATIENT PHYSICAL THERAPY AND OCCUPATIONAL THERAPY SERVICES.

    (a) INCREASE IN ANNUAL LIMITATION- Section 1833(g) (42 U.S.C. 1395l(g)) is amended by striking ‘$750’ and inserting ‘$900’ each place it appears.

    (b) STUDY- (1) The Physician Payment Review Commission shall conduct a study of the appropriateness of continuing an annual limitation on the amount of payment for outpatient services of independently practicing physical and occupational therapists under the medicare program.

    (2) By not later than January 1, 1995, the Commission shall submit to the Committees on Energy and Commerce and Ways and Means of the House of Representatives and the Committee on Finance of the Senate a report on the study conducted under paragraph (1). Such report shall include such recommendations for changes in such annual limitation as the Commission finds appropriate.

    (c) EFFECTIVE DATE- The amendment made by subsection (a) shall apply to services furnished on or after January 1, 1994.

SEC. 5070. MISCELLANEOUS AND TECHNICAL CORRECTIONS.

    (a) REVISION OF INFORMATION ON PART B CLAIMS FORMS- Section 1833(q)(1) (42 U.S.C. 1395l(q)(1)) is amended--

      (1) by striking ‘provider number’ and inserting ‘unique physician identification number’; and

      (2) by striking ‘and indicate whether or not the referring physician is an interested investor (within the meaning of section 1877(h)(5))’.

    (b) CONSULTATION FOR SOCIAL WORKERS- Effective with respect to services furnished on or after January 1, 1991, section 6113(c) of OBRA-1989 is amended--

      (1) by inserting ‘and clinical social worker services’ after ‘psychologist services’; and

      (2) by striking ‘psychologist’ the second and third place it appears and inserting ‘psychologist or clinical social worker’.

    (c) REPORTS ON HOSPITAL OUTPATIENT PAYMENT- (1) OBRA-1989 is amended by striking section 6137.

    (2) Section 1135(d) (42 U.S.C. 1320b-5(d)) is amended--

      (A) by striking paragraph (6); and

      (B) in paragraph (7)--

        (i) by striking ‘systems’ each place it appears and inserting ‘system’; and

        (ii) by striking ‘paragraphs (1) and (6)’ and inserting ‘paragraph (1)’.

    (d) RADIOLOGY AND DIAGNOSTIC SERVICES PROVIDED IN HOSPITAL OUTPATIENT DEPARTMENTS- (1) Effective as if included in the enactment of OBRA-1989, section 1833(n)(1)(B)(i)(II) (42 U.S.C. 1395l(n)(1)(B)(i)(II)) is amended--

      (A) by inserting ‘and for services described in subsection (a)(2)(E)(ii) furnished on or after January 1, 1992’ after ‘1989’; and

      (B) by striking ‘1842(b)’ and inserting ‘1842(b) (or, in the case of services furnished on or after January 1, 1992, under section 1848)’.

    (2) Effective as if included in the enactment of OBRA-1989, section 1833(n)(1)(B)(i)(II) (42 U.S.C. 1395l(n)(1)(B)(i)(II)) is amended by striking ‘January 1,’ and inserting ‘April 1,’.

    (e) PAYMENTS TO NURSE PRACTITIONERS IN RURAL AREAS (SECTION 4155 OF OBRA-1990)- (1) Section 1861(s)(2)(K)(iii) (42 U.S.C. 1395x(s)(2)(K)(iii)) is amended--

      (A) by striking ‘subsection (aa)(3)’ and inserting ‘subsection (aa)(5)’; and

      (B) by striking ‘subsection (aa)(4)’ and inserting ‘subsection (aa)(6)’.

    (2) Section 1833(a)(1) (42 U.S.C. 1395l(a)(1)) is amended--

      (A) by striking ‘and’ before ‘(N)’; and

      (B) with respect to the matter inserted by section 4155(b)(2)(B) of OBRA-1990--

        (i) by striking ‘(M)’ and inserting ‘, and (O)’, and

        (ii) by transferring and inserting it (as amended) immediately before the semicolon at the end.

    (3) Section 1833(r)(1) (42 U.S.C. 1395l(r)(1)) is amended--

      (A) by striking ‘ambulatory’ each place it appears and inserting ‘or ambulatory’; and

      (B) by striking ‘center,’ and inserting ‘center’.

    (4) Section 1833(r)(2)(A) (42 U.S.C. 1395l(r)(2)(A)) is amended by striking ‘subsection (a)(1)(M)’ and inserting ‘subsection (a)(1)(O)’.

    (5) Section 1861(b)(4) (42 U.S.C. 1395x(b)(4)) is amended by striking ‘subsection (s)(2)(K)(i)’ and inserting ‘clauses (i) or (iii) of subsection (s)(2)(K)’.

    (6) Section 1861(aa)(5) (42 U.S.C. 1395x(aa)(5)) is amended by striking ‘this Act’ and inserting ‘this title’.

    (7) Section 1862(a)(14) (42 U.S.C. 1395y(a)(14)) is amended by striking ‘1861(s)(2)(K)(i)’ and inserting ‘1861(s)(2)(K)(i) or 1861(s)(2)(K)(iii)’.

    (8) Section 1866(a)(1)(H) (42 U.S.C. 1395cc(a)(1)(H)) is amended by striking ‘1861(s)(2)(K)(i)’ and inserting ‘1861(s)(2)(K)(i) or 1861(s)(2)(K)(iii)’.

    (f) OTHER MISCELLANEOUS AND TECHNICAL AMENDMENTS-

      (1) IMMEDIATE ENROLLMENT IN PART B BY INDIVIDUALS COVERED BY AN EMPLOYMENT-BASED PLAN- (A) Subparagraphs (A) and (B) of section 1837(i)(3) (42 U.S.C. 1395p(i)(3)) are each amended--

        (i) by striking ‘beginning with the first day of the first month in which the individual is no longer enrolled’ and inserting ‘including each month during any part of which the individual is enrolled’; and

        (ii) by striking ‘and ending seven months later’ and inserting ‘ending with the last day of the eighth consecutive month in which the individual is at no time so enrolled’.

      (B) Paragraphs (1) and (2) of section 1838(e) (42 U.S.C. 1395q(e)) are amended to read as follows:

      ‘(1) in any month of the special enrollment period in which the individual is at any time enrolled in a plan (specified in subparagraph (A) or (B), as applicable, of section 1837(i)(3)) or in the first month following such a month, the coverage period shall begin on the first day of the month in which the individual so enrolls (or, at the option of the individual, on the first day of any of the following three months), or

      ‘(2) in any other month of the special enrollment period, the coverage period shall begin on the first day of the month following the month in which the individual so enrolls.’.

      (C) The amendments made by subparagraphs (A) and (B) shall take effect on the first day of the first month that begins after the expiration of the 120-day period that begins on the date of the enactment of this Act.

      (2) BLEND AMOUNTS FOR AMBULATORY SURGICAL CENTER PAYMENTS- Subclauses (I) and (II) of section 1833(i)(3)(B)(ii) (42 U.S.C. 1395l(i)(3)(B)(ii)) are each amended--

        (A) by striking ‘for reporting’ and inserting ‘for portions of cost reporting’; and

        (B) by striking ‘and on or before’ and inserting ‘and ending on or before’.

      (3) CLINICAL DIAGNOSTIC LABORATORY TESTS (SECTION 4154 OF OBRA-1990)- Section 4154(e)(5) of OBRA-1990 is amended by striking ‘(1)(A)’ and inserting ‘(1)(A),’.

      (4) SEPARATE PAYMENT UNDER PART B FOR CERTAIN SERVICES (SECTION 4157 OF OBRA-1990)- Section 4157(a) of OBRA-1990 is amended by striking ‘(a) SERVICES OF’ and all that follows through ‘Section’ and inserting ‘(a) TREATMENT OF SERVICES OF CERTAIN HEALTH PRACTITIONERS- Section’.

      (5) COMMUNITY HEALTH CENTERS AND RURAL HEALTH CLINICS (SECTION 4161 OF OBRA-1990)- (A) The fourth sentence of section 1861(aa)(2) (42 U.S.C. 1395x(aa)(2)) is amended--

        (i) by striking ‘certification’ the first place it appears and inserting ‘approval’; and

        (ii) by striking ‘the Secretary’s approval or disapproval of the certification’ and inserting ‘Secretary’s approval or disapproval’.

      (B) Section 4161(a)(7)(B) of OBRA-1990 is amended by inserting ‘and to the Committee on Finance of the Senate’ after ‘Representatives’.

      (6) SCREENING MAMMOGRAPHY (SECTION 4163 OF OBRA-1990)- Section 4163 of OBRA-1990 is amended--

        (A) by adding at the end of subsection (d) the following new paragraph:

      ‘(3) The amendment made by paragraph (2)(A)(iv) shall apply to screening pap smears performed on or after July 1, 1990.’; and

        (B) in subsection (e), by striking ‘The amendments’ and inserting ‘Except as provided in subsection (d)(3), the amendments’.

      (7) INJECTABLE DRUGS FOR TREATMENT OF OSTEOPOROSIS-

        (A) CLARIFICATION OF DRUGS COVERED- The section 1861(jj) (42 U.S.C. 1395x(jj)) inserted by section 4156(a)(2) of OBRA-1990 is amended--

          (i) in the matter preceding paragraph (1), by striking ‘a bone fracture related to’; and

          (ii) in paragraph (1), by striking ‘patient’ and inserting ‘individual has suffered a bone fracture related to post-menopausal osteoporosis and that the individual’.

        (B) LIMITING COVERAGE TO DRUGS PROVIDED BY HOME HEALTH AGENCIES- (i) The section 1861(jj) (42 U.S.C. 1395x(jj)) inserted by section 4156(a)(2) of OBRA-1990 is amended by striking ‘if’ and inserting ‘by a home health agency if’.

        (ii) Section 1861(m)(5) (42 U.S.C. 1395x(m)(5)) is amended by striking ‘but excluding’ and inserting ‘and a covered osteoporosis drug (as defined in subsection (kk), but excluding other’.

        (iii) Section 1861(s)(2) (42 U.S.C. 1395x(s)(2)) is amended--

          (I) by adding ‘and’ at the end of subparagraph (N), and

          (II) by striking subparagraph (O) and redesignating subparagraph (P) as subparagraph (O).

        (C) PAYMENT BASED ON REASONABLE COST- Section 1833(a)(2) (42 U.S.C. 1395l(a)(2)) is amended--

          (i) in subparagraph (A), by striking ‘health services’ and inserting ‘health services (other than covered osteoporosis drug (as defined in section 1861(kk)))’;

          (ii) by striking ‘and’ at the end of subparagraph (D);

          (iii) by striking the semicolon at the end and inserting ‘; and’; and

          (iv) by adding at the end the following new subparagraph:

        ‘(F) with respect to covered osteoporosis drug (as defined in section 1861(kk)) furnished by a home health agency, 80 percent of the reasonable cost of such service, as determined under section 1861(v);’.

        (D) APPLICATION OF PART B DEDUCTIBLE- Section 1833(b)(2) (42 U.S.C. 1395l(b)(2)) is amended by striking ‘services’ and inserting ‘services (other than covered osteoporosis drug (as defined in section 1861(kk)))’.

        (E) COVERED OSTEOPOROSIS DRUG (SECTION 4156 OF OBRA-1990)- Section 1861 (42 U.S.C. 1395x) is amended, in the subsection (jj) inserted by section 4156(a)(2) of OBRA-1990, by striking ‘(jj) The term’ and inserting ‘(kk) The term’.

      (8) OTHER MISCELLANEOUS AND TECHNICAL CORRECTIONS (SECTION 4164 OF OBRA-1990)-

        (A) OWNERSHIP DISCLOSURE REQUIREMENTS- (i) Section 1124A(a)(2)(A) (42 U.S.C. 1320a-3a(a)(2)(A)) is amended by striking ‘of the Social Security Act’.

        (ii) Section 4164(b)(4) of OBRA-1990 is amended by striking ‘paragraph’ and inserting ‘paragraphs’.

        (B) DIRECTORY OF UNIQUE PHYSICIAN IDENTIFIER NUMBERS- Section 4164(c) of OBRA-1990 is amended by striking ‘publish’ and inserting ‘publish, and shall periodically update,’.

    (g) EFFECTIVE DATE- Except as otherwise provided in this section, the amendments made by this section shall take effect as if included in the enactment of OBRA-1990.

CHAPTER 2--PROVISIONS RELATING TO PARTS A AND B

SEC. 5071. ELIMINATION OF ADD-ON FOR OVERHEAD OF HOSPITAL-BASED HOME HEALTH AGENCIES.

    (a) GENERAL RULE- The first sentence of section 1861(v)(1)(L)(ii) (42 U.S.C. 1395x(v)(1)(L)(ii)) is amended by striking ‘, with appropriate adjustment for administrative and general costs of hospital-based agencies’.

    (b) EFFECTIVE DATE- The amendment made by subsection (a) applies to cost reporting periods beginning after fiscal year 1993.

SEC. 5072. STUDY AND REPORT ON MEDICARE GME PAYMENTS.

    (a) STUDY- The Secretary of Health and Human Services shall conduct a study of the methodology used to determine payments to hospitals under the medicare program for the costs of medical residency training programs and shall include in the study an analysis of the causes of variation among such programs in the per resident costs of direct graduate medical education, including the extent of support for such programs from non-hospital sources.

    (b) REPORT- Not later than 1 year after the date of the enactment of this Act, the Secretary shall submit a report to Congress on the study conducted under subsection (a), and shall include in the report any recommendations considered appropriate by the Secretary for modifications to the methodology used to determine payments to hospitals under the medicare program for the costs of medical residency training programs that will encourage greater uniformity among medical residency training programs in the per resident costs of direct graduate medical education.

SEC. 5073. MEDICARE AS SECONDARY PAYER.

    (a) EXTENSION OF DATA MATCH PROGRAM- Section 1862(b)(5)(C)(iii) (42 U.S.C. 1395y(b)(5)(C)(iii)) is amended by striking ‘1995’ and inserting ‘1998’.

    (b) PERMANENT APPLICATION TO DISABLED INDIVIDUALS- Section 1862(b)(1)(B) (42 U.S.C. 1395y(b)(1)(B)) is amended by striking clause (iii).

    (c) APPLICATION OF ESRD RULES TO CERTAIN AGED AND DISABLED BENEFICIARIES AND EXTENSION OF APPLICATION OF 18-MONTH RULE-

      (1) Subparagraphs (A)(iv) and (B)(ii) of section 1862(b)(1) (42 U.S.C. 1395y(b)(1)) are each amended--

        (A) by striking ‘Clause (i) shall not apply’ and inserting ‘Subparagraph (C) shall apply instead of clause (i)’, and

        (B) by inserting ‘(without regard to entitlement under section 226)’ after ‘or’ the second place it appears.

      (2) The second sentence of section 1862(b)(1)(C) is amended by striking ‘on or before January 1, 1996’ and inserting ‘before October 1, 1998’.

    (d) UNIFORM RULES FOR SIZE OF EMPLOYER-

      (1) IN GENERAL- Section 1862(b)(1) (42 U.S.C. 1395y(b)(1)) is amended by adding at the end the following:

        ‘(E) GENERAL PROVISIONS-

          ‘(i) EXCLUSION OF GROUP HEALTH PLAN OF A SMALL EMPLOYER- Subparagraphs (A) through (C) do not apply to a group health plan unless the plan is a plan of, or contributed to by, an employer or employee organization that has 20 or more individuals in current employment status for each working day in each of 20 or more calendar weeks in the current calendar year or the preceding calendar year.

          ‘(ii) EXCEPTION FOR SMALL EMPLOYERS IN MULTIEMPLOYER OR MULTIPLE EMPLOYER GROUP HEALTH PLANS- Subparagraphs (A) through (C) also do not apply with respect to individuals enrolled in a multiemployer or multiple employer group health plan if the coverage of the individuals under the plan is by virtue of current employment status with an employer that does not have 20 or more individuals in current employment status for each working day in each of 20 or more calendar weeks in the current calendar year and the preceding calendar year; but the exception provided in this clause applies only if the plan elects treatment under this clause.

          ‘(iii) APPLICATION OF CONTROLLED GROUP RULES- For purposes of clauses (i) and (ii)--

            ‘(I) all employees of corporations which are members of a controlled group of corporations (within the meaning of section 1563(a) of the Internal Revenue Code of 1986, determined without regard to subsection (a)(4) or (e)(3)(C)), shall be treated as employed by a single employer,

            ‘(II) all employees of trades or businesses (whether or not incorporated) which are under common control (under regulations prescribed by the Secretary of the Treasury under section 414(c) of that Code) shall be treated as employed by a single employer,

            ‘(III) all employees of the members of an affiliated service group (as defined in section 414(m) of that Code) shall be treated as employed by a single employer, and

            ‘(IV) leased employees (as defined in section 414(n)(2) of that Code) shall be treated as employees of the person for whom they perform services to the extent they are so treated under section 414(n) of that Code.

          In applying sections of the Internal Revenue Code of 1986 under this clause, the Secretary shall rely upon the regulations and decisions of the Secretary of the Treasury respecting such sections.

          ‘(iv) GROUP HEALTH PLAN DEFINED- For purposes of this subsection, the term ‘group health plan’ has the meaning given such term in section 5000(b) of the Internal Revenue Code of 1986, without regard to section 5000(d) of such Code.

          ‘(v) CURRENT EMPLOYMENT STATUS DEFINED- For purposes of this subsection, an individual has ‘current employment status’ with an employer if the individual is an employee, is the employer, or is associated with the employer in a business relationship.

          ‘(vi) TREATMENT OF SELF-EMPLOYED PERSONS AS EMPLOYERS- For purposes of this subsection, the term ‘employer’ includes a self-employed person.’.

      (2) CONFORMING AMENDMENTS FOR WORKING AGED- Section 1862(b)(1)(A) (42 U.S.C. 1395y(b)(1)(A)) is amended--

        (A) by amending subclauses (I) and (II) of clause (i) to read as follows:

            ‘(I) may not take into account that an individual (or the individual’s spouse) who is covered under the plan by virtue of the individual’s current employment status with an employer is entitled to benefits under this title under section 226(a), and

            ‘(II) shall provide that any individual age 65 or over (and the individual’s spouse age 65 or older) who is covered under the plan by virtue of the individual’s current employment status with an employer shall be entitled to the same benefits under the plan under the same conditions as any such individual (or spouse) under age 65.’;

        (B) by striking clauses (ii), (iii), and (v), and

        (C) by redesignating clause (iv) as clause (ii).

      (3) AMENDMENTS FOR DISABLED INDIVIDUALS- Section 1862(b) (42 U.S.C. 1395y(b)) is amended--

        (A) by amending the heading and clause (i) of paragraph (1)(B) to read as follows:

        ‘(B) DISABLED INDIVIDUALS UNDER GROUP HEALTH PLANS-

          ‘(i) IN GENERAL- A group health plan may not take into account that an individual (or a member of the individual’s family) who is covered under the plan by virtue of the individual’s current employment status with an employer is entitled to benefits under this title under section 226(b).’;

        (B) by striking clause (iv) of paragraph (1)(B); and

        (C) in the second sentence of paragraph (2)(A), by striking ‘or large group health plan’.

      (4) AMENDMENTS FOR INDIVIDUALS WITH ESRD- Section 1862(b)(1)(C) (42 U.S.C. 1395y(b)(1)(C)) is amended--

        (A) in the matter preceding clause (i), by striking ‘(as defined in subparagraph (A)(v))’,

        (B) by striking ‘solely’ each place it appears,

        (C) by striking ‘by reason of’ and inserting ‘under’ each place it appears, and

        (D) by inserting ‘or eligible for’ after ‘entitled to’ each place it appears.

    (e) SECONDARY PAYER EXEMPTION FOR MEMBERS OF RELIGIOUS ORDERS- Effective as if included in the enactment of OBRA-1989, section 6202(e)(2) of such Act is amended by adding at the end the following: ‘Such amendment also shall apply to items and services furnished before such date with respect to secondary payer cases which the Secretary of Health and Human Services had not identified as of such date.’.

    (f) IMPROVING IDENTIFICATION OF MEDICARE SECONDARY PAYER SITUATIONS-

      (1) SURVEY OF BENEFICIARIES-

        (A) IN GENERAL- Section 1862(b)(5) (42 U.S.C. 1395y(b)(5)) is amended by adding at the end the following new subparagraph:

        ‘(D) OBTAINING INFORMATION FROM BENEFICIARIES- Before an individual applies for benefits under part A or enrolls under part B, the Administrator shall mail the individual a questionnaire to obtain information on whether the individual is covered under a primary plan and the nature of the coverage provided under the plan, including the name, address, and identifying number of the plan.’.

        (B) DISTRIBUTION OF QUESTIONNAIRE BY CONTRACTOR- The Secretary of Health and Human Services shall enter into an agreement with an entity not later than April 1, 1994, to distribute the questionnaire described in section 1862(b)(5)(D) of the Social Security Act (as added by subparagraph (A)).

        (C) NO MEDICARE SECONDARY PAYER DENIAL BASED ON FAILURE TO COMPLETE QUESTIONNAIRE- Section 1862(b)(2) (42 U.S.C. 1395y(b)(2)) is amended by adding at the end the following new subparagraph:

        ‘(C) TREATMENT OF QUESTIONNAIRES- The Secretary may not fail to make payment under subparagraph (A) solely on the ground that an individual failed to complete a questionnaire concerning the existence of a primary plan.’.

      (2) MANDATORY SCREENING BY PROVIDERS AND SUPPLIERS UNDER PART B-

        (A) IN GENERAL- Section 1862(b) (42 U.S.C. 1395y(b)) is amended by adding at the end the following new paragraph:

      ‘(6) SCREENING REQUIREMENTS FOR PROVIDERS AND SUPPLIERS-

        ‘(A) IN GENERAL- Notwithstanding any other provision of this title, no payment may be made for any item or service furnished under part B unless the entity furnishing such item or service completes (to the best of its knowledge and on the basis of information obtained from the individual to whom the item or service is furnished) the portion of the claim form relating to the availability of other health benefit plans.

        ‘(B) PENALTIES- An entity that knowingly, willfully, and repeatedly fails to complete a claim form in accordance with subparagraph (A) or provides inaccurate information relating to the availability of other health benefit plans on a claim form under such subparagraph shall be subject to a civil money penalty of not to exceed $2,000 for each such incident. The provisions of section 1128A (other than subsections (a) and (b)) shall apply to a civil money penalty under the previous sentence in the same manner as such provisions apply to a penalty or proceeding under section 1128A(a).’.

        (B) EFFECTIVE DATE- The amendment made by subparagraph (A) shall apply with respect to items and services furnished on or after January 1, 1994.

    (g) IMPROVEMENTS IN RECOVERY OF PAYMENTS FROM PRIMARY PAYERS-

      (1) SUBMISSION OF REPORTS ON EFFORTS TO RECOVER ERRONEOUS PAYMENTS- Section 1842(b)(3) (42 U.S.C. 1395u(b)(3)) is amended--

        (A) by striking ‘and’ at the end of subparagraph (H); and

        (B) by inserting after subparagraph (H) the following new subparagraph:

      ‘(I) will submit annual reports to the Secretary describing the steps taken to recover payments made under this part for items or services for which payment has been or could be made under a primary plan (as defined in section 1862(b)(2)(A)).’.

      (2) REQUIREMENTS UNDER CARRIER PERFORMANCE EVALUATION PROGRAM- Section 1842(b)(2) (42 U.S.C. 1395u(b)(2)) is amended by adding at the end the following new subparagraph:

    ‘(D) In addition to any other standards and criteria established by the Secretary for evaluating carrier performance under this paragraph relating to avoiding erroneous payments, the Secretary shall establish standards and criteria relating to the carrier’s success in recovering payments made under this part for items or services for which payment has been or could be made under a primary plan (as defined in section 1862(b)(2)(A)).’.

      (3) DEADLINE FOR REIMBURSEMENT BY PRIMARY PLANS-

        (A) IN GENERAL- Section 1862(b)(2)(B)(i) (42 U.S.C. 1395y(b)(2)(B)(i)) is amended by adding at the end the following sentence: ‘If reimbursement is not made to the appropriate Trust Fund before the expiration of the 60-day period that begins on the date such notice or other information is received, the Secretary may charge interest (beginning with the date on which the notice or other information is received) on the amount of the reimbursement until reimbursement is made (at a rate determined by the Secretary in accordance with regulations of the Secretary of the Treasury applicable to charges for late payments).’.

        (B) CONFORMING AMENDMENT- The heading of clause (i) of section 1862(b)(2)(B) is amended to read as follows: ‘REPAYMENT REQUIRED- ’.

        (C) EFFECTIVE DATE- The amendments made by this paragraph shall apply to payments for items and services furnished on or after the date of the enactment of this Act.

      (4) EFFECTIVE DATE- The amendments made by paragraphs (1) and (2) shall apply to contracts with fiscal intermediaries and carriers under title XVIII of the Social Security Act for years beginning with 1994.

    (h) MISCELLANEOUS AND TECHNICAL CORRECTIONS-

      (1) The sentence in section 1862(b)(1)(C) added by section 4203(c)(1)(B) of OBRA-1990 is amended by striking ‘clauses (i) and (ii)’ and inserting ‘this subparagraph’.

      (2) Effective as if included in the enactment of OBRA-1989, section 1862(b)(1) is amended--

        (A) in subparagraphs (A)(v) and (B)(iv)(II), by inserting ‘, without regard to section 5000(d) of such Code’ before the period at the end of each subparagraph;

        (B) in subparagraph (A)(iii), by striking ‘current calendar year or the preceding calendar year’ and inserting ‘current calendar year and the preceding calendar year’; and

        (C) in the matter in subparagraph (C) after clause (ii), by striking ‘taking into account that’ and inserting ‘paying benefits secondary to this title when’.

      (3) Section 1862(b)(5)(C)(i) (42 U.S.C. 1395y(b)(5)(C)(i)) is amended by striking ‘6103(l)(12)(D)(iii)’ and inserting ‘6103(l)(12)(E)(iii)’.

      (4) Section 4203(c)(2) of OBRA-1990 is amended--

        (A) by striking ‘the application of clause (iii)’ and inserting ‘the second sentence’;

        (B) by striking ‘on individuals’ and all that follows through ‘section 226A of such Act’;

        (C) in clause (ii), by striking ‘clause’ and inserting ‘sentence’;

        (D) in clause (v), by adding ‘and’ at the end; and

        (E) in clause (vi)--

          (i) by inserting ‘of such Act’ after ‘1862(b)(1)(C)’, and

          (ii) by striking the period at the end and inserting the following: ‘, without regard to the number of employees covered by such plans.’.

      (5) Section 4203(d) of OBRA-1990 is amended by striking ‘this subsection’ and inserting ‘this section’.

      (6) Except as provided in paragraph (2), the amendments made by this subsection shall be effective as if included in the enactment of OBRA-1990 and shall be executed before the amendments made by subsections (a) through (d) of this section.

    (i) EFFECTIVE DATE-

      (1) IN GENERAL- Except as otherwise provided in this section, the amendments made by this section shall take effect on the date of the enactment of this Act.

      (2) ESRD AND UNIFORM SIZE RULES- The amendments made by subsections (c) and (d) apply to items and services furnished on or after January 1, 1994.

SEC. 5074. EXTENSION OF SELF-REFERRAL BAN TO ADDITIONAL SPECIFIED SERVICES.

    (a) EXTENSION TO DESIGNATED HEALTH SERVICES-

      (1) IN GENERAL- Section 1877 (42 U.S.C. 1395nn) is amended--

        (A) by striking ‘clinical laboratory services’ and ‘CLINICAL LABORATORY SERVICES’ and inserting ‘designated health services’ and ‘DESIGNATED HEALTH SERVICES’, respectively, each place either appears in subsections (a)(1), (b)(2)(A)(ii), (b)(4), (d)(1), and (d)(3); and

        (B) by adding at the end the following new subsection:

    ‘(i) DESIGNATED HEALTH SERVICES DEFINED- In this section, the term ‘designated health services’ means--

      ‘(1) clinical laboratory services;

      ‘(2) physical or occupational therapy services;

      ‘(3) radiology or other diagnostic services;

      ‘(4) radiation therapy services;

      ‘(5) the furnishing of durable medical equipment;

      ‘(6) the furnishing of parenteral and enteral nutrition nutrients, supplies, and equipment;

      ‘(7) home health services; and

      ‘(8) home infusion therapy services.’.

      (2) CONFORMING AMENDMENTS- Section 1877 is further amended--

        (A) in subsection (g)(1), by striking ‘clinical laboratory service’ and inserting ‘designated health service’, and

        (B) in subsection (h)(7)(B), by striking ‘clinical laboratory service’ and inserting ‘designated health service’.

    (b) MULTIPLE LOCATIONS FOR GROUP PRACTICES- Section 1877(b)(2)(A)(ii)(II) (42 U.S.C. 1395nn(b)(2)(A)(ii)(II)) is amended by striking ‘centralized provision’ and inserting ‘provision of some or all’.

    (c) TREATMENT OF COMPENSATION ARRANGEMENTS-

      (1) RENTAL OF OFFICE SPACE AND EQUIPMENT- Paragraph (1) of section 1877(e) (42 U.S.C. 1395nn(e)) is amended to read as follows:

      ‘(1) RENTAL OF OFFICE SPACE; RENTAL OF EQUIPMENT-

        ‘(A) OFFICE SPACE- Payments made by a lessee to a lessor for the use of premises if--

          ‘(i) the lease is set out in writing, signed by the parties, and specifies the premises covered by the lease,

          ‘(ii) the aggregate space rented or leased is reasonable and necessary for the legitimate business purposes of the lease or rental and is used exclusively by the lessee when being used by the lessee,

          ‘(iii) the lease provides for a term of rental or lease for at least one year,

          ‘(iv) the rental charges over the term of the lease are set in advance, are consistent with fair market value, and are not determined in a manner that takes into account the volume or value of any referrals or other business generated between the parties,

          ‘(v) the lease would be commercially reasonable even if no referrals were made between the parties,

          ‘(vi) the lease covers all of the premises leased between the parties for the period of the lease, and

          ‘(vii) the compensation arrangement meets such other requirements as the Secretary may impose by regulation as needed to protect against program or patient abuse.

        ‘(B) EQUIPMENT- Payments made by a lessee of equipment to the lessor of the equipment for the use of the equipment if--

          ‘(i) the lease is set out in writing, signed by the parties, and specifies the equipment covered by the lease,

          ‘(ii) the equipment rented or leased is reasonable and necessary for the legitimate business purposes of the lease or rental and is used exclusively by the lessee when being used by the lessee,

          ‘(iii) the lease provides for a term of rental or lease of at least one year,

          ‘(iv) the rental charges over the term of the lease are set in advance, are consistent with fair market value, and are not determined in a manner that takes into account the volume or value of any referrals or other business generated between the parties,

          ‘(v) the lease would be commercially reasonable even if no referrals were made between the parties,

          ‘(vi) the lease covers all of the equipment leased between the parties for the period of the lease, and

          ‘(vii) the compensation arrangement meets such other requirements as the Secretary may impose by regulation as needed to protect against program or patient abuse.’.

      (2) BONA FIDE EMPLOYMENT RELATIONSHIPS- Section 1877(e)(2) (42 U.S.C. 1395nn(e)(2)) is amended--

        (A) by striking ‘AND SERVICE’ and ‘WITH HOSPITALS’;

        (B) by striking ‘An arrangement’ and all that follows through ‘if’ and inserting ‘Any amount paid by an employer to a physician (or immediate family member) who has a bona fide employment relationship with the employer for the provision of services if’;

        (C) in subparagraphs (A), (B), and (D), by striking ‘arrangement’ and inserting ‘employment’;

        (D) in subparagraph (C), by striking ‘to the hospital’; and

        (E) by adding at the end the following:

      ‘Subparagraph (B)(ii) shall not be construed as prohibiting the payment of remuneration in the form of shares of overall profits or in the form of a productivity bonus based on services performed personally by the physician or member, if the amount of the remuneration is not determined in a manner that takes into account directly the volume or value of any referrals by the referring physician.’.

      (3) PERSONAL SERVICE ARRANGEMENTS- Section 1877(e) is further amended by adding at the end the following new paragraph:

      ‘(7) PERSONAL SERVICE ARRANGEMENTS- Remuneration from an entity under an arrangement if--

        ‘(A) the arrangement is set out in writing, signed by the parties, and specifies the services covered by the arrangement,

        ‘(B) the arrangement covers all of the services to be provided,

        ‘(C) the aggregate services contracted for do not exceed those that are reasonable and necessary for the legitimate business purposes of the arrangement,

        ‘(D) the term of the arrangement is for at least one year,

        ‘(E) the compensation to be paid over the term of the arrangement is set in advance, does not exceed fair market value, and is not determined in a manner that takes into account the volume or value of any referrals or other business generated between the parties,

        ‘(F) the services to be performed under the arrangement do not involve the counseling or promotion of a business arrangement of other activity that violates any State or Federal law, and

        ‘(G) the arrangement meets such other requirements as the Secretary may impose by regulation as needed to protect against program or patient abuse.’.

      (4) ADDITIONAL EXCEPTIONS- Section 1877(e) is further amended by adding at the end the following new paragraphs:

      ‘(8) PAYMENTS BY A PHYSICIAN FOR ITEMS AND SERVICES- Payments made by a physician--

        ‘(A) to a laboratory in exchange for the provision of clinical laboratory services, or

        ‘(B) to an entity as compensation for other items or services if the items or services are furnished at a price that is consistent with fair market value.

      ‘(9) PAYMENTS FOR PATHOLOGY SERVICES OF A GROUP PRACTICE- Payments made to a group practice for pathology services under an agreement if--

        ‘(A) the agreement is set out in writing and specifies the services to be provided by the parties and the compensation for services provided under the agreement,

        ‘(B) the compensation paid over the term of the agreement is consistent with fair market value and is not determined in a manner that takes into account the volume or value of any referrals or other business generated between the parties,

        ‘(C) the compensation is provided pursuant to an agreement which would be commercially reasonable even if no referrals were made to the entity, and

        ‘(D) the compensation arrangement between the parties meets such other requirements as the Secretary may impose by regulation as needed to protect against program or patient abuse.’.

      (4) REFERRING PHYSICIANS- Section 1877(h)(7)(C) (42 U.S.C. 1395nn(h)(7)(C)) is amended--

        (A) by inserting ‘a request by a radiologist for diagnostic radiology services, and a request by a radiation oncologist for radiation therapy,’ after ‘examination services,’, and

        (B) by inserting ‘, radiologist, or radiation oncologist’ after ‘pathologist’ the second place it appears.

    (d) TREATMENT OF GROUP PRACTICES-

      (1) USE OF BILLING NUMBERS, ETC- Section 1877 is amended--

        (A) in subsection (b)(2)(B), by inserting ‘under a billing number assigned to the group practice’ after ‘member’,

        (B) in subsection (h)(4)(B), by inserting ‘and under a billing number assigned to the group’ after ‘in the name of the group’, and

        (C) in subsection (h)(4)(C), by striking ‘by members of the group’.

      (2) TREATMENT OF SERVICES UNDER ARRANGEMENTS BETWEEN HOSPITALS AND GROUP PRACTICES-

        (A) IN GENERAL- Section 1877(h)(4) (42 U.S.C. 1395nn(h)(4)) is amended--

          (i) in subparagraph (B) (as amended by paragraph (1)(B)), by inserting ‘(or are billed in the name of a hospital for which the group provides designated health services pursuant to an arrangement that meets the requirements of subparagraph (B))’ after ‘assigned to the group’;

          (ii) by redesignating subparagraphs (A) through (D) as clauses (i) through (iv), respectively;

          (iii) by inserting ‘(A)’ after ‘- ’; and

          (iv) by adding at the end the following new subparagraph:

      ‘(B) The requirements of this subparagraph, with respect to an arrangement for designated health services provided by the group and billed in the name of a hospital, are that--

        ‘(i) with respect to services provided to an inpatient of the hospital, the arrangement is pursuant to the provision of inpatient hospital services under section 1861(b)(3);

        ‘(ii) the arrangement began before December 19, 1989, and has continued in effect without interruption since such date;

        ‘(iii) the group provides substantially all of the designated health services to the hospital’s patients;

        ‘(iv) the arrangement is pursuant to an agreement that is set out in writing and that specifies the services to be provided by the parties and the compensation for services provided under the agreement;

        ‘(v) the compensation paid over the term of the agreement is consistent with fair market value and the compensation per unit of services is fixed in advance and is not determined in a manner that takes into account the volume or value of any referrals or other business generated between the parties;

        ‘(vi) the compensation is provided pursuant to an agreement which would be commercially reasonable even if no referrals were made to the entity; and

        ‘(vii) the arrangement between the parties meets such other requirements as the Secretary may impose by regulation as needed to protect against program or patient abuse.’.

        (B) CONFORMING AMENDMENT- Section 1877(b)(2)(B) (42 U.S.C. 1395nn(b)(2)(B)) is amended by inserting ‘(or by a hospital for which such a group practice provides designated health services pursuant to an arrangement that meets the requirements of subsection (h)(4)(B))’ before ‘, or by an entity’.

      (3) TREATMENT OF CERTAIN FACULTY PRACTICE PLANS- The last sentence of section 1877(h)(4)(A) (42 U.S.C. 1395nn(h)(4)(A)), as redesignated by paragraph (2)(A), is amended by inserting ‘, institution of higher education, or medical school’ after ‘hospital’.

    (e) EXPANDING RURAL PROVIDER EXCEPTION TO COVER COMPENSATION ARRANGEMENTS-

      (1) IN GENERAL- Section 1877(b) (42 U.S.C. 1395nn(b)) is amended--

        (A) by redesignating paragraph (5) as paragraph (7), and

        (B) by inserting after paragraph (4) the following new paragraph:

      ‘(5) RURAL PROVIDERS- In the case of designated services if--

        ‘(A) the entity furnishing the services is in a rural area (as defined in section 1886(d)(2)(D)), and

        ‘(B) substantially all of the services furnished by the entity to individuals entitled to benefits under this title are furnished to such individuals who reside in such a rural area.’.

      (2) CONFORMING AMENDMENTS- Section 1877(d) (42 U.S.C. 1395nn(d)) is amended--

        (A) by striking paragraph (2), and

        (B) by redesignating paragraph (3) as paragraph (2).

    (f) EXCEPTION FOR SHARED FACILITY LABORATORY SERVICES-

      (1) IN GENERAL- Section 1877 is amended--

        (A) in subsection (b), as amended by subsection (e)(1), by inserting after paragraph (5) the following new paragraph:

      ‘(6) SHARED FACILITY LABORATORY SERVICES-

        ‘(A) IN GENERAL- In the case of shared facility laboratory services of a shared facility--

          ‘(i) that are furnished--

            ‘(I) personally by the referring physician who is a shared facility physician or personally by an individual supervised by such a physician or by another shared facility physician and employed under the shared facility arrangement,

            ‘(II) by a shared facility in a building in which the referring physician furnishes physician’s services unrelated to the furnishing of shared facility laboratory services, and

            ‘(III) to a patient of a shared facility physician; and

          ‘(ii) that are billed by the referring physician or by an entity that is wholly owned by such physician.

        ‘(B) LIMITATION- The exception under this paragraph shall only apply to a shared facility only if the facility and the shared facility arrangement were established as of June 26, 1992.’; and

        (B) in subsection (h), by adding at the end the following new paragraph:

      ‘(8) SHARED FACILITY RELATED DEFINITIONS-

        ‘(A) SHARED FACILITY LABORATORY SERVICES- The term ‘shared facility laboratory services’ means, with respect to a shared facility, clinical laboratory services furnished by the facility to patients of shared facility physicians.

        ‘(B) SHARED FACILITY- The term ‘shared facility’ means an entity that furnishes shared facility laboratory services under a shared facility arrangement.

        ‘(C) SHARED FACILITY PHYSICIAN- The term ‘shared facility physician’ means, with respect to a shared facility, a physician who has a financial relationship under a shared facility arrangement with the facility.

        ‘(D) SHARED FACILITY ARRANGEMENT- The term ‘shared facility arrangement’ means, with respect to the provision of shared facility laboratory services in a building, a financial arrangement--

          ‘(i) which is only between physicians who are providing services (unrelated to shared facility laboratory services) in the same building,

          ‘(ii) in which the overhead expenses of the facility are shared, in accordance with methods previously determined by the physicians in the arrangement, among the physicians in the arrangement, and

          ‘(iii) which, in the case of a corporation, is wholly owned and controlled by shared facility physicians.’.

      (2) GAO STUDY OF SHARED FACILITY ARRANGEMENTS-

        (A) IN GENERAL- The Comptroller General shall analyze the effect on the utilization of health services of shared facility arrangements for which an exception is provided under the amendments made by paragraph (1). The analysis shall include a review of the effect of the limitation, described in section 1877(b)(6)(B) of the Social Security Act (as added by paragraph (1)), with respect to such exception and on the availability of services (including hematology services).

        (B) REPORT- Not later than January 1, 1995, the Comptroller General shall submit a report to Congress on the analysis conducted under subparagraph (A). The report shall include recommendations with respect to changing the limitation.

    (g) EXEMPTION OF COMPENSATION ARRANGEMENTS INVOLVING CERTAIN TYPES OF REMUNERATION- Section 1877(h)(1) (42 U.S.C. 1395nn(h)(1)) is amended--

      (1) by striking subparagraph (B);

      (2) in subparagraph (A), by inserting before the period the following: ‘(other than an arrangement involving only remuneration described in subparagraph (B))’; and

      (3) by adding at the end the following new subparagraph:

      ‘(B) Remuneration described in this subparagraph is any remuneration consisting of any of the following:

        ‘(i) The forgiveness of amounts owed for inaccurate tests or procedures, mistakenly performed tests or procedures, or the correction of minor billing errors.

        ‘(ii) The provision of items, devices, or supplies that are used solely to--

          ‘(I) collect, transport, process, or store specimens for the entity providing the item, device, or supply, or

          ‘(II) communicate the results of tests or procedures for such entity.’.

    (h) EXCEPTION FOR PUBLICLY-TRADED SECURITIES- Section 1877(c)(2) (42 U.S.C. 1395nn(d)(2)) is amended by striking ‘total assets exceeding $100,000,000’ and inserting ‘stockholder equity exceeding $75,000,000’.

    (i) MISCELLANEOUS AND TECHNICAL CORRECTIONS- Section 1877 (42 U.S.C. 1395nn) is amended--

      (1) in subsection (b)(2)(A)(i), in subparagraph (A)(i), by striking ‘who are employed by such physician or group practice and who are personally’ and inserting ‘who are directly’;

      (2) in the fourth sentence of subsection (f)--

        (A) by striking ‘provided’ and inserting ‘furnished’, and

        (B) by striking ‘provides’ and inserting ‘furnish’;

      (3) in the fifth sentence of subsection (f)--

        (A) by striking ‘providing’ each place it appears and inserting ‘furnishing’,

        (B) by striking ‘with respect to the providers’ and inserting ‘with respect to the entities’, and

        (C) by striking ‘diagnostic imaging services of any type’ and inserting ‘magnetic resonance imaging, computerized axial tomography scans, and ultrasound services’; and

      (4) in subsection (a)(2)(B), by striking ‘subsection (h)(1)(A)’ and inserting ‘subsection (h)(1)’.

    (j) EFFECTIVE DATES-

      (1) The amendments made by subsection (a) apply with respect to a referral by a physician for designated health services (as described in section 1877(i) of the Social Security Act) made after December 31, 1994.

      (2) The amendments made by this section (other than subsection (a)) shall apply to referrals made on or after January 1, 1992.

SEC. 5075. REDUCTION IN PAYMENT FOR ERYTHROPOIETIN.

    (a) IN GENERAL- Section 1881(b)(11)(B)(ii)(I) (42 U.S.C. 1395rr(b)(11)(B)(ii)(I)) is amended--

      (1) by striking ‘1991’ and inserting ‘1994’, and

      (2) by striking ‘$11’ and inserting ‘$10’.

    (b) EFFECTIVE DATE- The amendments made by subsection (a) apply to erythropoietin furnished after 1993.

SEC. 5076. MEDICARE HOSPITAL AGREEMENTS WITH ORGAN PROCUREMENT ORGANIZATIONS.

    (a) IN GENERAL- Section 1138(a)(1) (42 U.S.C. 1320b-8(a)(1)) is amended--

      (1) by striking ‘and’ at the end of subparagraph (A),

      (2) by striking the period at the end of subparagraph (B) and inserting ‘; and’, and

      (3) by adding at the end the following new subparagraph:

      ‘(C) in the case of a hospital or rural primary care hospital that has in effect an agreement (described in section 371(b)(3)(A) of the Public Health Service Act) with an organ procurement organization, the agreement is with such organization for the service area in which the hospital is located (as established under such section).’.

    (b) EFFECTIVE DATE- The amendments made by subsection (a) shall apply to hospitals participating in the programs under titles XVIII and XIX of the Social Security Act as of January 1, 1994.

SEC. 5077. EXTENSION OF WAIVER FOR WATTS HEALTH FOUNDATION.

    Section 9312(c)(3)(D) of OBRA-1986, as added by section 4018(d) of OBRA-1987 and as amended by section 6212(a)(1) of OBRA-1989, is amended by striking ‘1994’ and inserting ‘1996’.

SEC. 5078. IMPROVED OUTREACH FOR QUALIFIED MEDICARE BENEFICIARIES.

    The Secretary of Health and Human Services shall establish and implement a method for obtaining information from newly eligible medicare beneficiaries that may be used to determine whether such beneficiaries may be eligible for medical assistance for medicare cost-sharing under State medicaid plans as qualified medicare beneficiaries, and for transmitting such information to the State in which such a beneficiary resides.

SEC. 5079. SOCIAL HEALTH MAINTENANCE ORGANIZATIONS.

    (a) EXTENSION OF CURRENT WAIVERS- Section 4018(b) of OBRA-1987, as amended by section 4207(b)(4) of OBRA-1990, is amended--

      (1) in paragraph (1) by striking ‘December 31, 1995’ and inserting ‘December 31, 1997’; and

      (2) in paragraph (4) by striking ‘March 31, 1996’ and inserting ‘March 31, 1998’.

    (b) EXPANSION OF DEMONSTRATIONS- Section 2355 of the Deficit Reduction Act of 1984, as amended by section 4207(b)(4)(B) of OBRA-1990, is amended--

      (1) in the last sentence of subsection (a) by striking ‘12 months’ and inserting ‘36 months’; and

      (2) in subsection (b)(1)(B)--

        (A) by striking ‘or’ at the end of clause (iii), and

        (B) by redesignating clause (iv) as clause (v) and inserting after clause (iii) the following new clause:

          ‘(iv) integrating acute and chronic care management for patients with end-stage renal disease through expanded community care case management services (and for purposes of a demonstration project conducted under this clause, any requirement under a waiver granted under this section that a project disenroll individuals who develop end-stage renal disease shall not apply); or’.

    (c) EXPANSION OF NUMBER OF MEMBERS PER SITE- The Secretary of Health and Human Services may not impose a limit of less than 12,000 on the number of individuals that may participate in a project conducted under section 2355 of the Deficit Reduction Act of 1984.

    (d) MISCELLANEOUS AND TECHNICAL CORRECTIONS-

      (1) The section following section 4206 of OBRA-1990 is amended by striking ‘SEC. 4027.’ and inserting ‘SEC. 4207.’, and in this subtitle is referred to as section 4207 of OBRA-1990.

      (2) Section 2355(b)(1)(B) of the Deficit Reduction Act of 1984, as amended by section 4207(b)(4)(B)(ii) of OBRA-1990, is amended--

        (A) by striking ‘12907(c)(4)(A)’ and inserting ‘4207(b)(4)(B)(i)’, and

        (B) by striking ‘feasibilitly’ and inserting ‘feasibility’.

      (3) Section 4207(b)(4)(B)(iii)(III) of OBRA-1990 is amended by striking the period at the end and inserting a semicolon.

      (4) Subsections (c)(3) and (e) of section 2355 of the Deficit Reduction Act of 1984, as amended by section 4207(b)(4)(B) of OBRA-1990, are each amended by striking ‘12907(c)(4)(A)’ each place it appears and inserting ‘4207(b)(4)(B)’.

      (5) Section 4207(c)(2) of OBRA-1990 is amended by striking ‘the Committee on Ways and Means’ each place it appears and inserting ‘the Committees on Ways and Means and Energy and Commerce’.

      (6) Section 4207(d) of OBRA-1990 is amended by redesignating the second paragraph (3) (relating to effective date) as paragraph (4).

      (7) Section 4207(i)(2) of OBRA-1990 is amended--

        (A) by striking the period at the end of clause (iii) and inserting a semicolon, and

        (B) in clause (v), by striking ‘residents’ and inserting ‘patients’.

      (8) Section 4207(j) of OBRA-1990 is amended by striking ‘title’ each place it appears and inserting ‘subtitle’.

    (e) EFFECTIVE DATE- The amendments made by this section shall take effect as if included in the enactment of OBRA-1990.

SEC. 5080. PEER REVIEW ORGANIZATIONS.

    (a) REPEAL OF PRO PRECERTIFICATION REQUIREMENT FOR CERTAIN SURGICAL PROCEDURES-

      (1) IN GENERAL- Section 1164 (42 U.S.C. 1320c-13) is repealed.

      (2) CONFORMING AMENDMENTS-

        (A) Section 1154 (42 U.S.C. 1320c-3) is amended--

          (i) in subsection (a), by striking paragraph (12), and

          (ii) in subsection (d), by striking ‘(and except as provided in section 1164)’.

        (B) Section 1833 (42 U.S.C. 1395l) is amended--

          (i) in subsection (a)(1)(D)(i), by striking ‘, or for tests furnished in connection with obtaining a second opinion required under section 1164(c)(2) (or a third opinion, if the second opinion was in disagreement with the first opinion)’;

          (ii) in subsection (a)(1), by striking clause (G);

          (iii) in subsection (a)(2)(A), by striking ‘to items and services (other than clinical diagnostic laboratory tests) furnished in connection with obtaining a second opinion required under section 1164(c)(2) (or a third opinion, if the second opinion was in disagreement with the first opinion),’;

          (iv) in subsection (a)(2)(D)(i)--

            (I) by striking ‘related basis,’ and inserting ‘related basis or’, and

            (II) by striking ‘, or for tests furnished in connection with obtaining a second opinion required under section 1164(c)(2) (or a third opinion, if the second opinion was in disagreement with the first opinion)’;

          (v) in subsection (a)(3), by striking ‘and for items and services furnished in connection with obtaining a second opinion required under section 1164(c)(2), or a third opinion, if the second opinion was in disagreement with the first opinion)’; and

          (vi) in the first sentence of subsection (b), by striking ‘(4)’ and all that follows through ‘and (5)’ and inserting ‘and (4)’.

        (C) Section 1834(g)(1)(B) (42 U.S.C. 1395m(g)(1)(B)) is amended by striking ‘and for items and services furnished in connection with obtaining a second opinion required under section 1164(c)(2), or a third opinion, if the second opinion was in disagreement with the first opinion)’.

        (D) Section 1862(a) (42 U.S.C. 1395y(a)) is amended--

          (i) by adding ‘or’ at the end of paragraph (14),

          (ii) by striking ‘; or’ at the end of paragraph (15) and inserting a period, and

          (iii) by striking paragraph (16).

        (E) The third sentence of section 1866(a)(2)(A) (42 U.S.C. 1395w(a)(2)(A)) is amended by striking ‘, with respect to items and services furnished in connection with obtaining a second opinion required under section 1164(c)(2) (or a third opinion, if the second opinion was in disagreement with the first opinion),’.

      (3) EFFECTIVE DATE- The amendments made by this subsection shall apply to services provided on or after the date of the enactment of this Act.

    (b) MISCELLANEOUS AND TECHNICAL CORRECTIONS- (1) The third sentence of section 1156(b)(1) (42 U.S.C. 1320c-5(b)(1)) is amended by striking ‘whehter’ and inserting ‘whether’.

    (2)(A) Subparagraph (B) of section 1154(a)(9) (42 U.S.C. 1320c-3(a)(9)) is amended to read as follows:

      ‘(B) If the organization finds, after reasonable notice and opportunity for discussion with the physician or practitioner concerned, that the physician or practitioner has furnished services in violation of section 1156(a), the organization shall notify the State board or boards responsible for the licensing or disciplining of the physician or practitioner of its finding and of any action taken as a result of the finding.’.

    (B) Subparagraph (D) of section 1160(b)(1) (42 U.S.C. 1320c-9(b)(1)) is amended to read as follows:

        ‘(D) to provide notice in accordance with section 1154(a)(9)(B);’.

    (3) Section 4205(d)(2)(B) of OBRA-1990 is amended by striking ‘amendments’ and inserting ‘amendment’.

    (4) Section 1160(d) (42 U.S.C. 1320c-9(d)) is amended by striking ‘subpena’ and inserting ‘subpoena’.

    (5) Section 4205(e)(2) of OBRA-1990 is amended by striking ‘amendments’ and inserting ‘amendment’ and by striking ‘all’.

    (6)(A) Except as provided in subparagraph (B), the amendments made by this subsection shall take effect as if included in the enactment of OBRA-1990.

    (B) The amendments made by paragraph (2) (relating to the requirement on reporting of information to State boards) shall take effect on the date of the enactment of this Act.

SEC. 5081. HOSPICE INFORMATION TO HOME HEALTH BENEFICIARIES.

    (a) IN GENERAL- Section 1891(a)(1) (42 U.S.C. 1395bbb(a)(1)) is amended by adding at the end the following new subparagraph:

        ‘(H) The right, in the case of a resident who is entitled to benefits under this title, to be fully informed orally and in writing (at the time of coming under the care of the agency) of the entitlement of individuals to hospice care under section 1812(a)(4) (unless there is no hospice program providing hospice care for which payment may be made under this title within the geographic area of the facility and it is not the common practice of the agency to refer patients to hospice programs located outside such geographic area).’.

    (b) EFFECTIVE DATE- The amendment made by subsection (a) shall apply to services furnished on or after the first day of the first month beginning more than one year after the date of the enactment of this Act.

SEC. 5082. HEALTH MAINTENANCE ORGANIZATIONS.

    (a) ADJUSTMENT IN MEDICARE CAPITATION PAYMENTS TO ACCOUNT FOR REGIONAL VARIATIONS IN APPLICATION OF SECONDARY PAYER PROVISIONS-

      (1) IN GENERAL- Section 1876(a)(4) (42 U.S.C. 1395mm(a)(4)) is amended by adding at the end the following new sentence: ‘In establishing the adjusted average per capita cost for a geographic area, the Secretary shall take into account the differences between the proportion of individuals in the area with respect to whom there is a group health plan that is a primary plan (within the meaning of section 1862(b)(2)(A)) compared to the proportion of all such individuals with respect to whom there is such a group health plan.’.

      (2) EFFECTIVE DATE- The amendment made by paragraph (1) shall apply to contracts entered into for years beginning with 1994.

    (b) REVISIONS IN THE PAYMENT METHODOLOGY FOR RISK CONTRACTORS- Section 4204(b) of OBRA-1990 is amended to read as follows:

    ‘(b) REVISIONS IN THE PAYMENT METHODOLOGY FOR RISK CONTRACTORS- (1)(A) Not later than January 1, 1995, the Secretary of Health and Human Services (in this subsection referred to as the ‘Secretary’) shall submit a proposal to the Congress that provides for revisions to the payment method to be applied in years beginning with 1996 for organizations with a risk-sharing contract under section 1876(g) of the Social Security Act.

    ‘(B) In proposing the revisions required under subparagraph (A) the Secretary shall consider--

      ‘(i) the difference in costs associated with medicare beneficiaries with differing health status and demographic characteristics; and

      ‘(ii) the effects of using alternative geographic classifications on the determinations of costs associated with beneficiaries residing in different areas.

    ‘(2) Not later than 3 months after the date of submittal of the proposal made pursuant to paragraph (1), the Comptroller General shall review the proposal and shall report to Congress on the appropriateness of the proposed modifications.’.

    (c) MISCELLANEOUS AND TECHNICAL CORRECTIONS- (1) Section 1876(a)(3) (42 U.S.C. 1395mm(a)(3)) is amended by striking ‘subsection (c)(7)’ and inserting ‘subsections (c)(2)(B)(ii) and (c)(7)’.

    (2) Section 4204(c)(3) of OBRA-1990 is amended by striking ‘for 1991’ and inserting ‘for years beginning with 1991’.

    (3) Section 4204(d)(2) of OBRA-1990 is amended by striking ‘amendment’ and inserting ‘amendments’.

    (4) Section 1876(a)(1)(E)(ii)(I) (42 U.S.C. 1395mm(a)(1)(E)(ii)(I)) is amended by striking the comma after ‘contributed to’.

    (5) Section 4204(e)(2) of OBRA-1990 is amended by striking ‘(which has a risk-sharing contract under section 1876 of the Social Security Act)’.

    (6) Section 4204(f)(4) of OBRA-1990 is amended by striking ‘final’.

    (7) Section 1862(b)(3)(C) (42 U.S.C. 1395y(b)(3)(C)) is amended--

      (A) in the heading, by striking ‘PLAN’ and inserting ‘PLAN OR A LARGE GROUP HEALTH PLAN’;

      (B) by striking ‘group health plan’ and inserting ‘group health plan or a large group health plan’;

      (C) by striking ‘, unless such incentive is also offered to all individuals who are eligible for coverage under the plan’; and

      (D) by striking ‘the first sentence of subsection (a) and other than subsection (b)’ and inserting ‘subsections (a) and (b)’.

    (8) The amendments made by this subsection shall take effect as if included in the enactment of OBRA-1990.

SEC. 5083. MISCELLANEOUS AND TECHNICAL CORRECTIONS.

    (a) SURVEY AND CERTIFICATION REQUIREMENTS- (1) Section 1864 (42 U.S.C. 1395aa) is amended--

      (A) in subsection (e), by striking ‘title’ and inserting ‘title (other than any fee relating to section 353 of the Public Health Service Act)’; and

      (B) in the first sentence of subsection (a), by striking ‘1861(s) or’ and all that follows through ‘Service Act,’ and inserting ‘1861(s),’.

    (2) An agreement made by the Secretary of Health and Human Services with a State under section 1864(a) of the Social Security Act may include an agreement that the services of the State health agency or other appropriate State agency (or the appropriate local agencies) will be utilized by the Secretary for the purpose of determining whether a laboratory meets the requirements of section 353 of the Public Health Service Act.

    (b) OTHER MISCELLANEOUS AND TECHNICAL PROVISIONS- (1) Section 1833 (42 U.S.C. 1395l) is amended by redesignating the subsection (r) added by section 4206(b)(2) of OBRA-1990 as subsection (s).

    (2) Section 1866(f)(1) (42 U.S.C. 1395cc(f)(1)) is amended by striking ‘1833(r)’ and inserting ‘1833(s)’.

    (3) Section 1861(s)(2) (42 U.S.C. 1395x(s)(2)) is amended by moving subparagraph (O), as redesignated by section 5070(f)(7)(B)(iii)(II) of this subtitle, two ems to the left.

    (4) Section 1881(b)(1)(C) (42 U.S.C. 1395rr(b)(1)(C)) is amended by striking ‘1861(s)(2)(Q)’ and inserting ‘1861(s)(2)(P)’.

    (5) Section 4201(d)(2) of OBRA-1990 is amended by striking ‘(B) by striking’, ‘(C) by striking’, and ‘(3) by adding’ and inserting ‘(i) by striking’, ‘(ii) by striking’, and ‘(B) by adding’, respectively.

    (6)(A) Section 4207(a)(1) of OBRA-1990 is amended by adding closing quotation marks and a period after ‘such review.’.

    (B) Section 4207(a)(4) of OBRA-1990 is amended by striking ‘this subsection’ and inserting ‘paragraphs (2) and (3)’.

    (C) Section 4207(b)(1) of OBRA-1990 is amended by striking ‘section 3(7)’ and inserting ‘section 601(a)(1)’.

    (7) Section 4202 of OBRA-1990 is amended--

      (A) in subsection (b)(1)(A), by striking ‘home hemodialysis staff assistant’ and inserting ‘qualified home hemodialysis staff assistant (as described in subsection (d))’;

      (B) in subsection (b)(2)(B)(ii)(I), by striking ‘(as adjusted to reflect differences in area wage levels)’;

      (C) in subsection (c)(1)(A), by striking ‘skilled’; and

      (D) in subsection (c)(1)(E), by striking ‘(b)(4)’ and inserting ‘(b)(2)’.

    (c) EFFECTIVE DATE- The amendments made by this section shall take effect as if included in the enactment of OBRA-1990.

CHAPTER 3--PROVISIONS RELATING TO MEDICARE SUPPLEMENTAL INSURANCE POLICIES

SEC. 5091. STANDARDS FOR MEDICARE SUPPLEMENTAL INSURANCE POLICIES.

    (a) SIMPLIFICATION OF MEDICARE SUPPLEMENTAL POLICIES-

      (1) Section 4351 of OBRA-1990 is amended by striking ‘(a) IN GENERAL- ’.

      (2) Section 1882(p) (42 U.S.C. 1395ss(p)) is amended--

        (A) in paragraph (1)(A)--

          (i) by striking ‘promulgates’ and inserting ‘changes the revised NAIC Model Regulation (described in subsection (m)) to incorporate’,

          (ii) by striking ‘(such limitations, language, definitions, format, and standards referred to collectively in this subsection as ‘NAIC standards’),’, and

          (iii) by striking ‘included a reference to the NAIC standards’ and inserting ‘were a reference to the revised NAIC Model Regulation as changed under this subparagraph (such changed regulation referred to in this section as the ‘1991 NAIC Model Regulation’)’;

        (B) in paragraph (1)(B)--

          (i) by striking ‘promulgate NAIC standards’ and inserting ‘make the changes in the revised NAIC Model Regulation’,

          (ii) by striking ‘limitations, language, definitions, format, and standards described in clauses (i) through (iv) of such subparagraph (in this subsection referred to collectively as ‘Federal standards’)’ and inserting ‘a regulation’, and

          (iii) by striking ‘included a reference to the Federal standards’ and inserting ‘were a reference to the revised NAIC Model Regulation as changed by the Secretary under this subparagraph (such changed regulation referred to in this section as the ‘1991 Federal Regulation’)’;

        (C) in paragraph (1)(C)(i), by striking ‘NAIC standards or the Federal standards’ and inserting ‘1991 NAIC Model Regulation or 1991 Federal Regulation’;

        (D) in paragraphs (1)(C)(ii)(I), (1)(E), (2), and (9)(B), by striking ‘NAIC or Federal standards’ and inserting ‘1991 NAIC Model Regulation or 1991 Federal Regulation’;

        (E) in paragraph (2)(C), by striking ‘(5)(B)’ and inserting ‘(4)(B)’;

        (F) in paragraph (4)(A)(i), by inserting ‘or paragraph (6)’ after ‘(B)’;

        (G) in paragraph (4), by striking ‘applicable standards’ each place it appears and inserting ‘applicable 1991 NAIC Model Regulation or 1991 Federal Regulation’;

        (H) in paragraph (6), by striking ‘in regard to the limitation of benefits described in paragraph (4)’ and inserting ‘described in clauses (i) through (iii) of paragraph (1)(A)’;

        (I) in paragraph (7), by striking ‘policyholder’ and inserting ‘policyholders’;

        (J) in paragraph (8), by striking ‘after the effective date of the NAIC or Federal standards with respect to the policy, in violation of the previous requirements of this subsection’ and inserting ‘on and after the effective date specified in paragraph (1)(C) (but subject to paragraph (10)), in violation of the applicable 1991 NAIC Model Regulation or 1991 Federal Regulation insofar as such regulation relates to the requirements of subsection (o) or (q) or clause (i), (ii), or (iii) of paragraph (1)(A)’;

        (K) in paragraph (9), by adding at the end the following new subparagraph:

    ‘(D) Subject to paragraph (10), this paragraph shall apply to sales of policies occurring on or after the effective date specified in paragraph (1)(C).’; and

        (L) in paragraph (10), by striking ‘this subsection’ and inserting ‘paragraph (1)(A)(i)’.

    (b) GUARANTEED RENEWABILITY- Section 1882(q) (42 U.S.C. 1395ss(q)) is amended--

      (1) in paragraph (2), by striking ‘paragraph (2)’ and inserting ‘paragraph (4)’, and

      (2) in paragraph (4), by striking ‘the succeeding issuer’ and inserting ‘issuer of the replacement policy’.

    (c) ENFORCEMENT OF STANDARDS-

      (1) Section 1882(a)(2) (42 U.S.C. 1395ss(a)(2)) is amended--

        (A) in subparagraph (A), by striking ‘NAIC standards or the Federal standards’ and inserting ‘1991 NAIC Model Regulation or 1991 Federal Regulation’, and

        (B) by striking ‘after the effective date of the NAIC or Federal standards with respect to the policy’ and inserting ‘on and after the effective date specified in subsection (p)(1)(C)’.

      (2) The sentence in section 1882(b)(1) added by section 4353(c)(5) of OBRA-1990 is amended--

        (A) by striking ‘The report’ and inserting ‘Each report’,

        (B) by inserting ‘and requirements’ after ‘standards’,

        (C) by striking ‘and’ after ‘compliance,’, and

        (D) by striking the comma after ‘Commissioners’.

      (3) Section 1882(g)(2)(B) (42 U.S.C. 1395ss(g)(2)(B)) is amended by striking ‘Panel’ and inserting ‘Secretary’.

      (4) Section 1882(b)(1) (42 U.S.C. 1395ss(b)(1)) is amended by striking ‘the the Secretary’ and inserting ‘the Secretary’.

    (d) PREVENTING DUPLICATION-

      (1) Section 1882(d)(3)(A) (42 U.S.C. 1395ss(d)(3)(A)) is amended--

        (A) by amending the first sentence to read as follows:

    ‘(i) It is unlawful for a person to sell or issue to an individual entitled to benefits under part A or enrolled under part B of this title--

      ‘(I) a health insurance policy with knowledge that the policy duplicates health benefits to which the individual is otherwise entitled under this title or title XIX,

      ‘(II) a medicare supplemental policy with knowledge that the individual is entitled to benefits under another medicare supplemental policy, or

      ‘(III) a health insurance policy (other than a medicare supplemental policy) with knowledge that the policy duplicates health benefits to which the individual is otherwise entitled, other than benefits to which the individual is entitled under a requirement of State or Federal law.’;

        (B) by designating the second sentence as clause (ii) and, in such clause, by striking ‘the previous sentence’ and inserting ‘clause (i)’;

        (C) by designating the third sentence as clause (iii) and, in such clause--

          (i) by striking ‘the previous sentence’ and inserting ‘clause (i) with respect to the sale of a medicare supplemental policy’, and

          (ii) by striking ‘and the statement’ and all that follows up to the period at the end; and

        (D) by striking the last sentence.

      (2) Section 1882(d)(3)(B) (42 U.S.C. 1395ss(d)(3)(B)) is amended--

        (A) in clause (ii)(II), by striking ‘65 years of age or older’,

        (B) in clause (iii)(I), by striking ‘another medicare’ and inserting ‘a medicare’,

        (C) in clause (iii)(I), by striking ‘such a policy’ and inserting ‘a medicare supplemental policy’,

        (D) in clause (iii)(II), by striking ‘another policy’ and inserting ‘a medicare supplemental policy’, and

        (E) by amending subclause (III) of clause (iii) to read as follows:

    ‘(III) If the statement required by clause (i) is obtained and indicates that the individual is entitled to any medical assistance under title XIX, the sale of the policy is not in violation of clause (i) (insofar as such clause relates to such medical assistance), if a State medicaid plan under such title pays the premiums for the policy, or, in the case of a qualified medicare beneficiary described in section 1905(p)(1), if the State pays less than the full amount of medicare cost-sharing as described in subparagraphs (B), (C), and (D) of section 1905(p)(3) for such individual.’.

      (3)(A) Section 1882(d)(3)(C) (42 U.S.C. 1395ss(d)(3)(C)) is amended--

        (i) by striking ‘the selling’ and inserting ‘(i) the sale or issuance’, and

        (ii) by inserting before the period at the end the following: ‘, (ii) the sale or issuance of a policy or plan described in subparagraph (A)(i)(I) (other than a medicare supplemental policy to an individual entitled to any medical assistance under title XIX) under which all the benefits are fully payable directly to or on behalf of the individual without regard to other health benefit coverage of the individual but only if (for policies sold or issued more than 60 days after the date the statements are published or promulgated under subparagraph (D)) there is disclosed in a prominent manner as part of (or together with) the application the applicable statement (specified under subparagraph (D)) of the extent to which benefits payable under the policy or plan duplicate benefits under this title, or (iii) the sale or issuance of a policy or plan described in subparagraph (A)(i)(III) under which all the benefits are fully payable directly to or on behalf of the individual without regard to other health benefit coverage of the individual’.

      (B) Section 1882(d)(3) (42 U.S.C. 1395ss(d)(3)) is amended by adding at the end the following:

    ‘(D)(i) If--

      ‘(I) within the 90-day period beginning on the date of the enactment of this subparagraph, the National Association of Insurance Commissioners develops (after consultation with consumer and insurance industry representatives) and submits to the Secretary a statement for each of the types of health insurance policies (other than medicare supplemental policies and including, as separate types of policies, policies paying directly to the beneficiary fixed, cash benefits) which are sold to persons entitled to health benefits under this title, of the extent to which benefits payable under the policy or plan duplicate benefits under this title, and

      ‘(II) the Secretary approves all the statements submitted as meeting the requirements of subclause (I),

    each such statement shall be (for purposes of subparagraph (C)) the statement specified under this subparagraph for the type of policy involved. The Secretary shall review and approve (or disapprove) all the statements submitted under subclause (I) within 30 days after the date of their submittal. Upon approval of such statements, the Secretary shall publish such statements.

    ‘(ii) If the Secretary does not approve the statements under clause (i) or the statements are not submitted within the 90-day period specified in such clause, the Secretary shall promulgate (after consultation with consumer and insurance industry representatives and not later than 90 days after the date of disapproval or the end of such 90-day period (as the case may be)) a statement for each of the types of health insurance policies (other than medicare supplemental policies and including, as separate types of policies, policies paying directly to the beneficiary fixed, cash benefits) which are sold to persons entitled to health benefits under this title, of the extent to which benefits payable under the policy or plan duplicate benefits under this title, and each such statement shall be (for purposes of subparagraph (C)) the statement specified under this subparagraph for the type of policy involved.’.

      (C) The requirement of a disclosure under section 1882(d)(3)(C)(ii) of the Social Security Act shall not apply to an application made for a policy or plan before 60 days after the date of the Secretary of Health and Human Services publishes or promulgates all the statements under section 1882(d)(3)(D) of such Act.

      (4) Subparagraphs (A) and (B) of section 1882(q)(5) (42 U.S.C. 1395ss(q)(5)(A)) are amended by striking ‘of the Social Security Act’.

    (e) Loss Ratios and Refunds of Premiums-

      (1) Section 1882(r) (42 U.S.C. 1395ss(r)) is amended--

        (A) in paragraph (1), by striking ‘or sold’ and inserting ‘or renewed (or otherwise provide coverage after the date described in subsection (p)(1)(C))’;

        (B) in paragraph (1)(A), by inserting ‘for periods after the effective date of these provisions’ after ‘the policy can be expected’;

        (C) in paragraph (1)(A), by striking ‘Commissioners,’ and inserting ‘Commissioners)’;

        (D) in paragraph (1)(B), by inserting before the period at the end the following: ‘, treating policies of the same type as a single policy for each standard package’;

        (E) by adding at the end of paragraph (1) the following: ‘For the purpose of calculating the refund or credit required under paragraph (1)(B) for a policy issued before the date specified in subsection (p)(1)(C), the refund or credit calculation shall be based on the aggregate benefits provided and premiums collected under all such policies issued by an insurer in a State (separated as to individual and group policies) and shall be based only on aggregate benefits provided and premiums collected under such policies after the date specified in section 5091(m)(4) of the Omnibus Budget Reconciliation Act of 1993.’;

        (F) in the first sentence of paragraph (2)(A), by striking ‘by policy number’ and inserting ‘by standard package’;

        (G) by striking the second sentence of paragraph (2)(A) and inserting the following: ‘Paragraph (1)(B) shall not apply to a policy until 12 months following issue.’;

        (H) in the last sentence of paragraph (2)(A), by striking ‘in order’ and all that follows through ‘are effective’;

        (I) by adding at the end of paragraph (2)(A), the following new sentence: ‘In the case of a policy issued before the date specified in subsection (p)(1)(C), paragraph (1)(B) shall not apply until 1 year after the date specified in section 5091(m)(4) of the Omnibus Budget Reconciliation Act of 1993.’;

        (J) in paragraph (2), by striking ‘policy year’ each place it appears and inserting ‘calendar year’;

        (K) in paragraph (4), by striking ‘February’, ‘disllowance’, ‘loss-ratios’ each place it appears, and ‘loss-ratio’ and inserting ‘October’, ‘disallowance’, ‘loss ratios’, and ‘loss ratio’, respectively;

        (L) in paragraph (6)(A), by striking ‘issues a policy in violation of the loss ratio requirements of this subsection’ and ‘such violation’ and inserting ‘fails to provide refunds or credits as required in paragraph (1)(B)’ and ‘policy issued for which such failure occurred’, respectively; and

        (M) in paragraph (6)(B), by striking ‘to policyholders’ and inserting ‘to the policyholder or, in the case of a group policy, to the certificate holder’.

      (2) Section 1882(b)(1) (42 U.S.C. 1395ss(b)(1)) is amended, in the matter after subparagraph (H), by striking ‘subsection (F)’ and inserting ‘subparagraph (F)’.

      (3) Section 4355(d) of OBRA-1990 is amended by striking ‘sold or issued’ and all that follows and inserting ‘issued or renewed (or otherwise providing coverage after the date described in section 1882(p)(1)(C) of the Social Security Act) on or after the date specified in section 1882(p)(1)(C) of such Act.’.

    (f) TREATMENT OF HMO’S-

      (1) Section 1882(g)(1) (42 U.S.C. 1395ss(g)(1)) is amended by striking ‘a health maintenance organization or other direct service organization’ and all that follows through ‘1833’ and inserting ‘an eligible organization (as defined in section 1876(b)) if the policy or plan provides benefits pursuant to a contract under section 1876 or an approved demonstration project described in section 603(c) of the Social Security Amendments of 1983, section 2355 of the Deficit Reduction Act of 1984, or section 9412(b) of the Omnibus Budget Reconciliation Act of 1986 or, during the period beginning on the date specified in subsection (p)(1)(C) and ending on December 31, 1994, a policy or plan of an organization if the policy or plan provides benefits pursuant to an agreement under section 1833(a)(1)(A)’.

      (2) Section 4356(b) of OBRA-1990 is amended by striking ‘on the date of the enactment of this Act’ and inserting ‘on the date specified in section 1882(p)(1)(C) of the Social Security Act’.

    (g) PRE-EXISTING CONDITION LIMITATIONS- Section 1882(s) (42 U.S.C. 1395ss(s)) is amended--

      (1) in paragraph (2)(A), by striking ‘for which an application is submitted’ and inserting ‘in the case of an individual for whom an application is submitted prior to or’,

      (2) in paragraph (2)(A), by striking ‘in which the individual (who is 65 years of age or older) first is enrolled for benefits under part B’ and inserting ‘as of the first day on which the individual is 65 years of age or older and is enrolled for benefits under part B’, and

      (3) in paragraph (2)(B), by striking ‘before it’ and inserting ‘before the policy’.

    (h) MEDICARE SELECT POLICIES-

      (1) Section 1882(t) (42 U.S.C. 1395ss(t)) is amended--

        (A) in paragraph (1), by inserting ‘medicare supplemental’ after ‘If a’,

        (B) in paragraph (1), by striking ‘NAIC Model Standards’ and inserting ‘1991 NAIC Model Regulation or 1991 Federal Regulation’,

        (C) in paragraph (1)(A), by inserting ‘or agreements’ after ‘contracts’,

        (D) in subparagraphs (E)(i) and (F) of paragraph (1), by striking ‘NAIC standards’ and inserting ‘standards in the 1991 NAIC Model Regulation or 1991 Federal Regulation’, and

        (E) in paragraph (2), by inserting ‘the issuer’ before ‘is subject to a civil money penalty’.

      (2) Section 1154(a)(4)(B) (42 U.S.C. 1320c-3(a)(4)(B)) is amended--

        (A) by inserting ‘that is’ after ‘(or’, and

        (B) by striking ‘1882(t)’ and inserting ‘1882(t)(3)’.

    (i) HEALTH INSURANCE COUNSELING- Section 4360 of OBRA-1990 is amended--

      (1) in subsection (b)(2)(A)(ii), by striking ‘Act’ and inserting ‘Act)’;

      (2) in subsection (b)(2)(D), by striking ‘services’ and inserting ‘counseling’;

      (3) in subsection (b)(2)(I), by striking ‘assistance’ and inserting ‘referrals’;

      (4) in subsection (c)(1), by striking ‘and that such activities will continue to be maintained at such level’;

      (5) in subsection (d)(3), by striking ‘to the rural areas’ and inserting ‘eligible individuals residing in rural areas’;

      (6) in subsection (e)--

        (A) by striking ‘subsection (c) or (d)’ and inserting ‘this section’,

        (B) by striking ‘and annually thereafter, issue an annual report’ and inserting ‘and annually thereafter during the period of the grant, issue a report’, and

        (C) in paragraph (1), by striking ‘State-wide;’,

      (7) in subsection (f), by striking paragraph (2) and by redesignating paragraphs (3) through (5) as paragraphs (2) through (4), respectively; and

      (8) by redesignating the second subsection (f) (relating to authorization of appropriations for grants) as subsection (g).

    (j) TELEPHONE INFORMATION SYSTEM-

      (1) Section 1804 (42 U.S.C. 1395b-2) is amended--

        (A) by adding at the end of the heading the following: ‘; MEDICARE AND MEDIGAP INFORMATION’,

        (B) by inserting ‘(a)’ after ‘1804.’, and

        (C) by adding at the end the following new subsection:

    ‘(b) The Secretary shall provide information via a toll-free telephone number on the programs under this title.’.

      (2) Section 1882(f) (42 U.S.C. 1395ss(f)) is amended by adding at the end the following new paragraph:

    ‘(3) The Secretary shall provide information via a toll-free telephone number on medicare supplemental policies (including the relationship of State programs under title XIX to such policies).’.

      (3) Section 1889 (42 U.S.C. 1395zz) is repealed.

    (k) MAILING OF POLICIES- Section 1882(d)(4) (42 U.S.C. 1395ss(d)(4)) is amended--

      (1) in subparagraph (D), by striking ‘, if such policy’ and all that follows up to the period at the end, and

      (2) by adding at the end the following new subparagraph:

    ‘(E) Subparagraph (A) shall not apply in the case of an issuer who mails or causes to be mailed a policy, certificate, or other matter solely to comply with the requirements of subsection (q).’.

    (l) EFFECTIVE DATE- The amendments made by this section shall be effective as if included in the enactment of OBRA-1990; except that--

      (1) the amendments made by subsection (d)(1) shall take effect on the date of the enactment of this Act, but no penalty shall be imposed under section 1882(d)(3)(A) of the Social Security Act (for an action occurring after the effective date of the amendments made by section 4354 of OBRA-1990 and before the date of the enactment of this Act) with respect to the sale or issuance of a policy which is not unlawful under section 1882(d)(3)(A)(i)(II) of the Social Security Act (as amended by this section);

      (2) the amendments made by subsection (d)(2)(A) and by subparagraphs (A), (B), and (E) of subsection (e)(1) shall be effective on the date specified in subsection (m)(4); and

      (3) the amendment made by subsection (g)(2) shall take effect on January 1, 1994, and shall apply to individuals who attain 65 years of age or older on or after the effective date of section 1882(s)(2) of the Social Security Act (and, in the case of individuals who attained 65 years of age after such effective date and before January 1, 1994, and who were not covered under such section before January 1, 1994, the 6-month period specified in that section shall begin January 1, 1994).

    (m) TRANSITION PROVISIONS-

      (1) IN GENERAL- If the Secretary of Health and Human Services identifies a State as requiring a change to its statutes or regulations to conform its regulatory program to the changes made by this section, the State regulatory program shall not be considered to be out of compliance with the requirements of section 1882 of the Social Security Act due solely to failure to make such change until the date specified in paragraph (4).

      (2) NAIC STANDARDS- If, within 6 months after the date of the enactment of this Act, the National Association of Insurance Commissioners (in this subsection referred to as the ‘NAIC’) modifies its 1991 NAIC Model Regulation (adopted in July 1991) to conform to the amendments made by this section and to delete from section 15C the exception which begins with ‘unless’, such modifications shall be considered to be part of that Regulation for the purposes of section 1882 of the Social Security Act.

      (3) SECRETARY STANDARDS- If the NAIC does not make the modifications described in paragraph (2) within the period specified in such paragraph, the Secretary of Health and Human Services shall make the modifications described in such paragraph and such modifications shall be considered to be part of that Regulation for the purposes of section 1882 of the Social Security Act.

      (4) DATE SPECIFIED-

        (A) IN GENERAL- Subject to subparagraph (B), the date specified in this paragraph for a State is the earlier of--

          (i) the date the State changes its statutes or regulations to conform its regulatory program to the changes made by this section, or

          (ii) 1 year after the date the NAIC or the Secretary first makes the modifications under paragraph (2) or (3), respectively.

        (B) ADDITIONAL LEGISLATIVE ACTION REQUIRED- In the case of a State which the Secretary identifies as--

          (i) requiring State legislation (other than legislation appropriating funds) to conform its regulatory program to the changes made in this section, but

          (ii) having a legislature which is not scheduled to meet in 1994 in a legislative session in which such legislation may be considered,

        the date specified in this paragraph is the first day of the first calendar quarter beginning after the close of the first legislative session of the State legislature that begins on or after January 1, 1994. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of such session shall be deemed to be a separate regular session of the State legislature.

Subtitle B--Medicaid Program and Other Health Care Provisions

SEC. 5100. REFERENCES IN SUBTITLE; TABLE OF CONTENTS OF SUBTITLE.

    (a) AMENDMENTS TO SOCIAL SECURITY ACT- Except as otherwise specifically provided, whenever in this subtitle an amendment is expressed in terms of an amendment to or repeal of a section or other provision, the reference shall be considered to be made to that section or other provision of the Social Security Act.

    (b) REFERENCES TO OBRA- In this subtitle, the terms ‘OBRA-1986’, ‘OBRA-1987’, ‘OBRA-1989’, and ‘OBRA-1990’ refer to the Omnibus Budget Reconciliation Act of 1986 (Public Law 99-509), the Omnibus Budget Reconciliation Act of 1987 (Public Law 100-203), the Omnibus Budget Reconciliation Act of 1989 (Public Law 101-239), and the Omnibus Budget Reconciliation Act of 1990 (Public Law 101-508), respectively.

    (c) TABLE OF CONTENTS OF SUBTITLE- The table of contents of this subtitle is as follows:

Subtitle B--Medicaid Program and Other Health Care Provisions

      Sec. 5100. References in subtitle; table of contents of subtitle.

Chapter 1--Medicaid Program

SUBCHAPTER A--PROGRAM SAVINGS PROVISIONS

Part I--Repeal of Mandate

      Sec. 5101. Personal care services furnished outside the home as optional benefit.

Part II--Outpatient Prescription Drugs

      Sec. 5106. Permitting prescription drug formularies under State plans.

      Sec. 5107. Elimination of special exemption from prior authorization for new drugs.

      Sec. 5108. Technical corrections relating to section 4401 of OBRA-1990.

Part III--Restrictions on Divestiture of Assets and Estate Recovery

      Sec. 5111. Transfer of assets.

      Sec. 5112. Medicaid estate recoveries.

      Sec. 5113. Closing loophole permitting wealthy individuals to qualify for medicaid.

Part IV--Improvement in Identification and Collection of Third Party Payments

      Sec. 5116. Liability of third parties to pay for care and services.

      Sec. 5117. Health Coverage Clearinghouse.

‘TITLE XXI--HEALTH COVERAGE CLEARINGHOUSE

‘Sec. 2101. Establishment of clearinghouse.

‘Sec. 2102. Provision of information.

‘Sec. 2103. Requirement that employers furnish information.

‘Sec. 2104. Data bank.’.

      Sec. 5118. Medical child support.

Part V--Assuring Proper Payments to Disproportionate Share Hospitals

      Sec. 5121. Assuring proper payments to disproportionate share hospitals.

SUBCHAPTER B--MISCELLANEOUS PROVISIONS

Part I--Anti-fraud and Abuse Provisions

      Sec. 5131. Application of medicare rules limiting certain physician referrals.

      Sec. 5132. Intermediate sanctions for kickback violations.

      Sec. 5133. Requiring maintenance of effort for State medicaid fraud control units.

Part II--Managed Care Provisions

      Sec. 5135. Medicaid managed care anti-fraud provisions.

      Sec. 5136. Clarification of treatment of HMO enrollees in computing the medicaid inpatient utilization rate in qualifying hospitals as disproportionate share hospitals.

      Sec. 5137. Extension of period of applicability of enrollment mix requirement to certain health maintenance organizations providing services under Dayton Area Health Plan.

      Sec. 5138. Extension of medicaid waiver for Tennessee Primary Care Network.

      Sec. 5139. Waiver of application of medicaid enrollment mix requirement to District of Columbia Chartered Health Plan, Inc.

      Sec. 5140. Extension of Minnesota Prepaid Medicaid Demonstration Project.

Part III--Emergency Services to Undocumented Aliens

      Sec. 5141. Increase in Federal financial participation for emergency medical assistance to undocumented aliens.

      Sec. 5142. Limiting Federal medicaid matching payment to bona fide emergency services for undocumented aliens.

Part IV--Miscellaneous Provisions

      Sec. 5144. Increase in limit on Federal medicaid matching payments to Puerto Rico and other territories.

      Sec. 5145. Criteria for making determinations of denial of Federal medicaid matching payments to States.

      Sec. 5146. Renewal of unfunded demonstration project for low-income pregnant women and children.

      Sec. 5147. Optional medicaid coverage of TB-related services for certain TB-infected individuals.

      Sec. 5148. Application of mammography certification requirements under the medicaid program.

      Sec. 5149. Removal of sunset on extension of eligibility for working families.

      Sec. 5150. Extension of moratorium on treatment of certain facilities as institutions for mental diseases.

      Sec. 5150A. Treatment of certain clinics as federally-qualified health centers.

      Sec. 5150B. Nursing home reform.

SUBCHAPTER C--MISCELLANEOUS AND TECHNICAL CORRECTIONS RELATING TO OBRA-1990

      Sec. 5151. Effective date.

      Sec. 5152. Corrections relating to section 4402 (enrollment under group health plans).

      Sec. 5153. Corrections relating to section 4501 (low-income medicare beneficiaries).

      Sec. 5154. Corrections relating to section 4601 (child health).

      Sec. 5155. Corrections relating to section 4602 (outreach locations).

      Sec. 5156. Corrections relating to section 4604 (payment for hospital services for children under 6 years of age).

      Sec. 5157. Corrections relating to section 4703 (payment adjustments for disproportionate share hospitals).

      Sec. 5158. Corrections relating to section 4704 (Federally-qualified health centers).

      Sec. 5159. Corrections relating to section 4708 (substitute physicians).

      Sec. 5160. Corrections relating to section 4711 (home and community care for frail elderly).

      Sec. 5161. Corrections relating to section 4712 (community supported living arrangements services).

      Sec. 5162. Correction relating to section 4713 (COBRA continuation coverage).

      Sec. 5163. Correction relating to section 4716 (medicaid transition for family assistance).

      Sec. 5164. Corrections relating to section 4723 (medicaid spenddown option).

      Sec. 5165. Corrections relating to section 4724 (optional State disability determinations).

      Sec. 5166. Correction relating to section 4732 (special rules for health maintenance organizations).

      Sec. 5167. Corrections relating to section 4741 (home and community-based waivers).

      Sec. 5168. Corrections relating to section 4744 (frail elderly waivers).

      Sec. 5169. Corrections relating to section 4747 (coverage of HIV-positive individuals).

      Sec. 5170. Correction relating to section 4751 (advance directives).

      Sec. 5171. Corrections relating to section 4752 (physicians’ services).

      Sec. 5172. Corrections relating to section 4801 (nursing home reform).

      Sec. 5173. Other technical corrections.

      Sec. 5174. Corrections to designations of new provisions.

Chapter 2--Universal Access to Childhood Immunizations

      Sec. 5181. Establishment of entitlement and monitoring programs with respect to childhood immunizations.

‘Subtitle 3--Entitlement and Monitoring Programs With Respect to Childhood Immunizations

‘Part A--Entitlement Program

‘Sec. 2151. Delivery to States of sufficient quantities of pediatric vaccines.

‘Sec. 2152. Entitlements.

‘Sec. 2153. Voluntary participation of health care providers.

‘Sec. 2154. Intrastate distribution of pediatric vaccines.

‘Sec. 2155. General provisions.

‘Sec. 2156. State option regarding immunization of additional categories of children.

‘Sec. 2157. State application for vaccines.

‘Sec. 2158. Contracts with manufacturers of pediatric vaccines.

‘Sec. 2159. Certain administrative variations.

‘Sec. 2160. List of pediatric vaccines; schedule for administration.

‘Sec. 2161. Childhood Immunization Trust Fund.

‘Sec. 2162. Definitions.

‘Sec. 2163. Termination of program.

‘Part B--National System for Monitoring Immunization Status of Children

‘Sec. 2171. Formula grants for State registries with respect to monitoring.

‘Sec. 2172. Registry data.

‘Sec. 2173. General provisions.

‘Sec. 2174. Application for grant.

‘Sec. 2175. Determination of amount of allotment.

‘Sec. 2176. Definitions.

‘Sec. 2177. Authorization of appropriations.

‘Part C--Funding for Other Purposes Regarding Childhood Immunizations

‘Sec. 2181. Grants regarding Year 2000 health objectives.

      Sec. 5182. National Vaccine Injury Compensation Program amendments.

      Sec. 5183. Medicaid immunization provisions.

      Sec. 5184. Availability of medicaid payments for childhood vaccine replacement programs.

      Sec. 5185. Healthy start for infants.

      Sec. 5186. Increase in authorization of appropriations for the Maternal and Child Health Services Block Grant Program.

      Sec. 5187. Miscellaneous technical corrections to Public Health Service Act provisions.

CHAPTER 1--MEDICAID PROGRAM

Subchapter A--Program Savings Provisions

PART I--REPEAL OF MANDATE

SEC. 5101. PERSONAL CARE SERVICES FURNISHED OUTSIDE THE HOME AS OPTIONAL BENEFIT.

    (a) IN GENERAL- Section 1905(a) (42 U.S.C. 1396d(a)), as amended by section 5174(c)(1), is further amended--

      (1) in paragraph (7), by striking ‘including personal care services’ and all that follows through ‘nursing facility’;

      (2) in paragraph (23), by striking ‘and’ at the end;

      (3) by redesignating paragraph (24) as paragraph (25); and

      (4) by inserting after paragraph (23) the following new paragraph:

      ‘(24) personal care services furnished to an individual who is not an inpatient or resident of a nursing facility that are (A) authorized by a physician for the individual in accordance with a plan of treatment, (B) provided by an individual who is qualified to provide such services and who is not a member of the individual’s family, (C) supervised by a registered nurse, and (D) furnished in a home or other location; and’.

    (b) CONFORMING AMENDMENTS- (1) Section 1902(a)(10)(C)(iv) (42 U.S.C. 1396a(a)(10)(C)(iv)), as amended by section 5174(c)(2)(A), is amended by striking ‘through (23)’ and inserting ‘through (24)’.

    (2) Section 1902(j) (42 U.S.C. 1396a(j)), as amended by section 5174(c)(2)(B), is amended by striking ‘through (24)’ and inserting ‘through (25)’.

    (c) EFFECTIVE DATE- The amendments made by subsections (a) and (b) shall take effect as if included in the enactment of section 4721(a) of OBRA-90.

PART II--OUTPATIENT PRESCRIPTION DRUGS

SEC. 5106. PERMITTING PRESCRIPTION DRUG FORMULARIES UNDER STATE PLANS.

    (a) ELIMINATION OF PROHIBITION AGAINST USE OF FORMULARIES- Paragraph (54) of section 1902(a)(54) (42 U.S.C. 1396a(a)(54)) is amended to read as follows:

      ‘(54) in the case of a State plan that provides medical assistance for covered outpatient drugs (as defined in section 1927(k)), comply with the applicable requirements of section 1927;’.

    (b) STANDARDS FOR FORMULARIES- Section 1927(d) (42 U.S.C. 1396r-8(d)), as amended by sections 5107(a) and 5108(b)(4)(A)(iii), is amended--

      (1) by adding at the end of paragraph (1) the following new subparagraph:

      ‘(C) In the case of a State that establishes a formulary in accordance with paragraph (5), the State may exclude coverage of a covered outpatient drug that is not included in the formulary.’; and

      (2) by inserting after paragraph (4) the following new paragraph:

      ‘(5) REQUIREMENTS FOR FORMULARIES- A State may establish a formulary only if the following requirements are met:

        ‘(A) The formulary is established by a committee consisting of physicians, pharmacists, and other appropriate individuals appointed by the Governor of the State (or, at the option of the State, the State’s drug use review board established under subsection (g)(3)).

        ‘(B) Except as provided in subparagraph (C), the formulary includes the covered outpatient drugs of any manufacturer which has entered into and complies with an agreement under subsection (a).

        ‘(C) The committee may exclude a covered outpatient drug with respect to the treatment of a specific disease or condition for an identified population (if any) only if the committee finds, based on the drug’s labeling (or, in the case of a drug whose prescribed use is not approved under the Federal Food, Drug, and Cosmetic Act but is a medically accepted indication, based on information from the appropriate compendia described in subsection (k)(6)), that the excluded drug does not have a significant, clinically meaningful therapeutic advantage in terms of safety, effectiveness, or clinical outcome of such treatment for such population over other drugs included in the formulary.

        ‘(D) With respect to a decision to exclude a covered outpatient drug from the formulary or a prescribed use of such a drug, the committee issues a written explanation of its decision that is available to the public, unless the decision was made at a meeting of the committee which was open to the public.

        ‘(E) The manufacturer of the drug, and any person affected by the decision, may obtain a reversal of the committee’s decision to exclude a covered outpatient drug from the formulary under subparagraph (C) on the ground that the decision was arbitrary and capricious, in accordance with an appeals process that is established by the State and that provides an opportunity for judicial review of such decision.

        ‘(F) The State plan permits coverage of a drug excluded from the formulary pursuant to a prior authorization program that is consistent with paragraph (4).

        ‘(G) The formulary meets such other requirements as the Secretary may impose.’.

    (c) EFFECTIVE DATE- The amendments made by this section shall apply to calendar quarters beginning on or after October 1, 1993, without regard to whether or not regulations to carry out such amendments have been promulgated by such date.

SEC. 5107. ELIMINATION OF SPECIAL EXEMPTION FROM PRIOR AUTHORIZATION FOR NEW DRUGS.

    (a) IN GENERAL- Section 1927(d) (42 U.S.C. 1396r-8(d)), as amended by section 5108(b)(4)(A)(iii), is amended by striking paragraph (5).

    (b) CONFORMING AMENDMENT- Section 1927(d)(3) (42 U.S.C. 1396r-8(d)(3)) is amended by striking ‘(except with respect’ and all that follows through ‘of this paragraph)’.

    (c) EFFECTIVE DATE- The amendments made by this section shall apply to calendar quarters beginning on or after October 1, 1993, without regard to whether or not regulations to carry out such amendments have been promulgated by such date.

SEC. 5108. TECHNICAL CORRECTIONS RELATING TO SECTION 4401 OF OBRA-1990.

    (a) SECTION 1903, SSA- Paragraph (10) of section 1903(i), as inserted by section 4401(a)(1)(B) of OBRA-1990, is amended to read as follows:

      ‘(10) with respect to covered outpatient drugs unless there is a rebate agreement in effect under section 1927 with respect to such drugs or unless section 1927(a)(3) applies;’.

    (b) SECTION 1927, SSA- (1) Section 1927(a) (42 U.S.C. 1396r-8(a)) is amended--

      (A) in paragraph (1)--

        (i) by amending the second sentence to read as follows: ‘Any such agreement entered into prior to April 1, 1991, shall be deemed to have been entered into on January 1, 1991, and the amount of the rebate under such agreement shall be calculated as if the agreement had been entered into on January 1, 1991.’, and

        (ii) in the third sentence, by striking ‘March’ and inserting ‘April’;

      (B) in paragraph (2)--

        (i) by striking ‘first’, and

        (ii) by striking the period at the end and inserting the following: ‘, except that such paragraph (and section 1903(i)(10)(A)) shall not apply to the dispensing of such a drug before April 1, 1991, if the Secretary determines that there were extenuating circumstances with respect to the first calendar quarter of 1991.’;

      (C) in paragraph (3), by striking ‘single source’ and all that follows and inserting the following: ‘covered outpatient drugs if--

        ‘(A) based on information provided by a beneficiary’s physician, the State has made a determination that the availability of the drug is essential to the health of the beneficiary under the State plan, and the Secretary has reviewed and approved such determination; and

        ‘(B) the drug has been given a rating of 1-A by the Food and Drug Administration.’;

      (D) in paragraph (4)--

          (i) by striking ‘in compliance with’ and inserting ‘in effect under’, and

          (ii) by striking ‘coverage of the manufacturer’s drugs’ and inserting ‘ingredient costs of the manufacturer’s covered outpatient drugs covered’; and

        (E) by adding at the end the following new paragraph:

      ‘(5) APPLICATION IN CERTAIN STATES AND TERRITORIES-

        ‘(A) APPLICATION IN STATES OPERATING UNDER DEMONSTRATION PROJECTS- In the case of any State which is providing medical assistance to its residents under a waiver granted under section 1115, the Secretary shall require the State to meet the requirements of section 1902(a)(54) and of this section in the same manner as the State would be required to meet such requirements if the State had in effect a plan approved under this title.

        ‘(B) NO APPLICATION IN COMMONWEALTHS AND TERRITORIES- This section, and sections 1902(a)(54) and 1903(i)(10), shall only apply to a State that is one of the 50 States or the District of Columbia.’.

    (2) Section 1927(b) (42 U.S.C. 1396r-8(b)) is amended--

      (A) in paragraph (1)(A)--

        (i) by striking ‘(or periodically in accordance with a schedule specified by the Secretary)’ and inserting ‘(or other period specified by the Secretary)’, and

        (ii) by inserting ‘after December 31, 1990, for which payment was made’ after ‘dispensed’;

      (B) in paragraph (2)(A)--

        (i) by striking ‘calendar quarter’ and ‘the quarter’ and inserting ‘rebate period’ and ‘the period’, respectively,

        (ii) by striking ‘dosage units’ and inserting ‘units of each dosage form and strength’, and

        (iii) by inserting ‘after December 31, 1990, for which payment was made’ after ‘dispensed’;

      (C) in paragraph (3)(A)--

        (i) in clause (i), by striking ‘quarter’ each place it appears and inserting ‘calendar quarter or other rebate period under the agreement’,

        (ii) in clause (i), by striking the open parenthesis before ‘for’ and the close parenthesis after ‘drugs’,

        (iii) in clause (i), by striking ‘subsection (c)(2)(B)) for covered outpatient drugs’ and inserting ‘subsection (c)(1)(C) for each covered outpatient drug’, and

        (iv) in clause (ii), by inserting a comma after ‘this section’ and after ‘1990’;

      (D) in paragraph (3)(B)--

        (i) by striking ‘$100,000’ and inserting ‘$10,000’,

        (ii) by striking ‘if the wholesaler’ and inserting ‘for each instance in which the wholesaler’,

        (iii) by inserting ‘in response to such a request’ after ‘false information’, and

        (iv) by striking ‘(with respect to amounts of penalties or additional assessments)’;

      (E) in paragraph (3)(C)--

        (i) in clause (i), by striking ‘the penalty’ and inserting ‘the rebate next required to be paid’,

        (ii) in clause (i), by striking ‘and such amount shall be paid to the Treasury, and, if’ and inserting ‘. If’,

        (iii) in clause (ii), by inserting ‘under subparagraph (A)’ after ‘provides false information’, and

        (iv) in clause (ii), by striking ‘Such civil money penalties are’ and inserting ‘Any such civil money penalty shall be’;

      (F) in paragraph (3)(D), by striking ‘wholesaler,’ the first place it appears and inserting ‘wholesaler or the’; and

      (G) in paragraph (4)(B)(iii), by adding at the end the following: ‘In the case of such a termination, a State may terminate coverage of the drugs affected by such termination as of the effective date of such termination without providing any advance notice otherwise required by regulation.’.

    (3) Section 1927(c) (42 U.S.C. 1396r-8(c)) is amended--

      (A) in paragraph (1) in the matter preceding subparagraph (A)--

        (i) by striking the first sentence,

        (ii) in the second sentence, by striking ‘Except as otherwise provided’ and all that follows through ‘the Secretary)’ and inserting the following: ‘For purposes of this section, the amount of the rebate under this subsection for a rebate period’, and

        (iii) by inserting ‘(except as provided in subsection (b)(3)(C) and paragraph (2))’ after ‘drugs shall’;

      (B) in paragraph (1)(A), by striking ‘the quarter (or other period)’ and inserting ‘the rebate period’;

      (C) in subparagraph (C)--

        (i) by striking ‘For purposes of this paragraph’ and inserting ‘BEST PRICE DEFINED- For purposes of this section’,

        (ii) by inserting ‘provider,’ after ‘retailer,’, and

        (iii) by striking the semicolon at the end and inserting a period; and

      (D) by striking subparagraph (D) and inserting the following:

        ‘(D) USE OF ESTIMATED BEST PRICES DURING INITIAL YEAR OF AVAILABILITY OF DRUG- If the Secretary determines that a manufacturer cannot determine the best price for rebate periods during the first year in which an agreement is in effect until after the end of the year, as part of the agreement the Secretary may require the manufacturer to estimate the best price for rebate periods during the year and provide an adjustment to the rebate paid to the State to take into account the difference (if any) between the best price and the estimated best price.’.

    (4)(A) Section 1927(d) (42 U.S.C. 1396r-8(d)) is amended--

      (i) in paragraph (2)--

        (I) in subparagraph (A), by inserting ‘or loss’ after ‘gain’,

        (II) by striking subparagraph (I), and

        (III) by redesignating subparagraphs (J) and (K) as subparagraphs (I) and (J);

      (ii) in paragraph (3)--

        (I) by striking ‘described in paragraph (2)’, and

        (II) by inserting ‘described in paragraph (2)’ after ‘classes of drugs,’;

      (iii) by striking paragraph (4) and by redesignating paragraphs (5) through (7) as paragraphs (4) through (6);

      (iv) in paragraph (6), as so redesignated, by striking ‘provided’ and inserting ‘if’; and

      (v) by striking the second sentence of paragraph (6), as so redesignated, and paragraph (8) and inserting the following:

      ‘(7) CONSTRUCTION WITH RESPECT TO FRAUD AND ABUSE- Nothing in this section shall be construed to restrict the authority of a State to apply sanctions under this Act against any person for fraud or abuse.’.

    (B) Section 1927(d)(4), as redesignated by subparagraph (A)(iii), shall first apply to drugs dispensed on or after July 1, 1991.

    (5)(A) Section 1927(f) (42 U.S.C. 1396r-8(f)) is amended to read as follows:

    ‘(f) No Reductions in Pharmacy Reimbursement Limits-

      ‘(1) IN GENERAL- During the period beginning on November 5, 1990, and ending on December 31, 1994--

        ‘(A) a State may not reduce the amount paid by the State under this title with respect to the ingredient cost of a covered outpatient drug or the dispensing fee for such a drug below the amount in effect as of November 5, 1990, and

        ‘(B) the Secretary may not change the regulations in effect on November 5, 1990, governing the amounts described in subparagraph (A) which are eligible for Federal financial participation, to reduce the reimbursement limits described in such regulations.

      ‘(2) CONSTRUCTION- If the Secretary notified a State before November 5, 1990, that its payment amounts under this title with respect to the ingredient cost of a covered outpatient drug or the dispensing fee for such a drug were in excess of those permitted under regulations in effect on such date, paragraph (1)(B) shall not be construed as preventing a State from reducing payment amounts or dispensing fee in order to comply with such regulations.’.

    (B) Not later than April 1, 1994, the Secretary of Health and Human Services shall establish an upper limit on the amount of payment which is eligible for Federal financial participation under title XIX of the Social Security Act for each multiple source drug (as defined in section 1927(k)(7)(A)(i) of such Act) for which the Food and Drug Administration has rated at least 3 formulations of such drug as therapeutically and pharmaceutically equivalent, regardless of whether all the formulations of such drug are rated as so equivalent. In establishing such a limit for a drug, the Secretary shall take into account only those formulations of the drug which the Food and Drug Administration has rated as therapeutically and pharmaceutically equivalent.

    (6) Section 1927(g) (42 U.S.C. 1396r-8(g)) is amended--

      (A) by amending paragraph (1) to read as follows:

      ‘(1) REQUIREMENT FOR DRUG USE REVIEW PROGRAM- Each State shall provide, by not later than January 1, 1993, for a drug use review program for covered outpatient drugs (other than drugs dispensed to residents of nursing facilities) that--

        ‘(A) meets the requirements of paragraph (2), and

        ‘(B) is intended to assure that prescriptions for such drugs are appropriate, medically necessary, and not likely to lead to adverse medical results.’;

      (B) in paragraph (2)--

        (i) by amending the matter before subparagraph (A) to read as follows:

      ‘(2) REQUIREMENTS- ’,

        (ii) by amending subparagraph (A) to read as follows:

        ‘(A) PROSPECTIVE DRUG USE REVIEW- Each drug use review program shall provide for a review of drug therapy before each prescription is filled or delivered to an individual receiving benefits under this title (including counseling by pharmacists) consistent with standards established by the Secretary. Nothing in this paragraph shall be construed as requiring a pharmacist to provide consultation when an individual receiving benefits under this title or caregiver of such individual refuses such consultation.’,

        (iii) in subparagraph (C)--

          (I) by striking ‘APPLICATION OF STANDARDS- ’ and inserting ‘STANDARDS- (i)’,

          (II) by striking ‘and literature referred to in subsection (1)(B)’ and inserting ‘described in clause (ii)’,

          (III) by striking ‘including but not limited to’ and inserting ‘. Such assessment shall include’,

          (IV) by striking ‘abuse/misuse and, as necessary, introduce remedial strategies,’ and inserting ‘abuse or misuse and introduce remedial strategies’, and

          (V) by adding at the end the following new clause:

        ‘(ii) The compendia described in this clause are the American Hospital Formulary Service Drug Information, the United States Pharmacopeia-Drug Information, and the American Medical Association Drug Evaluations.’, and

        (iv) by amending subparagraph (D) to read as follows:

        ‘(D) EDUCATIONAL PROGRAM- The program shall educate (directly or by contract) pharmacists, physicians, and other individuals prescribing or dispensing covered outpatient drugs under the State plan on common drug therapy problems in order to improve prescribing or dispensing practices.’;

      (C) in paragraph (3)--

        (i) in subparagraph (A), by striking ‘(hereinafter’ and all that follows and inserting ‘(in this paragraph referred to as the ‘DUR Board’).’,

        (ii) in subparagraph (B), by striking ‘51 percent’ and all that follows and inserting ‘50 percent licensed and actively practicing physicians and at least 1/3 but not more than 50 percent licensed and actively practicing pharmacists.’,

        (iii) by amending subparagraph (C) to read as follows:

        ‘(C) RESPONSIBILITIES- The responsibilities of the DUR Board shall include the following:

          ‘(i) Carrying out retrospective drug use review pursuant to paragraph (2)(B).

          ‘(ii) Establishing and applying standards for drug use review described in paragraph (2)(C).

          ‘(iii) Implementing educational programs described in paragraph (2)(D).

          ‘(iv) Conducting ongoing evaluations of the effectiveness of its programs and activities in improving the quality and safety of drug therapy for individuals receiving benefits under the State plan.’; and

      (D) by amending subparagraph (D) to read as follows:

      ‘(4) ANNUAL REPORT- Each State shall submit a report each year to the Secretary on the nature and scope of the drug use review program under this subsection. Such report shall include an estimate of cost savings resulting from operation of such program.’.

    (7) Section 1927(h) (42 U.S.C. 1396r-8(h)) is amended to read as follows:

    ‘(h) ENCOURAGING ELECTRONIC CLAIMS MANAGEMENT- The Secretary shall encourage each single State agency under this title to establish, as its principal means of processing claims for covered outpatient drugs, a point-of-sale electronic claims management system for the purpose of verifying eligibility, transmitting data on claims, and assisting pharmacists and other authorized persons in applying for and receiving payment under the State plan.’.

    (8) Section 1927(i) (42 U.S.C. 1396r-8(i)) is amended to read as follows:

    ‘(i) ANNUAL REPORT ON REBATE PROGRAM- Not later than May 1 of each year, the Secretary shall submit to the Committee on Finance of the Senate, the Committee on Energy and Commerce of the House of Representatives, and the Committee on Aging of the Senate a report on the operation of the rebate agreements required for covered outpatient drugs under this section in the preceding fiscal year, and shall include in the report such information in addition to the information required to be reported under section 601(d) of the Veterans Health Care Act of 1992 as the Secretary considers appropriate.’.

    (9) Section 1927(j) (42 U.S.C. 1396r-8(j)) is amended to read as follows:

    ‘(j) EXEMPTION FROM CERTAIN REQUIREMENTS FOR CERTAIN HEALTH MAINTENANCE ORGANIZATIONS AND HOSPITALS-

      ‘(1) CERTAIN HEALTH MAINTENANCE ORGANIZATIONS AND PHARMACIES- The requirements of subsections (g) and (h) shall not apply with respect to covered outpatient drugs dispensed by--

        ‘(A) an entity which receives payment under a prepaid capitation basis or under any other risk basis in accordance with section 1903(m)(2)(A) for services provided under the State plan; or

        ‘(B) a pharmacy that is owned or operated by a qualified health maintenance organization (as defined in section 1310(d) of the Public Health Service Act) that operates its own prospective drug use review program.

      ‘(2) HOSPITALS WITH INDEPENDENT FORMULARY SYSTEMS-

        ‘(A) IN GENERAL- The requirements of subsections (g) and (h) shall not apply with respect to covered outpatient drugs dispensed by a hospital providing medical assistance under the State plan that dispenses such drugs under a drug formulary system.

        ‘(B) APPLICATION OF STATE FORMULARY- Nothing in subparagraph (A) shall be construed to permit payment to be made under the State plan for a covered outpatient drug that is included in a drug formulary but that is not included in the State formulary under subsection (d)(5).

      ‘(3) CONSTRUCTION IN DETERMINING BEST PRICE- Nothing in this subsection shall be construed to exclude any covered outpatient drugs subject to the provisions of this subsection from the determination of the best price (as defined in subsection (c)(1)(C)) for such drugs.’.

    (10) Section 1927(k) (42 U.S.C. 1396r-8(k)) is amended--

      (A) in paragraph (1), by striking ‘calendar quarter’ and inserting ‘rebate period’;

      (B) in paragraph (2)--

        (i) in the matter before clause (i) of subparagraph (A), by striking ‘paragraph (5)’ and inserting ‘subparagraph (D)’,

        (ii) by striking ‘, and’ at the end of subparagraph (A),

        (iii) by striking the period at the end of subparagraph (C) and inserting ‘; and’, and

        (iv) by adding at the end the following new subparagraph:

        ‘(D) a drug which may be sold without a prescription (commonly referred to as an ‘over-the-counter drug’), if the drug is prescribed by a physician (or other person authorized to prescribe under State law).’;

      (C) in paragraph (3)--

        (i) in subparagraph (E), by striking ‘**** emergency room visits’,

        (ii) in subparagraph (F), by striking ‘sevices’ and inserting ‘services’, and

        (iii) in subparagraph (H), by inserting ‘services’ after ‘dialysis’;

      (D) by striking paragraph (4);

      (E) by amending paragraph (5) to read as follows:

      ‘(5) MANUFACTURER- The term ‘manufacturer’ means, with respect to a covered outpatient drug,--

        ‘(A) the entity (if any) that both manufactures and distributes the drug, or

        ‘(B) if no such entity exists, the entity that distributes the drug.

      Such term does not include a wholesale distributor of the drug that does not hold a National Drug Code number for the drug or a retail pharmacy licensed under State law.’;

      (F) in paragraph (6), by striking ‘, which appears’ and all that follows and inserting ‘which is accepted by any of the compendia described in subsection (g)(2)(C)(ii).’;

      (G) in paragraph (7)--

        (i) in subparagraph (A)(i), by striking ‘calendar quarter’ and inserting ‘rebate period’,

        (ii) in subparagraph (A)(i), by striking ‘paragraph (5)’ and inserting ‘paragraph (2)(D)’,

        (iii) in subparagraph (A)(ii), by inserting ‘or product licensing application’ after ‘application’,

        (iv) in subparagraph (C)(i), by striking ‘pharmaceuutically’ and inserting ‘pharmaceutically’, and

        (v) in subparagraph (C)(iii), by striking ‘, provided that’ and inserting ‘and’; and

      (H) by redesignating paragraph (8) as paragraph (9) and by inserting after paragraph (7) the following new paragraph:

      ‘(8) REBATE PERIOD- The term ‘rebate period’ means, with respect to an agreement under subsection (a), a calendar quarter or other period specified with respect to the agreement under subsection (b)(1)(A) for the payment of rebates.’.

    (d) FUNDING- Section 4401(b)(2) of OBRA-1990 is amended by striking ‘75 percent,’ and all that follows and inserting ‘75 percent.’.

    (e) DEMONSTRATION PROJECTS- Section 4401(c)(1) of OBRA-1990 is amended--

      (A) in subparagraph (A), by striking ‘10’ and inserting ‘5’; and

      (B) in subparagraph (C), by striking ‘regiment’ and inserting ‘regimen’.

    (f) STUDIES- Section 4401(d) of OBRA-1990 is amended--

      (1) in paragraph (1)(A), by striking ‘other institutional facilities, and managed care plans’ and inserting ‘nursing facilities, intermediate care facilities for the mentally retarded, and health maintenance organizations’;

      (2) in paragraph (1)(B), by striking ‘under this subsection’ and inserting ‘under this paragraph’;

      (3) in paragraph (1)(B)(i), by striking ‘under this section’ and inserting ‘under section 1927 of the Social Security Act’;

      (4) in paragraph (1)(B)(ii)--

        (A) by striking ‘drug use review’ the second place it appears and inserting ‘the type of drug use review that is’, and

        (B) by striking ‘under this section’ and inserting ‘under such section’;

      (5) in paragraph (1)(B)(iii), by striking ‘under this title’ and inserting ‘under title XIX of the Social Security Act’;

      (6) in paragraph (1)(C)--

        (A) by striking ‘May 1, 1991’ and inserting ‘May 1, 1992’, and

        (B) by striking ‘hereafter’;

      (7) in paragraph (2), by striking ‘the Committees on Aging of the Senate and House of Representatives an annual report’ and inserting ‘the Committee on Aging of the Senate a report’;

      (8) in paragraph (3)--

        (A) in subparagraph (A), by striking ‘, acting in consultation with the Comptroller General,’, and

        (B) in subparagraph (B)--

          (i) by striking ‘December 31, 1991, the Secretary and the Comptroller General’ and inserting ‘June 1, 1993, the Secretary’, and

          (ii) by striking ‘the Committees on Aging of the Senate and the House of Representatives’ and inserting ‘the Committee on Aging of the Senate’;

      (9) in paragraph (4)(A), by striking ‘each’ and by striking the semicolon and inserting a comma; and

      (10) by striking paragraphs (5) and (6).

PART III--RESTRICTIONS ON DIVESTITURE OF ASSETS AND ESTATE RECOVERY

SEC. 5111. TRANSFER OF ASSETS.

    (a) PERIOD OF INELIGIBILITY-

      (1) EXTENDING LOOK-BACK PERIOD TO 36 MONTHS- Section 1917(c)(1) (42 U.S.C. 1396p(c)(1)) is amended by striking ‘30-month period’ and inserting ‘36-month period’.

      (2) ELIMINATING 30-MONTH LIMIT ON PERIOD OF INELIGIBILITY- The second sentence of such section is amended by striking ‘equal to’ and all that follows and inserting the following: ‘equal to--

      ‘(A) the total uncompensated value of the resources so transferred; divided by

      ‘(B) the average monthly cost, to a private patient at the time of the application, of nursing facility services in the State or, at State option, in the community in which the individual is institutionalized.’.

      (3) CUMULATIVE PERIODS OF INELIGIBILITY IN THE CASE OF MULTIPLE TRANSFERS- Such sentence is further amended by inserting ‘(or, in the case of a transfer which occurs during a period of ineligibility attributable to a previous transfer, the first month after the end of all periods of ineligibility attributable to any previous transfer)’ after ‘shall begin with the month in which such resources were transferred’.

    (b) CRITERIA FOR UNDUE HARDSHIP EXCEPTION- Section 1917(c)(2)(D) (42 U.S.C. 1396p(c)(2)(D)) is amended to read as follows:

      ‘(D) the State agency determines, under procedures established by the State (in accordance with standards specified by the Secretary) that the denial of eligibility would work an undue hardship (in accordance with criteria established by the Secretary).’.

    (c) TREATMENT OF JOINTLY HELD ASSETS- Section 1917(c) (42 U.S.C. 1936p(c)) is further amended by adding at the end the following new paragraph:

    ‘(6) For purposes of this subsection, in the case of an asset held by an individual in common with another person or persons in a joint tenancy or a similar arrangement, the asset (or the affected portion thereof) shall be considered to be transferred by such individual when any action is taken, either by such individual or by any other person, that reduces or eliminates such individual’s ownership or control of such asset.’.

    (d) MEDICAID QUALIFYING TRUSTS- Section 1902(k) (42 U.S.C. 1396a(k)) is amended to read as follows:

    ‘(k) TREATMENT OF TRUST AMOUNTS-

      ‘(1) IN GENERAL- For purposes of determining an individual’s eligibility for or amount of benefits under a State plan under this title, subject to paragraph (4), the following rules shall apply to a trust (which term includes, for purposes of this subsection, any similar legal instrument or device, such as an annuity) established by such individual:

        ‘(A) REVOCABLE TRUSTS- In the case of a revocable trust--

          ‘(i) the corpus of the trust shall be considered resources available to the individual,

          ‘(ii) payments from the trust to or for the benefit of the individual shall be considered income of the individual, and

          ‘(iii) any other payments from the trust shall be considered a transfer of assets by the individual subject to section 1917(c).

        ‘(B) IRREVOCABLE TRUSTS WHICH MAY BENEFIT GRANTOR- In the case of an irrevocable trust, if there are any circumstances under which payment from the trust could be made to or for the benefit of the individual--

          ‘(i) the corpus of the trust (or that portion of the corpus from which, or from the increase whereof, payment to the individual could be made) shall be considered resources available to the individual, and payments from that portion of the corpus (or increase)--

            ‘(I) to or for the benefit of the individual, shall be considered income of the individual, and

            ‘(II) for any other purpose, shall be considered a transfer of assets by the individual subject to the provisions of section 1917(c); and

          ‘(ii) any portion of the trust from which (or from the income whereof) no payment could under any circumstances be made to the individual shall be considered, as of the date of establishment of the trust (or, if later, the date on which payment to the individual was foreclosed), a transfer of assets by the individual subject to section 1917(c), and payments from such portion of the trust after such date shall be disregarded.

        ‘(C) IRREVOCABLE TRUSTS WHICH CANNOT BENEFIT GRANTOR- In the case of an irrevocable trust, if no payment may be made from the trust under any circumstances to or for the benefit of the individual--

          ‘(i) the corpus of the trust shall be considered, as of the date of establishment of the trust (or, if later, the date on which payment to the individual was foreclosed), a transfer of assets subject to section 1917(c), and

          ‘(ii) payments from the trust after the date specified in clause (i) shall be disregarded.

      ‘(2) DETERMINATION OF GRANTOR-

        ‘(A) TREATMENT OF ACTS BY INDIVIDUAL AND OTHERS- For purposes of this subsection, an individual shall be considered to have established a trust if--

          ‘(i) the individual (or the individual’s spouse), or a person (including a court or administrative body) with legal authority to act in place of or on behalf of such individual (or spouse), or any person (including any court or administrative body) acting at the direction or upon the request of such individual (or spouse), established (other than by will) such a trust, and

          ‘(ii) assets of the individual (as defined in subparagraph (B)) were used to form all or part of the corpus of such trust.

        ‘(B) ASSETS- For purposes of this paragraph, assets of an individual include all income and resources of the individual and of the individual’s spouse, including any income or resources which the individual (or spouse) is entitled to but does not receive because of action by the individual (or spouse), by a person (including a court or administrative body) with legal authority to act in place of or on behalf of such individual (or spouse), or by any person (including any court or administrative body) acting at the direction or upon the request of such individual (or spouse).

        ‘(C) TRUSTS CONTAINING ASSETS OF MORE THAN ONE INDIVIDUAL- In the case of a trust whose corpus includes assets of an individual (as determined pursuant to subparagraph (A)) and assets of any other person or persons, the provisions of this subsection shall apply to the portion of the trust attributable to the assets of the individual.

      ‘(3) APPLICATION; RELATION TO OTHER PROVISIONS- Subject to paragraph (4), this subsection shall apply without regard to--

        ‘(A) the purposes for which the trust is established,

        ‘(B) whether the trustees have or exercise any discretion under the trust,

        ‘(C) any restrictions on when or whether distributions may be made from the trust, or

        ‘(D) any restrictions on the use of distributions from the trust.

      ‘(4) EXCEPTIONS AND HARDSHIP WAIVER-

        ‘(A) EXCEPTION FOR CERTAIN TRUSTS- This subsection shall not apply to any of the following trusts:

          ‘(i) A trust established for the benefit of a disabled individual (as determined under section 1614(a)(3)) by a parent, grandparent, or other representative payee of the individual.

          ‘(ii) A trust established in a State for the benefit of an individual if--

            ‘(I) the trust is composed only of pension, Social Security, and other income to the individual (and accumulated income in the trust),

            ‘(II) the State will receive any amounts remaining in the trust upon the death of the individual, and

            ‘(III) the State makes medical assistance available to individuals described in section 1902(a)(10)(A)(ii)(V), but does not make such assistance available to any group of individuals under section 1902(a)(10)(C).

        ‘(B) SPECIAL TREATMENT OF ANNUITIES- In this subsection, the term ‘trust’ includes an annuity only to such extent and in such manner as the Secretary specifies.

        ‘(C) HARDSHIP WAIVER- The State agency shall establish procedures (in accordance with standards specified by the Secretary) under which the agency waives the application of this subsection with respect to an individual if the individual establishes (under criteria established by the Secretary) that such application would work an undue hardship on the individual.’.

    (e) EFFECTIVE DATE- (1) The amendments made by this section shall apply, except as provided in this subsection, to payments under title XIX of the Social Security Act for calendar quarters beginning on or after October 1, 1993, without regard to whether or not final regulations to carry out such amendments have been promulgated by such date.

    (2) The amendments made by this section shall not apply--

      (A) to medical assistance provided for services furnished before October 1, 1993,

      (B) with respect to resources disposed of before May 11, 1993,

      (C) with respect to trusts established before May 11, 1993, or

      (D) with respect to inter-spousal transfers.

SEC. 5112. MEDICAID ESTATE RECOVERIES.

    (a) REQUIRING ESTABLISHMENT OF ESTATE RECOVERY PROGRAMS-

      (1) IN GENERAL- Section 1902(a)(51) (42 U.S.C. 1396a(a)(51)) is amended by striking ‘and (B)’ and inserting ‘(B) provide for an estate recovery program that meets the requirements of section 1917(b)(1), and (C)’.

      (2) REQUIREMENTS FOR ESTATE RECOVERY PROGRAMS- Section 1917(b) (42 U.S.C. 1396p(b)) is amended--

        (A) in paragraph (1)--

          (i) by striking ‘(b)(1)’ and inserting ‘(2)’, and

          (ii) by striking ‘(a)(1)(B)’ and inserting ‘(a)(1)(B)(i)’;

        (B) in paragraph (2), by striking ‘(2) Any adjustment or recovery under’ and inserting ‘(3) Any adjustment or recovery under an estate recovery program under’; and

        (C) by inserting before paragraph (2), as designated by subparagraph (A), the following:

    ‘(b)(1) For purposes of section 1902(a)(51)(B), the requirements for an estate recovery program of a State are as follows:

      ‘(A) The program provides for identifying and tracking (and, at the option of the State, preserving) resources (whether excluded or not) of individuals who are furnished any of the following long-term care services for which medical assistance is provided under this title:

        ‘(i) Nursing facility services.

        ‘(ii) Home and community-based services (as defined in section 1915(d)(5)(C)(i)).

        ‘(iii) Services described in section 1905(a)(14) (relating to services in an institution for mental diseases).

        ‘(iv) Home and community care provided under section 1929.

        ‘(v) Community supported living arrangements services provided under section 1930.

      ‘(B) The program provides for promptly ascertaining--

        ‘(i) when such an individual dies;

        ‘(ii) in the case of such an individual who was married at the time of death, when the surviving spouse dies; and

        ‘(iii) at the option of the State, cases in which adjustment or recovery may not be made at the time of death because of the application of paragraph (3)(A) or paragraph (3)(B).

      ‘(C)(i) The program provides for the collection consistent with paragraph (3) of an amount (not to exceed the amount described in clause (ii)) from--

        ‘(I) the estate of the individual;

        ‘(II) in the case of an individual described in subparagraph (B)(ii), from the estate of the surviving spouse; or

        ‘(III) at the option of the State, in a case described in subparagraph (B)(iii), from the appropriate person.

      ‘(ii) The amount described in this clause is the amount of medical assistance correctly paid under this title for long-term care services described in subparagraph (A) furnished on behalf of the individual.’.

    (b) HARDSHIP WAIVER- Section 1917(b) (42 U.S.C. 1396p(b)) is further amended by adding at the end the following new paragraph:

    ‘(4) The State agency shall establish procedures (in accordance with standards specified by the Secretary) under which the agency waives the application of this subsection if such application would work an undue hardship (in accordance with criteria established by the Secretary).’.

    (c) DEFINITION OF ESTATE- Section 1917(b) (42 U.S.C. 1396(b)) is further amended by adding at the end the following new paragraph:

    ‘(5) For purposes of this section, the term ‘estate’, with respect to a deceased individual, includes all real and personal property and other assets in which the individual had any legally cognizable title or interest at the time of his death, including such assets conveyed to a survivor, heir, or assign of the deceased individual through joint tenancy, survivorship, life estate, living trust, or other arrangement.’.

    (d) EFFECTIVE DATE-

      (1)(A) The amendments made by subsections (a) and (b) apply (except as provided under subparagraph (B)) to payments under title XIX of the Social Security Act for calendar quarters beginning on or after October 1, 1993, without regard to whether or not final regulations or standards to carry out such amendments have been promulgated by such date.

      (B) In the case of a State plan for medical assistance under title XIX of the Social Security Act which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirements imposed by the amendments made by subsections (a) and (b), the State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet these additional requirements before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of the enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of such session shall be deemed to be a separate regular session of the State legislature.

      (2) The amendments made by this section shall not apply to individuals who died before October 1, 1993.

SEC. 5113. CLOSING LOOPHOLE PERMITTING WEALTHY INDIVIDUALS TO QUALIFY FOR MEDICAID.

    (a) IN GENERAL- Section 1902(r)(2) (42 U.S.C. 1396a(r)(2)) is amended by adding at the end the following:

    ‘(C)(i) Notwithstanding subparagraph (A), except as provided in clause (ii), a State plan may not provide pursuant to this paragraph for disregarding any assets--

      ‘(I) to the extent that payments are made under a long-term care insurance policy; or

      ‘(II) because an individual has received (or is entitled to receive) benefits for a specified period of time under a long-term care insurance policy.

    ‘(ii) Clause (i) shall not apply to State plan provisions that are approved as of May 14, 1993.’.

    (b) EFFECTIVE DATE- The amendment made by subsection (a) shall take effect on the date of the enactment of this Act.

PART IV--IMPROVEMENT IN IDENTIFICATION AND COLLECTION OF THIRD PARTY PAYMENTS

SEC. 5116. LIABILITY OF THIRD PARTIES TO PAY FOR CARE AND SERVICES.

    (a) LIABILITY OF ERISA PLANS- (1) Section 1902(a)(25)(A) (42 U.S.C. 1396a(a)(25)(A)) is amended by striking ‘insurers)’ and inserting ‘insurers and group health plans (as defined in section 607(1) of the Employee Retirement Income Security Act of 1974) and including a service benefit plan and a health maintenance organization)’.

    (2) Section 1903(o) of such Act (42 U.S.C. 1396b(o)) is amended by striking ‘regulation)’ and inserting ‘regulation and including a group health plan (as defined in section 607(1) of the Employee Retirement Income Security Act of 1974)), a service benefit plan, and a health maintenance organization’.

    (b) REQUIRING STATE TO PROHIBIT INSURERS FROM TAKING MEDICAID STATUS INTO ACCOUNT- Section 1902(a)(25) (42 U.S.C. 1396a(a)(25)) is amended--

      (1) by striking ‘and’ at the end of subparagraph (F);

      (2) by adding ‘and’ at the end of subparagraph (G); and

      (3) by adding after subparagraph (G) the following new subparagraph:

        ‘(H) that the State prohibits any health insurer (including a group health plan, as defined in section 607(1) of the Employee Retirement Income Security Act of 1974, a service benefit plan, and a health maintenance organization), in enrolling an individual or in making any payments for benefits to the individual or on the individual’s behalf, from taking into account that the individual is eligible for or is provided medical assistance under a State plan;’.

    (c) STATE RIGHT TO SUBROGATION- Section 1902(a)(25) (42 U.S.C. 1396a(a)(25)), as amended by subsection (b), is further amended--

      (1) by striking ‘and’ at the end of subparagraph (G);

      (2) by adding ‘and’ at the end of subparagraph (H); and

      (3) by adding after subparagraph (H) the following new subparagraph:

        ‘(I) that to the extent that payment has been made under the State plan for medical assistance in any case where a third party has a legal liability to make payment for such assistance, the State is subrogated to the right of any other party to payment for such assistance;’.

    (d) EFFECTIVE DATE- (1) Except as provided in paragraph (2), the amendments made by subsections (a)(1), (b), and (c) shall apply to calendar quarters beginning on or after October 1, 1993, without regard to whether or not final regulations to carry out such amendments have been promulgated by such date.

    (2) In the case of a State plan for medical assistance under title XIX of the Social Security Act which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirements imposed by the amendments made by subsections (a) and (b), the State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet these additional requirements before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of the enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of such session shall be deemed to be a separate regular session of the State legislature.

    (3) The amendment made by subsection (a)(2) shall apply to items and services furnished on or after October 1, 1993.

SEC. 5117. HEALTH COVERAGE CLEARINGHOUSE.

    (a) IN GENERAL- The Social Security Act is amended by adding at the end the following new title:

‘TITLE XXI--HEALTH COVERAGE CLEARINGHOUSE

‘ESTABLISHMENT OF CLEARINGHOUSE

    ‘SEC. 2101. (a) IN GENERAL- The Secretary shall establish and operate a Health Coverage Clearinghouse (in this title referred to as the ‘Clearinghouse’) for the purpose of identifying, for beneficiaries of a covered health program (as defined in subsection (c)), third parties (which may include a covered health program) which may be liable for payment for health care items and services furnished to such beneficiaries under such program.

    ‘(b) DIRECTOR- The Clearinghouse shall be headed by a Director (in this title referred to as the ‘Director’) appointed by the Secretary.

    ‘(c) COVERED HEALTH PROGRAM DEFINED- In this title, the term ‘covered health program’ means any of the following under which payment is made for health care items or services furnished to a beneficiary:

      ‘(1) The medicare program under title XVIII.

      ‘(2) A State plan for medical assistance under title XIX (including a State plan operating under a Statewide waiver under section 1115).

      ‘(3) The Indian Health Service and any program under the Indian Health Care Improvement Act.

      ‘(4) A State program under title V that provides payment for items or services.

    ‘(d) OTHER DEFINITIONS- In this title:

      ‘(1) The term ‘administrator’ means, with respect to the covered health program described in--

        ‘(A) subsection (c)(1), the Administrator of the Health Care Financing Administration;

        ‘(B) subsection (c)(2), the single State agency referred to in section 1902(a)(5);

        ‘(C) subsection (c)(3), the Director of the Indian Health Service; and

        ‘(D) subsection (c)(4), the State agency receiving funds under title V.

      ‘(2) The term ‘group health plan’ has the meaning given such term in section 6103(l)(12)(E)(ii) of such Code.

      ‘(3) The term ‘qualified employer’ has the meaning given such term in section 6103(l)(12)(E)(iii) of the Internal Revenue Code of 1986.

‘PROVISION OF INFORMATION

    ‘SEC. 2102. (a) REQUEST FOR INFORMATION- An administrator of a covered health program may request from the Director information concerning the employment and group health coverage of a program beneficiary, the beneficiary’s spouse, and (if the beneficiary is a dependent child) the beneficiary’s parents. The Director shall provide such information if the request--

      ‘(1) is in such form and manner and at such a time as the Director may require, and

      ‘(2) specifies the name and tax identification number of the beneficiary.

    ‘(b) DATA MATCHING PROGRAM-

      ‘(1) REQUEST BY DIRECTOR- The Director shall, at such intervals as the Director finds appropriate, transmit to the Secretary of the Treasury the names and tax identification numbers of beneficiaries with respect to whom a request has been made pursuant to subsection (a), and request that such Secretary disclose to the Commissioner of Social Security the following information:

        ‘(A) Whether the beneficiary is married and, if so, the name of the spouse and such spouse’s tax identification number.

        ‘(B) If the beneficiary is a dependent child, the name of and tax identification numbers of the beneficiary’s parents.

      ‘(2) INFORMATION FROM COMMISSIONER OF SOCIAL SECURITY- The Secretary, acting through the Commissioner of Social Security, shall, upon written request from the Director, disclose to the Director, the following information:

        ‘(A) For each individual who is identified as having received wages (as defined in section 3401(a) of the Internal Revenue Code of 1986) from, and as having available coverage under a group health plan of, an employer in a previous year--

          ‘(i) the name and taxpayer identification number of the individual;

          ‘(ii) the name, address, and taxpayer identification number of the employer, and whether such employer is a qualified employer; and

          ‘(iii) whether the employer has made available a group health plan to the employee and the plan coverage provided (if any) with respect to the employee and family members of the employee under the group health plan.

        ‘(B) For each individual who is identified as married and whose spouse is identified as having received wages (as defined in section 3401(a) of the Internal Revenue Code of 1986) from, and as having available coverage under a group health plan of, an employer in a previous year--

          ‘(i) the name and taxpayer identification number of the individual and of the individual’s spouse;

          ‘(ii) the name, address, and taxpayer identification number of the spouse’s employer, and whether such employer is a qualified employer; and

          ‘(iii) whether the spouse’s employer has made available a group health plan to the spouse and the plan coverage provided (if any) with respect to the spouse and family members of the spouse under the group health plan.

        ‘(C) For each individual who is identified as a dependent child and whose parent is identified as having received wages (as defined in section 3401(a) of the Internal Revenue Code of 1986) from, and as having available coverage under a group health plan of, an employer in a previous year--

          ‘(i) the name and taxpayer identification number of the individual and of the individual’s parent;

          ‘(ii) the name, address, and taxpayer identification number of the parent’s employer, and whether such employer is a qualified employer; and

          ‘(iii) whether the parent’s employer has made available a group health plan to the parent and the plan coverage provided (if any) with respect to the parent and dependent children of the parent under the group health plan.

      ‘(3) INFORMATION FROM EMPLOYERS- The Director shall--

        ‘(A) request, from the employer of each individual (including each spouse) with respect to whom information was received from the Commissioner of Social Security pursuant to paragraph (2), specific information concerning coverage of such individual (and of the individual’s spouse and dependent children) under the employer’s group health plan (including the period and nature of the coverage, and the name, address, and identifying number of the plan), and

        ‘(B) furnish the information received in response to such request with respect to an individual (or such individual’s spouse or dependent children) to the administrator requesting such information pursuant to subsection (a).

‘REQUIREMENT THAT EMPLOYERS FURNISH INFORMATION

    ‘SEC. 2103. (a) IN GENERAL- An employer shall furnish to the Director the information requested pursuant to section 2102(b)(3) within 30 days after receipt of such a request.

    ‘(b) SUNSET ON REQUIREMENT- Subsection (a) shall not apply to inquiries made after September 30, 1998.

    ‘(c) CIVIL MONEY PENALTY FOR FAILURE TO COOPERATE-

      ‘(1) IN GENERAL- An employer (other than a Federal or other governmental entity) who willfully or repeatedly fails to provide timely and accurate response to a request for information pursuant to section 2102(b)(3) shall be subject, in addition to any other penalties that may be prescribed by law, to a civil money penalty of not to exceed $1,000 for each individual with respect to whom such a request is made.

      ‘(2) ENFORCEMENT AUTHORITY- In cases of failure to respond to the Director in accordance with subsection (a) to inquiries relating to requests pursuant to section 2102, the provisions of section 1128A (other than subsections (a) and (b)) shall apply to civil money penalties under paragraph (1) in the same manner as such provisions apply to penalties or proceedings under section 1128A(a).

‘DATA BANK

    ‘SEC. 2104. (a) MAINTENANCE OF INFORMATION- The Clearinghouse shall maintain a data bank, containing information on individuals obtained pursuant to this title. Individual information in the data bank shall be retained for not less than one year after the date the information was obtained.

    ‘(b) DISCLOSURE OF INFORMATION IN DATA BANK-

      ‘(1) IN GENERAL- The Director is authorized (subject to paragraph (2)) to disclose any information in the data bank established pursuant to subsection (a) with respect to an individual (or an individual’s spouse or parent)--

        ‘(A) to the Commissioner of Social Security, the Secretary of the Treasury, administrators, employers, and insurers, to the extent necessary to assist such administrators;

        ‘(B) to Federal and State law enforcement officials responsible for enforcement of civil or criminal laws, in connection with investigations or administrative or judicial law enforcement proceedings relating to a covered health program; and

        ‘(C) for research or statistical purposes.

      ‘(2) RESTRICTIONS ON DISCLOSURE- Information in the data bank may be disclosed under this subsection only for purposes of, and to the extent necessary in, determining the extent to which an individual is covered under any group health plan.

    ‘(c) USE OF CONTRACTORS- The responsibilities of the Clearinghouse under this section may be carried out by contract.

    ‘(d) FEES- The Clearinghouse shall--

      ‘(1) establish fees for services under this section designed to cover the full costs to the Clearinghouse of providing such services, and

      ‘(2) require the payment of such fees to provide such services.’.

    (b) CONFORMING MEDICARE AMENDMENTS- Section 1862(b)(5) (42 U.S.C. 1395y(b)(5)) is amended--

      (1) in subparagraph (A)(i)--

        (A) by striking ‘Secretary of the Treasury’ and inserting ‘Director of the Health Coverage Clearinghouse’,

        (B) by striking ‘(as defined in section 6103(l)(12) of the Internal Revenue Code of 1986)’ and inserting ‘(as defined in clause (iii))’, and

        (C) by striking ‘and request’ and all that follows and inserting a period;

      (2) in subparagraph (A)(ii)--

        (A) by striking ‘the Commissioner of the Social Security Administration’ and all that follows and inserting ‘the Director of the Health Coverage Clearinghouse to obtain and disclose to the Administrator, pursuant to section 2102(b) and to subparagraph (C) of section 6103(l)(12) of the Internal Revenue Code of 1986, the information described in section 2102(b) and subparagraph (B) of such section 6103(l)(12).’, and

        (B) by inserting ‘, pursuant to section 1144(c),’ after ‘disclose to the Administrator’; and

      (3) by striking subparagraph (C).

    (c) MEDICAID USE OF CLEARINGHOUSE- Section 1902(a)(25)(A) (42 U.S.C. 1396a(a)(25)(A)) is amended by inserting ‘(including making appropriate requests to the Director of the Health Coverage Clearinghouse under section 2102)’ after ‘all reasonable measures’.

    (d) COLLECTION OF THIRD PARTY PAYMENTS UNDER MATERNAL AND CHILD HEALTH BLOCK GRANT PROGRAM- Section 505(a) (42 U.S.C. 705(a)) is amended--

      (1) by striking ‘and’ at the end of paragraph (4),

      (2) by striking the period at the end of paragraph (5) and inserting ‘; and’, and

      (3) by inserting after paragraph (5) the following new paragraph:

      ‘(6) provides for an entity providing health services with assistance from the State under this title taking all reasonable steps--

        ‘(A) to ascertain the legal liability of third parties to pay for such services, and

        ‘(B) where such liability is found to exist, to seek reimbursement for such services.’.

    (e) EFFECTIVE DATES-

      (1) The amendments made by subsections (a), (b), and (d) shall take effect on April 1, 1995.

      (2) The amendments made by subsection (c) shall apply to allotments for years beginning with fiscal year 1994.

SEC. 5118. MEDICAL CHILD SUPPORT.

    (a) STATE PLAN REQUIREMENT- Section 1902(a)(45) (42 U.S.C. 1396a(a)(45)) is amended by striking ‘owed to recipients’ and inserting ‘and have in effect laws relating to medical child support’.

    (b) MEDICAL CHILD SUPPORT LAWS- Section 1912 of such Act (42 U.S.C. 1396k) is amended--

      (1) by adding at the end of the heading the following: ‘; REQUIRED LAWS RELATING TO MEDICAL CHILD SUPPORT’; and

      (2) by adding at the end the following new subsection:

    ‘(c) The laws relating to medical child support, which a State is required to have in effect under section 1902(a)(45), are as follows:

      ‘(1) A law that prohibits an insurer from denying enrollment of a child under the health coverage of the child’s parent on the ground that the child was born out of wedlock, on the ground that the child may not be claimed as a dependent on the parent’s Federal income tax return, or on the ground that the child does not reside with the parent or in the insurer’s service area. In this subsection, the term ‘insurer’ includes a group health plan, as defined in section 607(1) of the Employee Retirement Income Security Act of 1974, a health maintenance organization, and an entity offering a service benefit plan.

      ‘(2) A law that requires an insurer, in any case in which a parent is required by court or administrative order to provide health coverage for a child and the parent is eligible for family health coverage through the insurer--

        ‘(A) to permit such parent, upon application and without regard to any enrollment season restrictions, to enroll the parent and such child under such family coverage;

        ‘(B) if such a parent is enrolled but fails to make application to obtain coverage of such child, to enroll such child under such family coverage upon application by the child’s other parent or by the State agency administering the program under this title or part D of title IV; and

        ‘(C) not to disenroll (or eliminate coverage of) such a child unless the insurer is provided satisfactory written evidence that--

          ‘(i) such court or administrative order is no longer in effect, or

          ‘(ii) the child is or will be enrolled in comparable health coverage through another insurer which will take effect not later than the effective date of such disenrollment.

      ‘(3) A law that requires an employer doing business in the State, in the case of health coverage offered through employment with the employer and providing coverage of a child of an employee pursuant to a court or administrative order, to withhold from such employee’s compensation the employee’s share (if any) of premiums for health coverage (to the maximum amount permitted under section 303(b) of the Consumer Credit Protection Act) and to pay such share of premiums to the insurer.

      ‘(4) A law that prohibits an insurer from imposing requirements upon a State agency, which is acting as an agent or subrogee of an individual eligible for medical assistance under this title and covered for health benefits from the insurer, that are different from requirements applicable to an agent or subrogee of any other individual so covered.

      ‘(5) A law that requires an insurer, in any case in which a child has health coverage through the insurer of a noncustodial parent--

        ‘(A) to provide such information to the custodial parent as may be necessary for the child to obtain benefits through such coverage;

        ‘(B) to permit the custodial parent (or provider, with the custodial parent’s approval) to submit claims for covered services without the approval of the noncustodial parent; and

        ‘(C) to make payment on claims submitted in accordance with subparagraph (B) directly to the custodial parent or the provider.

      ‘(6) A law that requires the State agency under this title to garnish the wages, salary, or other employment income of, and to withhold amounts from State tax refunds to, any person who--

        ‘(A) is required by court or administrative order to provide coverage of the costs of health services to a child who is eligible for medical assistance under this title,

        ‘(B) has received payment from a third party for the costs of such services to such child, but

        ‘(C) has not used such payments to reimburse, as appropriate, either the other parent or guardian of such child or the provider of such services,

      to the extent necessary to reimburse the State agency for expenditures for such costs under its plan under this title, but any claims for current or past-due child support shall take priority over any such claims for the costs of such services.’.

    (c) EFFECTIVE DATE- (1) Except as provided in paragraph (2), the amendments made by this section apply to calendar quarters beginning on or after April 1, 1994, without regard to whether or not final regulations to carry out such amendments have been promulgated by such date.

    (2) In the case of a State plan under title XIX of the Social Security Act which the Secretary of Health and Human Services determines requires State legislation in order for the plan to meet the additional requirements imposed by the amendments made by this section, the State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet these additional requirements before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of such session shall be deemed to be a separate regular session of the State legislature.

PART V--ASSURING PROPER PAYMENTS TO DISPROPORTIONATE SHARE HOSPITALS

SEC. 5121. ASSURING PROPER PAYMENTS TO DISPROPORTIONATE SHARE HOSPITALS.

    (a) DISPROPORTIONATE SHARE HOSPITALS REQUIRED TO PROVIDE MINIMUM LEVEL OF SERVICES TO MEDICAID PATIENTS- Section 1923 (42 U.S.C. 1396r-4) is amended--

      (1) in subsection (a)(1)(A), by striking ‘requirement’ and inserting ‘requirements’;

      (2) in subsection (b)(1), by striking ‘requirement’ and inserting ‘requirements’;

      (3) in the heading to subsection (d), by striking ‘REQUIREMENT’ and inserting ‘REQUIREMENTS’;

      (4) by adding at the end of subsection (d) the following new paragraph:

      ‘(3) No hospital may be defined or deemed as a disproportionate share hospital under a State plan under this title or under subsection (b) or (e) of this section unless the hospital has a medicaid inpatient utilization rate (as defined in subsection (b)(2)) of not less than 1 percent.’;

      (5) in subsection (e)(1)--

        (A) by striking ‘and’ before ‘(B)’, and

        (B) by inserting before the period at the end the following: ‘, and (C) the plan meets the requirement of subsection (d)(3) and such payment adjustments are made consistent with the fourth sentence of subsection (c)’; and

      (6) in subsection (e)(2)--

        (A) in subparagraph (A), by inserting ‘(other than the fourth sentence of subsection (c))’ after ‘(c)’,

        (B) by striking ‘and’ at the end of subparagraph (A),

        (C) by striking the period at the end of subparagraph (B) and inserting ‘, and’, and

        (D) by adding at the end the following new subparagraph:

      ‘(C) subsection (d)(3) shall apply.’.

    (b) LIMITING AMOUNT OF PAYMENT ADJUSTMENTS FOR STATE OR COUNTY HOSPITALS TO UNCOVERED COSTS- Subsection (c) of such section is amended by adding at the end the following: ‘A payment adjustment during a year is not considered to be consistent with this subsection with respect to a hospital owned or operated by a State (or by an instrumentality of or a unit of government within a State) if the payment adjustment exceeds the costs of furnishing hospital services (as determined by the Secretary and net of payments under this title, other than under this section, and by uninsured patients) by the hospital to individuals who either are eligible for medical assistance under the State plan or have no health insurance (or other source of third party payment) for such services during the year. For purposes of the preceding sentence, payments made to a hospital for services provided to indigent patients made by a State or a unit of local government within a State shall not be considered to be a source of third party payment.’.

    (c) EFFECTIVE DATE- The amendments made by this section shall apply to payments to States under section 1903(a) of the Social Security Act for payments to hospitals made under State plans after--

      (1) the end of the State fiscal year that ends during 1994, or

      (2) in the case of a State with a State legislature which is not scheduled to have a regular legislative session in 1994, the end of the State fiscal year that ends during 1995;

    without regard to whether or not final regulations to carry out such amendments have been promulgated by either such date.

Subchapter B--Miscellaneous Provisions

PART I--ANTI-FRAUD AND ABUSE PROVISIONS

SEC. 5131. APPLICATION OF MEDICARE RULES LIMITING CERTAIN PHYSICIAN REFERRALS.

    (a) IN GENERAL- Section 1903(i) (42 U.S.C. 1396b(i)), as amended by section 5174(b), is amended--

        (A) in paragraph (12), by striking or at the end,

        (B) in paragraph (13), by striking the period at the end and inserting ‘; or’, and

        (C) by inserting after paragraph (13) the following new paragraph:

      ‘(14) with respect to any amount expended for an item or service for which payment would be denied under section 1877(g)(1) if the item or service were furnished to an individual entitled to benefits under title XVIII.’.

    (b) EFFECTIVE DATE- The amendment made by subsection (a) shall apply to items and services furnished on or after October 1, 1993.

SEC. 5132. INTERMEDIATE SANCTIONS FOR KICKBACK VIOLATIONS.

    (a) PENALTY FOR KICKBACKS- Section 1128A(a) (42 U.S.C. 1320a-7a(a)) is amended--

      (1) by striking ‘or’ at the end of paragraphs (1) and (2);

      (2) by adding ‘or’ at the end of paragraph (3);

      (3) by inserting after paragraph (3) the following new paragraph:

      ‘(4) carries out any activity in violation of paragraph (1) or (2) of section 1128B(b);’;

      (4) by striking ‘given).’ at the end of the first sentence and inserting ‘given or, in cases under paragraph (4), $50,000 for each such violation).’;

      (5) in the second sentence, by inserting ‘in cases under paragraphs (1), (2), and (3),’ after ‘In addition,’; and

      (6) by inserting after the second sentence, the following new sentence: ‘In cases under paragraph (4), such a person shall be subject to an assessment of not more than twice the total amount of the remuneration offered, paid, solicited, or received in violation of section 1128B(b), determined without regard to whether a portion of such remuneration was offered, paid, solicited, or received for a lawful purpose.’.

    (b) AUTHORIZATION TO ACT- The first sentence of section 1128A(c)(1) (42 U.S.C. 1320a-7a(c)(1)) is amended by striking all that follows ‘(b)’ and inserting the following: ‘unless, within one year after the date the Secretary presents a case to the Attorney General for consideration, the Attorney General brings an action in a district court of the United States.’.

    (c) EFFECTIVE DATES-

      (1) The amendments made by subsection (a) shall apply to remuneration offered, paid, solicited, or received before, on, or after the date of the enactment of this Act.

      (2) The amendment made by subsection (b) shall apply to cases presented by the Secretary of Health and Human Services for consideration on or after the date of the enactment of this Act.

SEC. 5133. REQUIRING MAINTENANCE OF EFFORT FOR STATE MEDICAID FRAUD CONTROL UNITS.

    (a) IN GENERAL- Section 1902(a)(49) (42 U.S.C. 1396a(a)(49)) is amended--

      (1) by inserting ‘(A)’ after ‘(49)’, and

      (2) by adding at the end the following new subparagraph:

      ‘(B) provide that the State will expend for its medicaid fraud and abuse control unit (as defined in section 1903(q)), for each State fiscal year, an amount that is not less than the amount expended for such unit in the State fiscal year that ended in 1992 adjusted to reflect the percentage increase in total expenditures under the State plan between such State fiscal year and the State fiscal year involved;’.

    (b) EFFECTIVE DATE- The amendments made by subsection (a) shall apply to State fiscal years ending after 1993.

PART II--MANAGED CARE PROVISIONS

SEC. 5135. MEDICAID MANAGED CARE ANTI-FRAUD PROVISIONS.

    (a) PROHIBITING AFFILIATIONS WITH INDIVIDUALS DEBARRED BY FEDERAL AGENCIES-

      (1) IN GENERAL- Section 1903(m) (42 U.S.C. 1396b(m)) is amended--

        (A) in paragraph (2)(A)--

          (i) by striking ‘and’ at the end of clause (x),

          (ii) by striking the period at the end of clause (xi) and inserting ‘; and’, and

          (iii) by adding at the end the following new clause:

      ‘(xii) the entity complies with the requirements of paragraph (3) (relating to certain protections against fraud and abuse).’;

        (B) in paragraph (2)(B), as amended by section 5158(b), by striking ‘clause (ix)’ and inserting ‘clauses (ix) and (xii)’; and

        (C) by inserting after paragraph (2) the following new paragraph:

    ‘(3)(A)(i) A health maintenance organization may not have a person described in clause (iv) as a director, officer, partner, or person with beneficial ownership of more than 5 percent of organization’s equity.

    ‘(ii) A health maintenance organization may not have an employment, consulting, or other agreement with a person described in clause (iv) for the provision of goods and services that are significant and material to the organization’s obligations under its contract with the State described in paragraph (2)(A)(iii).

    ‘(iii) If a health maintenance organization is not in compliance with clause (i) or clause (ii)--

      ‘(I) a State may continue an existing agreement with the organization unless the Secretary (in consultation with the Inspector General of the Department of Health and Human Services) directs otherwise; and

      ‘(II) a State may not renew or otherwise extend the duration of an existing agreement with the organization unless the Secretary (in consultation with the Inspector General of the Department of Health and Human Services) provides a written statement describing compelling reasons that exist for renewing or extending the agreement.

    ‘(iv) A person described in this clause is a person that--

      ‘(I) is debarred or suspended by the Federal Government, pursuant to the Federal acquisition regulation, from Government contracting and subcontracting, or

      ‘(II) is an affiliate (within the meaning of the Federal acquisition regulation) of a person described in subclause (I).’.

      (2) EFFECTIVE DATE- The amendments made by paragraph (1) shall apply to agreements between a State and an entity under section 1903(m) of the Social Security Act entered into or renewed on or after October 1, 1993, without regard to whether regulations to carry out such amendments are promulgated by such date.

    (b) REQUIREMENT FOR STATE CONFLICT-OF-INTEREST SAFEGUARDS IN MEDICAID RISK CONTRACTING-

      (1) IN GENERAL- Section 1903(m)(2)(A) (42 U.S.C. 1396b(m)(2)(A)), as amended by subsection (a)(1)(C), is amended--

        (A) by striking ‘and’ at the end of clause (xi),

        (B) by striking the period at the end of clause (xii) and inserting ‘; and’, and

        (C) by adding at the end the following new clause:

      ‘(xiii) the State certifies to the Secretary that it has in effect conflict-of-interest safeguards with respect to officers and employees of the State with responsibility with respect to contracts with organizations under this subsection that are at least as effective as the Federal safeguards, provided under section 27 of the Office of Federal Procurement Policy Act (41 U.S.C. 423), against conflicts of interest that apply with respect to Federal procurement officials with comparable responsibilities with respect to such contracts.’.

      (2) EFFECTIVE DATE- The amendments made by paragraph (1) shall apply as of July 1, 1994, without regard to whether regulations to carry out such amendments are promulgated by such date.

    (c) REQUIRING DISCLOSURE OF FINANCIAL INFORMATION-

      (1) IN GENERAL- Section 1903(m)(3), as inserted by subsection (a)(1)(C), is amended by adding at the end the following new subparagraph:

    ‘(B) The contract between the State and an entity referred to in paragraph (2)(A)(iii) shall provide that--

      ‘(i) the entity agrees to report to the State such financial information as the Secretary or the State may require to demonstrate that the entity has a fiscally sound operation; and

      ‘(ii) the entity agrees to make available to its enrollees upon reasonable request--

        ‘(I) the information reported under paragraph (1),

        ‘(II) the information required to be disclosed under sections 1124 and 1126, and

        ‘(III) a description of each transaction, described in subparagraphs (A) through (C) of section 1318(a)(3) of the Public Health Service Act, between the entity and a party in interest (as defined in section 1318(b) of such Act).’.

      (2) EFFECTIVE DATE- The amendment made by paragraph (1) shall apply to contract years beginning on or after October 1, 1993, without regard to whether regulations to carry out such amendments are promulgated by such date, with respect to information reported or required to be disclosed, or transactions occurring, before, on, or after such date.

    (d) PROHIBITING MARKETING FRAUD-

      (1) IN GENERAL- Section 1903(m)(3), as inserted by subsection (a)(1) and as amended by subsection (c)(1), is amended by adding at the end the following new subparagraph:

    ‘(C) The contract between the State and an entity referred to in paragraph (2)(A)(iii) shall provide that the entity agrees to comply with such procedures and conditions as the Secretary prescribes in order to ensure that, before an individual is enrolled with the entity, the individual is provided accurate and sufficient information to make an informed decision whether or not to enroll.’.

      (2) EFFECTIVE DATE- The amendment made by paragraph (1) shall apply to contract years that begin on or after October 1, 1993, without regard to whether regulations to carry out such amendment are promulgated by such date.

    (e) REQUIRING ADEQUATE EQUITY FOR FOR-PROFIT ENTITIES-

      (1) IN GENERAL- Section 1903(m)(3), as previously amended by this section, is further amended by adding at the end the following new subparagraph:

    ‘(D)(i) The contract between the State and an entity referred to in paragraph (2)(A)(iii) shall require, in the case of a for-profit entity, that the entity shall maintain an average ratio of--

      ‘(I) equity capital to

      ‘(II) payments made by the State to the entity under the contract on a capitation basis or any other risk basis,

    of not less than such minimum ratio as the Secretary shall specify.

    ‘(ii) The contract between the State and a non-profit entity referred to in paragraph (2)(A)(iii) shall require that no payment shall be made directly or indirectly under an agreement between the non-profit entity and a related for-profit entity (as defined by the Secretary) unless the for-profit entity maintains an average ratio of equity capital to payments under such agreement of not less than such ratio as the Secretary shall specify.’.

      (2) EFFECTIVE DATE- The amendment made by paragraph (1) shall apply to contract years beginning on or after July 1, 1994, without regard to whether regulations to carry out such amendment are promulgated by such date.

    (f) REQUIRING ADEQUATE PROVISION AGAINST RISK OF INSOLVENCY-

      (1) IN GENERAL- Section 1903(m)(1)(A)(ii) (42 U.S.C. 1396b(m)(1)(A)(ii)) is amended by inserting ‘, which meets such standards as the Secretary shall prescribe’ after ‘satisfactory to the State’.

      (2) EFFECTIVE DATE AND TRANSITION- (A) The amendment made by paragraph (1) shall apply to contract years beginning on or after July 1, 1994, without regard to whether regulations to carry out such amendments are promulgated by such date.

      (B) If the Secretary of Health and Human Services has not promulgated standards to carry out the amendment made by paragraph (1) by July 1, 1994, until such standards have been promulgated a provision of a health maintenance organization against the risk of insolvency shall not be considered to meet standards prescribed by the Secretary, for purposes of section 1903(m)(1)(A)(ii) of the Social Security Act, unless such provision has been found satisfactory by the Secretary under section 1876(b)(2)(E) of such Act.

    (g) REQUIRING REPORT ON NET EARNINGS AND ADDITIONAL BENEFITS-

      (1) IN GENERAL- Section 1903(m)(3), as previously amended by this section, is amended by adding at the end the following new subparagraph:

    ‘(E) The contract between the State and an entity referred to in paragraph (2)(A)(iii) shall provide that the entity shall submit a report to the State and the Secretary not later than 12 months after the close of a contract year containing--

      ‘(i) a financial statement of the entity’s net earnings under the contract during the contract year, which statement has been audited using auditing standards established by the Secretary in consultation with the States; and

      ‘(ii) a description of any benefits that are in addition to the benefits required to be provided under the contract that were provided during the contract year to members enrolled with the entity and entitled to medical assistance under the plan.’.

      (2) EFFECTIVE DATE- The amendment made by paragraph (1) shall apply to contract years beginning on or after October 1, 1993, without regard to whether regulations to carry out such amendments are promulgated by such date.

    (h) REPORT ON NET EARNINGS OF CONTRACTORS- Not later than 6 months after the date of the enactment of this Act, the Secretary of Health and Human Services shall submit a report to Congress on the earnings of organizations with contracts to receive payment for providing medical assistance under title XIX of the Social Security Act on a prepaid capitation or any other risk basis. The report shall include the Secretary’s recommendations on options for requiring such organizations, as a condition of participation under such title, to dedicate a portion of such earnings to the provision of additional benefits to individuals enrolled with the organization.

SEC. 5136. CLARIFICATION OF TREATMENT OF HMO ENROLLEES IN COMPUTING THE MEDICAID INPATIENT UTILIZATION RATE IN QUALIFYING HOSPITALS AS DISPROPORTIONATE SHARE HOSPITALS.

    (a) IN GENERAL- Section 1923(b)(2) (42 U.S.C. 1396r-4(b)(2)) is amended by inserting before the period at the end the following: ‘and whether or not the individual is enrolled with an entity contracting with the State on a prepaid capitation basis or other risk basis under section 1903(m)’.

    (b) EFFECTIVE DATE- The amendment made by subsection (a) shall apply to payments to States under section 1903(a) of the Social Security Act for payments to hospitals made under State plans on and after the first day of the first calendar quarter beginning after the date of the enactment of this Act.

SEC. 5137. EXTENSION OF PERIOD OF APPLICABILITY OF ENROLLMENT MIX REQUIREMENT TO CERTAIN HEALTH MAINTENANCE ORGANIZATIONS PROVIDING SERVICES UNDER DAYTON AREA HEALTH PLAN.

    Section 2 of Public Law 102-276 is amended by striking ‘January 31, 1994’ and inserting ‘December 31, 1995’.

SEC. 5138. EXTENSION OF MEDICAID WAIVER FOR TENNESSEE PRIMARY CARE NETWORK.

    Section 6411(f) of the Omnibus Budget Reconciliation Act of 1989, as amended by section 1 of Public Law 102-317, is amended by striking ‘January 31, 1994’ and inserting ‘December 31, 1995’.

SEC. 5139. WAIVER OF APPLICATION OF MEDICAID ENROLLMENT MIX REQUIREMENT TO DISTRICT OF COLUMBIA CHARTERED HEALTH PLAN, INC.

    (a) IN GENERAL- The Secretary of Health and Human Services shall waive the application of the requirement described in section 1903(m)(2)(A)(ii) of the Social Security Act to the entity known as the District of Columbia Chartered Health Plan, Inc., for the period described in subsection (b), if the Secretary determines that the entity is making continuous efforts and progress toward achieving compliance with such requirement.

    (b) PERIOD OF APPLICABILITY- The period referred to in subsection (a) is the period that begins on October 1, 1992, and ends on December 31, 1995.

SEC. 5140. EXTENSION OF MINNESOTA PREPAID MEDICAID DEMONSTRATION PROJECT.

    (a) IN GENERAL- Section 507 of the Family Support Act of 1988, as amended by section 6411(j) of OBRA-1989 and by section 4733 of OBRA-1990, is amended by striking ‘1996’ and inserting ‘1998’.

    (b) AUTHORITY TO IMPOSE PREMIUM-

      (1) IN GENERAL- Notwithstanding section 1916 of the Social Security Act and subject to paragraph (2), the State of Minnesota may impose a premium on individuals receiving medical assistance under the Minnesota Prepaid Demonstration Project operated under a waiver granted by the Secretary of Health and Human Services under section 1115(a) of the Social Security Act and other individuals eligible under the State’s plan for medical assistance under title XIX of such Act.

      (2) LIMITATION ON AMOUNT OF PREMIUM- In no case may the amount of any premium imposed on an individual receiving medical assistance under the State plan or under the Demonstration Project described in paragraph (1) exceed 10 percent of the amount by which the family income (less expenses for the care of a dependent child) of the individual exceeds 110 percent of the income official poverty line (as defined by the Office of Management and Budget), and revised annually in accordance with section 673(2) of the Omnibus Budget Reconciliation Act of 1981) applicable to a family of the size involved.

PART III--EMERGENCY SERVICES TO UNDOCUMENTED ALIENS

SEC. 5141. INCREASE IN FEDERAL FINANCIAL PARTICIPATION FOR EMERGENCY MEDICAL ASSISTANCE TO UNDOCUMENTED ALIENS.

    (a) IN GENERAL- Section 1905(b) (42 U.S.C. 1396d(b)) is amended by adding at the end the following: ‘Notwithstanding the first sentence of this section, subject to 1903(v)(4), the Federal medical assistance percentage shall be 100 per centum with respect to amounts expended by an eligible State in a covered fiscal year (as defined in section 1903(v)(4)(C)) as medical assistance for care and services described in section 1903(v)(2) to aliens described in section 1903(v)(1).’.

    (b) LIMITATION- Section 1903(v) (42 U.S.C. 1396b(v)) is amended by adding at the end the following new paragraphs:

    ‘(4)(A) With respect to any eligible State (as defined in subparagraph (C)(i)), the amount of the increase in payments to a State under subsection (a) in a covered fiscal year (as defined in subparagraph (C)(ii)), resulting from the increase in the Federal medical assistance percentage under the fourth sentence of section 1905(b), shall not exceed the State’s allotment determined under subparagraph (B).

    ‘(B)(i) The total of the allotments to all States for a covered fiscal year under this paragraph shall be $300,000,000.

    ‘(ii) From the total allotment under clause (i) for a covered fiscal year, the Secretary shall determine the amount of the allotment for each eligible State. Subject to clause (iii), the amount of such allotment for such a fiscal year shall bear the same ratio to the total amount specified in clause (i) for the fiscal year as the ratio of--

      ‘(I) the allotment to the State for fiscal year 1993 under section 204 of the Immigration Reform and Control Act of 1986, to

      ‘(II) the total of such allotments for all such eligible States for fiscal year 1993.

    ‘(iii) In the case of an eligible State which notifies the Secretary that an amount of its allotment will not be used by the State under this paragraph, the State’s allotment shall be reduced by such amount and such amount shall be redistributed among the other eligible States in proportion to the amount otherwise allotted to such State under clause (ii).

    ‘(C) For purposes of this paragraph and the fourth sentence of section 1905(b):

      ‘(i) The term ‘eligible State’ means a State--

        ‘(I) with a plan approved under this title (including a State which is providing medical assistance to its residents under a statewide waiver granted under section 1115), and

        ‘(II) for which its allotment for fiscal year 1993 under section 204 of the Immigration Reform and Control Act of 1986 is at least 1 percent of the total of such allotments for all the States for fiscal year 1993.

      ‘(ii) The term ‘covered fiscal year’ means only fiscal year 1994.

    ‘(D) Nothing in this paragraph or the fourth sentence of section 1905(b) shall be construed as establishing entitlement authority (within the meaning of section 3(9) of the Congressional Budget Act of 1974) for any fiscal year other than a covered fiscal year.’.

SEC. 5142. LIMITING FEDERAL MEDICAID MATCHING PAYMENT TO BONA FIDE EMERGENCY SERVICES FOR UNDOCUMENTED ALIENS.

    (a) IN GENERAL- Section 1903(v)(2) (42 U.S.C. 1396b(v)(2)) is amended--

      (1) by striking ‘and’ at the end of subparagraph (A),

      (2) by striking the period at the end of subparagraph (B) and inserting ‘, and’, and

      (3) by adding at the end the following new subparagraph:

      ‘(C) such care and services are not related to an organ transplant procedure.’.

    (b) EFFECTIVE DATE- (1) Subject to paragraph (2), the amendments made by subsection (a) shall apply as if included in the enactment of OBRA-1986.

    (2) The Secretary of Health and Human Services shall not disallow expenditures made for the care and services described in section 1903(v)(2)(C) of the Social Security Act, as added by subsection (a), furnished before the date of the enactment of this Act.

PART IV--MISCELLANEOUS PROVISIONS

SEC. 5144. INCREASE IN LIMIT ON FEDERAL MEDICAID MATCHING PAYMENTS TO PUERTO RICO AND OTHER TERRITORIES.

    (a) IN GENERAL- Paragraphs (1) through (5) of section 1108(c) (42 U.S.C. 1308(c)) are amended to read as follows:

      ‘(1) Puerto Rico shall not exceed (A) $104,000,000 for fiscal year 1994 and (B) for each succeeding fiscal year the amount provided in this paragraph for the preceding fiscal year increased by the percentage increase in the medical care component of the consumer price index for all urban consumers (as published by the Bureau of Labor Statistics) for the twelve-month period ending in March preceding the beginning of the fiscal year, rounded to the nearest $100,000;

      ‘(2) the Virgin Islands shall not exceed (A) $3,425,000 for fiscal year 1994, and (B) for each succeeding fiscal year the amount provided in this paragraph for the preceding fiscal year increased by the percentage increase referred to in paragraph (1)(B), rounded to the nearest $10,000;

      ‘(3) Guam shall not exceed (A) $3,290,000 for fiscal year 1994, and (B) for each succeeding fiscal year the amount provided in this paragraph for the preceding fiscal year increased by the percentage increase referred to in paragraph (1)(B), rounded to the nearest $10,000;

      ‘(4) Northern Mariana Islands shall not exceed (A) $990,000 for fiscal year 1994, and (B) for each succeeding fiscal year the amount provided in this paragraph for the preceding fiscal year increased by the percentage increase referred to in paragraph (1)(B), rounded to the nearest $10,000; and

      ‘(5) American Samoa shall not exceed (A) $1,910,000 for fiscal year 1994, and (B) for each succeeding fiscal year the amount provided in this paragraph for the preceding fiscal year increased by the percentage increase referred to in paragraph (1)(B), rounded to the nearest $10,000.’.

    (b) EFFECTIVE DATE- The amendment made by subsection (a) shall apply beginning with fiscal year 1994.

SEC. 5145. CRITERIA FOR MAKING DETERMINATIONS OF DENIAL OF FEDERAL MEDICAID MATCHING PAYMENTS TO STATES.

    (a) IN GENERAL- Section 1903 (42 U.S.C. 1396b) is amended by adding at the end the following new subsection:

    ‘(x)(1) In any case in which the Secretary proposes to disallow under section 1116(d) a claim by a State under this section and the State exercises its right of reconsideration under section 1116(d), the Departmental Appeals Board established in the Department of Health and Human Services shall, if such Board upholds the basis for the disallowance, determine whether the amount of the disallowance should be reduced. In making this determination, the Board shall take into account (to the extent the State makes a showing) factors which shall include--

      ‘(A) the nature of the basis for the disallowance;

      ‘(B) whether the amount of the disallowance is proportionate to the error or deficiency on which the disallowance is based;

      ‘(C) whether the basis of the disallowance constitutes noncompliance that prevented or materially affected the provision of appropriate services to individuals eligible under this title; or

      ‘(D) whether Federal guidance with respect to the action that is the basis for the proposed disallowance was insufficient and the State made good faith efforts to conform its action to the intent of the applicable Federal statute or regulation.

    ‘(2) No disallowance shall be taken or upheld if the action of the State on which the disallowance would be based is consistent with its approved State plan.’.

    (b) EFFECTIVE DATE- The amendment made by subsection (a) shall apply to disallowances made after the date of the enactment of this Act and shall take effect without regard to the promulgation of implementing regulations.

SEC. 5146. RENEWAL OF UNFUNDED DEMONSTRATION PROJECT FOR LOW-INCOME PREGNANT WOMEN AND CHILDREN.

    (a) IN GENERAL- Section 6407 of OBRA-89 is amended--

      (1) in subsection (d), by striking ‘3 years’ and inserting ‘5 years’;

      (2) in subsection (f), by striking ‘$10,000,000 in each of fiscal years 1990, 1991, and 1992’ and inserting ‘$30,000,000’; and

      (3) in subsection (g)(2), by striking ‘January 1, 1994’ and inserting ‘one year after the termination of the demonstration projects’.

    (b) EFFECTIVE DATE- The amendments made by subsection (a) shall take effect as if included in the enactment of OBRA-89.

SEC. 5147. OPTIONAL MEDICAID COVERAGE OF TB-RELATED SERVICES FOR CERTAIN TB-INFECTED INDIVIDUALS.

    (a) COVERAGE AS OPTIONAL, CATEGORICALLY NEEDY GROUP- Section 1902(a)(10)(A)(ii) (42 U.S.C. 1396a(a)(10)(A)(ii)) is amended--

      (1) by striking ‘or’ at the end of subclause (X),

      (2) by adding ‘or’ at the end of subclause (XI), and

      (3) by adding at the end the following new subclause:

            ‘(XII) who are described in subsection (z)(1) (relating to certain TB-infected individuals);’.

    (b) GROUP AND BENEFIT DESCRIBED- Section 1902 is amended by adding at the end the following new subsection:

    ‘(z)(1) Individuals described in this paragraph are individuals not described in subsection (a)(10)(A)(i)--

      ‘(A) who have tested positively to be infected with tuberculosis;

      ‘(B) whose income (as determined under the State plan under this title with respect to disabled individuals) does not exceed the maximum amount of income a disabled individual described in subsection (a)(10)(A)(i) may have and obtain medical assistance under the plan; and

      ‘(C) whose resources (as determined under the State plan under this title with respect to disabled individuals) do not exceed the maximum amount of resources a disabled individual described in subsection (a)(10)(A)(i) may have and obtain medical assistance under the plan.

    ‘(2) For purposes of subsection (a)(10), the term ‘TB-related services’ means each of the following services relating to treatment of infection with tuberculosis:

      ‘(A) Prescribed drugs.

      ‘(B) Physicians’ services and services described in section 1905(a)(2).

      ‘(C) Laboratory and X-ray services.

      ‘(D) Clinic services and Federally-qualified health center services.

      ‘(E) Case management services (as defined in section 1915(g)(2)).

      ‘(F) Services (other than room and board) designed to encourage completion of regimens of prescribed drugs by outpatients, including services to observe directly the intake of prescribed drugs.’.

    (c) LIMITATION ON BENEFITS- Section 1902(a)(10), as amended by section 5162(a), is amended, in the matter following subparagraph (F)--

      (1) by striking ‘, and (XII)’ and inserting ‘, (XII)’, and

      (2) by inserting before the semicolon at the end the following: ‘, and (XIII) the medical assistance made available to an individual described in subsection (z)(1) who is eligible for medical assistance only because of subparagraph (A)(ii)(XII) shall be limited to medical assistance for TB-related services (as defined in subsection (z)(2))’.

    (d) CONFORMING EXPANSION OF CASE MANAGEMENT SERVICES OPTION- Section 1915(g)(1) (42 U.S.C. 1396n(g)(1)) is amended by inserting ‘or to individuals described in section 1902(z)(1)(A),’ after ‘or with either,’.

    (e) CONFORMING AMENDMENT- Section 1905(a) (42 U.S.C. 1396d(a)) is amended--

      (1) by striking ‘or’ at the end of clause (ix),

      (2) by adding ‘or’ at the end of clause (x),

      (3) by inserting after clause (x) the following new clause:

      ‘(xi) individuals described in section 1902(z)(1),’, and

      (4) by amending paragraph (19) to read as follows:

      ‘(19) case management services (as defined in section 1915(g)(2)) and TB-related services described in section 1902(z)(2)(F);’.

    (f) EFFECTIVE DATE- The amendments made by this section shall apply to medical assistance furnished on or after January 1, 1994, without regard to whether or not final regulations to carry out such amendments have been promulgated by such date.

SEC. 5148. APPLICATION OF MAMMOGRAPHY CERTIFICATION REQUIREMENTS UNDER THE MEDICAID PROGRAM.

    (a) IN GENERAL- Section 1902(a)(9) (42 U.S.C. 1396a(a)(9)) is amended--

      (1) by striking ‘and’ at the end of subparagraph (B),

      (2) by striking the semicolon at the end of subparagraph (C) and inserting ‘, and’, and

      (3) by adding at the end the following new subparagraph:

        ‘(D) that any mammography paid for under such plan must be conducted by a facility that has a certificate (or provisional certificate) issued under section 354 of the Public Health Service Act;’.

    (b) EFFECTIVE DATE- (1) Except as provided in paragraph (2), the amendments made by subsection (a) shall apply to mammography furnished by a facility during calendar quarters beginning on or after the first date that the certificate requirements of section 354(b) of the Public Health Service Act apply to such mammography conducted by such facility, without regard to whether or not final regulations to carry out such amendments have been promulgated by such date.

    (2) In the case of a State plan for medical assistance under title XIX of the Social Security Act which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirement imposed by the amendment made by subsection (a)(3), the State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet this additional requirement before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of the enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of such session shall be deemed to be a separate regular session of the State legislature.

SEC. 5149. REMOVAL OF SUNSET ON EXTENSION OF ELIGIBILITY FOR WORKING FAMILIES.

    Subsection (f) of section 1925 (42 U.S.C. 1396r-6) is repealed.

SEC. 5150. EXTENSION OF MORATORIUM ON TREATMENT OF CERTAIN FACILITIES AS INSTITUTIONS FOR MENTAL DISEASES.

    Effective as if included in the enactment of OBRA-1989, section 6408(a)(3) of such Act is amended by striking ‘180 days’ and all that follows and inserting ‘December 31, 1995.’.

SEC. 5150A. TREATMENT OF CERTAIN CLINICS AS FEDERALLY-QUALIFIED HEALTH CENTERS.

    (a) IN GENERAL- Section 1905(l)(2)(B) (42 U.S.C. 1396d(l)(2)(B)), as amended by section 5158(c), is amended--

      (1) by striking ‘or’ at the end of clause (ii)(II),

      (2) by adding ‘or’ at the end of clause (iii), and

      (3) by inserting after clause (iii) the following new clause:

      ‘(iv) was treated by the Secretary, for purposes of part B of title XVIII, as a comprehensive Federally funded health center as of January 1, 1990;’.

    (b) EFFECTIVE DATE- The amendments made by subsection (a) shall apply to calendar quarters beginning on or after July 1, 1993.

SEC. 5150B. NURSING HOME REFORM.

    (a) SUSPENSION OF DECERTIFICATION OF NURSE AIDE TRAINING AND COMPETENCY EVALUATION PROGRAMS BASED ON EXTENDED SURVEYS-

      (1) IN GENERAL- Section 1919(f)(2)(B)(iii)(I)(b) (42 U.S.C. 1396r(f)(2)(B)(iii)(I)(b)) is amended by striking the semicolon and inserting the following: ‘, unless the survey shows that the facility is in compliance with the requirements of subsections (b), (c), and (d) of this section;’.

      (2) EFFECTIVE DATE- The amendment made by paragraph (1) shall take effect as included in the enactment of OBRA-1990.

    (b) REQUIREMENTS FOR CONSULTANTS CONDUCTING REVIEWS OF USE OF DRUGS-

      (1) IN GENERAL- Section 1919(c)(1)(D) (42 U.S.C. 1396r(c)(1)(D)) is amended by adding at the end the following sentence: ‘In determining whether such a consultant is qualified to conduct reviews under the previous sentence, the Secretary shall take into account the needs of nursing facilities under this title to have access to the services of such a consultant on a timely basis.’.

      (2) EFFECTIVE DATE- The amendment made by paragraph (1) shall take effect as included in the enactment of OBRA-1987.

    (c) INCREASE IN MINIMUM AMOUNT REQUIRED FOR SEPARATE DEPOSIT OF PERSONAL FUNDS-

      (1) IN GENERAL- Section 1919(c)(6)(B)(i) (42 U.S.C. 1396r(c)(6)(B)(i)) is amended by striking ‘$50’ and inserting ‘$100’.

      (2) EFFECTIVE DATE- The amendment made by paragraph (1) shall take effect October 1, 1993.

    (d) DUE PROCESS PROTECTIONS FOR NURSE AIDES-

      (1) PROHIBITING STATE FROM INCLUDING UNDOCUMENTED ALLEGATIONS IN NURSE AIDE REGISTRY- Section 1919(e)(2)(B) (42 U.S.C. 1396r(e)(2)(B)) is amended by striking the period at the end of the first sentence and inserting the following: ‘, but shall not include any allegations of resident abuse or neglect or misappropriation of resident property that are not specifically documented by the State under such subsection.’.

      (2) DUE PROCESS REQUIREMENTS FOR REBUTTING ALLEGATIONS- Section 1919(g)(1)(C) (42 U.S.C. 1396r(g)(1)(C)) is amended by striking the second sentence and inserting the following: ‘The State shall, after providing the individual involved with a written notice of the allegations (including a statement of the availability of a hearing for the individual to rebut the allegations) and the opportunity for a hearing on the record, make a written finding as to the accuracy of the allegations.’.

      (3) EFFECTIVE DATE- The amendments made by this subsection shall take effect October 1, 1993.

Subchapter C--Miscellaneous and Technical Corrections Relating to OBRA-1990

SEC. 5151. EFFECTIVE DATE.

    Except as otherwise provided, the amendments made by this subchapter shall take effect as if included in the enactment of OBRA-1990.

SEC. 5152. CORRECTIONS RELATING TO SECTION 4402 (ENROLLMENT UNDER GROUP HEALTH PLANS).

    Section 4402(b) of OBRA-1990 is amended by striking ‘1903(u)(1)(C)(iv) (42 U.S.C. 1396b(u)(1)(C)(iv))’ and inserting ‘1903(u)(1)(D)(iv) (42 U.S.C. 1396b(u)(1)(D)(iv))’.

SEC. 5153. CORRECTIONS RELATING TO SECTION 4501 (LOW-INCOME MEDICARE BENEFICIARIES).

    (a) Section 1902(a)(10)(E)(iii), as added by section 4501(b)(3) of OBRA-1990, is amended by striking ‘cost sharing’ and inserting ‘cost-sharing’.

    (b) Section 1905(p)(4)(B), as amended by section 4501(c)(1) of OBRA-1990, is amended by striking ‘1902(a)(10)(E)(iii)’ and inserting ‘section 1902(a)(10)(E)(iii)’.

SEC. 5154. CORRECTIONS RELATING TO SECTION 4601 (CHILD HEALTH).

    (a) Section 1902(a)(10)(A)(i)(VII), as added by section 4601(a)(10)(A)(iii) of OBRA-1990, is amended by striking ‘family;’ and inserting ‘family; and’.

    (b) Section 1902(l), as amended by section 4601(a)(1)(C) of OBRA-1990, is amended--

      (1) in paragraph (1)(C), by striking ‘children’ after ‘(C)’;

      (2) in paragraph (3), by striking ‘(a)(10)(A)(i)(VII),,’ and inserting ‘(a)(10)(A)(i)(VII),’; and

      (3) in paragraph (4)(B), by inserting a comma before ‘(a)(10)(A)(i)(VI),’.

    (c) Subsections (a)(3)(C) and (b)(3)(C)(i) of section 1925, as amended by section 4601(a) of OBRA-1990, are each amended by striking ‘(i)(VI)’ and inserting ‘(i)(VI),’.

SEC. 5155. CORRECTIONS RELATING TO SECTION 4602 (OUTREACH LOCATIONS).

    (a) Section 1902(a)(55), as added by section 4602(a)(3) of OBRA-1990, is amended--

      (1) in the matter preceding subparagraph (A)--

        (A) by striking ‘subsection’ and inserting ‘paragraph’, and

        (B) by striking ‘(a)’ each place it appears; and

      (2) in subparagraph (A), by striking ‘1905(1)(2)(B)’ and inserting ‘1905(l)(2)(B)’.

    (b) Section 1902(l)(1) is amended by striking ‘who are not described in any of subclauses (I) through (III) of subsection (a)(10)(A)(i) and’.

SEC. 5156. CORRECTIONS RELATING TO SECTION 4604 (PAYMENT FOR HOSPITAL SERVICES FOR CHILDREN UNDER 6 YEARS OF AGE).

    (a) Section 1902(a)(10) is amended in clause (X) in the matter following subparagraph (F) by striking ‘under one year of age’ and inserting ‘under 6 years of age’.

    (b) Section 1902(s), as added by section 4604(a) of OBRA-1990, is amended to read as follows:

    ‘(s) In order to meet the requirements of subsection (a)(56), the State plan must provide that payments to hospitals under the plan for inpatient services furnished to infants who have not attained the age of 1 year (or, in the case of such an individual who is an inpatient on his first birthday, until such individual is discharged) shall--

      ‘(1) if made on a prospective basis (whether per diem, per case, or otherwise) provide for an outlier adjustment in payment amounts for medically necessary inpatient hospital services involving exceptionally high costs or exceptionally long lengths of stay;

      ‘(2) not be limited by the imposition of day limits; and

      ‘(3) not be limited by the imposition of dollar limits (other than dollar limits resulting from prospective payments as adjusted pursuant to paragraph (1)).’.

    (c) Section 1923(a)(2)(C) is amended by striking ‘provided on or after July 1, 1989,’ and all that follows and inserting the following: ‘involving exceptionally high costs or exceptionally long lengths of stay--

      ‘(i) for individuals under 1 year of age, in the case of services provided on or after July 1, 1989, and on or before June 30, 1991; and

      ‘(ii) for individuals under 6 years of age, in the case of services provided on or after July 1, 1991.’.

SEC. 5157. CORRECTIONS RELATING TO SECTION 4703 (PAYMENT ADJUSTMENTS FOR DISPROPORTIONATE SHARE HOSPITALS).

    (a) Section 1923(c) is amended--

      (1) in paragraph (2), by striking ‘paragraph (b)(3)’ and inserting ‘subsection (b)(3)’;

      (2) by striking the period at the end of paragraph (3)(B) and inserting a comma; and

      (3) in the third sentence, by striking ‘the payment adjustment described in paragraph (2)’ and inserting ‘a payment adjustment described in paragraph (2) or (3)’.

    (b) Effective December 22, 1987, section 1923(d)(2)(A)(ii) is amended by striking ‘the date of the enactment of this Act’ and inserting ‘December 22, 1987’.

    (c) Section 4703(d) of OBRA-1990 is amended by striking ‘412(a)(2)’ and inserting ‘4112(a)(2)’.

SEC. 5158. CORRECTIONS RELATING TO SECTION 4704 (FEDERALLY-QUALIFIED HEALTH CENTERS).

    (a) Clause (ix) of section 1903(m)(2)(A), as added by section 4704(b)(1)(C) of OBRA-1990, is amended--

      (1) by striking ‘of such center’ the first place it appears;

      (2) by striking ‘federally qualified’ and inserting ‘Federally-qualified’;

      (3) by inserting ‘section’ before ‘1905(a)(2)(C)’; and

      (4) by moving such clause 2 ems to the left.

    (b) Section 1903(m)(2)(B), as amended by section 4704(b)(2) of OBRA-1990, is amended by striking ‘except with respect to clause (ix) of subparagraph (A),’ and inserting ‘(except with respect to clause (ix) of such subparagraph)’.

    (c) Section 1905(l)(2), as amended by section 4704(c) of OBRA-1990, is amended--

      (1) in subparagraph (A)--

        (A) by striking ‘Federally-qualififed’ and inserting ‘Federally-qualified’, and

        (B) by striking ‘an patient’ and inserting ‘a patient’; and

      (2) in subparagraph (B)--

        (A) in the matter preceding clause (i), by striking ‘a entity’ and inserting ‘an entity’,

        (B) by striking ‘or’ at the end of clause (i),

        (C) by striking the semicolon at the end of clause (ii)(II) and inserting ‘, or’,

        (D) by moving clause (ii) 4 ems to the left, and

        (E) in the last sentence, by striking ‘clause (ii)’ and inserting ‘clause (iii)’.

SEC. 5159. CORRECTIONS RELATING TO SECTION 4708 (SUBSTITUTE PHYSICIANS).

    Section 1902(a)(32)(C), as added by section 4708(a)(3) of OBRA-1990, is amended to read as follows:

        ‘(C) payment may be made to a physician for physicians’ services (and services furnished incident to such services) furnished by a second physician to patients of the first physician if (i) the first physician is unavailable to provide the services; (ii) the services are furnished pursuant to an arrangement between the two physicians that (I) is informal and reciprocal, or (II) involves per diem or other fee-for-time compensation for such services; (iii) the services are not provided by the second physician over a continuous period of more than 60 days; and (iv) the claim form submitted to the carrier for such services includes the second physician’s unique identifier (provided under the system established under subsection (x)) and indicates that the claim meets the requirements of this clause for payment to the first physician.’.

SEC. 5160. CORRECTIONS RELATING TO SECTION 4711 (HOME AND COMMUNITY CARE FOR FRAIL ELDERLY).

    (a) Section 1929, as added by section 4711(b) of OBRA-1990, is amended--

      (1) in subsection (c)(2)(F), by moving the second sentence 2 ems to the right;

      (2) in subsection (d)(2)(F)(ii), by striking ‘they manage’ and inserting ‘it manages’;

      (3) in subsection (d)(2)(F)(iii), by inserting ‘the agency or organization’ after ‘(iii)’;

      (4) in subsection (e)(2)(B), by striking ‘fiscal year 1989’ and inserting ‘fiscal year 1990’;

      (5) in subsection (f)(1), by striking ‘Community care’ and inserting ‘community care’;

      (6) in subsection (g)(1)--

        (A) by striking ‘SETTINGS’ and inserting ‘SETTING’, and

        (B) in subparagraph (B), by striking ‘setting.’ and inserting ‘setting in which home and community care under this section is provided.’;

      (7) in subsection (g)(2), by striking ‘community care’ the second, third, and fourth places it appears and inserting ‘home and community care’;

      (8) in subsection (h)(1)--

        (A) by striking ‘more than 8’ each place it appears and inserting ‘8 or more’, and

        (B) in subparagraph (B), by inserting ‘(other than merely board)’ after ‘personal services’;

      (9) in subsection (h)(2), by striking ‘community care’ the second and third places it appears and inserting ‘home and community care’;

      (10) in subsection (j)(1)--

        (A) in subparagraph (B)(ii), by striking ‘1990’ and inserting ‘1991’, and

        (B) by adding at the end the following new subparagraph:

        ‘(C) APPLICABILITY TO COMMUNITY CARE SETTINGS- Subparagraphs (A) and (B) shall apply to community care settings in the same manner as such subparagraphs apply to providers of home or community care.’;

      (11) in subsection (j)(2), by adding at the end the following new subparagraph:

        ‘(D) APPLICABILITY TO COMMUNITY CARE SETTINGS- Subparagraphs (A), (B), and (C) shall apply to community care settings in the same manner as such subparagraphs apply to providers of home or community care.’;

      (12) in subsection (k)(1)(A)(i)--

        (A) by striking ‘(d)(2)(E)’ and inserting ‘(d)(2)’, and

        (B) by striking ‘settings,’ and inserting ‘settings),’;

      (13) in subsection (l), by striking ‘State wideness’ and inserting ‘Statewideness’;

      (14) in subsection (m)--

        (A) in paragraph (2), by striking ‘Individual Community Care Plan’ and inserting ‘individual community care plan’,

        (B) in paragraph (3), by striking ‘and need for services’ and inserting ‘need for services, and income’,

        (C) in the second sentence in paragraph (4), by striking ‘elderly individuals’ and all that follows and inserting ‘individuals receiving home and community care under this section who reside in such State in relation to the total number of individuals receiving home and community care under this section.’, and

        (D) by adding at the end the following new paragraph:

      ‘(5) NOTICE TO STATES OF AMOUNTS AVAILABLE FOR ASSISTANCE-

        ‘(A) NOTICE TO SECRETARY- In order to receive Federal medical assistance for expenditures for home and community care under this section for a fiscal year (beginning with fiscal year 1994), a State shall submit a notice to the Secretary of its intention to provide such care under this section not later than 3 months before the beginning of the fiscal year.

        ‘(B) NOTICE TO STATES- Not later than 2 months before the beginning of each fiscal year (beginning with fiscal year 1994), the Secretary shall notify each State that has submitted a notice to the Secretary under subparagraph (A) for the fiscal year of the amount of Federal medical assistance that will be available to the State for the fiscal year (as established under paragraph (4)).’; and

      (15) by adding at the end the following new subsection:

    ‘(n) COMMUNITY CARE SETTING DEFINED- In this section, the term ‘community care setting’ means a small community care setting (as defined in subsection (g)(1)) or a large community care setting (as defined in subsection (h)(1)).’.

    (b) Section 1905(r)(5) is amended by striking ‘1905(a)’ and inserting ‘subsection (a) (other than services described in paragraph (22) or (23) of such subsection)’.

    (c) Section 4711(f) of OBRA-1990 is amended by striking ‘Act’ each place it appears and inserting ‘section’.

SEC. 5161. CORRECTIONS RELATING TO SECTION 4712 (COMMUNITY SUPPORTED LIVING ARRANGEMENTS SERVICES).

    (a) Section 1930, as added by section 4712(b)(2) of OBRA-1990, is amended--

      (1) in subsection (b)--

        (A) by striking ‘title the term,’ and inserting ‘title, the term’,

        (B) by striking ‘guardian’ and inserting ‘guardian or’, and

        (C) by striking ‘3 other’ and inserting ‘3’;

      (2) in subsection (d)--

        (A) in the matter preceding paragraph (1), by striking ‘program,’ and inserting ‘program’, and

        (B) in the second sentence, by striking ‘plan’ each place it appears and inserting ‘program’; and

      (3) in subsection (i), by striking ‘FUNDS’ and inserting ‘FUNDS’.

    (b) Section 4712(c) of OBRA-1990 is amended--

      (1) in paragraph (1), by inserting ‘of section 1930 of the Social Security Act’ after ‘subsection (h)’; and

      (2) in paragraph (2), by striking ‘this section’ and inserting ‘such section’.

SEC. 5162. CORRECTION RELATING TO SECTION 4713 (COBRA CONTINUATION COVERAGE).

    (a) Section 1902(a)(10) is amended in the matter following subparagraph (F)--

      (1) by striking ‘; and (XI)’ and inserting ‘, (XI)’;

      (2) by striking ‘individuals, and (XI)’ and inserting ‘individuals, and (XII)’; and

      (3) by striking ‘COBRA continuation premiums’ and inserting ‘COBRA premiums’.

    (b) Section 1902(u)(3), as added by section 4713(a)(2) of OBRA-1990, is amended by striking ‘title VI’ and inserting ‘part 6 of subtitle B of title I’.

SEC. 5163. CORRECTION RELATING TO SECTION 4716 (MEDICAID TRANSITION FOR FAMILY ASSISTANCE).

    Section 4716(a) of OBRA-1990 is amended by striking ‘AMENDMENTS- Subsection (f) of section’ and inserting ‘IN GENERAL- Section’.

SEC. 5164. CORRECTIONS RELATING TO SECTION 4723 (MEDICAID SPENDDOWN OPTION).

    Section 1903(f)(2), as amended by section 4723(a) of OBRA-1990, is amended--

      (1) by striking ‘(A)’ after ‘(2)’;

      (2) by striking ‘or, (B)’ and inserting ‘. There shall also be excluded,’;

      (3) by striking ‘to the State, provided that’ and inserting ‘to the State if’; and

      (4) by striking ‘pursuant to this subparagraph.’ and inserting ‘pursuant to the previous sentence’.

SEC. 5165. CORRECTIONS RELATING TO SECTION 4724 (OPTIONAL STATE DISABILITY DETERMINATIONS).

    Section 1902(v), as added by section 4724 of OBRA-1990, is amended--

      (1) by striking ‘(v)(1)’ and inserting ‘(v)’; and

      (2) by striking ‘of the Social Security Act’.

SEC. 5166. CORRECTION RELATING TO SECTION 4732 (SPECIAL RULES FOR HEALTH MAINTENANCE ORGANIZATIONS).

    Section 1903(m)(2)(F)(i), as amended by section 4732(b)(2)(B) of OBRA-1990, is amended by striking ‘or’ before ‘with an eligible organization’.

SEC. 5167. CORRECTIONS RELATING TO SECTION 4741 (HOME AND COMMUNITY-BASED WAIVERS).

    The first sentence of section 1915(d)(3) is amended by striking the period at the end and inserting the following: ‘, and a waiver of the requirements of section 1902(a)(23) (relating to choice of providers) insofar as such requirements relate to the provision of case management services and the State provides assurances satisfactory to the Secretary that a waiver of such requirements will not substantially limit access to such services).’

SEC. 5168. CORRECTIONS RELATING TO SECTION 4744 (FRAIL ELDERLY WAIVERS).

    (a) Section 1924(a)(5), as added by section 4744(b)(1) of OBRA-1990, is amended by striking ‘1986.’ and inserting ‘1986 or a waiver under section 603(c) of the Social Security Amendments of 1983.’.

    (b) Section 603(c) of the Social Security Amendments of 1983 is amended--

      (1) by striking ‘(c)’ and inserting ‘(c)(1)’;

      (2) by redesignating paragraphs (1) and (2) as subparagraphs (A) and (B); and

      (3) by adding at the end the following new paragraph:

    ‘(2) Section 1924 of the Social Security Act shall apply to any individual receiving services from an organization receiving a waiver under this subsection.’.

SEC. 5169. CORRECTIONS RELATING TO SECTION 4747 (COVERAGE OF HIV-POSITIVE INDIVIDUALS).

    Section 4747 of OBRA-1990 is amended--

      (1) in subsection (a), by striking ‘subsection (c)’ and inserting ‘subsection (b)’;

      (2) in subsection (b)(2)--

        (A) by striking ‘preventative’ each place it appears and inserting ‘preventive’, and

        (B) by adding a period at the end of subparagraph (J);

      (3) in subsection (c)(1)--

        (A) by striking ‘subsection (c)’ and inserting ‘subsection (b)’, and

        (B) by striking ‘paragraphs (1) and (2) of’; and

      (4) in subsection (d)--

        (A) by striking ‘paragraph (3)’ and inserting ‘subsection (b)’, and

        (B) by striking ‘paragraph (1)’ and inserting ‘subsection (a)’.

SEC. 5170. CORRECTION RELATING TO SECTION 4751 (ADVANCE DIRECTIVES).

    Section 1903(m)(1)(A), as amended by section 4751(b)(1) of OBRA-1990, is amended--

      (1) by striking ‘1902(w)’ and inserting ‘1902(w) and’; and

      (2) by striking ‘1902(a)’ and inserting ‘1902(w)’.

SEC. 5171. CORRECTIONS RELATING TO SECTION 4752 (PHYSICIANS’ SERVICES).

    (a) The paragraph (58) of section 1902(a) added by section 4752(c)(1)(C) of OBRA-1990 is amended by striking ‘subsection (v)’ and inserting ‘subsection (x)’.

    (b) Subparagraphs (A) and (B) of the paragraph (14) of section 1903(i) added by section 4752(e)(2) of OBRA-1990 are each amended--

      (1) by striking ‘or’ at the end of clause (v);

      (2) by redesignating clause (vi) as clause (vii); and

      (3) by inserting after clause (v) the following new clause:

          ‘(vi) delivers such services in the emergency department of a hospital participating in the state plan approved under this title, or’.

SEC. 5172. CORRECTIONS RELATING TO SECTION 4801 (NURSING HOME REFORM).

    (a) Section 1919(b)(3)(C)(i)(I), as amended by section 4801(e)(3) of OBRA-1990, is amended by striking ‘no later than’ before ‘not to exceed 14 days’.

    (b) Section 1919(b)(5)(D), as amended by section 4801(a)(4) of OBRA-1990, is amended by striking the comma before ‘or a new competency evaluation program.’.

    (c) Section 1919(b)(5)(G) is amended by striking ‘or licensed or certified social worker’ and inserting ‘licensed or certified social worker, registered respiratory therapist, or certified respiratory therapy technician’.

    (d) Section 1919(f)(2)(B)(i) is amended by striking ‘facilities,’ and inserting ‘facilities (subject to clause (iii)),’.

    (e) Section 1919(f)(2)(B)(iii)(I)(c) is amended by striking ‘clauses’ each place it appears and inserting ‘clause’.

    (f) Section 1919(g)(5)(B) is amended by striking ‘paragraphs’ and inserting ‘paragraph’.

    (g) Section 4801(a)(6)(B) of OBRA-1990 is amended--

      (1) by striking ‘The amendments’ and inserting ‘(i) The amendments’;

      (2) by redesignating clauses (i) through (v) as subclauses (I) through (V); and

      (3) by adding at the end the following new clause:

        ‘(ii) Notwithstanding clause (i) and subject to section 1919(f)(2)(B)(iii) of the Social Security Act (as amended by subparagraph (A)), a State may approve a training and competency evaluation program or a competency evaluation program offered by or in a nursing facility described in clause (i) if, during the previous 2 years, none of the subclauses of clause (i) applied to the facility.’.

SEC. 5173. OTHER TECHNICAL CORRECTIONS.

    (a) Section 1905(o)(1)(A) is amended--

      (1) in the first sentence, by striking ‘intermediate care facility services’ and inserting ‘for nursing facility services or intermediate care facility services for the mentally retarded’; and

      (2) in the second sentence, by striking ‘or intermediate care facility’ and inserting ‘(for purposes of title XVIII), a nursing facility, or an intermediate care facility for the mentally retarded’.

    (b) Section 1915(d) is amended--

      (1) by striking ‘skilled nursing facility or intermediate care facility’ each place it appears in paragraphs (1), (2)(B), and (2)(C) and inserting ‘nursing facility’;

      (2) in paragraph (2)(B)(i), by striking ‘skilled nursing or intermediate care facility’ and inserting ‘nursing facility’;

      (3) in paragraph (5)(A), by striking ‘under’ the second place it appears and inserting ‘(or, in the case of waiver years beginning on or after October 1, 1990, with respect to nursing facility services and home and community-based services) under’; and

      (4) in paragraph (5)(B)--

        (A) in clause (i), by striking ‘furnished’ and inserting ‘(or, with respect to waiver years beginning on or after October 1, 1990, for nursing facility services) furnished’; and

        (B) in clause (iii)(I), by striking ‘(regardless’ and inserting ‘(or, with respect to waiver years beginning on or after October 1, 1990, which comprise nursing facility services) (regardless’.

SEC. 5174. CORRECTIONS TO DESIGNATIONS OF NEW PROVISIONS.

    (a) PARAGRAPHS ADDED TO SECTION 1902(a)- Section 1902(a) is amended--

      (1) by striking ‘and’ at the end of paragraph (54);

      (2) in the paragraph (55) inserted by section 4602(a)(3) of OBRA-1990, by striking the period at the end and inserting a semicolon;

      (3) by redesignating the paragraph (55) inserted by section 4604(b)(3) of OBRA-1990 as paragraph (56), by transferring and inserting it after the paragraph (55) inserted by section 4602(a)(3) of such Act, and by striking the period at the end and inserting a semicolon;

      (4) by placing paragraphs (57) and (58), inserted by section 4751(a)(1)(C) of OBRA-1990, immediately after paragraph (56), as redesignated by paragraph (3);

      (5) in the paragraph (58) inserted by section 4751(a)(1)(C) of OBRA-1990, by striking the period at the end and inserting ‘; and’; and

      (6) by redesignating the paragraph (58) inserted by section 4752(c)(1)(C) of OBRA-1990 as paragraph (59) and by transferring and inserting it after the paragraph (58) inserted by section 4751(a)(1)(C) of such Act.

    (b) PARAGRAPHS ADDED TO SECTION 1903(i)- Section 1903(i), as amended by section 2(b)(2) of the Medicaid Voluntary Contribution and Provider-Specific Tax Amendments of 1991, is amended--

      (1) in the paragraph (10) inserted by section 4401(a)(1)(B) of OBRA-1990, by striking all that follows ‘1927(g)’ and inserting a semicolon;

      (2) by redesignating the paragraph (12) inserted by section 4752(a)(2) of OBRA-1990 as paragraph (11), by transferring and inserting it after the paragraph (10) inserted by section 4401(a)(1)(B) of OBRA-1990, and by striking the period at the end and inserting a semicolon;

      (3) by redesignating the paragraph (14) inserted by section 4752(e) of OBRA-1990 as paragraph (12), by transferring and inserting it after paragraph (11), as redesignated by paragraph (2), and by striking the period at the end and inserting ‘; or’; and

      (4) by redesignating the paragraph (11) inserted by section 4801(e)(16)(A) of OBRA-1990 as paragraph (13) and by transferring and inserting it after paragraph (12), as redesignated by paragraph (3).

    (c) PARAGRAPHS ADDED TO SECTION 1905(a)-

      (1) IN GENERAL- Section 1905(a) is amended--

        (A) by striking ‘and’ at the end of paragraph (21);

        (B) in paragraph (24), by striking the period at the end and inserting ‘; and’; and

        (C) by redesignating paragraphs (22), (23), and (24) as paragraphs (24), (22), and (23), respectively, and by transferring and inserting paragraph (24) after paragraph (23), as so redesignated.

      (2) CONFORMING AMENDMENTS- (A) Effective July 1, 1991, section 1902(a)(10)(C)(iv), as amended by section 4755(c)(1)(A) of OBRA-1990, is amended by striking ‘through (21)’ and inserting ‘through (23)’.

      (B) Effective July 1, 1991, section 1902(j), as amended by section 4711(d)(1) of OBRA-1990, is amended by striking ‘through (22)’ and inserting ‘through (24)’.

    (d) FINAL SECTIONS- Section 1928, as redesignated by section 4401(a)(3) of OBRA-1990, is amended--

      (1) by transferring such section to the end of title XIX of the Social Security Act; and

      (2) by redesignating such section as section 1931.

CHAPTER 2--UNIVERSAL ACCESS TO CHILDHOOD IMMUNIZATIONS

SEC. 5181. ESTABLISHMENT OF ENTITLEMENT AND MONITORING PROGRAMS WITH RESPECT TO CHILDHOOD IMMUNIZATIONS.

    (a) IN GENERAL- Title XXI of the Public Health Service Act (42 U.S.C. 300aa-1 et seq.) is amended by adding at the end the following subtitle:

‘Subtitle 3--Entitlement and Monitoring Programs With Respect to Childhood Immunizations

‘PART A--ENTITLEMENT PROGRAM

‘SEC. 2151. DELIVERY TO STATES OF SUFFICIENT QUANTITIES OF PEDIATRIC VACCINES.

    ‘(a) IN GENERAL- In the case of any State that submits to the Secretary an application in accordance with section 2157, the Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall provide for the purchase and delivery on behalf of the State of such quantities of pediatric vaccines as may be necessary for the immunization of each eligible child in the State. The preceding sentence is subject to sections 2152(d) and 2159(a).

    ‘(b) ELIGIBLE CHILDREN- For purposes of this part, the term ‘eligible child’ means an individual 18 years of age or younger who--

      ‘(1) with respect to the State involved, is entitled to medical assistance under the plan approved for the State under title XIX of the Social Security Act (including a State operating under a statewide waiver under section 1115 of such Act);

      ‘(2)(A) is uninsured with respect to health insurance policies or plans (including group health plans or prepaid health plans and including employee welfare benefit plans under the Employee Retirement Income Security Act of 1974); or

      ‘(B) is covered under such a policy or plan, but under the policy or plan benefits are not available with respect to immunizations; or

      ‘(3) is an Indian.

‘SEC. 2152. ENTITLEMENTS.

    ‘(a) ENTITLEMENT OF STATES- Subject to subsection (d), in the case of any State that submits to the Secretary an application in accordance with section 2157, the State is entitled to have the Secretary provide for the purchase and delivery on behalf of the State of pediatric vaccines under section 2151. The preceding sentence constitutes budget authority in advance of appropriations Acts, and represents the obligation of the Federal Government to provide for the purchase and delivery to the State of the vaccines.

    ‘(b) ENTITLEMENTS OF CHILDREN AND HEALTH CARE PROVIDERS- Subject to subsection (d), the Secretary may provide for the purchase and delivery of pediatric vaccines under section 2151 on behalf of a State only if the State agrees as follows:

      ‘(1) Each eligible child in the State, in receiving an immunization with a pediatric vaccine from a program-registered provider (as defined in section 2153(a)), is entitled to receive the immunization without charge for the cost of such vaccine.

      ‘(2) Each program-registered provider in the State who administers a pediatric vaccine to an eligible child in the State is entitled to receive such vaccine from the State without charge.

      ‘(3) The State will carry out a program to administer the entitlements established pursuant to paragraphs (1) and (2).

    ‘(c) ENFORCEMENT OF PROVIDER RIGHTS BY ELIGIBLE CHILDREN- With respect to the obligation of a State under the entitlement established in subsection (b)(2), an eligible child (or representative of the child) may enforce the rights of the provider under such paragraph if--

      ‘(1) the provider administered a pediatric vaccine to the child notwithstanding the failure of the State to carry out such obligation with respect to the vaccine; or

      ‘(2) an immunization with the vaccine was sought for the child by a parent of the child, but the provider, on the basis of such failure of the State, did not administer the vaccine to the child.

    ‘(d) CERTAIN CONDITIONS-

      ‘(1) IN GENERAL- This part does not apply with respect to any vaccine administered before October 1, 1994.

      ‘(2) RELATIONSHIP TO PURCHASE CONTRACTS WITH MANUFACTURERS- With respect to a pediatric vaccine, the obligation of the Federal Government pursuant to subsection (a), and the obligations of the State pursuant to subsection (b), are effective only to the extent that there is in effect a contract under section 2158 for the purchase and delivery of the vaccine.

      ‘(3) SUBMISSION OF APPLICATION-

        ‘(A) Subject to subparagraph (C), the entitlements established pursuant to subsections (a) and (b) are established with respect to a State upon the State submitting to the Secretary an application in accordance with section 2157.

        ‘(B) An application submitted to the Secretary under section 2157 is deemed to have been submitted in accordance with such section unless the Secretary, not later than 30 days after the date on which the application is submitted, notifies the State that the application is not in accordance with such section.

        ‘(C) In the case of a State whose application submitted under section 2157 is not submitted in accordance with such section, the Secretary may, upon the submission by the State of an application that is in accordance with such section, provide that the entitlements established pursuant to such submission are deemed to have been established on the date on which the State first submitted the application.

‘SEC. 2153. VOLUNTARY PARTICIPATION OF HEALTH CARE PROVIDERS.

    ‘(a) IN GENERAL-

      ‘(1) REQUEST FOR PARTICIPATION; REQUIRED APPROVAL- The Secretary may provide for the purchase and delivery of pediatric vaccines under section 2151 on behalf of a State only if the State agrees that federally-supplied pediatric vaccines will not be distributed to a health care provider unless--

        ‘(A) the provider submits to the State a written request to participate in the program established by the State pursuant to section 2152(b)(3);

        ‘(B) the request is in such form and is made in such manner as the Secretary may require; and

        ‘(C) the provider makes the agreements described in this section.

      ‘(2) PROGRAM-REGISTERED PROVIDERS- For purposes of this part, the term ‘program-registered provider’ means a health care provider that meets the conditions specified in subparagraphs (A) through (C) of paragraph (1).

    ‘(b) ELIGIBILITY OF CHILDREN-

      ‘(1) IN GENERAL- An agreement for a health care provider under subsection (a) is that the provider--

        ‘(A) before administering a pediatric vaccine to a child, will ask a parent of the child such questions as are necessary to determine whether the child is an eligible child;

        ‘(B) will, for a period of time specified by the Secretary, maintain records of responses made to the questions; and

        ‘(C) will, upon request, make such records available to the State involved and to the Secretary, subject to paragraph (2).

      ‘(2) RESTRICTION ON USE OF INFORMATION- Records provided to a State or to the Secretary under paragraph (1)(C) may be used only for purposes of audit of the program carried out under section 2152(b)(3) by the State.

    ‘(c) CHARGES FOR VACCINES-

      ‘(1) VACCINES PER SE- An agreement for a health care provider under subsection (a) is that, in administering a federally-supplied pediatric vaccine to an eligible child, the provider will not impose a charge for the cost of the vaccine.

      ‘(2) ADMINISTRATION OF VACCINES- With respect to compliance with an agreement under paragraph (1), a program-registered provider may impose a charge for the administration of a federally-supplied pediatric vaccine, subject to an agreement by the provider that the provider will not impose such charge with respect to a child if a parent of the child certifies to the provider that the parent is unable to pay the charge.

    ‘(d) RULES OF CONSTRUCTION-

      ‘(1) EXTENT OF PARTICIPATION- This section may not be construed as requiring that a program-registered provider administer a federally-supplied pediatric vaccine to each eligible child for whom an immunization with the vaccine is sought from the provider.

      ‘(2) VERIFICATION OF INFORMATION- With respect to compliance with agreements under subsections (b) and (c), such agreements may not be construed as requiring a program-registered provider to verify independently the information provided to the provider by a parent pursuant to such subsections.

‘SEC. 2154. INTRASTATE DISTRIBUTION OF PEDIATRIC VACCINES.

    ‘(a) IN GENERAL- Not later than 180 days after the date of the enactment of the Omnibus Budget Reconciliation Act of 1993, the Secretary shall, through publication in the Federal Register, establish criteria for the delivery on behalf of the States of federally-supplied pediatric vaccines to program-registered providers in the State.

    ‘(b) INVOLVEMENT OF CERTAIN PROVIDERS-

      ‘(1) IN GENERAL- In establishing criteria under subsection (a), the Secretary shall establish criteria with respect to encouraging the entities described in paragraph (2) to become program-registered providers.

      ‘(2) RELEVANT PROVIDERS- The entities referred to in paragraph (1) are--

        ‘(A) private health care providers; and

        ‘(B)(i) health care providers that receive funds under title V of the Indian Health Care Improvement Act;

        ‘(ii) the Indian Health Service; and

        ‘(iii) health programs or facilities operated by Indian tribes or tribal organizations.

    ‘(c) CULTURAL CONTEXT OF SERVICES- In establishing criteria under subsection (a), the Secretary shall require that, in providing a federally-supplied pediatric vaccine to any population of eligible children a substantial portion of whose parents have a limited ability to speak the English language, a State have in effect a reasonable plan to administer the vaccines through program-registered providers who are able to communicate with the population involved in the language and cultural context that is most appropriate.

    ‘(d) COMPLIANCE BY STATES- The Secretary may provide for the purchase and delivery of pediatric vaccines under section 2151 on behalf of a State only if the State agrees to maintain compliance with the criteria established under subsection (a).

‘SEC. 2155. GENERAL PROVISIONS.

    ‘(a) FEDERAL STANDARDS ON ACCOUNTABILITY-

      ‘(1) ESTABLISHMENT OF STANDARDS- Not later than 180 days after the date of the enactment of the Omnibus Budget Reconciliation Act of 1993, the Secretary shall, through publication in the Federal Register, establish standards with respect to determining the extent to which States and program-registered providers are in compliance with the agreements made under this part.

      ‘(2) COMPLIANCE BY STATES- The Secretary may provide for the purchase and delivery of pediatric vaccines under section 2151 on behalf of a State only if the State agrees to maintain compliance with the standards established under subsection (a).

    ‘(b) STATE MAINTENANCE OF IMMUNIZATION LAWS- The Secretary may provide for the purchase and delivery of vaccines under section 2151 on behalf of a State only if the State certifies to the Secretary that, if it had in effect as of May 1, 1993, a law that requires some or all health insurance policies or plans to provide some coverage with respect to a pediatric vaccine, the State has not modified or repealed such law in a manner that reduces the amount of coverage so required.

    ‘(c) PARTICIPATION IN NATIONAL MONITORING SYSTEM- On and after January 1, 1998, the Secretary may provide for the purchase and delivery of vaccines under section 2151 on behalf of a State only if the State certifies to the Secretary that the State is operating a registry in accordance with part B.

‘SEC. 2156. STATE OPTION REGARDING IMMUNIZATION OF ADDITIONAL CATEGORIES OF CHILDREN.

    ‘(a) STATE PURCHASES- Subject to subsections (b) and (c), for the purpose of administering a pediatric vaccine to children in addition to eligible children, any participating State under section 2151 may, pursuant to section 2158(a)(2), purchase the vaccine from a manufacturer of the vaccine at the price in effect under section 2158.

    ‘(b) REQUIREMENTS- A State may purchase pediatric vaccines pursuant to subsection (a) only if the following conditions are met:

      ‘(1) The State agrees that the vaccines will be used to provide immunizations for children who are not eligible children.

      ‘(2) The State designates the particular categories of children who are to receive the immunizations, and submits to the Secretary a description of the categories so designated.

      ‘(3) The State provides to the Secretary such information as the Secretary determines to be necessary to provide for quantities of pediatric vaccines for the State to purchase pursuant to section 2158(a)(2).

      ‘(4) The State agrees, subject to subsection (c), that the program established by the State pursuant to section 2152(b)(3) applies to children designated under paragraph (2) to the same extent and in the same manner as the program applies to eligible children (except for the State being the purchaser of the pediatric vaccines involved).

    ‘(c) CERTAIN LIMITATIONS- A State may purchase pediatric vaccines pursuant to subsection (a) only if the State agrees as follows:

      ‘(1) The authorization established in such subsection with respect to a pediatric vaccine is subject to the quantity of the vaccine that, on behalf of the State, the Secretary provides for under section 2158(a)(2).

      ‘(2) In any case in which multiple contracts are in effect under section 2158 with respect to such a vaccine and the State elects to purchase the vaccine pursuant to subsection (a), the Secretary will determine which of such contracts will be applicable to the purchase.

‘SEC. 2157. STATE APPLICATION FOR VACCINES.

    ‘(a) IN GENERAL- An application by a State for pediatric vaccines under section 2151(a) is in accordance with this section if the application--

      ‘(1) is submitted not later than the date specified by the Secretary;

      ‘(2) contains each agreement required in this part (including the agreements required in section 2156, if the State is electing to purchase pediatric vaccines pursuant to such section);

      ‘(3) contains any information required in this part to be submitted to the Secretary (including the information required in section 2156, if the State is electing to purchase pediatric vaccines pursuant to such section);

      ‘(4) contains the certification required in subsection (b) of section 2155 and, as applicable, the certification required in subsection (c) of such section; and

      ‘(5) is in such form, is made in such manner, and contains such agreements, assurances, and information as the Secretary determines to be necessary to carry out this part.

    ‘(b) FAILURE TO APPLY-

      ‘(1) IN GENERAL- If, as of January 1, 1998, a State is not receiving pediatric vaccines under section 2151 and carrying out a program pursuant to section 2152(b)(3), the Secretary shall, subject to paragraph (2), terminate payments to the State under part A of title XIX.

      ‘(2) EXCEPTIONS- Paragraph (1) does not apply in the case of a State described in such paragraph that--

        ‘(A) is, through all willing health care providers, providing for the immunization of eligible children with pediatric vaccines, and is not imposing a charge on such providers or children for the costs of the vaccines; or

        ‘(B) meets or exceeds the objectives established by the Secretary for the year 2000 for the immunization status of children in the United States who are 2 years of age.

‘SEC. 2158. CONTRACTS WITH MANUFACTURERS OF PEDIATRIC VACCINES.

    ‘(a) IN GENERAL- Subject to the provisions of this section, the Secretary shall periodically enter into negotiations with manufacturers of pediatric vaccines for the purpose of maintaining contracts under which--

      ‘(1) the Secretary provides for the purchase of quantities of pediatric vaccines necessary for carrying out section 2151, and provides for the delivery of the vaccines to participating States under such section; and

      ‘(2) each participating State, at the option of the State under section 2156, is permitted to obtain additional quantities of pediatric vaccines (subject to limits in such contracts regarding quantities) through purchasing the vaccines from the manufacturers at the price negotiated by the Secretary for the quantities specified in paragraph (1).

    The Secretary shall enter into the initial negotiations under the preceding sentence not later than 180 days after the date of the enactment of the Omnibus Budget Reconciliation Act of 1993.

    ‘(b) NEGOTIATION OF PURCHASE PRICE-

      ‘(1) IN GENERAL- In negotiating the prices at which pediatric vaccines will be purchased from a manufacturer under subsection (a), the Secretary shall negotiate a price that provides a reasonable profit for the manufacturer.

      ‘(2) CERTAIN FACTORS-

        ‘(A) In determining a reasonable profit for a manufacturer under paragraph (1), the Secretary shall consider the following factors:

          ‘(i) The costs of the manufacturer in researching, developing, and producing the pediatric vaccine involved.

          ‘(ii) The costs of the manufacturer in researching and developing new or improved vaccines (pediatric or otherwise).

          ‘(iii) The costs of shipping and handling pediatric vaccines in compliance with the agreement under subsection (c).

          ‘(iv) Such other factors as the Secretary determines to be appropriate.

        ‘(B) With respect to factors considered under subparagraph (A), the Secretary may enter into a contract under subsection (a) only if the manufacturer involved provides to the Secretary such information regarding the factors as the Secretary determines to be appropriate.

      ‘(3) CONFIDENTIALITY- With respect to information provided to the Secretary by a manufacturer under paragraph (2), the following applies:

        ‘(A) The Secretary shall maintain the confidentiality of the information, with provision for reasonable disclosures.

        ‘(B) For purposes of section 552(b)(4) of title 5, United States Code, the information shall be considered to be trade secrets and commercial or financial information obtained from a person and privileged or confidential.

        ‘(C) Section 1905 of title 18, United States Code, applies to information maintained confidentially under subparagraph (A).

    ‘(c) CHARGES FOR SHIPPING AND HANDLING- The Secretary may enter into a contract under subsection (a) only if the manufacturer involved agrees that the manufacturer will provide for delivering the vaccines on behalf of the States in accordance with the programs established by the States pursuant to section 2152(b)(3), and will not impose any charges for the costs of such delivery (except to the extent such costs are provided for in the price negotiated under subsection (b)).

    ‘(d) QUANTITY OF VACCINES- For the purpose of ensuring that the Federal Government has the ability to carry out section 2151, the Secretary, in negotiations under subsection (a), shall negotiate for maintaining a supply of pediatric vaccines to meet unanticipated needs for the vaccines. For purposes of the preceding sentence, the Secretary shall negotiate for a 6-month supply of vaccines in addition to the quantity that the Secretary otherwise would provide for in such negotiations. In carrying out this paragraph, the Secretary shall consider the potential for outbreaks of the diseases with respect to which the vaccines have been developed.

    ‘(e) NEGOTIATING AUTHORITY OF SECRETARY- In carrying out subsection (a), the Secretary, to the extent determined by the Secretary to be appropriate, may enter into contracts described in such subsection, may decline to enter into such contracts, and with the consent of the manufacturers involved, may modify such agreements and may extend such agreements.

    ‘(f) CERTAIN CONTRACT PROVISIONS-

      ‘(1) DURATION- A contract entered into by the Secretary under subsection (a) is effective for such period as the Secretary and the manufacturer involved may agree in the contract.

      ‘(2) ADVANCE FUNDING- The Secretary may, pursuant to section 2152(a), enter into contracts under subsection (a) under which the Federal Government is obligated to make outlays, the budget authority for which is not provided for in advance in appropriations Acts.

    ‘(g) REPORTS TO SECRETARY- The Secretary may enter into a contract under subsection (a) only if the manufacturer involved agrees to submit to the Secretary such reports as the Secretary determines to be appropriate with respect to compliance with the contract. For purposes of paragraph (3) of subsection (b), such reports shall be considered to be information provided by the manufacturer to the Secretary under paragraph (2) of such subsection.

    ‘(h) MULTIPLE SUPPLIERS-

      ‘(1) IN GENERAL- In the case of the pediatric vaccine involved, the Secretary shall, as appropriate, enter into a contract under subsection (a) with each manufacturer of the vaccine that meets the terms and conditions of the Secretary for an award of such a contract (including terms and conditions regarding safety, quality, and price).

      ‘(2) RULE OF CONSTRUCTION- With respect to multiple contracts entered into pursuant to paragraph (1), such paragraph may not be construed as prohibiting the Secretary from having in effect different prices under each of such contracts.

‘SEC. 2159. CERTAIN ADMINISTRATIVE VARIATIONS.

    ‘(a) TRIBES AND TRIBAL ORGANIZATIONS-

      ‘(1) IN GENERAL- Subject to paragraph (2), the Secretary shall provide for the purchase and delivery on behalf of each Indian tribe and each tribal organization of such quantities of pediatric vaccines as may be necessary for the immunization of each Indian child in the State in which the tribe or organization (as the case may be) is located.

      ‘(2) ENTITLEMENTS; ADMINISTERING PROGRAM- The Secretary may provide for the purchase and delivery of pediatric vaccines under paragraph (1) on behalf of an Indian tribe or tribal organization only if the tribe or organization (as the case may be) agrees that this part applies to the tribe or organization (in relation to Indian children) to the same extent and in the manner as such part applies to States (in relation to eligible children).

    ‘(b) STATE AS MANUFACTURER-

      ‘(1) PAYMENTS IN LIEU OF VACCINES- In the case of a participating State under section 2151 that manufactures a pediatric vaccine and is not receiving the vaccine under such section, if the Secretary determines that the program of the State under 2152(b)(3) is carried out with respect to the vaccine, the Secretary shall provide to the State an amount equal to the value of the quantity of such vaccine that otherwise would have been delivered to the State under section 2151, subject to the provisions of this subsection.

      ‘(2) DETERMINATION OF VALUE- In determining the amount to pay a State under paragraph (1) with respect to a pediatric vaccine, the value of the quantity of vaccine shall be determined on the basis of the price in effect for the vaccine under contracts under section 2158. If more than 1 such contract is in effect, the Secretary shall determine such value on the basis of the average of the prices under the contracts, after weighting each such price in relation to the quantity of vaccine under the contract involved.

      ‘(3) USE OF PAYMENTS- A State may expend payments received under paragraph (1) only for purposes relating to pediatric vaccines.

‘SEC. 2160. LIST OF PEDIATRIC VACCINES; SCHEDULE FOR ADMINISTRATION.

    ‘(a) RECOMMENDED PEDIATRIC VACCINES-

      ‘(1) IN GENERAL- The Secretary shall establish a list of the vaccines that the Secretary recommends for administration to all children for the purpose of immunizing the children, subject to such contraindications for particular medical categories of children as the Secretary may establish under subsection (b)(1)(D). The Secretary shall periodically review the list, and shall revise the list as appropriate.

      ‘(2) RULE OF CONSTRUCTION-

        ‘(A) The list of vaccines specified in subparagraph (B) is deemed to be the list of vaccines maintained under paragraph (1).

        ‘(B) The list of vaccines specified in this subparagraph is the list of vaccines that, for purposes of paragraph (1), is established (and periodically reviewed and as appropriate revised) by the Advisory Committee on Immunization Practices, an advisory committee established by the Secretary, acting through the Director of the Centers for Disease Control and Prevention.

    ‘(b) RECOMMENDED SCHEDULE FOR ADMINISTRATION-

      ‘(1) IN GENERAL- Subject to paragraph (2), in the case of a pediatric vaccine, the Secretary shall establish (and periodically review and as appropriate revise) a schedule of nonbinding recommendations for the following:

        ‘(A) The number of immunizations with the vaccine that children should receive.

        ‘(B) The ages at which children should receive the immunizations.

        ‘(C) The dosage of vaccine that should be administered in the immunizations.

        ‘(D) Any contraindications regarding administration of the vaccine to particular medical categories of children.

        ‘(E) Such other guidelines as the Secretary determines to be appropriate with respect to administering the vaccine to children.

      ‘(2) VARIATIONS IN MEDICAL PRACTICE- In establishing and revising a schedule under paragraph (1), the Secretary shall ensure that, in the case of the pediatric vaccine involved, the schedule provides for the full range of variations in medical judgment regarding the administration of the vaccine, subject to remaining within medical norms.

      ‘(3) RULE OF CONSTRUCTION-

        ‘(A) The schedule specified in subparagraph (B) is deemed to be the schedule maintained under paragraph (1).

        ‘(B) The schedule specified in this subparagraph is the schedule that, for purposes of paragraph (1), is established (and periodically reviewed and as appropriate revised) by the advisory committee specified in subsection (a)(2)(B).

    ‘(c) GENERALLY APPLICABLE RULES OF CONSTRUCTION-

      ‘(1) IN GENERAL- The list established under subsection (a) and the schedules established under subsection (b) do not constitute guidelines, standards, performance measures, or review criteria for purposes of the program carried out by the Administrator for Health Care Policy and Research under part B of title IX or under section 1142 of the Social Security Act.

      ‘(2) STATE LAWS- This section does not supersede any State law on requirements with respect to receiving immunizations (including any such law relating to religious exemptions or medical exemptions).

    ‘(d) ISSUANCE OF LIST AND SCHEDULES- Not later than 180 days after the date of the enactment of the Omnibus Budget Reconciliation Act of 1993, the Secretary shall establish the initial list required in subsection (a) and the schedule required in subsection (b).

‘SEC. 2161. CHILDHOOD IMMUNIZATION TRUST FUND.

    ‘(a) ESTABLISHMENT OF FUND- There is established in the Treasury of the United States a fund to be known as the National Childhood Immunization Trust Fund (in this section referred to as the ‘Fund’). The Fund shall consist of such amounts as may be appropriated to the Fund in appropriations Acts, in the Internal Revenue Code of 1986, or in subsection (c)(3). Amounts appropriated to the Fund shall remain available until expended.

    ‘(b) EXPENDITURES FROM FUND- Amounts in the Fund are available to the Secretary for the purpose of carrying out this part. Payments under the program under this part, and the costs of carrying out such program, shall be exempt from reduction under any order issued under part C of the Balanced Budget and Emergency Deficit Control Act of 1985.

    ‘(c) INVESTMENT-

      ‘(1) IN GENERAL- The Secretary of the Treasury shall invest such amounts of the Fund as such Secretary determines are not required to meet current withdrawals from the Fund. Such investments may be made only in interest-bearing obligations of the United States. For such purpose, such obligations may be acquired on original issue at the issue price, or by purchase of outstanding obligations at the market price.

      ‘(2) SALE OF OBLIGATIONS- Any obligation acquired by the Fund may be sold by the Secretary of the Treasury at the market price.

      ‘(3) AVAILABILITY OF INCOME- Any interest derived from obligations acquired by the Fund, and proceeds from any sale or redemption of such obligations, are hereby appropriated to the Fund.

‘SEC. 2162. DEFINITIONS.

    ‘For purposes of this subtitle:

      ‘(1) The term ‘eligible child’ has the meaning given such term in section 2151(b).

      ‘(2) The term ‘federally-supplied’, with respect to a pediatric vaccine, means that such vaccine is purchased and delivered on behalf of a State under section 2151(a).

      ‘(3) The term ‘health care provider’, with respect to the administration of vaccines to children, means an entity that is licensed or otherwise authorized for such administration under the law of the State in which the entity administers the vaccine, subject to section 333(e).

      ‘(4) The term ‘immunization’ means an immunization against a vaccine-preventable disease.

      ‘(5) Each of the terms ‘Indian’, ‘Indian tribe’, and ‘tribal organization’ has the meaning given such term in section 4 of the Indian Health Care Improvement Act.

      ‘(6) The term ‘Indian child’ means an Indian who is 18 years of age or younger.

      ‘(7) The term ‘manufacturer’ means any corporation, organization, or institution, whether public or private (including Federal, State, and local departments, agencies, and instrumentalities), which manufactures, imports, processes, or distributes under its label any pediatric vaccine. The term ‘manufacture’ means to manufacture, import, process, or distribute a vaccine.

      ‘(8) The term ‘parent’, with respect to a child, means a legal guardian of the child.

      ‘(9) The term ‘participating State under section 2151’ means a State that has submitted to the Secretary an application in accordance with section 2157.

      ‘(10) The term ‘pediatric vaccine’ means a vaccine included on the list established under section 2160(a).

      ‘(11) The term ‘program-registered provider’ has the meaning given such term in 2153(a)(2).

‘SEC. 2163. TERMINATION OF PROGRAM.

    This part shall cease to be in effect beginning on such date as may be prescribed in Federal law providing for immunization services for all children as part of a broad-based reform of the national health care system.

‘Part B--National System for Monitoring Immunization Status of Children

‘SEC. 2171. FORMULA GRANTS FOR STATE REGISTRIES WITH RESPECT TO MONITORING.

    ‘(a) IN GENERAL- For the purpose described in subsection (b), the Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall make an allotment each fiscal year for each State in an amount determined in accordance with section 2175. The Secretary shall make a grant to the State of the allotment made for the State for the fiscal year if the State submits to the Secretary an application in accordance with section 2174.

    ‘(b) AUTHORIZED ACTIVITIES- The Secretary may make a grant under subsection (a) only if the State agrees to expend the grant for the purpose of--

      ‘(1) collecting the data described in section 2172;

      ‘(2) operating registries to maintain the data (and establishing such registries, in the case of a State that is not operating such a registry);

      ‘(3) utilizing the data to monitor the extent to which children have received immunizations in accordance with the schedule established under section 2160(b);

      ‘(4) notifying parents if children have not received immunizations in accordance with such schedule; and

      ‘(5) such other activities as the Secretary may authorize with respect to achieving the objectives established by the Secretary for the year 2000 for the immunization status of children in the United States.

    ‘(c) REQUIREMENT REGARDING STATE LAWS-

      ‘(1) IN GENERAL- The Secretary may make a grant under subsection (a) only if the State involved--

        ‘(A) provides assurances satisfactory to the Secretary that, not later than October 1, 1996, the State will be operating a registry in accordance with this part, including having in effect such laws and regulations as may be necessary to so operate such a registry; and

        ‘(B) agrees that, prior to such date, the State will make such efforts to operate a registry in accordance with this part as may be authorized in the law and regulations of the State.

      ‘(2) RULES OF CONSTRUCTION-

        ‘(A) With respect to the agreements made by a State under this part, other than the agreement under paragraph (1)(B), the Secretary may require compliance with the agreements only to the extent consistent with such paragraph.

        ‘(B) This part does not authorize the Secretary, as a condition of the receipt of a grant under subsection (a) by a State, to prohibit the State from providing any parent, upon the request of the parent, with an exemption from the requirements established by the State pursuant to this part for the collection of data regarding any child of the parent.

‘SEC. 2172. REGISTRY DATA.

    ‘(a) IN GENERAL- For purposes of section 2171(b)(1), the data described in this section are the data described in subsection (b) and the data described in subsection (c). This section applies to data regarding a child without regard to whether the child is an eligible child as defined in section 2162.

    ‘(b) DATA REGARDING BIRTH OF CHILD- With respect to the birth of a child, the data described in this subsection is as follows:

      ‘(1) The name of each child born in the State involved on or after October 1, 1993.

      ‘(2) Demographic data on the child.

      ‘(3) The name of one or both of the parents of the child.

      ‘(4) The address, as of the date of the birth of the child, of each parent whose name is received in the registry pursuant to paragraph (3).

    ‘(c) DATA REGARDING INDIVIDUAL IMMUNIZATIONS- With respect to a child to whom a pediatric vaccine is administered in the State involved, the data described in this subsection is as follows:

      ‘(1) The name, age, and address of the child.

      ‘(2) The date on which the vaccine was administered to the child.

      ‘(3) The name and business address of the health care provider that administered the vaccine.

      ‘(4) The address of the facility at which the vaccine was administered.

      ‘(5) The name and address of one or both parents of the child as of the date on which the vaccine was administered, if such information is available to the health care provider.

      ‘(6) The type of vaccine.

      ‘(7) The number or other information identifying the particular manufacturing batch of the vaccine, if such information appears on the container or packaging for the vaccine or is otherwise readily accessible to the health care provider.

      ‘(8) The dosage of vaccine that was administered.

      ‘(9) A description of any adverse medical reactions that the child experienced in relation to the vaccine and of which the health care provider is aware.

      ‘(10) Any other contraindications noted by the health care provider with respect to administration of the vaccine to the child.

      ‘(11) Such other data regarding immunizations for the child, including identifying data, as the Secretary may require consistent with applicable law (including social security account numbers furnished pursuant to section 205(c)(2)(E) of the Social Security Act).

    ‘(d) DATE CERTAIN FOR SUBMISSION TO REGISTRY- The Secretary may make a grant under section 2171 only if the State involved agrees to ensure that, with respect to a child--

      ‘(1) the data described in subsection (b) are submitted to the registry under such section not later than 6 weeks after the date on which the child is born; and

      ‘(2) the data described in subsection (c) with respect to a vaccine are submitted to such registry not later than 6 weeks after the date on which the vaccine is administered to the child.

‘SEC. 2173. GENERAL PROVISIONS.

    ‘(a) FEDERAL STANDARDS ON CONFIDENTIALITY- The Secretary shall by regulation establish standards providing for maintaining the confidentiality of the identity of individuals with respect to whom data are maintained in registries under section 2171. Such standards shall, with respect to a State, provide that the State is to have in effect laws regarding such confidentiality, including appropriate penalties for violation of the laws. The Secretary may make a grant under such section only if the State involved agrees to comply with the standards.

    ‘(b) USE OF SOCIAL SECURITY ACCOUNT NUMBERS- Any usage or disclosure of data in registries under section 2171 that consists of social security account numbers and related information which is otherwise permitted under this part may be exercised only to the extent permitted under section 205(c)(2)(E) of the Social Security Act. For purposes of the preceding sentence, the term ‘related information’ has the meaning given such term in clause (iv)(II) of such section.

    ‘(c) UNIFORMITY IN METHODOLOGIES- The Secretary shall establish standards regarding the methodologies used in establishing and operating registries under section 2171, and may make a grant under such section only if the State agrees to comply with the standards. The Secretary shall provide for a reasonable degree of uniformity among the States in such methodologies for the purpose of ensuring the utility, comparability, and exchange of the data maintained in such registries.

    ‘(d) COORDINATION AMONG STATES- The Secretary may make a grant under section 2171 to a State only if, with respect to the operation of the registry of the State under such section, the State agrees to cooperate with the Secretary and with other States in carrying out activities with respect to achieving the objectives established by the Secretary for the year 2000 for the immunization status of children in the United States.

    ‘(e) REPORTS TO SECRETARY- The Secretary may make a grant under section 2171 only if the State involved agrees to submit to the Secretary such reports as the Secretary determines to be appropriate with respect to the activities of the State under this part.

‘SEC. 2174. APPLICATION FOR GRANT.

    ‘An application by a State for a grant under section 2171 is in accordance with this section if the application--

      ‘(1) is submitted not later than the date specified by the Secretary;

      ‘(2) contains each agreement required in this part;

      ‘(3) contains any information required in this part to be submitted to the Secretary; and

      ‘(4) is in such form, is made in such manner, and contains such agreements, assurances, and information as the Secretary determines to be necessary to carry out this part.

‘SEC. 2175. DETERMINATION OF AMOUNT OF ALLOTMENT.

    ‘The Secretary shall determine the amount of the allotments required in section 2171 for States for a fiscal year in accordance with a formula established by the Secretary that allots the amounts appropriated under section 2177 for the fiscal year on the basis of the costs of the States in establishing and operating registries under section 2171.

‘SEC. 2176. DEFINITIONS.

    ‘For purposes of this part, each of the terms ‘health care provider, ‘pediatric vaccine’ and ‘parent’ has the meaning given the term in section 2162.

‘SEC. 2177. AUTHORIZATION OF APPROPRIATIONS.

    ‘For the purpose of carrying out this part, there are authorized to be appropriated $50,000,000, for fiscal year 1994, $152,000,000 for fiscal year 1995, $125,000,000 for fiscal year 1996, and $35,000,000 for each of the fiscal years 1997 through 1999.

‘Part C--Funding for Other Purposes Regarding Childhood Immunizations

‘SEC. 2181. GRANTS REGARDING YEAR 2000 HEALTH OBJECTIVES.

    ‘(a) IN GENERAL- The Secretary, acting through the Director of the Centers for Disease Control and Prevention, may make grants to States for the purpose of carrying out activities with respect to achieving the objectives established by the Secretary for the year 2000 for the immunization status of children in the United States, other than providing for the purchase and delivery on behalf of the State of any pediatric vaccine (as defined in section 2162).

    ‘(b) CERTAIN ACTIVITIES- Subject to subsection (a), the purposes for which a grant under such subsection may be expended include the following:

      ‘(1) Research into the prevention and control of diseases that may be prevented through vaccination.

      ‘(2) Demonstration projects for the prevention and control of such diseases.

      ‘(3) Public information and education programs for the prevention and control of such diseases.

      ‘(4) Education, training, and clinical skills improvement activities in the prevention and control of such diseases for health professionals (including allied health personnel).

      ‘(5) Such other activities as the Secretary determines to be appropriate.

    ‘(c) APPLICATION FOR GRANT- The Secretary may make a grant under subsection (a) only if an application for the grant is submitted to the Secretary and the application is in such form, is made in such manner, and contains such agreements, assurances, and information as the Secretary determines to be necessary to carry out this section.

    ‘(d) SUPPLIES AND SERVICES IN LIEU OF GRANT FUNDS- The Secretary, at the request of a recipient of a grant under subsection (a), may reduce the amount of such grant by--

      ‘(1) the fair market value of any supplies or equipment furnished the grant recipient, and

      ‘(2) the amount of the pay, allowances, and travel expenses of any officer or employee of the Federal Government when detailed to the grant recipient and the amount of any other costs incurred in connection with the detail of such officer or employee.

    When the furnishing of such supplies or equipment or the detail of such an officer or employee is for the convenience of and at the request of such grant recipient and for the purpose of carrying out a program with respect to which the grant under subsection (a) is made. The amount by which any such grant is so reduced shall be available for payment by the Secretary of the costs incurred in furnishing the supplies or equipment, or in detailing the personnel, on which the reduction of such grant is based, and such amount shall be deemed as part of the grant and shall be deemed to have been paid to the grant recipient.

    ‘(e) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out this part, there are authorized to be appropriated $580,000,000 for fiscal year 1993, $680,000,000 for fiscal year 1994, and such sums as may be necessary for each of the fiscal years 1995 through 1999.’.

    (b) AUTHORITY TO USE SOCIAL SECURITY ACCOUNT NUMBERS- Section 205(c)(2) of the Social Security Act (42 U.S.C. 405(c)(2)) is amended--

      (1) by redesignating subparagraphs (E) and (F) as subparagraphs (F) and (G), respectively; and

      (2) by inserting after subparagraph (D) the following new subparagraph:

    ‘(E)(i) The Secretary and each State receiving grants under section 2171(a) of the Public Health Service Act may utilize social security account numbers issued by the Secretary under this subsection for purposes of--

      ‘(I) operating registries under such section to maintain information including such numbers (and establishing such registries, in the case of a State that is not operating such a registry),

      ‘(II) utilizing such numbers to monitor the extent to which children have received immunizations in accordance with the schedule established under section 2160(b) of the Public Health Service Act, and

      ‘(III) notifying parents if children have not received immunizations in accordance with such schedule.

    ‘(ii) Disclosure by individuals of social security account numbers may be required by a State for purposes of identification of children in a registry operated pursuant to a grant referred to in clause (i), except that such disclosure may be required to be made only to persons specifically authorized in regulations of the Secretary prescribed under part B of subtitle 3 of title XXI of the Public Health Service Act. The Secretary shall take such actions as are necessary to restrict access to information consisting of such numbers and related information only to such authorized persons whose duties or responsibilities require access for the purposes described in clause (i). The Secretary shall issue regulations governing the use, maintenance, and disclosure by any holder of such information, including appropriate administrative, technical, and physical safeguards, to ensure that only such authorized persons have access to such information. Any use or disclosure of such information in violation of such regulations shall be deemed a disclosure in violation of subparagraph (C)(vii).

    ‘(iii) The Secretary shall submit a report to the Committee on Ways and Means of the House of Representatives and the Committee on Finance of the Senate not later than January 1, 1996, and biennially thereafter, on the operation of this subparagraph.

    ‘(iv) For purposes of this subparagraph--

      ‘(I) the term ‘State’ has the meaning provided such term under section 2(f) of the Public Health Service Act, and

      ‘(II) the term ‘related information’ means any record, list, or compilation which indicates, directly or indirectly, the identity of any individual with respect to whom a social security account number is maintained pursuant to this subparagraph and part B of subtitle 3 of title XXI of the Public Health Service Act.’.

    (c) RELATIONSHIP OF NEW PROGRAM OF IMMUNIZATION GRANTS TO CURRENT PROGRAM-

      (1) STRIKING OF CURRENT PROGRAM- Section 317 of the Public Health Service Act (42 U.S.C. 247b) is amended--

        (A) in subsection (j)--

          (i) by striking paragraph (1); and

          (ii) by striking the remaining paragraph designation; and

        (B) in subsection (k)--

          (i) by striking paragraph (1); and

          (ii) by redesignating paragraphs (2) through (5) as paragraphs (1) through (4), respectively.

      (2) TRANSITIONAL AUTHORITY UNDER NEW PROGRAM- With respect to activities that the Secretary of Health and Human Services was authorized to carry out pursuant to section 317(j)(1) of the Public Health Service Act (as in effect on the day before the date of the enactment of this Act), the Secretary may, for fiscal year 1994, carry out any such activity under section 2181 of the Public Health Service Act (as added by subsection (a) of this section), notwithstanding the provisions of such section 2181. The authority established in the preceding sentence includes the authority to purchase vaccines.

    (d) CONTINUED COVERAGE OF COSTS OF A PEDIATRIC VACCINE UNDER GROUP HEALTH PLANS-

      (1) REQUIREMENT- The requirement of this paragraph, with respect to a group health plan for plan years beginning after the date of the enactment of this Act, is that the group health plan not reduce its coverage of the costs of pediatric vaccines (as defined under section 2162 of the Public Health Service Act) below the coverage it provided as of May 1, 1993.

      (2) ENFORCEMENT-

        (A) For purposes of section 2207 of the Public Health Service Act, the requirement of paragraph (1) is deemed a requirement of title XXII of such Act.

        (B) For purposes of subsections (a) through (e) of section 4980B of the Internal Revenue Code of 1986, paragraph (1) is deemed a requirement of subsection (f) of such section.

        (C) For purposes of section 502 of the Employee Retirement Income Security Act of 1974, paragraph (1) is deemed a provision of part 6 of subtitle B of title I of such Act.

SEC. 5182. NATIONAL VACCINE INJURY COMPENSATION PROGRAM AMENDMENTS.

    (a) USE OF VACCINE INJURY COMPENSATION TRUST FUND- Section 6601(r) of the Omnibus Budget Reconciliation Act of 1989 is amended by striking ‘$2,500,000 for each of fiscal years 1991 and 1992’ each place it appears and inserting ‘$3,000,000 for fiscal year 1994 and each fiscal year thereafter’ (in three places).

    (b) AMENDMENT OF VACCINE INJURY TABLE- Section 2116(b) of the Public Health Service Act (42 U.S.C. 300aa-16(b)) is amended by striking ‘such person may file’ and inserting ‘or to significantly increase the likelihood of obtaining compensation, such person may, notwithstanding section 2111(b)(2), file’.

    (c) EXTENSION OF TIME FOR DECISION- Section 2112(d)(3)(D) of such Act (42 U.S.C. 300aa-12(d)(3)(D)) is amended by striking ‘540 days’ and inserting ‘30 months (but for no more than 6 months at a time)’.

    (d) SIMPLIFICATION OF VACCINE INFORMATION MATERIALS-

      (1) Section 2126(b) of such Act (42 U.S.C. 300aa-26(b)) is amended--

        (A) by striking ‘by rule’ in the matter preceding paragraph (1);

        (B) by striking, in paragraph (1), ‘, opportunity for a public hearing, and 90’ and inserting ‘and 30’; and

        (C) by striking, in paragraph (2), ‘, appropriate health care providers and parent organizations’.

      (2) Section 2126(c) of such Act (42 U.S.C. 300aa-26(c)) is amended--

        (A) by inserting ‘shall be based on available data and information,’ after ‘such materials’ in the matter preceding paragraph (1), and

        (B) by striking paragraphs (1) through (10) and inserting the following:

      ‘(1) a concise description of the benefits of the vaccine,

      ‘(2) a concise description of the risks associated with the vaccine,

      ‘(3) a statement of the availability of the National Vaccine Injury Compensation Program, and

      ‘(4) such other relevant information as may be determined by the Secretary.’.

      (3) Subsections (a) and (d) of section 2126 of such Act (42 U.S.C. 300aa-26) are each amended by inserting ‘or to any other individual’ after ‘to the legal representatives of any child’.

      (4) Subsection (d) of section 2126 of such Act (42 U.S.C. 300aa-26) is amended--

        (A) by striking all after ‘subsection (a),’ the second place it appears in the first sentence and inserting ‘supplemented with visual presentations or oral explanations, in appropriate cases.’, and

        (B) by striking ‘or other information’ in the last sentence.

SEC. 5183. MEDICAID IMMUNIZATION PROVISIONS.

    (a) OUTREACH AND EDUCATION-

      (1) IMMUNIZATION OUTREACH THROUGH EPSDT PROGRAM- Section 1902(a)(43)(A) (42 U.S.C. 1396a(a)(43)(A)) is amended by inserting before the comma at the end the following: ‘and the need for age-appropriate immunizations against vaccine-preventable diseases’.

      (2) COORDINATION WITH MATERNAL AND CHILD HEALTH BLOCK GRANT PROGRAMS AND WIC PROGRAMS- Section 1902(a)(11) (42 U.S.C. 1396a(a)(11)) is amended--

        (A) in clause (B)--

          (i) by striking ‘effective July 1, 1969,’,

          (ii) by striking ‘and’ before ‘(ii)’, and

          (iii) by striking ‘to him under section 1903’ and inserting ‘to the individual under section 1903, and (iii) providing for coordination of information and education on childhood vaccinations and delivery of immunization services’; and

        (B) in clause (C), by inserting ‘(including the provision of information and education on childhood vaccinations and the delivery of immunization services)’ after ‘operations under this title’.

      (3) COVERAGE OF PUBLIC HOUSING HEALTH CENTERS AS FEDERALLY-QUALIFIED HEALTH CENTERS- Section 1905(l)(2)(B) (42 U.S.C. 1396d(l)(2)(B)) is amended by striking ‘or 340’ each place it appears and inserting ‘340, or 340A’.

      (4) EFFECTIVE DATE- (A) Except as provided in subparagraph (B), the amendments made by this subsection shall apply to calendar quarters beginning on or after October 1, 1993, without regard to whether or not final regulations to carry out such amendments have been promulgated by such date.

      (B) In the case of a State plan for medical assistance under title XIX of the Social Security Act which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirements imposed by the amendments made by this subsection, the State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet these additional requirements before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of the enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of such session shall be deemed to be a separate regular session of the State legislature.

    (b) SCHEDULE OF IMMUNIZATIONS UNDER EPSDT-

      (1) IN GENERAL- Section 1905(r)(1) (42 U.S.C. 1396d(r)(1)) is amended--

        (A) in subparagraph (A)(i), by inserting ‘and, with respect to immunizations under subparagraph (B)(iii), in accordance with the schedule recommended by the Secretary under section 2160 of the Public Health Service Act’ after ‘child health care’; and

        (B) in subparagraph (B)(iii), by inserting ‘(according to the schedule recommended by the Secretary under section 2160 of the Public Health Service Act)’ after ‘appropriate immunizations’.

      (2) EFFECTIVE DATE- The amendments made by subparagraphs (A) and (B) of paragraph (1) shall first apply 90 days after the date the Secretary of Health and Human Services first issues the recommended schedule referred to in subparagraphs (A)(i) and subparagraph (B)(iii) of section 1905(r)(1) of the Social Security Act (as amended by such respective subparagraphs).

    (c) ASSURING ADEQUATE PAYMENT RATES FOR ADMINISTRATION OF VACCINES TO CHILDREN-

      (1) PAYMENT RATES- Section 1926(a)(4)(B) (42 U.S.C. 1396r-7(a)(4)(B)) is amended by inserting ‘(including the administration of vaccines)’ after ‘means services’.

      (2) EFFECTIVE DATE- The amendment made by paragraph (1) shall apply to the plan amendment required to be submitted under section 1926(a)(2) of the Social Security Act by not later than April 1, 1994.

    (d) DENIAL OF FEDERAL FINANCIAL PARTICIPATION FOR INAPPROPRIATE ADMINISTRATION OF SINGLE-ANTIGEN VACCINE-

      (1) IN GENERAL- Section 1903(i) (42 U.S.C. 1396b(i)), as amended by sections 5174(b) and 5131(a), is amended--

        (A) in paragraph (13), by striking ‘or’ at the end,

        (B) in paragraph (14), by striking the period at the end and inserting ‘; or’, and

        (C) by inserting after paragraph (14) the following new paragraph:

      ‘(15) with respect to any amount expended for a single-antigen vaccine and its administration in any case in which the administration of a combined-antigen vaccine was medically appropriate (as determined by the Secretary).’.

      (2) EFFECTIVE DATE- The amendments made by paragraph (1) shall apply to amounts expended for vaccines administered on or after October 1, 1993.

    (e) REQUIRING MEDICAID MANAGED CARE PLANS TO COMPLY WITH IMMUNIZATION AND OTHER EPSDT REQUIREMENTS-

      (1) IN GENERAL- Section 1903(m) (42 U.S.C. 1396b(m)) is amended--

        (A) in paragraph (2)(A), as amended by subsections (a)(1) and (b)(1) of section 5135--

          (i) by striking ‘and’ at the end of clause (xii),

          (ii) by striking the period at the end of clause (xiii) and inserting ‘; and’, and

          (iii) by adding at the end the following new clause:

      ‘(xiv) the entity complies with the requirements of paragraph (7) (relating to EPSDT compliance).’; and

        (B) by adding at the end the following new paragraph:

    ‘(7) The contract between the State and an entity referred to in paragraph (2)(A)(iii) shall--

      ‘(A) specify which early and periodic screening, diagnostic, and treatment services are to be provided under the contract to individuals under age 21 enrolled with the entity;

      ‘(B) in the case of such services which are not to be so provided, specify the steps the entity will take (through referrals or other arrangements) to assure that such individuals will receive such services; and

      ‘(C) require the entity to submit such periodic reports as may be necessary to enable the State to prepare and submit timely reports under section 1902(a)(43)(D) and section 506(a)(2).’.

      (2) APPLICATION OF INTERMEDIATE SANCTIONS FOR FAILURE TO PROVIDE IMMUNIZA- TIONS AND OTHER EPSDT SERVICES- Section 1903(m)(5)(A) (42 U.S.C. 1396b(m)(5)(A)) is amended--

        (A) by striking ‘, or’ at the end of clause (iv) and inserting a semicolon,

        (B) by striking the comma at the end of clause (v) and inserting ‘; or’, and

        (C) by inserting after clause (v) the following new clause:

      ‘(vi) fails substantially to provide early and periodic screening, diagnostic, and treatment services to the extent specified in the contract under paragraph (7)(A);’.

      (3) EFFECTIVE DATE- The amendments made by this subsection shall apply to contract years beginning on or after October 1, 1993, without regard to whether or not final regulations to carry out such amendments have been promulgated by such date.

    (f) TRANSITION RULE-

      (1) MEDICAID USE OF CDC CONTRACT PRICE- The Secretary of Health and Human Services shall not, on or after the date of the enactment of this Act, enter into a contract for the purchase by the Centers for Disease Control and Prevention of pediatric vaccines for distribution (as provided for in section 317 or section 2181 of the Public Health Service Act) unless such contract provides that the charge for such vaccines, for which medical assistance is provided under a State plan under title XIX of the Social Security Act, will not exceed the price negotiated under the contract. The previous sentence shall not apply, with respect to a vaccine for which medical assistance is provided by a State, on and after such date as the State becomes entitled to have the Secretary provide for the purchase and delivery on behalf of the State of that vaccine under section 2151 of the Public Health Service Act.

      (2) OPTIONAL USE BY STATES OF CDC CONTRACT PRICE- Nothing in paragraph (1) shall be construed as limiting the Federal financial participation available to States, under title XIX of the Social Security Act, for the cost of a pediatric vaccine to the contract price described in such paragraph for the vaccine.

SEC. 5184. AVAILABILITY OF MEDICAID PAYMENTS FOR CHILDHOOD VACCINE REPLACEMENT PROGRAMS.

    (a) IN GENERAL- Section 1902(a)(32) (42 U.S.C. 1396a(a)(32)) is amended--

      (1) by striking ‘and’ at the end of subparagraph (B),

      (2) by striking the period at the end of subparagraph (C) and inserting ‘; and’, and

      (3) by adding at the end the following new subparagraph:

        ‘(D) in the case of payment for a childhood vaccine administered to individuals entitled to medical assistance under the State plan, the State plan may make payment directly to the manufacturer of the vaccine under a voluntary replacement program agreed to by the State pursuant to which the manufacturer (i) supplies doses of the vaccine to providers administering the vaccine, (ii) periodically replaces the supply of the vaccine, and (iii) charges the State the manufacturer’s bid price to the Centers for Disease Control and Prevention for the vaccine so administered plus a reasonable premium to cover shipping and the handling of returns;’.

    (b) EFFECTIVE DATE- The amendments made by subsection (a) shall take effect on the date of the enactment of this Act.

SEC. 5185. HEALTHY START FOR INFANTS.

    (a) IN GENERAL- Part D of title III of the Public Health Service Act (42 U.S.C. 254b et seq.) is amended by inserting after section 330 the following section:

‘HEALTHY START FOR INFANTS

    ‘SEC. 330A. (a) GRANTS FOR COMPREHENSIVE SERVICES-

      ‘(1) IN GENERAL- The Secretary may make grants for the operation of not more than 21 demonstration projects to provide the services described in subsection (b) for the purpose of reducing, in the geographic areas in which the projects are carried out--

        ‘(A) the incidence of infant mortality and morbidity;

        ‘(B) the incidence of fetal deaths;

        ‘(C) the incidence of maternal mortality;

        ‘(D) the incidence of fetal alcohol syndrome; and

        ‘(E) the incidence of low-birthweight births.

      ‘(2) ACHIEVEMENT OF YEAR 2000 HEALTH STATUS OBJECTIVES- With respect to the objectives established by the Secretary for the health status of the population of the United States for the year 2000, the Secretary shall, in providing for a demonstration project under paragraph (1) in a geographic area, seek to meet the objectives that are applicable to the purpose described in such paragraph and the populations served by the project.

    ‘(b) AUTHORIZED SERVICES-

      ‘(1) IN GENERAL- Subject to subsection (h), the services referred to in this subsection are comprehensive services (including preventive and primary health services for pregnant women and infants and childhood immunizations in accordance with the schedule recommended by the Secretary under section 2160) for carrying out the purpose described in subsection (a), including services other than health services.

      ‘(2) CERTAIN PROVIDERS- The Secretary may make a grant under subsection (a) only if the applicant involved agrees that, in making any arrangements under which other entities provide authorized services in the demonstration project involved, the applicant will include among the entities with which the arrangements are made grantees under any of sections 329, 330, 340, and 340A, if such grantees are providing services in the service area of such project and the grantees are willing to make such arrangements with the applicant.

    ‘(c) ELIGIBLE GEOGRAPHIC AREAS- The Secretary may make a grant under subsection (a) only if--

      ‘(1) the applicant for the grant specifies the geographic area in which the demonstration project under such subsection is to be carried out and agrees that the project will not be carried out in other areas; and

      ‘(2) the rate of infant mortality in the geographic area equals or exceeds 150 percent of the national average in the United States of such rates.

    ‘(d) MINIMUM QUALIFICATIONS OF GRANTEES-

      ‘(1) PUBLIC OR NONPROFIT PRIVATE ENTITIES- The Secretary may make a grant under subsection (a) only if the applicant for the grant is a State or local department of health, or other public or nonprofit private entity, or a consortium of public or nonprofit private entities.

      ‘(2) APPROVAL OF POLITICAL SUBDIVISIONS- With respect to a proposed demonstration project under subsection (a), the Secretary may make a grant under such subsection only if--

        ‘(A) the chief executive officer of each political subdivision in the service area of such project approves the applicant for the grant as being qualified to carry out the project; and

        ‘(B) the leadership of any Indian tribe or tribal organization with jurisdiction over any portion of such area so approves the applicant.

      ‘(3) STATUS AS MEDICAID PROVIDER-

        ‘(A) In the case of any service described in subsection (b) that is available pursuant to the State plan approved under title XIX of the Social Security Act for a State in which a demonstration project under subsection (a) is carried out, the Secretary may make a grant under such subsection for the project only if, subject to subparagraph (B)--

          ‘(i) the applicant for the grant will provide the service directly, and the applicant has entered into a participation agreement under the State plan and is qualified to receive payments under such plan; or

          ‘(ii) the applicant will enter into an agreement with a public or private entity under which the entity will provide the service, and the entity has entered into such a participation agreement under the State plan and is qualified to receive such payments.

        ‘(B)(i) In the case of an entity making an agreement pursuant to subparagraph (A)(ii) regarding the provision of services, the requirement established in such subparagraph regarding a participation agreement shall be waived by the Secretary if the entity does not, in providing health care services, impose a charge or accept reimbursement available from any third-party payor, including reimbursement under any insurance policy or under any Federal or State health benefits plan.

        ‘(ii) A determination by the Secretary of whether an entity referred to in clause (i) meets the criteria for a waiver under such clause shall be made without regard to whether the entity accepts voluntary donations regarding the provision of services to the public.

    ‘(e) STATE APPROVAL OF PROJECT- With respect to a proposed demonstration project under subsection (a), the Secretary may make a grant under such subsection to the applicant involved only if--

      ‘(1) the chief executive officer of the State in which the project is to be carried out approves the proposal of the applicant for carrying out the project; and

      ‘(2) the leadership of any Indian tribe or tribal organization with jurisdiction over any portion of the service area of the project so approves the proposal.

    ‘(f) ELIGIBILITY FOR SERVICES PROVIDED WITH GRANT FUNDS-

      ‘(1) IN GENERAL- With respect to any authorized service under subsection (b), if the service is a service that States are required or authorized to provide under title XIX of the Social Security Act, the Secretary may make a grant under subsection (a) only if the applicant involved agrees that the grant will not be expended to provide the service to any individual to whom States are required or authorized under such title to provide the service. The Secretary may not make a grant under subsection (a) unless the State involved agrees that the grant will not be expended to make payment for any item or service to the extent that payment has been made, or can reasonably be expected to be made, with respect to such item or service--

        ‘(A) under a health insurance policy or plan (including a group health plan or a prepaid health plan),

        ‘(B) under any Federal or State health benefits program, including any program under title V, XVIII, or XIX of the Social Security Act, or

        ‘(C) under subpart 2 of part B of title XIX of this Act.

      ‘(2) RULES OF CONSTRUCTION- For purposes of paragraph (1):

        ‘(A) Individuals to whom States are authorized to provide services under title XIX of the Social Security Act include, pursuant to section 1902(l) of such title, pregnant women, infants, and children with an income level not less than 133 percent, and not more than 185 percent, of the official poverty line.

        ‘(B) Authorized services under subsection (b) that are authorized to be provided under title XIX of such Act include, pursuant to section 1920 of such title, ambulatory prenatal services during a period of presumptive eligibility.

        ‘(C) Authorized services under subsection (b) that are required to be provided under title XIX of such Act include, pursuant to section 1905(a)(4)(B) of such title, early and periodic screening, diagnostic, and treatment services for children under the age of 21.

        ‘(D) Authorized services under subsection (b) that are authorized to be provided under title XIX of such Act include, pursuant to section 1905(a)(19) of such title, case-management services.

    ‘(g) MAINTENANCE OF EFFORT-

      ‘(1) GRANTEE- With respect to authorized services under subsection (b), the Secretary may make a grant under subsection (a) only if the applicant involved agrees to maintain expenditures of non-Federal amounts for such services at a level that is not less than the level of such expenditures maintained by the applicant for fiscal year 1991.

      ‘(2) RELEVANT POLITICAL SUBDIVISIONS- With respect to authorized services under subsection (b), the Secretary may make a grant under subsection (a) only if each political subdivision in the service area of the demonstration project involved agrees to maintain expenditures of non-Federal amounts for such services at a level that is not less than the level of such expenditures maintained by the political subdivision for fiscal year 1991.

    ‘(h) RESTRICTIONS ON EXPENDITURE OF GRANT-

      ‘(1) IN GENERAL- Except as provided in paragraph (3), the Secretary may make a grant under subsection (a) only if the applicant involved agrees that the grant will not be expended--

        ‘(A) to provide inpatient services, except with respect to residential treatment for substance abuse provided in settings other than hospitals;

        ‘(B) to make cash payments to intended recipients of health services or mental health services; or

        ‘(C) to purchase or improve real property (other than minor remodeling of existing improvements to real property) or to purchase major medical equipment (other than mobile medical units for providing ambulatory prenatal services).

      ‘(2) ADMINISTRATIVE EXPENSES; DATA COLLECTION- The Secretary may make a grant under subsection (a) only if the applicant involved agrees that not more than an aggregate 10 percent of the grant will be expended for administering the grant and the collection and analysis of data.

      ‘(3) WAIVER- If the Secretary finds that the purpose described in subsection (a) cannot otherwise be carried out, the Secretary may, with respect to an otherwise qualified applicant, waive the restriction established in paragraph (1)(C).

    ‘(i) DETERMINATION OF CAUSE OF INFANT DEATHS- The Secretary may make a grant under subsection (a) only if the applicant involved--

      ‘(1) agrees to provide for a determination of the cause of each infant death in the service area of the demonstration project involved; and

      ‘(2) the applicant has made such arrangements with public entities as may be necessary to carry out paragraph (1).

    ‘(j) ANNUAL REPORTS TO SECRETARY- The Secretary may make a grant under subsection (a) only if the applicant involved agrees that, for each fiscal year for which the applicant operates a demonstration project under such subsection the applicant will, not later than April 1 of the subsequent fiscal year, submit to the Secretary a report providing the following information with respect to the project:

      ‘(1) The number of individuals that received authorized services, and the demographic characteristics of the population of such individuals.

      ‘(2) The types of authorized services provided, including the types of ambulatory prenatal services provided and the trimester of the pregnancy in which the services were provided.

      ‘(3) The sources of payment for the authorized services provided.

      ‘(4) The extent to which children under age 2 receiving authorized services have received the appropriate number and variety of immunizations against vaccine-preventable diseases.

      ‘(5) An analysis of the causes of death determined under subsection (i).

      ‘(6) The extent of progress being made toward meeting the health status objectives specified in subsection (a)(2).

      ‘(7) The extent to which, in the service area involved, progress is being made toward meeting the participation goals established for the State by the Secretary under section 1905(r) of the Social Security Act (relating to early periodic screening, diagnostic, and treatment services for children under the age of 21).

    ‘(k) COMMUNITY PARTICIPATION- The Secretary may make a grant under subsection (a) only if the applicant involved agrees that, in preparing the proposal of the applicant for the demonstration project involved, and in the operation of the project, the applicant will consult with the residents of the service area for the project and with public and nonprofit private entities that provide authorized services to such residents.

    ‘(l) APPLICATION FOR GRANT- The Secretary may make a grant under subsection (a) only if an application for the grant is submitted to the Secretary and the application is in such form, is made in such manner, and contains such agreements, assurances, and information as the Secretary determines to be necessary to carry out this subsection.

    ‘(m) REPORT TO CONGRESS- Not later than February 1, 1998, the Secretary shall submit to the Committee on Energy and Commerce of the House of Representatives, and the Committee on Labor and Human Resources of the Senate, a report--

      ‘(1) summarizing the reports received by the Secretary under subsection (j);

      ‘(2) describing the extent to which demonstration projects under subsection (a) have been cost effective; and

      ‘(3) describing the extent to which the Secretary has, in the service areas of such projects, been successful in meeting the health status objectives specified in subsection (a)(2).

    ‘(n) LIMITATION ON CERTAIN EXPENSES OF SECRETARY- Of the amounts appropriated under subsection (o) for a fiscal year, the Secretary may not obligate more than an aggregate 5 percent for the administrative costs of the Secretary in carrying out this section, for the provision of technical assistance regarding demonstration projects under subsection (a), and for evaluations of such projects.

    ‘(o) DEFINITIONS- For purposes of this section:

      ‘(1) The term ‘authorized services’ means the services specified in subsection (b).

      ‘(2) The terms ‘Indian tribe’ and ‘tribal organization’ have the meaning given such terms in section 4(b) and section 4(c) of the Indian Self-Determination and Education Assistance Act.

      ‘(3) The term ‘service area’, with respect to a demonstration project under subsection (a), means the geographic area specified in subsection (c).

    ‘(p) AUTHORIZATION OF APPROPRIATIONS- For the purpose of carrying out this section, there are authorized to be appropriated for each of the fiscal years 1994 through 1997 such sums as may be necessary.

    ‘(q) SUNSET- Effective October 1, 1997, this section is repealed.’.

    (b) REPORT FOR FISCAL YEAR 1993- With respect to grants under section 330A of the Public Health Service Act, as added by subsection (a) of this section, the Secretary of Health and Human Services may make a grant under such section for fiscal year 1994 only if the applicant for the grant agrees to submit to the Secretary, not later than April 1 of such year, a report on any federally-supported project of the applicant that is substantially similar to the demonstration projects authorized in such section 330A, which report provides, to the extent practicable, the information described in subsection (j) of such section.

    (c) SAVINGS PROVISION- With respect to grants under section 330A of the Public Health Service Act, as added by subsection (a) of this section and in effect for the fiscal years 1994 through 1997, such grants remain available for obligation and expenditure in accordance with the terms upon which the grants were made, notwithstanding the repeal of such section 330A pursuant to subsection (q) of such section.

    (d) USE OF GENERAL AUTHORITY UNDER PUBLIC HEALTH SERVICE ACT- With respect to the program established in section 330A of the Public Health Service Act, as added by subsection (a) of this section, section 301 of the Public Health Service Act may not be construed as providing to the Secretary of Health and Human Services any authority to carry out, during any fiscal year in which such program is in operation, any demonstration project to provide any of the services specified in subsection (b) of such section 330A.

SEC. 5186. INCREASE IN AUTHORIZATION OF APPROPRIATIONS FOR THE MATERNAL AND CHILD HEALTH SERVICES BLOCK GRANT PROGRAM.

    Section 501(a) (42 U.S.C. 701(a)) is amended by striking ‘$686,000,000 for fiscal year 1990’ and inserting ‘$705,000,000 for fiscal year 1994’.

SEC. 5187. MISCELLANEOUS TECHNICAL CORRECTIONS TO PUBLIC HEALTH SERVICE ACT PROVISIONS.

    (a) COMPENSATION FOR MEMBERS OF NATIONAL ADVISORY COUNCIL ON NATIONAL HEALTH SERVICE CORPS-

    (1) IN GENERAL- Section 337(b)(2) of the Public Health Service Act (42 U.S.C. 254j(b)(2)) is amended--

        (A) by inserting after ‘so serving’ the following: ‘compensation at a rate fixed by the Secretary (but not to exceed’, and

        (B) by striking ‘Schedule;’ and inserting ‘Schedule);’.

      (2) EFFECTIVE DATE- The amendments made by paragraph (1) shall take effect on the date of the enactment of this Act.

    (b) LIABILITY PROTECTIONS FOR INDIVIDUALS PROVIDING SERVICES AT CERTAIN CLINICS-

      (1) CLARIFICATION OF VOLUNTARY PARTICIPATION BY CERTAIN ENTITIES- (A) Section 224(g) of the Public Health Service Act (42 U.S.C. 133(g)(1)), as added by section 2(a) of the Federally Supported Health Centers Assistance Act of 1992, is amended--

        (i) in paragraph (4), by striking ‘An entity’ and inserting ‘Except as provided in paragraph (6), an entity’, and

        (ii) by adding at the end the following new paragraph:

    ‘(6) An entity may elect not to be treated as being described in paragraph (4) if the entity establishes that on a continuous basis since October 24, 1992, the entity has been a participant in, and partial owner of, a nonprofit risk retention group which offers malpractice and other liability coverage to the entity.’.

      (B) Section 224(k)(2) of such Act (42 U.S.C. 233(k)(2)), as added by section 4 of the Federally Supported Health Centers Assistance Act of 1992, is amended by striking ‘entities receiving funds’ and all that follows through ‘subsection (g)’ and inserting the following: ‘entities described in subsection (g)(4) and receiving funds under each of the grant programs described in such subsection’.

      (2) CLARIFICATION OF COVERAGE OF OFFICERS AND EMPLOYEES OF CLINICS- The first sentence of section 224(g)(1) of the Public Health Service Act (42 U.S.C. 233(g)(1)) is amended by striking ‘officer, employee, or contractor’ and inserting the following: ‘officer or employee of such an entity, and any contractor’.

      (3) COVERAGE FOR SERVICES FURNISHED TO INDIVIDUALS OTHER THAN PATIENTS OF CLINIC- Section 224(g) of such Act (42 U.S.C. 233(g)(1)), as amended by paragraph (1), is amended--

        (A) in the first sentence of paragraph (1), by inserting after ‘Service’ the following: ‘with respect to services provided to patients of the entity and (subject to paragraph (7)) to certain other individuals’; and

        (B) by adding at the end the following new paragraph:

    ‘(7) For purposes of paragraph (1), an officer, employee, or contractor described in such paragraph may be deemed to be an employee of the Public Health Service with respect to services provided to individuals who are not patients of an entity described in paragraph (4) only if the Secretary determines--

      ‘(A) that the provision of the services to such individuals is necessary to assure the treatment of patients of such an entity; or

      ‘(B) that such services are otherwise required to be provided to such individuals under an employment contract (or other similar arrangement) between the individual and the entity.’.

      (4) DETERMINING COMPLIANCE OF ENTITY WITH REQUIREMENTS FOR COVERAGE- Section 224(h) of such Act (42 U.S.C. 233(h)), as added by section 2(b) of the Federally Supported Health Centers Assistance Act of 1992, is amended by striking ‘the entity--’ and inserting the following: ‘the Secretary, after receiving such assurances and conducting such investigation as the Secretary considers necessary, finds that the entity--’.

      (5) EFFECTIVE DATE- The amendments made by this subsection shall take effect as if included in the enactment of the Federally Supported Health Centers Assistance Act of 1992.

    (c) ELIMINATION OF DUPLICATE WAIVER AUTHORITY FOR PARTICIPANTS IN NATIONAL HEALTH SERVICE CORPS- Section 338E(c) of the Public Health Service Act (42 U.S.C. 254o(c)) is amended by striking paragraph (3) and redesignating paragraph (4) as paragraph (3).

    (d) CLARIFICATION OF PROHIBITION AGAINST RESALE OF DRUGS UNDER DRUG REBATE AGREEMENTS- Section 340B(a)(5)(B) of the Public Health Service Act (42 U.S.C. 256b(a)(5)(B)), as added by section 602(a) of the Veterans Health Care of 1992, is amended by striking ‘entity.’ and inserting ‘covered entity.’.

Subtitle C--Communications Licensing Improvement

SEC. 5200. TABLE OF CONTENTS.

    The table of contents is as follows:

Subtitle C--Communications Licensing Improvement

      Sec. 5200. Table of contents.

Chapter 1--Competitive Bidding Authority

      Sec. 5201. Short title.

      Sec. 5202. Findings.

      Sec. 5203. Authority to use competitive bidding.

      Sec. 5204. Conforming amendments.

      Sec. 5205. Regulatory parity.

      Sec. 5206. Effective dates; deadlines for Commission action.

Chapter 2--Emerging Telecommunications Technologies

      Sec. 5221. Short title.

      Sec. 5222. Amendment to the National Telecommunications and Information Administration Organization Act.

Chapter 3--Communications Technical Amendments

      Sec. 5241. Clerical corrections.

      Sec. 5242. Transfer of provisions of law concerning public telecommunications facilities, children’s educational television, and telecommunications demonstration program.

      Sec. 5243. Elimination of expired and outdated provisions.

      Sec. 5244. Stylistic consistency.

CHAPTER 1--COMPETITIVE BIDDING AUTHORITY

SEC. 5201. SHORT TITLE.

    This chapter may be cited as the ‘Licensing Improvement Act of 1993’.

SEC. 5202. FINDINGS.

    The Congress finds that--

      (1) current licensing procedures often delay delivery of services to the public and can result in the unjust enrichment of applicants on the basis of the value of the public airwaves;

      (2) if licensees are engaged in reselling the use of the public airwaves to subscribers for a fee, the licensee should pay reasonable compensation to the public for those public resources;

      (3) a carefully designed system to obtain competitive bids from competing qualified applicants can speed delivery of services, promote efficient and intensive use of the electromagnetic spectrum, prevent unjust enrichment, and produce revenues to compensate the public for the use of the public airwaves; and

      (4) therefore, the Federal Communications Commission should have the authority to differentiate among multiple qualified applicants for a single license using a system of competitive bids.

SEC. 5203. AUTHORITY TO USE COMPETITIVE BIDDING.

    Section 309 of the Communications Act of 1934 (47 U.S.C. 309) is amended by adding at the end the following new subsection:

    ‘(j) USE OF COMPETITIVE BIDDING-

      ‘(1) GENERAL AUTHORITY- If mutually exclusive applications are filed for any initial license or construction permit which will involve a use of the electromagnetic spectrum described in paragraph (2), then the Commission shall have the authority to grant such license or permit to a qualified applicant through the use of a system of competitive bidding that meets the requirements of this subsection.

      ‘(2) USES TO WHICH BIDDING MAY APPLY- A use of the electromagnetic spectrum is described in this paragraph if the Commission determines that--

        ‘(A) the principal use of such spectrum will involve, or is reasonably likely to involve, the licensee receiving compensation from subscribers in return--

          ‘(i) for the licensee enabling those subscribers to receive communications signals that are transmitted utilizing frequencies on which the licensee is licensed to operate; or

          ‘(ii) for the licensee enabling those subscribers to transmit directly communications signals utilizing frequencies on which the licensee is licensed to operate; and

        ‘(B) a system of competitive bidding will promote the objectives described in paragraph (3).

      ‘(3) DESIGN OF SYSTEMS OF COMPETITIVE BIDDING- For each license or permit, or class of licenses or permits, that the Commission grants through the use of a competitive bidding system, the Commission shall, by rule, establish a competitive bidding methodology. The Commission shall seek to design and test multiple alternative methodologies under appropriate circumstances. In identifying licenses and permits to be issued by competitive bidding, in specifying eligibility and other characteristics of such licenses and permits, and in designing the methodologies for use under this subsection, the Commission shall seek to promote the purposes specified in section 1 of this Act and the following objectives:

        ‘(A) the development and rapid deployment of new technologies, products, and services for the benefit of the public, including those residing in rural areas, without administrative or judicial delays;

        ‘(B) promoting economic opportunity and competition and ensuring that new and innovative technologies are readily accessible to the American people by avoiding excessive concentration of licenses and by disseminating licenses among a wide variety of applicants, including small businesses and businesses owned by members of minority groups and women;

        ‘(C) recovery for the public of a portion of the value of the public spectrum resource made available for commercial use and avoidance of unjust enrichment through the methods employed to award uses of that resource; and

        ‘(D) efficient and intensive use of the electromagnetic spectrum.

      ‘(4) CONTENTS OF REGULATIONS- In prescribing rules pursuant to paragraph (3), the Commission shall--

        ‘(A) consider alternative payment schedules and methods of calculation, including initial lump sums, installment or royalty payments, guaranteed annual minimum payments, or other schedules or methods that promote the objectives described in paragraph (3)(B), and combinations of such schedules and methods;

        ‘(B) include performance requirements, such as appropriate deadlines and penalties for performance failures, to ensure prompt delivery of service to rural areas, to prevent stockpiling or warehousing of spectrum by licensees or permittees, and to promote investment in and rapid deployment of new technologies and services;

        ‘(C) consistent with the public interest, convenience, and necessity, the purposes of this Act, and the characteristics of the proposed service, prescribe area designations and bandwidth assignments that promote (i) an equitable distribution of licenses and services among geographic areas, (ii) economic opportunity for a wide variety of applicants, including small businesses and businesses owned by members of minority groups and women, and (iii) investment in and rapid deployment of new technologies and services; and

        ‘(D) require such transfer disclosures and antitrafficking restrictions and payment schedules as may be necessary to prevent unjust enrichment as a result of the methods employed to issue licenses and permits.

      ‘(5) BIDDER AND LICENSEE QUALIFICATION- No person shall be permitted to participate in a system of competitive bidding pursuant to this subsection unless such bidder submits such information and assurances as the Commission may require to demonstrate that such bidder’s application is acceptable for filing. No license shall be granted to an applicant selected pursuant to this subsection unless the Commission determines that the applicant is qualified pursuant to subsection (a) and sections 308(b) and 310. Consistent with the objectives described in paragraph (3), the Commission shall, by rule, prescribe expedited procedures consistent with the procedures authorized by subsection (i)(2) for the resolution of any substantial and material issues of fact concerning qualifications.

      ‘(6) RULES OF CONSTRUCTION- Nothing in this subsection, or in the use of competitive bidding, shall--

        ‘(A) limit or otherwise affect the requirements of subsection (h) of this section, section 301, 304, 307, 310, or 706, or any other provision of this Act (other than subsections (d)(2) and (e) of this section);

        ‘(B) be construed to convey any rights, including any expectation of renewal of a license, that differ from the rights that apply to other licenses within the same service that were not issued pursuant to this subsection; or

        ‘(C) be construed to prohibit the Commission from issuing nationwide licenses or permits.

      ‘(7) LIMITATION OF EFFECT ON ALLOCATION DECISIONS- In making a decision pursuant to section 303(c) to assign a band of frequencies to a use for which licenses or permits will be issued pursuant to this subsection, and in prescribing regulations pursuant to paragraph (4)(A) and (4)(C) of this subsection, the Commission may not base a finding of public interest, convenience, and necessity solely or predominantly on the expectation of Federal revenues from the use of a system of competitive bidding under this subsection.

      ‘(8) TREATMENT OF REVENUES- All proceeds from the use of a competitive bidding system under this subsection shall be deposited in the Treasury in accordance with chapter 33 of title 31, United States Code. A license or permit issued by the Commission under this section shall not be treated as the property of the licensee for tax purposes by any State or local government entity.

      ‘(9) TERMINATION; EVALUATION- The authority of the Commission to grant a license or permit under this subsection shall expire September 30, 1998. Not later than September 30, 1997, the Commission shall conduct a public inquiry and submit to the Congress a report--

        ‘(A) describing the methodologies established by the Commission pursuant to paragraphs (3) and (4);

        ‘(B) comparing the relative advantages and disadvantages of such methodologies in terms of attaining the objectives described in such paragraphs;

        ‘(C) evaluating the extent to which such methodologies have secured prompt delivery of service to rural areas; and

        ‘(D) containing a statement of the revenues obtained, and a projection of the future revenues, from the use of competitive bidding systems under this subsection.’.

SEC. 5204. CONFORMING AMENDMENTS.

    Section 309 of the Communications Act of 1934 is further amended--

      (1) by striking subsection (i)(1) and inserting the following:

    ‘(i) RANDOM SELECTION-

      ‘(1) GENERAL AUTHORITY- If--

        ‘(A) there is more than one application for any initial license or construction permit which will involve a use of the electromagnetic spectrum; and

        ‘(B) the Commission has determined that the use is not described in subsection (j)(2)(A);

      then the Commission shall have the authority to grant such license or permit to a qualified applicant through the use of a system of random selection.’;

      (2) in paragraph (2)--

        (A) by indenting paragraph (2), including subparagraphs (A) through (C), by an additional 2 em spaces; and

        (B) by inserting ‘DETERMINATIONS OF QUALIFICATIONS- ’ after ‘(2)’;

      (3) in paragraph (3)--

        (A) by indenting subparagraphs (A) and (B), and so much of subparagraph (C) as precedes clause (i), by an additional 2 em spaces;

        (B) by indenting clauses (i) and (ii) of subparagraph (C) by an additional 4 em spaces; and

        (C) by inserting ‘PREFERENCES; DIVERSITY- ’ after ‘(3)’;

      (4) in paragraph (4)--

        (A) by indenting subparagraphs (A) and (B) of such paragraph by an additional 2 em spaces;

        (B) by inserting ‘RULEMAKING SCHEDULE AND AUTHORITY- ’ after ‘(4)’; and

        (C) by adding at the end the following new subparagraph:

      ‘(C) Not later than 180 days after the date of enactment of this subparagraph, the Commission shall prescribe such transfer disclosures and antitrafficking restrictions and payment schedules as are necessary to prevent the unjust enrichment of recipients of licenses or permits as a result of the methods employed to issue licenses under this subsection.’.

SEC. 5205. REGULATORY PARITY.

    (a) AMENDMENT- Section 332 of the Communications Act of 1934 (47 U.S.C. 332) is amended--

      (1) by striking ‘PRIVATE LAND’ from the heading of the section; and

      (2) by amending striking subsection (c) and inserting the following:

    ‘(c) REGULATORY TREATMENT OF MOBILE SERVICES-

      ‘(1) COMMON CARRIER TREATMENT OF COMMERCIAL MOBILE SERVICES- (A) A person engaged in the provision of commercial mobile services shall, insofar as such person is so engaged, be treated as a common carrier for purposes of this Act, except for such provisions of title II as the Commission may, consistent with the public interest, specify as inapplicable by rule. In prescribing any such rule, the Commission may not specify section 201, 202, or 208, or any other provision that the Commission determines to be necessary in order to ensure that the charges, practices, classifications, or regulations for or in connection with commercial mobile services are just and reasonable and are not unjustly or unreasonably discriminatory or is otherwise in the public interest.

      ‘(B) Upon reasonable request of any person providing commercial mobile service, the Commission shall order a common carrier to establish physical connections with such service pursuant to the provisions of section 201 of this Act. Except to the extent that the Commission is required to respond to such a request, this subparagraph shall not be construed as a limitation or expansion of the Commission’s authority to order interconnection pursuant to this Act.

      ‘(2) NONCOMMON CARRIER TREATMENT OF PRIVATE LAND MOBILE SERVICES- A person engaged in private land mobile service shall not, insofar as such person is so engaged, be treated as a common carrier for any purpose under this Act. A common carrier (other than a person that was treated as provider of private land mobile services prior to the enactment of the Licensing Improvement Act of 1993) shall not provide any dispatch service on any frequency allocated for common carrier service, except to the extent such dispatch service is provided on stations licensed in the domestic public land mobile radio service before January 1, 1982. The Commission may by regulation terminate, in whole or in part, the prohibition contained in the preceding sentence if the Commission determines that such termination will serve the public interest.

      ‘(3) STATE AUTHORITY TO REGULATE- (A) Notwithstanding sections 2(b) and 221(b), no State or local government shall have any authority to impose any rate or entry regulation upon any commercial mobile service or any private land mobile service, except that this paragraph shall not prohibit a State from regulating the other terms and conditions of commercial mobile services.

      ‘(B) Notwithstanding subparagraph (A), a State may petition the Commission for authority to regulate the rates for any commercial mobile service and the Commission shall grant such petition if such State demonstrates that (i) such service is a substitute for land line telephone exchange service for a substantial portion of the public within such State, or (ii) market conditions with respect to such services fail to protect subscribers adequately from unjust and unreasonable rates or rates that are unjustly or unreasonably discriminatory. The Commission shall provide reasonable opportunity for public comment in response to such petition, and shall, within 9 months after the date of its submission, grant or deny such petition. If the Commission grants such petition, the Commission shall authorize the State to exercise under State law such authority over rates, for such periods of time, as the Commission deems necessary to ensure that such rates are just and reasonable and not unjustly or unreasonably discriminatory.

      ‘(4) REGULATORY TREATMENT OF COMMUNICATIONS SATELLITE CORPORATION- Nothing in this subsection shall be construed to alter or affect the regulatory treatment required by title IV of the Communications Satellite of 1962 of the corporation authorized by title III of such Act.

    ‘(d) DEFINITIONS- For purposes of this section--

      ‘(1) the term ‘commercial mobile service’ means all mobile services (as defined in section 3(n)) that--

        ‘(A) are provided for profit (i) to the public, (ii) on an indiscriminate basis, or (iii) to such broad classes of eligible users as to be effectively available to a substantial portion of the public; and

        ‘(B) are interconnected (or have requested interconnection pursuant to paragraph (1)(B)) with the public switched network (as such terms are defined by regulation by the Commission); and

      ‘(2) the term ‘private mobile service’ means any mobile service (as defined in section 3(n)) that is not a commercial mobile service.’.

    (b) CONFORMING AMENDMENTS-

      (1) AMENDMENTS TO DEFINITIONS- Section 3 of the Communications Act of 1934 (47 U.S.C. 153) is amended--

        (A) in subsection (n)--

          (i) by inserting ‘(1)’ after ‘and includes’; and

          (ii) by inserting before the period at the end the following: ‘, (2) a mobile service which provides a regularly interacting group of base, mobile, portable, and associated control and relay stations (whether licensed on an individual, cooperative, or multiple basis) for private one-way or two-way land mobile radio communications by eligible users over designated areas of operation, and (3) any service for which a license is required in a personal communications service established pursuant to the proceeding entitled ‘Amendment of the Commission’s Rules to Establish New Personal Communications Services’ (GEN Docket No. 90-314; ET Docket No. 92-100), or any successor proceeding’; and

        (B) by striking subsection (gg).

      (2) CONFORMING AMENDMENTS TO SECTION 332- Section 332 of such Act is further amended--

        (A) in subsection (a), by inserting after ‘(a)’ the following: ‘MANAGEMENT OF PRIVATE LAND MOBILE FREQUENCIES- ’;

        (B) in subsection (b)--

          (i) by indenting the margin of paragraphs (2) through (4) by 2 em spaces;

          (ii) by striking ‘(b)(1)’ and inserting the following:

    ‘(b) USE OF ADVISORY COMMITTEE-

      ‘(1) COORDINATION OF FREQUENCY ASSIGNMENT- ’;

          (iii) by inserting ‘EXEMPTION- ’ after ‘(2)’;

          (iv) by inserting ‘NONEMPLOYEE STATUS- ’ after ‘(3)’; and

          (v) by inserting ‘APPLICATION OF FEDERAL ADVISORY COMMITTEE ACT- ’ after ‘(4).

SEC. 5206. EFFECTIVE DATES; DEADLINES FOR COMMISSION ACTION.

    (a) EFFECTIVE DATES-

      (1) IN GENERAL- Except as provided in paragraph (2), the amendments made by this chapter are effective on the date of enactment of this Act.

      (2) EFFECTIVE DATE OF MOBILE SERVICE AMENDMENTS- The amendments made by section 5205 shall be effective 1 year after such date of enactment, except that any person that provides private land mobile services before such date of enactment shall continue to be treated as a provider of private land mobile service until 3 years after such date of enactment.

    (b) DEADLINES FOR COMMISSION ACTION-

      (1) GENERAL RULEMAKING- The Federal Communications Commission shall prescribe rules to implement section 309(j) of the Communications Act of 1934 (as added by this chapter) within 210 days after the date of enactment of this Act.

      (2) PCS ORDERS AND LICENSING- The Commission shall--

        (A) within 180 days after such date of enactment, issue a final report and order (i) in the matter entitled ‘Redevelopment of Spectrum to Encourage Innovation in the Use of New Telecommunications Technologies’ (ET Docket No. 92-9); and (ii) in the matter entitled ‘Amendment of the Commission’s Rules to Establish New Personal Communications Services’ (GEN Docket No. 90-314; ET Docket No. 92-100); and

        (B) within 270 days after such date of enactment, commence issuing licenses and permits in the personal communications service.

      (3) MOBILE SERVICE RULEMAKING REQUIRED- Within 1 year after the date of enactment of this Act, the Federal Communications Commission shall--

        (A) issue such modifications or terminations of its regulations concerning private land mobile services as are necessary to implement the amendments made by section 5205;

        (B) make such other modifications of such regulations as may be necessary to equalize the regulatory treatment of providers of all commercial mobile services that offer services that are substantially similar; and

        (C) include in such modifications and terminations such provisions as are necessary to provide for an orderly transition to the regulatory treatment required by such amendments.

    (c) SPECIAL RULE- The Federal Communications Commission shall not issue any license or permit pursuant to section 309(i) of the Communications Act of 1934 after the date of enactment of this Act unless the Commission has made the determination required by paragraph (1)(B) of such section (as added by this chapter).

CHAPTER 2--EMERGING TELECOMMUNICATIONS TECHNOLOGIES

SEC. 5221. SHORT TITLE.

    This chapter may be cited as the ‘Emerging Telecommunications Technologies Act of 1993’.

SEC. 5222. AMENDMENT TO THE NATIONAL TELECOMMUNICATIONS AND INFORMATION ADMINISTRATION ORGANIZATION ACT.

    The National Telecommunications and Information Administration Organization Act is amended--

      (1) by striking the heading of part B and inserting the following:

‘PART D--SPECIAL AND TEMPORARY PROVISIONS’;

      (2) by redesignating sections 131 through 135 as sections 151 through 155, respectively; and

      (3) by inserting after part A the following new part:

‘PART B--EMERGING TELECOMMUNICATIONS TECHNOLOGIES

‘SEC. 111. FINDINGS.

    ‘The Congress finds that--

      ‘(1) the Federal Government currently reserves for its own use, or has priority of access to, approximately 40 percent of the electromagnetic spectrum that is assigned for use pursuant to the Communications Act of 1934;

      ‘(2) many of such frequencies are underutilized by Federal Government licensees;

      ‘(3) the public interest requires that many of such frequencies be utilized more efficiently by Federal Government and non-Federal licensees;

      ‘(4) additional frequencies are assigned for services that could be obtained more efficiently from commercial carriers or other vendors;

      ‘(5) scarcity of assignable frequencies for licensing by the Commission can and will--

        ‘(A) impede the development and commercialization of new telecommunications products and services;

        ‘(B) limit the capacity and efficiency of the United States telecommunications systems;

        ‘(C) prevent some State and local police, fire, and emergency services from obtaining urgently needed radio channels; and

        ‘(D) adversely affect the productive capacity and international competitiveness of the United States economy;

      ‘(6) a reassignment of these frequencies can produce significant economic returns; and

      ‘(7) the Secretary of Commerce, the President, and the Federal Communications Commission should be directed to take appropriate steps to correct these deficiencies.

‘SEC. 112. NATIONAL SPECTRUM PLANNING.

    ‘(a) PLANNING ACTIVITIES- The Assistant Secretary and the Chairman of the Commission shall meet, at least biannually, to conduct joint spectrum planning with respect to the following issues--

      ‘(1) the future spectrum requirements for public and private uses, including State and local government public safety agencies;

      ‘(2) the spectrum allocation actions necessary to accommodate those uses; and

      ‘(3) actions necessary to promote the efficient use of the spectrum, including spectrum management techniques to promote increased shared use of the spectrum that does not cause harmful interference as a means of increasing commercial access.

    ‘(b) REPORTS- The Assistant Secretary and the Chairman of the Commission shall submit a joint annual report to the Committee on Energy and Commerce of the House of Representatives, the Committee on Commerce, Science, and Transportation of the Senate, the Secretary, and the Commission on the joint spectrum planning activities conducted under subsection (a) and recommendations for action developed pursuant to such activities.

    ‘(c) REPORTING REQUIREMENTS- The first annual report submitted after the date of the report by the advisory committee under section 113(d)(4) shall--

      ‘(1) include an analysis of and response to that committee report; and

      ‘(2) include an analysis of the effect on spectrum efficiency and the cost of equipment to Federal spectrum users of maintaining separate allocations for Federal Government and non-Federal Government licensees for the same or similar services.

‘SEC. 113. IDENTIFICATION OF REALLOCABLE FREQUENCIES.

    ‘(a) IDENTIFICATION REQUIRED- The Secretary shall, within 24 months after the date of the enactment of this part, prepare and submit to the President and the Congress a report identifying bands of frequencies that--

      ‘(1) are allocated on a primary basis for Federal Government use and eligible for licensing pursuant to section 305(a) of the Act (47 U.S.C. 305(a));

      ‘(2) are not required for the present or identifiable future needs of the Federal Government;

      ‘(3) can feasibly be made available, as of the date of submission of the report or at any time during the next 15 years, for use under the Act (other than for Federal Government stations under such section 305);

      ‘(4) will not result in costs to the Federal Government, or losses of services or benefits to the public, that are excessive in relation to the benefits that may be obtained by non-Federal licensees; and

      ‘(5) are most likely to have the greatest potential for productive uses and public benefits under the Act.

    ‘(b) MINIMUM AMOUNT OF SPECTRUM RECOMMENDED-

      ‘(1) IN GENERAL- Based on the report required by subsection (a), the Secretary shall recommend for reallocation, for use other than by Federal Government stations under section 305 of the Act (47 U.S.C. 305), bands of frequencies that span a total of not less than 200 megahertz, that are located below 6 gigahertz, and that meet the criteria specified in paragraphs (1) through (4) of subsection (a). The Secretary may not include, in such 200 megahertz, bands of frequencies that span more than 20 megahertz and that are located between 5 and 6 gigahertz. If the report identifies (as meeting such criteria) bands of frequencies spanning more than 200 megahertz, the report shall identify and recommend for reallocation those bands (spanning not less than 200 megahertz) that meet the criteria specified in paragraph (5) of such subsection.

      ‘(2) MIXED USES PERMITTED TO BE COUNTED- Bands of frequencies which the Secretary’s report recommends be partially retained for use by Federal Government stations, but which are also recommended to be reallocated to be made available under the Act for use by non-Federal stations, may be counted toward the minimum spectrum required by paragraph (1) of this subsection, except that--

        ‘(A) the bands of frequencies counted under this paragraph may not count toward more than one-half of the minimum required by paragraph (1) of this subsection;

        ‘(B) a band of frequencies may not be counted under this paragraph unless the assignments of the band to Federal Government stations under section 305 of the Act (47 U.S.C. 305) are limited by geographic area, by time, or by other means so as to guarantee that the potential use to be made by such Federal Government stations is substantially less (as measured by geographic area, time, or otherwise) than the potential use to be made by non-Federal stations; and

        ‘(C) the operational sharing permitted under this paragraph shall be subject to coordination procedures which the Commission shall establish and implement to ensure against harmful interference.

    ‘(c) CRITERIA FOR IDENTIFICATION-

      ‘(1) NEEDS OF THE FEDERAL GOVERNMENT- In determining whether a band of frequencies meets the criteria specified in subsection (a)(2), the Secretary shall--

        ‘(A) consider whether the band of frequencies is used to provide a communications service that is or could be available from a commercial carrier or other vendor;

        ‘(B) seek to promote--

          ‘(i) the maximum practicable reliance on commercially available substitutes;

          ‘(ii) the sharing of frequencies (as permitted under subsection (b)(2));

          ‘(iii) the development and use of new communications technologies; and

          ‘(iv) the use of nonradiating communications systems where practicable; and

        ‘(C) seek to avoid--

          ‘(i) serious degradation of Federal Government services and operations; and

          ‘(ii) excessive costs to the Federal Government and users of Federal Government services.

      ‘(2) FEASIBILITY OF USE- In determining whether a frequency band meets the criteria specified in subsection (a)(3), the Secretary shall--

        ‘(A) assume such frequencies will be assigned by the Commission under section 303 of the Act (47 U.S.C. 303) over the course of not less than 15 years;

        ‘(B) assume reasonable rates of scientific progress and growth of demand for telecommunications services;

        ‘(C) determine the extent to which the reallocation or reassignment will relieve actual or potential scarcity of frequencies available for licensing by the Commission for non-Federal use;

        ‘(D) seek to include frequencies which can be used to stimulate the development of new technologies; and

        ‘(E) consider the immediate and recurring costs to reestablish services displaced by the reallocation of spectrum.

      ‘(3) ANALYSIS OF BENEFITS- In determining whether a band of frequencies meets the criteria specified in subsection (a)(4), the Secretary shall consider--

        ‘(A) the extent to which equipment is or will be available that is capable of utilizing the band;

        ‘(B) the proximity of frequencies that are already assigned for commercial or other non-Federal use; and

        ‘(C) the activities of foreign governments in making frequencies available for experimentation or commercial assignments in order to support their domestic manufacturers of equipment.

      ‘(4) POWER AGENCY FREQUENCIES-

        ‘(A) ELIGIBLE FOR MIXED USE ONLY- The frequencies assigned to any Federal power agency may only be eligible for mixed use under subsection (b)(2) in geographically separate areas and shall not be recommended for the purposes of withdrawing that assignment. In any case where a frequency is to be shared by an affected Federal power agency and a non-Federal user, such use by the non-Federal user shall, consistent with the procedures established under subsection (b)(2)(C), not cause harmful interference to the affected Federal power agency or adversely affect the reliability of its power system.

        ‘(B) DEFINITION- As used in this paragraph, the term ‘Federal power agency’ means the Tennessee Valley Authority, the Bonneville Power Administration, the Western Area Power Administration, or the Southwestern Power Administration.

    ‘(d) PROCEDURE FOR IDENTIFICATION OF REALLOCABLE BANDS OF FREQUENCIES-

      ‘(1) SUBMISSION OF PRELIMINARY IDENTIFICATION TO CONGRESS- Within 12 months after the date of the enactment of this part, the Secretary shall prepare and submit to the Congress a report which makes a preliminary identification of reallocable bands of frequencies which meet the criteria established by this section.

      ‘(2) CONVENING OF ADVISORY COMMITTEE- Not later than the date the Secretary submits the report required by paragraph (1), the Secretary shall convene an advisory committee to--

        ‘(A) review the bands of frequencies identified in such report;

        ‘(B) advise the Secretary with respect to (i) the bands of frequencies which should be included in the final report required by subsection (a), and (ii) the effective dates which should be established under subsection (e) with respect to such frequencies;

        ‘(C) receive public comment on the Secretary’s report and on the final report; and

        ‘(D) prepare and submit the report required by paragraph (4).

      The advisory committee shall meet at least monthly until each of the actions required by section 114(a) have taken place.

      ‘(3) COMPOSITION OF COMMITTEE; CHAIRMAN- The advisory committee shall include--

        ‘(A) the Chairman of the Commission and the Assistant Secretary, and one other representative of the Federal Government as designated by the Secretary; and

        ‘(B) representatives of--

          ‘(i) United States manufacturers of spectrum-dependent telecommunications equipment;

          ‘(ii) commercial carriers;

          ‘(iii) other users of the electromagnetic spectrum, including radio and television broadcast licensees, State and local public safety agencies, and the aviation industry; and

          ‘(iv) other interested members of the public who are knowledgeable about the uses of the electromagnetic spectrum.

      A majority of the members of the committee shall be members described in subparagraph (B), and one of such members shall be designated as chairman by the Secretary.

      ‘(4) RECOMMENDATIONS ON SPECTRUM ALLOCATION PROCEDURES- The advisory committee shall, not later than 36 months after the date of the enactment of this part, submit to the Secretary, the Commission, the Committee on Energy and Commerce of the House of Representatives, and the Committee on Commerce, Science, and Transportation of the Senate, a report containing such recommendations as the advisory committee considers appropriate for the reform of the process of allocating the electromagnetic spectrum between Federal and non-Federal use, and any dissenting views thereon.

    ‘(e) TIMETABLE FOR REALLOCATION AND LIMITATION-

      ‘(1) TIMETABLE REQUIRED- The Secretary shall, as part of the report required by subsection (a), include a timetable that recommends immediate and delayed effective dates by which the President shall withdraw or limit assignments on the frequencies specified in the report.

      ‘(2) EXPEDITED REALLOCATION OF INITIAL 30 MHZ PERMITTED- The Secretary may prepare and submit to the President a report which specifically identifies an initial 30 megahertz of spectrum that meets the criteria described in subsection (a) and that can be made available for reallocation immediately upon issuance of the report required by this section.

      ‘(3) DELAYED EFFECTIVE DATE- The recommended delayed effective dates shall--

        ‘(A) permit the earliest possible reallocation of the frequency bands, taking into account the requirements of section 115(1);

        ‘(B) be based on the useful remaining life of equipment that has been purchased or contracted for to operate on identified frequencies;

        ‘(C) be based on the need to coordinate frequency use with other nations; and

        ‘(D) take into account the relationship between the costs to the Federal Government of changing to different frequencies and the benefits that may be obtained from commercial and other non-Federal uses of the reassigned frequencies.

‘SEC. 114. WITHDRAWAL OF ASSIGNMENT TO FEDERAL GOVERNMENT STATIONS.

    ‘(a) IN GENERAL- The President shall--

      ‘(1) within 6 months after receipt of the Secretary’s report under section 113(a), withdraw the assignment to a Federal Government station of any frequency which the report recommends for immediate reallocation;

      ‘(2) within such 6-month period, limit the assignment to a Federal Government station of any frequency which the report recommends be made immediately available for mixed use under section 113(b)(2);

      ‘(3) by the delayed effective date recommended by the Secretary under section 113(e) (except as provided in subsection (b)(4) of this section), withdraw or limit the assignment to a Federal Government station of any frequency which the report recommends be reallocated or made available for mixed use on such delayed effective date;

      ‘(4) assign or reassign other frequencies to Federal Government stations as necessary to adjust to such withdrawal or limitation of assignments; and

      ‘(5) transmit a notice and description to the Commission and each House of Congress of the actions taken under this subsection.

    ‘(b) EXCEPTIONS-

      ‘(1) AUTHORITY TO SUBSTITUTE- If the President determines that a circumstance described in paragraph (2) exists, the President--

        ‘(A) may substitute an alternative frequency or band of frequencies for the frequency or band that is subject to such determination and withdraw (or limit) the assignment of that alternative frequency or band in the manner required by subsection (a); and

        ‘(B) shall submit a statement of the reasons for taking the action described in subparagraph (A) to the Committee on Energy and Commerce of the House of Representatives and the Committee on Commerce, Science, and Transportation of the Senate.

      ‘(2) GROUNDS FOR SUBSTITUTION- For purposes of paragraph (1), the following circumstances are described in this paragraph:

        ‘(A) the reassignment would seriously jeopardize the national defense interests of the United States;

        ‘(B) the frequency proposed for reassignment is uniquely suited to meeting important governmental needs;

        ‘(C) the reassignment would seriously jeopardize public health or safety; or

        ‘(D) the reassignment will result in costs to the Federal Government that are excessive in relation to the benefits that may be obtained from commercial or other non-Federal uses of the reassigned frequency.

      ‘(3) CRITERIA FOR SUBSTITUTED FREQUENCIES- For purposes of paragraph (1), a frequency may not be substituted for a frequency identified by the report of the Secretary under section 113(a) unless the substituted frequency also meets each of the criteria specified by section 113(a).

      ‘(4) DELAYS IN IMPLEMENTATION- If the President determines that any action cannot be completed by the delayed effective date recommended by the Secretary pursuant to section 113(e), or that such an action by such date would result in a frequency being unused as a consequence of the Commission’s plan under section 115, the President may--

        ‘(A) withdraw or limit the assignment to Federal Government stations on a later date that is consistent with such plan, except that the President shall notify each committee specified in paragraph (1)(B) and the Commission of the reason that withdrawal or limitation at a later date is required; or

        ‘(B) substitute alternative frequencies pursuant to the provisions of this subsection.

    ‘(c) LIMITATION ON DELEGATION- Notwithstanding any other provision of law, the authorities and duties established by this section may not be delegated.

‘SEC. 115. DISTRIBUTION OF FREQUENCIES BY THE COMMISSION.

    ‘Not later than 1 year after the President notifies the Commission pursuant to section 114(a)(5), the Commission shall prepare, in consultation with the Assistant Secretary when necessary, and submit to the President and the Congress, a plan for the distribution under the Act of the frequency bands reallocated pursuant to the requirements of this part. Such plan shall--

      ‘(1) not propose the immediate distribution of all such frequencies, but, taking into account the timetable recommended by the Secretary pursuant to section 113(e), shall propose--

        ‘(A) gradually to distribute the frequencies remaining, after making the reservation required by subparagraph (B), over the course of a period of not less than 10 years beginning on the date of submission of such plan; and

        ‘(B) to reserve a significant portion of such frequencies for distribution beginning after the end of such 10-year period;

      ‘(2) contain appropriate provisions to ensure--

        ‘(A) the availability of frequencies for new technologies and services in accordance with the policies of section 7 of the Act (47 U.S.C. 157); and

        ‘(B) the availability of frequencies to stimulate the development of such technologies;

      ‘(3) address (A) the feasibility of reallocating spectrum from current commercial and other non-Federal uses to provide for more efficient use of the spectrum, and (B) innovation and marketplace developments that may affect the relative efficiencies of different spectrum allocations; and

      ‘(4) not prevent the Commission from allocating bands of frequencies for specific uses in future rulemaking proceedings.

‘SEC. 116. AUTHORITY TO RECOVER REASSIGNED FREQUENCIES.

    ‘(a) AUTHORITY OF PRESIDENT- Subsequent to the withdrawal of assignment to Federal Government stations pursuant to section 114, the President may reclaim reassigned frequencies for reassignment to Federal Government stations in accordance with this section.

    ‘(b) PROCEDURE FOR RECLAIMING FREQUENCIES-

      ‘(1) UNALLOCATED FREQUENCIES- If the frequencies to be reclaimed have not been allocated or assigned by the Commission pursuant to the Act, the President shall follow the procedures for substitution of frequencies established by section 114(b) of this part.

      ‘(2) ALLOCATED FREQUENCIES- If the frequencies to be reclaimed have been allocated or assigned by the Commission, the President shall follow the procedures for substitution of frequencies established by section 114(b) of this part, except that the notification required by section 114(b)(1)(A) shall include--

        ‘(A) a timetable to accommodate an orderly transition for licensees to obtain new frequencies and equipment necessary for its utilization; and

        ‘(B) an estimate of the cost of displacing spectrum users licensed by the Commission.

    ‘(c) COSTS OF RECLAIMING FREQUENCIES; APPROPRIATIONS AUTHORIZED- The Federal Government shall bear all costs of reclaiming frequencies pursuant to this section, including the cost of equipment which is rendered unusable, the cost of relocating operations to a different frequency band, and any other costs that are directly attributable to the reclaiming of the frequency pursuant to this section. There are authorized to be appropriated such sums as may be necessary to carry out the purposes of this section.

    ‘(d) EFFECTIVE DATE OF RECLAIMED FREQUENCIES- The Commission shall not withdraw licenses for any reclaimed frequencies until the end of the fiscal year following the fiscal year in which the President’s notification is received.

    ‘(e) EFFECT ON OTHER LAW- Nothing in this section shall be construed to limit or otherwise affect the authority of the President under sections 305 and 706 of the Act (47 U.S.C. 305, 606).

‘SEC. 117. DEFINITIONS.

    ‘As used in this part:

      ‘(1) The term ‘allocation’ means an entry in the National Table of Frequency Allocations of a given frequency band for the purpose of its use by one or more radiocommunication services.

      ‘(2) The term ‘assignment’ means an authorization given to a station licensee to use specific frequencies or channels.

      ‘(3) The term ‘commercial carrier’ means any entity that uses a facility licensed by the Federal Communications Commission pursuant to the Communications Act of 1934 for hire or for its own use, but does not include Federal Government stations licensed pursuant to section 305 of the Act (47 U.S.C. 305).

      ‘(4) The term ‘the Act’ means the Communications Act of 1934 (47 U.S.C. 151 et seq.).’.

CHAPTER 3--COMMUNICATIONS TECHNICAL AMENDMENTS

SEC. 5241. CLERICAL CORRECTIONS.

    (a) AMENDMENTS TO THE COMMUNICATIONS ACT OF 1934- The Communications Act of 1934 is amended--

      (1) in section 4(f)(3), by striking ‘overtime exceeds beyond’ and inserting ‘overtime extends beyond’;

      (2) in section 5, by redesignating subsection (f) as subsection (e);

      (3) in section 220(b), by striking ‘clasess’ and inserting ‘classes’;

      (4) in section 223(b)(3), by striking ‘defendant restrict access’ and inserting ‘defendant restricted access’;

      (5) in section 226(d), by striking paragraph (2) and redesignating paragraphs (3) and (4) as paragraphs (2) and (3), respectively;

      (6) in section 227(e)(2), by striking ‘national datebase’ and inserting ‘national database’;

      (7) in section 228(c)(6)(D), by striking ‘conservation’ and inserting ‘conversation’;

      (8) in section 308(c), by striking ‘May 24, 1921’ and inserting ‘May 27, 1921’;

      (9) in section 331, by amending the heading of such section to read as follows:

‘VERY HIGH FREQUENCY STATIONS AND AM RADIO STATIONS’;

      (10) in section 358, by striking ‘(a)’;

      (11) in part III of title III--

        (A) by inserting before section 381 the following heading:

‘VESSELS TRANSPORTING MORE THAN SIX PASSENGERS FOR HIRE REQUIRED TO BE EQUIPPED WITH RADIO TELEPHONE’;

        (B) by inserting before section 382 the following heading:

‘VESSELS EXCEPTED FROM RADIO TELEPHONE REQUIREMENT’;

        (C) by inserting before section 383 the following heading:

‘EXEMPTIONS BY COMMISSION’;

        (D) by inserting before section 384 the following heading:

‘AUTHORITY OF COMMISSION; OPERATIONS, INSTALLATIONS, AND ADDITIONAL EQUIPMENT’;

        (E) by inserting before section 385 the following heading:

‘INSPECTIONS’; AND

        (F) by inserting before section 386 the following heading:

‘FORFEITURES’;

      (12) in section 410(c), by striking ‘, as referred to in sections 202(b) and 205(f) of the Interstate Commerce Act,’;

      (13) in section 705(e)(3)(A), by striking ‘paragraph (4) of subsection (d)’ and inserting ‘paragraph (4) of this subsection’;

      (14) in section 705, by redesignating subsections (f) and (g) (as added by Public Law 100-667) as subsections (g) and (h); and

      (15) in section 705(h) (as so redesignated), by striking ‘subsection (f)’ and inserting ‘subsection (g)’.

    (b) AMENDMENTS TO THE COMMUNICATIONS SATELLITE ACT OF 1962- The Communications Satellite Act of 1962 is amended--

      (1) in section 303(a)--

        (A) by striking ‘section 27(d)’ and inserting ‘section 327(d)’;

        (B) by striking ‘sec. 29-911(d)’ and inserting ‘sec. 29-327(d)’;

        (C) by striking ‘section 36’ and inserting ‘section 336’; and

        (D) by striking ‘sec. 29-916d’ and inserting ‘sec. 29-336(d)’;

      (2) in section 304(d), by striking ‘paragraphs (1), (2), (3), (4), and (5) of section 310(a)’ and inserting ‘subsection (a) and paragraphs (1) through (4) of subsection (b) of section 310’; and

      (3) in section 304(e)--

        (A) by striking ‘section 45(b)’ and inserting ‘section 345(b)’; and

        (B) by striking ‘sec. 29-920(b)’ and inserting ‘sec. 29-345(b)’; and

      (4) in sections 502(b) and 503(a)(1), by striking ‘Communications Satellite Corporation’ and inserting ‘communications satellite corporation established pursuant to title III of this Act’.

    (c) CONFORMING AMENDMENT- Section 1253 of the Omnibus Budget Reconciliation Act of 1981 is repealed.

SEC. 5242. TRANSFER OF PROVISIONS OF LAW CONCERNING PUBLIC TELECOMMUNICATIONS FACILITIES, CHILDREN’S EDUCATIONAL TELEVISION, AND TELECOMMUNICATIONS DEMONSTRATION PROGRAM.

    (a) AMENDMENTS- The Communications Act of 1934 (hereinafter in this section referred to as ‘the 1934 Act’) and the National Telecommunications and Information Administration Organization Act (hereinafter in this section referred to as ‘the NTIAO Act’) are amended as follows:

      (1) The NTIAO Act is amended by inserting after part B (as added by chapter 2 of this subtitle) a new part C, the heading of which shall be as follows:

‘PART C--ASSISTANCE FOR PUBLIC TELECOMMUNICATIONS FACILITIES; CHILDREN’S EDUCATIONAL TELEVISION; TELECOMMUNICATIONS DEMONSTRATIONS’;

      (2) Sections 390, 391, 392, 393, 393A, 394, and 395 of the 1934 Act are transferred to such new part C of the NTIAO Act and are redesignated as sections 121, 122, 123, 124, 125, 131, and 135, respectively, of the NTIAO Act.

      (3) Such new part C of the NTIAO Act is amended--

        (A) by inserting before section 121 the following:

‘Subpart 1--Assistance for Public Telecommunications Facilities’ and;

        (B) by inserting before section 131 the following:

‘Subpart 2--National Endowment for Children’s Television’ and;

        (C) by inserting before section 135 the following:

‘Subpart 3--Telecommunications Demonstrations’.

      (4) Section 125 of the NTIAO Act (as added by paragraph (2) of this subsection) is amended by striking ‘section 390’ and inserting ‘section 121’.

      (5) Each of such sections 121 through 135 is amended so that the section designation and section heading of each such shall be in the form and typeface of the section designation and section heading of this section.

    (b) CONFORMING AMENDMENT TO COMMUNICATIONS ACT OF 1934- Part IV of title III of the 1934 Act is amended by striking out subparts A, B, and C.

    (c) REFERENCES IN OTHER LAWS AND DOCUMENTS- Any reference to any section or other provision of subpart A, B, or C of part IV of title III of the 1934 Act in any law, rule, regulation, certificate, directive, instruction, or other official paper in force on the date of enactment of this section shall be deemed to refer to the section or other provision of subpart 1, 2, or 3 of part C of the NTIAO Act to which such section or other provision is transferred by this section.

SEC. 5243. ELIMINATION OF EXPIRED AND OUTDATED PROVISIONS.

    (a) AMENDMENTS TO THE COMMUNICATIONS ACT OF 1934- The Communications Act of 1934 is amended--

      (1) in section 7(b), by striking ‘or twelve months after the date of the enactment of this section, if later’ both places it appears;

      (2) in section 212, by striking ‘After sixty days from the enactment of this Act it shall’ and inserting ‘It shall’;

      (3) in section 213, by striking subsection (g) and redesignating subsection (h) as subsection (g);

      (4) in section 214(a), by striking ‘section 221 or 222’ and inserting ‘section 221’;

      (5) in section 220(b), by striking ‘, as soon as practicable,’;

      (6) in section 222--

        (A) by striking paragraph (1) of subsection (a);

        (B) by redesignating paragraphs (2) and (3) of such subsection as paragraphs (1) and (2), respectively;

        (C) by striking paragraph (2) of subsection (b);

        (D) by redesignating subsection (b)(1) as subsection (b); and

        (E) by striking subsections (c), (d), and (e);

      (7) in section 224(b)(2), by striking ‘Within 180 days from the date of enactment of this section the Commission’ and inserting ‘The Commission’;

      (8) in 226(e)(1), by striking ‘, within 9 months after the date of enactment of this section,’;

      (9) in section 309(i)(4)(A), by striking ‘The commission, not later than 180 days after the date of the enactment of the Communications Technical Amendments Act of 1982, shall,’ and inserting ‘The Commission shall,’;

      (10) by striking section 328;

      (11) in section 331(b), by striking the last sentence;

      (12) in section 413, by striking ‘, within sixty days after the taking effect of this Act,’;

      (13) in section 624(d)(2)--

        (A) by striking out ‘(A)’;

        (B) by inserting ‘of’ after ‘restrict the viewing’; and

        (C) by striking subparagraph (B);

      (14) by striking sections 702 and 703;

      (15) in section 704--

        (A) by striking subsections (b) and (d); and

        (B) by redesignating subsection (c) as subsection (b);

      (16) in section 705(g) (as redesignated by section 5211(15)), by striking ‘Within 6 months after the date of enactment of the Satellite Home Viewer Act of 1988, the Federal Communications Commission’ and inserting ‘The Commission’;

      (16) in section 710(f)--

        (A) by striking the first and second sentences; and

        (B) in the third sentence, by striking ‘Thereafter, the Commission’ and inserting ‘The Commission’;

      (17) in section 712(a), by striking ‘, within 120 days after the effective date of the Satellite Home Viewer Act of 1988,’; and

      (18) by striking section 713.

    (b) AMENDMENTS TO THE COMMUNICATIONS SATELLITE ACT OF 1962- The Communications Satellite Act of 1962 is amended--

      (1) in section 201(a)(1), by striking ‘as expeditiously as possible,’;

      (2) by striking sections 301 and 302 and inserting the following:

‘SEC. 301. CREATION OF CORPORATION.

    ‘There is authorized to be created a communications satellite corporation for profit which will not be an agency or establishment of the United States Government.

‘SEC. 302. APPLICABLE LAWS.

    ‘The corporation shall be subject to the provisions of this Act and, to the extent consistent with this Act, to the District of Columbia Business Corporation Act. The right to repeal, alter, or amend this Act at any time is expressly reserved.’;

      (3) in section 304(a), by striking ‘at a price not in excess of $100 for each share and’;

      (4) in section 404--

        (A) by striking subsections (a) and (c); and

        (B) by striking ‘(b)’ at the beginning of subsection (b);

      (5) in section 503--

        (A) by striking paragraph (2) of subsection (a); and

        (B) by redesignating paragraph (3) of subsection (a) as paragraph (2) of such subsection;

        (C) by striking subsection (b);

        (D) in subsection (g)--

          (i) by striking ‘subsection (c)(3)’ and inserting ‘subsection (b)(3)’; and

          (ii) by striking the last sentence; and

        (E) by redesignating subsections (c) through (h) as subsections (b) through (g), respectively;

      (5) by striking sections 505, 506, and 507; and

      (6) by redesignating section 508 as section 505.

SEC. 5244. STYLISTIC CONSISTENCY.

    The Communications Act of 1934 and the Communications Satellite Act of 1962 are amended so that the section designation and section heading of each section of such Acts shall be in the form and typeface of the section designation and heading of this section.

Subtitle D--Energy Programs

SEC. 5301. NUCLEAR REGULATORY COMMISSION ANNUAL CHARGES.

    Section 6101(a)(3) of the Omnibus Budget Reconciliation Act of 1990 (42 U.S.C. 2214(a)(3)) is amended by striking ‘September 30, 1995’ and inserting ‘September 30, 1998’.

TITLE VI--COMMITTEE ON FOREIGN AFFAIRS

    In order to implement its reconciliation instructions, the Committee on Foreign Affairs recommends changes in law that are also recommended by the Committee on Post Office and Civil Service. These changes in law, which are contained in title X of this Act, would reduce direct spending under the Foreign Service Retirement and Disability Fund and the Foreign Service Pension System by requiring a 3-month delay in cost-of-living adjustments in each of the fiscal years 1994, 1995, and 1996.

TITLE VII--COMMITTEE ON THE JUDICIARY

SEC. 7001. PATENT AND TRADEMARK FEES.

    Section 10101 of the Omnibus Budget Reconciliation Act of 1990 (35 U.S.C. 41 note) is amended--

      (1) in subsection (a) by striking ‘1995’ and inserting ‘1998’;

      (2) in subsection (b)(2) by striking ‘1995’ and inserting ‘1998’; and

      (3) in subsection (c)--

        (A) by striking ‘through 1995’ and inserting ‘through 1998’; and

        (B) by adding at the end the following:

      ‘(6) $111,000,000 in fiscal year 1996.

      ‘(7) $115,000,000 in fiscal year 1997.

      ‘(8) $119,000,000 in fiscal year 1998.’.

TITLE VIII--COMMITTEE ON MERCHANT MARINE AND FISHERIES

SEC. 8001. EXTENSION OF VESSEL TONNAGE DUTIES.

    (a) EXTENSION OF DUTIES- Section 36 of the Act of August 5, 1909 (36 Stat. 111; 46 App. U.S.C. 121), is amended by--

      (1) striking ‘and 1995,’ each place it appears and inserting ‘1995, 1996, 1997, 1998,’;

      (2) striking ‘place,’ and inserting ‘place;’; and

      (3) striking ‘port, not, however, to include vessels in distress or not engaged in trade’ and inserting ‘port. However, neither duty shall be imposed on vessels in distress or not engaged in trade’.

    (b) CONFORMING AMENDMENT- The Act of March 8, 1910 (36 Stat. 234; 46 App. U.S.C. 132), is amended by striking ‘and 1995,’ and inserting ‘1995, 1996, 1997, and 1998,’.

    (c) TECHNICAL CORRECTION-

      (1) CORRECTION- Section 10402(a) of the Omnibus Budget Reconciliation Act of 1990 (104 Stat. 1388-398) is amended by striking ‘in the second paragraph’.

      (2) EFFECTIVE DATE- The amendment made by paragraph (1) shall be effective on and after November 5, 1990.

SEC. 8002. SENSE OF THE CONGRESS ON THE INLAND WATERWAYS FUEL TAX.

    (a) FINDINGS- The Congress finds the following:

      (1) The Administration has proposed to increase the tax on inland barge fuels from $0.19 to $1.19 per gallon by 1997, which represents an increase of 525 percent.

      (2) The General Accounting Office has recently identified 117 forms of Federal fees, taxes, and assessments, not including customs duties, which raise some $2,000,000,000 in Federal revenues each year.

      (3) Barge transportation is one of the most competitive, efficient, safe, and environmentally friendly modes of transportation.

      (4) Barges transport 15 percent of our Nation’s commerce and provide jobs to some 180,000 Americans.

      (5) The Administration’s proposed increase would add $420,000,000 in new taxes for operators on inland waterways, which is more than their pretax profits.

      (6) This increase would cause barge rates to skyrocket, increasing costs to consumers and devastating industries dependent upon the commercial use of barges such as coal, agriculture, and petrochemicals, and would add to our unfavorable balance of trade payments by hurting the competitiveness of United States exports.

      (7) Because the price of certain agricultural commodities, such as grain, are set in the world marketplace, increased inland barge fuel taxes could not be passed on to consumers and would largely be borne by our Nation’s farmers.

      (8) The Senate on March 18, 1993, voted 88 to 12 to reject any further increase in inland barge fuel taxes.

      (9) This huge tax increase would cause many barge companies to go out of business, would result in thousands of lost American jobs, and would further burden the already beleaguered United States maritime industry.

    (b) SENSE OF CONGRESS- It is the sense of the Congress that the inland waterways fuel tax should not be further increased beyond those increases already mandated by law.

TITLE IX--COMMITTEE ON NATURAL RESOURCES

SEC. 9001. ANNUAL DIRECT GRANT ASSISTANCE.

    (a) REPEAL- Sections 3 and 4 of the Act of March 24, 1976 entitled ‘a Joint Resolution to approve the ‘Covenant To Establish a Commonwealth of the Northern Mariana Islands in Political Union with the United States of America’, and for other purposes’ (90 Stat. 263 and following; 48 U.S.C. 1681 note) are repealed, effective on October 1, 1993.

    (b) DEFINITIONS- As used in this section:

      (1) COMMITTEES- The term ‘committees’ means the Committee on Natural Resources of the House of Representatives and the Committee on Energy and Natural Resources of the Senate.

      (2) RECOMMENDATIONS- The term ‘Recommendations’ means the document executed December 17, 1992, between the special representative of the President of the United States and the special representatives of the Governor of the Commonwealth of the Northern Mariana Islands relating to future federal assistance for the Northern Mariana Islands.

      (3) REPORTING DATE- The term ‘reporting date’ means the date on which the budget of the President for the fiscal year 1995 is required to be submitted to the Congress under section 1105 of title 31, United States Code.

    (c) ASSISTANCE-

        (1) AMOUNTS- Except as otherwise provided under this section, enactment of this section shall constitute a commitment and pledge of the full faith and credit of the United States for the payment of the following amounts:

          (A) In fulfillment of the United States obligation under P.L. 94-241 and the authorization in P.L. 95-348, $3,000,000 for fiscal year 1994, which shall be available only for the American Memorial Park, located at Tanapag Harbor Reservation, Saipan, to be expended in accordance with section 5 of the Act entitled ‘An Act to authorize appropriations for certain insular areas of the United States, and for other purposes’, approved August 18, 1978 (92 Stat. 492), for the primary purpose of constructing an appropriate monument honoring the dead in the World War II Mariana Islands campaign.

          (B) $19,000,000 for fiscal year 1994, to be held in trust in a special account by the Secretary of the Interior for American Samoa, the Commonwealth of the Northern Mariana Islands, Guam, the Trust Territory of the Pacific Islands, and the Virgin Islands, and to be disbursed by the Secretary during fiscal year 1994 for essential capital improvement projects. Such disbursements shall be made by the Secretary for projects described in plans submitted to the Secretary by the governments of American Samoa, the Commonwealth of the Northern Mariana Islands, Guam, the Trust Territory of the Pacific Islands, and the Virgin Islands. No such disbursements shall be made pursuant to any such plan until after the expiration of a period of 60 days after such plan has been submitted to the committees. No such disbursements shall be made to the Commonwealth of the Northern Mariana Islands during fiscal year 1994 pursuant to any such plan until the committees have received the reports required under subsection (d)(3) and a Joint Resolution has been adopted expressing the sense of Congress that disbursements are appropriate. The Inspector General of the Department of the Interior shall (i) monitor the expenditure of such funds to determine whether such funds are expended in accordance with applicable law, and (ii) submit a report of the findings to the committees not later than January 1, 1995.

          (C) Subject to paragraphs (2), (3), and (4) and subject to subsection (d), not more than $98,000,000 for the 6-year period beginning October 1, 1994, for the government of the Commonwealth of the Northern Mariana Islands, for capital improvement projects, at annual amounts that shall not exceed those specified for the Federal contribution within the general funding schedule contained in the Recommendations.

        (2) MATCHING RATIO AND INTEREST EARNINGS- Nothing in this section shall be construed to--

          (A) modify the matching ratio requirement specified in the funding schedule contained in the Recommendations; or

          (B) modify the terms of the Recommendations as to the availability of interest earnings on funds contributed under Public Law 99-396 upon meeting the terms of the grant pledge agreements entered into under Public Law 99-396.

        (3) ROTA, TINIAN, AND SAIPAN- No less than 1/8 th share of the funds made available under subsection (c)(1)(C) shall be expended in the islands of Rota and Tinian and no less than 1/4 th share shall be expended in Saipan.

        (4) APPLICABILITY OF GRANT REGULATIONS- The Federal assistance provided under this section shall be subject to the applicable Federal grant regulations set forth in the Common Rule (43 C.F.R. 12a, OMB Circular A-102, and OMB Circular A-128).

    (d) CONDITION ON MULTI-YEAR ASSISTANCE-

      (1) JOINT RESOLUTION- Amounts under subsection (c)(1)(C) for fiscal years 1995 through 2000 shall be as determined by the Congress by joint resolution. It is the intent of the Congress that the committees report such a joint resolution after considering the plan referred to in paragraph (2) and reports required by this subsection.

      (2) CAPITAL IMPROVEMENT PROJECTS PLAN- The plan referred to in paragraph (1) is a plan developed and submitted by the Governor of the Commonwealth of the Northern Mariana Islands to the Secretary of the Interior as approved by the legislature of the Commonwealth for new and reconstructed capital infrastructure projects, indicating the order of priority, together with cost estimates for each project and identification of sources of financing for each project. The Secretary of the Interior shall submit the plan, together with his recommendations, to the committees not later than the reporting date.

      (3) REPORTS- Each of the following reports shall be submitted to the committees not later than the reporting date as follows:

        (A) REVENUE BURDEN- The Comptroller General of the United States, after consultation with the government of the Northern Mariana Islands, shall submit a report describing the effective revenue burden (including all taxes and fees) imposed by the government of the Commonwealth of the Northern Mariana Islands. The report shall--

          (i) address whether revenues raised are sufficient to meet the infrastructure needs of the Commonwealth; and

          (ii) compare the revenue burden of the Commonwealth with that of Guam.

        (B) COMPLIANCE WITH AUDIT RECOMMENDATIONS- The Inspector General of the Department of the Interior shall submit a report on (i) compliance by the government of the Commonwealth of the Northern Mariana Islands with recommendations made by the Inspector General pursuant to audits of the government of the Commonwealth, and (ii) on all unfulfilled commitments made by the government of the Commonwealth in response to those recommendations.

        (C) ASSESSMENT OF MINIMUM WAGE- The Secretary of Labor, after consultation with the government of the Commonwealth of the Northern Mariana Islands, shall submit a report which assesses whether--

          (i) the minimum wage policies of the Commonwealth are sufficient for the maintenance of the minimum standard of living necessary for health, efficiency, and general well-being of workers in the Commonwealth;

          (ii) the prevailing wages paid in the Commonwealth are effectively reduced by the immigration policy of the Commonwealth; and

          (iii) the wage rate in the Commonwealth gives industries in the Commonwealth a competitive advantage over industries in the United States outside of the Commonwealth.

        (D) IMMIGRATION POLICY AND BURDEN ON INFRASTRUCTURE- (i) The Attorney General of the United States, after consultation with the government of the Commonwealth of the Northern Mariana Islands, shall submit a report which assesses--

          (I) whether the immigration laws of the Commonwealth are appropriate in light of the social and economic situation in the Commonwealth;

          (II) the extent to which the Commonwealth is relying on temporary alien workers to meet the Commonwealth’s permanent labor needs;

          (III) whether the Commonwealth has taken steps to reduce its dependence on temporary alien workers; and

          (IV) the political and civil rights of the alien population as compared to the resident population.

        (ii) The Comptroller General of the United States shall submit a report to the Congress which analyzes the socioeconomic impact of the immigration policy of the Commonwealth of the Northern Mariana Islands, including the financial burden imposed by the alien population on the infrastructure.

        (E) ENVIRONMENTAL LAWS- The Secretary of the Interior and the Administrator of the Environmental Protection Agency shall each submit a report to the Congress on the compliance by the Commonwealth of the Northern Mariana Islands with United States environmental laws, including (but not limited to) the National Environmental Policy Act of 1969, the Endangered Species Act of 1973, and the Federal Water Pollution Control Act.

SEC. 9002. NET RECEIPTS SHARING.

    Section 35 of the Mineral Leasing Act is amended as follows:

      (1) Strike the last sentence.

      (2) Insert ‘(a) IN GENERAL- ’ after ‘SEC. 35.’

      (3) Insert ‘and, subject to subsection (b),’ between ‘United States;’ and ‘50 percentum’.

      (4) Add the following new subsection at the end thereof:

    ‘(b) ADMINISTRATIVE COSTS- (1) In calculating the amount to be paid to each State during any fiscal year under this section and under other provisions of law requiring payment to a State of any revenues derived from the leasing of any other onshore lands or interest in land owned by the United States for the production of the same types of minerals as are leasable under this Act or for the production of geothermal steam, prior to the division and distribution of such leasing receipts between the States and the United States, the Secretary shall deduct 50 percent of the portion of the enacted appropriations of the Department of the Interior and of other departments and agencies of the United States for the preceding fiscal year allocable to the administration and enforcement of this Act and such other provisions of law. Such deduction shall be in approximately equal amounts each month (subject to paragraph (3)).

    ‘(2) The proportion of the deduction required under paragraph (1) which is allocable to each State shall be a percentage of the total deduction allocable to all States. The percentage shall be determined by dividing--

      ‘(A) the monies disbursed to the State during the preceding fiscal year under the provisions of this section and the other provisions of law referred to in paragraph (1), by

      ‘(B) the total money disbursed to all States during that fiscal year under such provisions.

    ‘(3) If the amount otherwise deductible under this subsection in any month from the portion of revenues to be distributed to a State exceeds the amount payable to the State during that month, any amount exceeding the amount payable shall be carried forward and deducted from amounts payable to the State in subsequent months.

    ‘(4) All amounts deducted under this subsection from monies otherwise payable to a State shall be credited to miscellaneous receipts in the Treasury.’.

SEC. 9003. HARD ROCK MINING CLAIM MAINTENANCE AND LOCATION FEES.

    (a) CLAIM MAINTENANCE AND LOCATION FEES-

      (1) CLAIM MAINTENANCE FEES- The holder of each unpatented mining claim, mill or tunnel site located pursuant to the Mining Laws of the United States (whether located before or after enactment of this Act) shall pay to the Secretary of the Interior or his designee for each assessment year a flat claim maintenance fee of not less than $100 per claim. Such claim maintenance fee shall be in lieu of the assessment work requirement contained in the Mining Law of 1872 (30 U.S.C. 28-28e) and the related filing requirements contained in section 314 (a) and (c) of the Federal Land Policy and Management Act of 1976 (43 U.S.C. 1744 (a) and (c)).

      (2) LOCATION FEE- For each mining claim, mill or tunnel site located pursuant to the Mining Laws of the United States after the date of enactment of this Act, the claimant shall pay the Secretary a location fee of $25.

    (b) TIME OF PAYMENT- The claim maintenance fee payable under subsection (a)(1) for any assessment year shall be paid before the commencement of the assessment year, except that for the initial assessment year in which the location is made, the locator shall pay the claim maintenance fee at the time the location notice is recorded with the Bureau of Land Management. The location fee imposed under subsection (a)(2) shall be payable not later than 90 days after the date of location

    (c) DEPOSIT IN TREASURY- The Secretary shall deposit monies received under this Act as miscellaneous receipts in the Treasury.

    (d) CO-OWNERSHIP- The co-ownership provisions of section 2324 of the Mining Law of 1872 (30 U.S.C. 28) shall remain in effect with respect to mining claims subject to such provisions except that the annual claim maintenance fee, where applicable, shall be paid in lieu of applicable assessment requirements and expenditures.

    (e) FORFEITURE- Failure to make the annual payment of any claim maintenance or location fee required with respect to any unpatented mining claim, mill, or tunnel site required by subsection (a) shall conclusively constitute a forfeiture by the holder of the unpatented mining claim, mill or tunnel site, effective at noon on the date the payment is due.

    (f) FLPMA FILING REQUIREMENTS- Nothing in this Act shall change or modify the requirements of section 314(b) of the Federal Land Policy and Management Act of 1976 (43 U.S.C. 1744(b)) or the requirements of section 314(c) of the Federal Land Policy and Management Act of 1976 (43 U.S.C. 1744(c)) related to filings required by such section 314(b). Such requirements shall remain in effect with respect to claims, and mill or tunnel sites for which fees are required to be paid under this section.

    (g) RULES AND REGULATIONS- The Secretary of the Interior shall promulgate rules and regulations to carry out the purposes of this section as soon as practicable after the date of enactment of this Act.

    (h) PURCHASING POWER ADJUSTMENT- Every 5 years following the date of enactment of this Act, or more frequently if the Secretary determines a more frequent adjustment to be reasonable, the Secretary of the Interior shall adjust the fees specified in subsection (a) to reflect changes in the purchasing power of the dollar. The Secretary shall use the Consumer Price Index for all urban consumers published by the Department of Labor as the basis for adjustment, rounding according to the adjustment process of conditions of the Federal Civil Penalties Inflation Adjustment Act of 1990 (104 Stat. 890). The Secretary shall provide claimants notice of any adjustment made under this subsection not later than July 1 of any year in which the adjustment is made. A fee adjustment under this paragraph shall begin to apply the first assessment which begins after the adjustment is made.

    (i) OIL SHALE CLAIMS SUBJECT TO CLAIM MAINTENANCE FEES UNDER ENERGY POLICY ACT OF 1992- This section shall not apply to any oil shale claims for which a fee is required to be paid under section 2511(e)(2) of the Energy Policy Act of 1992 (Public Law 102-486; 106 Stat. 3111; 30 U.S.C. 242).

    (j) EXCEPTION FOR HOLDERS OF FEWER THAN 50 CLAIMS-

      (1) ELIGIBILITY- In accordance with paragraph (3), a claimant may be eligible for a waiver or reduction of the claim maintenance fees imposed under this section if the claimant certifies in writing to the Secretary that on the date the payment was due, the claimant and all related parties--

        (A) held not more than 50 mining claims, mill sites, or tunnel sites, or any combination thereof, on public lands; and

        (B) have performed assessment work sufficient to maintain the mining claims held by the claimant and such related parties for the assessment year ending on noon of September 1 of the calendar year in which payment of the claim maintenance fee was due; except that such performance of assessment work shall not be required by reason of section 5 of Public Law 94-429, commonly known as the Mining in the Parks Act, or such other laws that before the date of the enactment of this Act removed the applicability of the assessment work requirement of the general mining laws for any claim subject to such laws.

      (2) HOLDER- For purposes of paragraph (1), with respect to any claimant, the term ‘related parties’ means--

        (A) the spouse and dependent children (as defined in section 152 of the Internal Revenue Code of 1986), of the claimant; and

        (B) a person affiliated with the claimant, including--

          (i) a person controlled by, controlling, or under common control with the claimant; and

          (ii) a subsidiary or parent company or corporation of the claimant.

      (3) WAIVED OR REDUCED MAINTENANCE FEES-

        (A) 10 OR FEWER CLAIMS- The Secretary of the Interior may waive the claim maintenance fee imposed under this section in its entirety for 10 or fewer claims held by a claimant eligible under paragraph (1).

        (B) 11 OR MORE CLAIMS-

          (i) IN GENERAL- Subject to clause (ii), for a claimant eligible under paragraph (1), the Secretary may reduce the claim maintenance fee imposed under this section to $25 per claim for each claim in excess of 10.

          (ii) LIMITATION- The reduction provided for in this subparagraph shall be available for no more than 50 claims held by a claimant who is eligible under paragraph (1).

      (4) PAYMENT IN LIEU OF ANNUAL LABOR REQUIREMENTS- The third sentence of section 2324 of the Revised Statutes (30 U.S.C. 28) is amended by inserting after ‘On each claim located after the tenth day of May, eighteen hundred and seventy-two,’ the following: ‘for which a waiver of the maintenance fee, or a reduced maintenance fee, under section 9003 of the Omnibus Budget Reconciliation Act of 1993 has been granted under subsection (j) of that section,’.

      (5) FILING REQUIREMENTS- The holder of any unpatented mining claim for which a waiver of the maintenance fee, or a reduced maintenance fee, has been granted pursuant to this subsection shall continue to be subject to the filing requirements contained in sections 314(a) and (c) of the Federal Land Policy Management Act of 1976 (43 U.S.C. 1744(a) and (c)).

    (k) EFFECTIVE DATE- This section shall take effect with respect to assessment years beginning after August 31, 1994.

SEC. 9004. FEDERAL IRRIGATION WATER SURCHARGE.

    (a) FINDINGS AND PURPOSES-

      (1) FINDINGS- The Congress finds that--

        (A) the construction and operation of Federal reclamation projects have contributed to the depletion of streams, the alteration of riparian habitat, and the degradation of water quality;

        (B) such impacts have had adverse impacts on fish and wildlife resources; and

        (C) the restoration of fish and wildlife and related habitat affected by the construction or operation of Federal reclamation projects is a continuing responsibility of the beneficiaries of such projects.

      (2) PURPOSES- The purposes of this section are to--

        (A) incorporate the restoration of fish and wildlife resources and related habitat affected by the construction or operation of Federal reclamation projects into the annual operation and maintenance requirements of such projects;

        (B) establish a fair and equitable mechanism for securing timely payments from the beneficiaries of such projects for the implementation, operation, and maintenance of fish and wildlife restoration measures;

        (C) accelerate the rate of restoration and recovery of depleted populations of indigenous fish and wildlife; and

        (D) encourage more efficient use of water resources by the beneficiaries of Federal reclamation projects.

    (b) OPERATIONAL CHARGES-

      (1) IN GENERAL- Individuals or non-Federal entities that receive delivery of water (including by exchange) which is stored in or transported through Federal reclamation projects or project facilities or projects or project facilities constructed by the Secretary of the Army that meet the conditions specified in paragraph (1) or (2) of section 212(a) of the Reclamation Reform Act of 1982 (Public Law 97-293, 43 U.S.C. 390ll), except for facilities of the Central Valley Project, California (as that project is defined by title XXXIV of Public Law 102-575), shall, pursuant to such terms, conditions, and procedures as the Secretary of the Interior may prescribe, pay to the United States an operation and maintenance charge sufficient to yield at least $10,000,000 (January 1993 price levels) annually in the years 1994, 1995, and 1996 and at least $15,000,000 (January 1993 price levels) annually in 1997 and each year thereafter.

      (2) PAYMENTS- Payments required by paragraph (1) shall be made without reduction or deferral by the Secretary under any provision of reclamation law and without regard to whether an individual or entity has discharged its repayment obligation within the meaning of the first section of the Act of July 2, 1956 (70 Stat. 483; 43 U.S.C. 485h-1), section 213 of the Reclamation Reform Act of 1982 (Public Law 97-293, 43 U.S.C. 390mm), or any other provision of Federal Reclamation law. The payments shall be in addition to any other repayments owed or made to the United States and shall not be applied or credited to an individual’s or entity’s repayment of project construction costs, payment of other annual project operation and maintenance costs, payment of interest, or reduction of any contractual obligation the individual or entity may have with the United States.

    (c) NATURAL RESOURCES RESTORATION FUND- There is hereby established in the Treasury of the United States a fund to be known as the ‘Natural Resources Restoration Fund’ (hereafter in this section referred to as the ‘Fund’). All payments of the operation and maintenance charges authorized in subsection (b) shall be deposited in the Fund, and shall be available in the fiscal year following deposit and thereafter, to such extent or in such amounts as are provided in advance in appropriation Acts, for expenditures by the Secretary of the Interior for the benefit of fish and wildlife resources, including habitat, affected by construction or operation of the projects referred to in this section.

    (d) INDIAN LAND OWNERS- For the purposes of this section, Indian tribes or individual Indian beneficial owners of land held in trust by the United States or subject to a restriction against alienation by the United States shall be considered to be Federal entities.

    (e) FEDERAL RECLAMATION LAW- This section shall constitute an amendment of and a supplement to the Federal Reclamation laws (the Reclamation Act of 1902, 32 Stat. 388, and Acts amendatory thereof and supplementary thereto).

SEC. 9005. RECREATION USER FEES.

    (a) LAND AND WATER CONSERVATION FUND ACT OF 1965-

      (1) IN GENERAL- The first sentence of section 4(b) of the Land and Water Conservation Fund Act of 1965 (relating to recreation use fees) is amended by striking out ‘picnic tables, or boat ramps’ and all that follows down through the period at the end thereof and inserting the following: ‘or picnic tables, and in no event shall there be any charge for the use of any campground not having a majority of the following: tent or trailer spaces, drinking water, access road, refuse containers, toilet facilities, fee collection by an employee or agent of the Federal agency operating the facility, reasonable visitor protection, and simple devices for containing a campfire (where campfires are permitted). For purposes of this subsection, the term ‘specialized outdoor recreation site’ includes but shall not be limited to campgrounds, swimming sites, boat launch facilities, and managed parking lots.’. The second sentence of such section 4(b) is hereby repealed.

      (2) CONFORMING AMENDMENT- Section 210 of Public Law 90-483 (82 Stat. 746; 16 U.S.C. 460d-3) is repealed.

    (b) COSTS OF COLLECTION- Section 4(i) of the Land and Water Conservation Fund Act of 1965 (relating to special accounts for fees collected) is amended by inserting ‘(A)’ after ‘(1)’ and by adding the following at the end of paragraph (1):

    ‘(B) Notwithstanding subparagraph (A), in any fiscal year, the Secretary of Agriculture and the Secretary of the Interior may withhold from the special account established under subparagraph (A) such portion of all receipts the fees collected in that fiscal year under this section as such Secretary determines to be equal to the additional fee collection costs for that fiscal year. The amounts so withheld shall be retained by the Secretary of Agriculture or the Secretary of the Interior and shall be available, without further appropriation, for expenditure by the Secretary concerned in the fiscal year in which collected to cover such additional fee collection costs. The Secretary concerned shall deposit in the special account established pursuant to subparagraph (A) any amounts so retained which remain unexpended and unobligated at the end of such fiscal year. For the purposes of this subparagraph, for any fiscal year, the term ‘additional fee collection costs’ means those costs for personnel and infrastructure directly associated with the collection of fees imposed under this section which exceed the costs for personnel and infrastructure directly associated with the collection of such fees during fiscal year 1993.’.

    (c) GOLDEN AGE PASSPORT- The second sentence of section 4(a)(4) of the Land and Water Conservation Fund Act of 1965 (relating to Golden Age Passports) is amended to read as follows: ‘Such permit shall be nontransferable, shall be issued for a charge of $10, and shall entitle the permittee and the permittee’s spouse accompanying the permittee to general admission into any area designated pursuant to this section.’.

    (d) USER FEES FOR RIGHTS-OF-WAY- In each fiscal year after the enactment of this Act, the Secretary of the Interior shall impose and collect an annual fee for the use and occupancy of any right-of-way through any national park system unit for which a permit has been issued by the Secretary pursuant to any general or specific statutory right-of-way authority (whether issued before or after the enactment of this Act) or for any other right-of-way allowed as of the date of the enactment of this Act. The amount of such annual fee shall be equal to the fair market rental value, as determined by the Secretary, of such use and occupancy for the fiscal year concerned. The fair market value shall be reviewed (and revised if necessary) not less frequently than every 3 years. The Secretary shall deposit all fees collected under this subsection in the special account established under section 4(i) of the Land and Water Conservation Fund Act of 1965.

    (e) COMMERCIAL TOUR USE FEES- (1) In the case of each unit of the National Park System for which an admission fee is charged under section 4 of the Land and Water Conservation Fund Act of 1965 (16 U.S.C. 460l-4), the Secretary of the Interior shall establish, by October 1, 1993, a commercial tour use fee to be imposed on each vehicle or aircraft entering the unit (or the airspace of the unit) for the purpose of providing commercial tour services within (or within the air space of) the unit. Fee revenue derived from such commercial tour use fees shall be deposited into the special account established under section 4(i) of the Land and Water Conservation Fund Act of 1965.

    (2) The Secretary shall establish the amount of fee to be imposed under this subsection per entry. The fee shall not be less than--

      (A) $25 per vehicle or aircraft with a passenger capacity of 25 persons or less,

      (B) $50 per vehicle or aircraft with a passenger capacity of 26 to 99 persons, and

      (C) $100 per vehicle or aircraft with a passenger capacity of 100 to 299 persons.

    The Secretary may periodically increase the fee imposed under this subsection as he deems necessary and justifiable.

    (3) The commercial tour use fee imposed under this subsection shall not apply to either of the following:

      (A) Any vehicle or aircraft transporting organized school groups or outings conducted for educational purposes by schools or other bona fide educational institutions.

      (B) Any vehicle or aircraft entering a park system unit pursuant to a contract issued under the Act of October 9, 1965 (16 U.S.C. 20-20g) entitled ‘An Act relating to the establishment of concession policies in the areas administered by the National Park Service and for other purposes’.

    (f) FAIR MARKET VALUE FOR COMMUNICATION SITE FEES- No permit or other authorization for the use of any area of the public lands of the United States for purposes of commercial telephone transmission facilities shall remain in force and effect after January 1, 1994 unless, before that date, and before January 1 of each year thereafter, the holder of such permit or other authorization pays to Secretary of the Department having administrative jurisdiction over such lands an amount equal to the fair market value, as determined by such Secretary, of the right to use and occupy such area for such purposes. For purposes of this subsection, the term ‘public lands of the United States’ means lands owned by the United States and administered by the Secretary of the Interior (other than lands held for the benefit of Indians, Aleuts, and Eskimos) and lands within the National Forest System.

SEC. 9006. NUCLEAR REGULATORY COMMISSION ANNUAL CHARGES.

    Section 6101(a)(3) of the Omnibus Budget Reconciliation Act of 1990 (42 U.S.C. 2214(a)(3)) is amended by striking ‘September 30, 1995’ and inserting ‘September 30, 1998’.

SEC. 9007. RECOVERING THE COST FOR GOVERNMENT SERVICES.

    (a) REPORT- Not later than January 1, 1994, the Secretary of the Interior and the Secretary of Energy shall each submit a report identifying fees, penalties, and other charges to the Committee on Natural Resources of the House of Representatives and the Committee on Energy and Natural Resources of the Senate. Each report shall--

      (1) identify all fees, penalties, and other charges imposed by the respective Secretary for the provision of services;

      (2) include the procedures for adjusting such fees to recover the cost of providing those services; and

      (3) identify those services for which no fee is currently charged and make recommendations for a fee appropriate to cover the cost of providing each service.

    (b) ADJUSTMENT OF FEES- Except as provided in subsection (d), for fiscal year 1995 and each fiscal year thereafter, the Secretary of the Interior and the Secretary of Energy shall adjust each fee, penalty, and other charge for the provision of services identified pursuant to subsection (a)(1). Each such fee, penalty, and charge shall be adjusted in accordance with the procedures identified pursuant to subsection (a)(2).

    (c) IMPLEMENTATION OF FEES FOR SERVICES NOT COVERED- Beginning with fiscal year 1995, the Secretary of the Interior and the Secretary of Energy shall charge fees for each of the services identified pursuant to subsection (a)(3) in an amount sufficient to recover the cost of providing the service. For each fiscal year thereafter, the fee shall be adjusted in the same manner as adjustments are made pursuant to subsection (b), using fiscal year 1995 as the base year.

    (d) CERTAIN FEES, PENALTIES AND CHARGES NOT COVERED- Subsection (b) shall not apply to any fee, penalty, or charge the amount of which is expressly specified in any statute or contract.

SEC. 9008. UNFUNDED LIABILITIES OF THE FEDERAL GOVERNMENT.

    Section 1105 of title 31, United States Code, is amended by adding the following subsection at the end thereof:

    ‘(g) The President shall transmit with materials related to each budget an estimate of unfunded future liabilities of the Federal Government that are not accounted for in the budget itself. Such estimate shall include (but not be limited to) liabilities for future remediation of environmental and natural resources damage, and cleaning up waste sites, on Federal lands. Sources of liabilities shall include (but not be limited to) active, inactive, or abandoned mines or oil or gas wells, irrigation waste water impacts, decommissioning of nuclear power plants, and uranium mining and processing activities (without regard to the location of such mining or processing activities) affecting the health of Native Americans and carried out pursuant to a program administered by the United States.’.

TITLE X--COMMITTEE ON POST OFFICE AND CIVIL SERVICE

Subtitle A--Civil Service

SEC. 10001. DELAY IN COST-OF-LIVING ADJUSTMENTS IN FEDERAL EMPLOYEE RETIREMENT BENEFITS DURING FISCAL YEARS 1994, 1995, AND 1996.

    (a) APPLICABILITY- This section shall apply with respect to any cost-of-living increase scheduled to take effect, during fiscal year 1994, 1995, or 1996, under--

      (1) section 8340(b) or 8462(b) of title 5, United States Code;

      (2) section 826 or 858 of the Foreign Service Act of 1980; or

      (3) section 291 of the Central Intelligence Agency Retirement Act (50 U.S.C. 2131), as set forth in section 802 of the CIARDS Technical Corrections Act of 1992 (Public Law 102-496; 106 Stat. 3196).

    (b) DELAY IN EFFECTIVE DATE OF ADJUSTMENTS- A cost-of-living increase described in subsection (a) shall not take effect until the first day of the third calendar month after the date such increase would otherwise take effect.

    (c) RULE OF CONSTRUCTION- Nothing in this section shall be considered to affect any determination relating to eligibility for an annuity increase or the amount of the first increase in an annuity under section 8340(b) or (c) or section 8462(b) or (c) of title 5, United States Code, or comparable provisions of law.

SEC. 10002. PERMANENT ELIMINATION OF THE ALTERNATIVE-FORM-OF-ANNUITY OPTION EXCEPT FOR INDIVIDUALS WITH A CRITICAL MEDICAL CONDITION.

    (a) CIVIL SERVICE RETIREMENT SYSTEM; FEDERAL EMPLOYEES’ RETIREMENT SYSTEM- Sections 8343a and 8420a of title 5, United States Code, are each amended--

      (1) in subsection (a) by striking ‘an employee or Member may,’ and inserting ‘any employee or Member who has a life-threatening affliction or other critical medical condition may,’; and

      (2) by striking subsection (f).

    (b) FOREIGN SERVICE RETIREMENT AND DISABILITY SYSTEM- Section 807(e)(1) of the Foreign Service Act of 1980 (22 U.S.C. 4047(e)(1)) is amended by striking ‘a participant may,’ and inserting ‘any participant who has a life-threatening affliction or other critical medical condition may,’.

    (c) CENTRAL INTELLIGENCE AGENCY RETIREMENT AND DISABILITY SYSTEM- Section 294(a) of the Central Intelligence Agency Retirement Act (50 U.S.C. 2143(a)), as set forth in section 802 of the CIARDS Technical Corrections Act of 1992 (Public Law 102-496; 106 Stat. 3196), is amended by striking ‘a participant may,’ and inserting ‘any participant who has a life-threatening affliction or other critical medical condition may,’.

    (d) EFFECTIVE DATE- The amendments made by this section shall become effective on January 1, 1994, and shall apply with respect to any annuity commencing on or after that date.

SEC. 10003. PAY LIMITATIONS.

    (a) ELIMINATION OF THE 1994 ANNUAL PAY ADJUSTMENT-

      (1) STATUTORY PAY SYSTEMS- Notwithstanding section 633 of the Treasury, Postal Service and General Government Appropriations Act, 1991 (5 U.S.C. 5303 note) or any other provision of law, the adjustment in rates of basic pay that is scheduled to take effect in 1994 under section 5303 of title 5, United States Code, shall not take effect.

      (2) OTHER PAY SYSTEMS-

        (A) IN GENERAL- Notwithstanding any other provision of law, any general pay adjustment, similar to the adjustment referred to in paragraph (1), which is scheduled to take effect in 1994 with respect to any civilian officers or employees in the executive branch (other than those affected by paragraph (1)) shall not take effect.

        (B) EXCEPTIONS- Subparagraph (A) shall not apply with respect to--

          (i) any pay adjustment required under the terms of a contract, as in effect before the date of the enactment of this Act; or

          (ii) any alien or noncitizen of the United States who occupies a position outside the United States.

        (C) REGULATIONS- The Office of Personnel Management may prescribe any regulations it considers necessary for the administration of this paragraph.

    (b) MODIFICATION IN FORMULA FOR COMPUTING ANNUAL PAY ADJUSTMENTS FOR 1995, 1996, AND 1997-

      (1) STATUTORY PAY SYSTEMS- Section 5303(a) of title 5, United States Code, is amended--

        (A) by striking ‘(a)’ and inserting ‘(a)(1)’; and

        (B) by adding at the end the following:

    ‘(2) Notwithstanding section 633 of the Treasury, Postal Service and General Government Appropriations Act, 1991 or any other provision of law, for purposes of any adjustment scheduled to take effect under this section in 1995, 1996, or 1997, paragraph (1) shall be deemed to be amended by striking ‘equal to’ through ‘less than’ and inserting ‘equal to one and one-half percentage points less than’.’.

      (2) OTHER PAY SYSTEMS- Section 704(a)(1) of the Ethics Reform Act of 1989 (5 U.S.C. 5318 note) is amended by adding at the end the following:

        ‘(C) SPECIAL RULE- For purposes of any pay adjustment scheduled to take effect in 1995, 1996, or 1997, subparagraph (B) shall be deemed to be amended by striking ‘one-half of 1 percent’ and inserting ‘one and one-half percent’.’.

SEC. 10004. PROVISIONS RELATING TO LOCALITY-BASED COMPARABILITY PAYMENTS.

    (a) LOCALITY-BASED COMPARABILITY PAYMENTS-

      (1) CHANGE IN EFFECTIVE DATE OF PAYMENTS- Section 5304(d)(2) of title 5, United States Code, is amended by striking ‘January 1’ and inserting ‘July 1’.

      (2) LIMITATION RELATING TO AGGREGATE AMOUNT PAYABLE DURING CERTAIN PERIODS- Section 5304 of title 5, United States Code, is amended--

        (A) by redesignating subsection (i) as subsection (j); and

        (B) by inserting after subsection (h) the following:

    ‘(i)(1) Notwithstanding any other provision of this section, comparability payments may not be established or adjusted under this section in a manner that would cause the resulting estimated total amount payable under this section during the period which--

      ‘(A) begins on July 1, 1994, and ends on June 30, 1995, to exceed $1,800,000,000;

      ‘(B) begins on July 1, 1995, and ends on June 30, 1996, to exceed $2,500,000,000;

      ‘(C) begins on July 1, 1996, and ends on June 30, 1997, to exceed $3,300,000,000;

      ‘(D) begins on July 1, 1997, and ends on June 30, 1998, to exceed $4,200,000,000; or

      ‘(E) begins on July 1, 1998, and ends on September 30, 1998, to exceed $1,747,000,000.

    ‘(2) If necessary in order to achieve compliance with any of the respective limitations under paragraph (1), the President may, in carrying out subsection (d)(2), specify levels of comparability payments less than the minimum which would otherwise be required under subsection (a)(3).

    ‘(3) The pay agent shall develop and include in the appropriate reports under subsection (d)(1) the methodology for making any estimates under this subsection, and any such estimate shall be made in accordance with the methodology so included in the then most recent report.

    ‘(4) Whenever any authority under this subsection is exercised, the President shall so indicate in his next report under subsection (d)(3), including specific information as to how such authority was exercised and the reasons why it was so exercised.’.

    (b) TEMPORARY CHANGE IN EFFECTIVE DATE OF ANNUAL PAY ADJUSTMENTS UNDER SECTION 5303 OF TITLE 5, UNITED STATES CODE- Section 5303(a) of title 5, United States Code (as amended by section 10003(b)(1)), is further amended by adding after paragraph (2) of such section 5303(a) (as so amended) the following:

    ‘(3) Effective for the period beginning on January 1, 1995, and ending on December 31, 2003, paragraph (1) shall be deemed to be amended by striking ‘January 1’ and inserting ‘July 1’.’.

    (c) REPEAL OF THE PROVISION EXCLUDING SENIOR EXECUTIVES FROM THE LIMITATION GENERALLY APPLICABLE ON THE ACCUMULATION OF ANNUAL LEAVE-

      (1) IN GENERAL- Section 6304(f) of title 5, United States Code, is repealed, effective as of January 1, 1994.

      (2) SAVINGS PROVISION-

        (A) APPLICABILITY- This paragraph shall apply with respect to an individual--

          (i) who, as of December 31, 1993, has more than 30 days of annual leave to such individual’s credit (or more than 45 days, if the individual would be subject to section 6304(b) of such title) which were accrued in any position described in section 6304(f) of title 5, United States Code (as in effect on the date of the enactment of this Act); and

          (ii) only for so long as such individual remains continuously employed in any such position (disregarding any break in service of 3 days or less).

        (B) STATEMENT OF THE RULE- For purposes of administering section 6304 of title 5, United States Code, with respect to any individual to whom this paragraph applies--

          (i) subsection (a) of such section shall be deemed amended by striking ‘30’ and inserting the number corresponding to the number of days determined for such individual under subparagraph (A)(i); and

          (ii) subsection (b) of such section shall be deemed amended by striking ‘45’ and inserting the number corresponding to the number of days determined for such individual under subparagraph (A)(i).

      (3) CONFORMING AMENDMENT- Section 6304(a) of title 5, United States Code, is amended by striking ‘(d), (e), (f), and (g)’ and inserting ‘(d) and (e)’.

    (d) NO CASH AWARDS BETWEEN FISCAL YEARS 1994 THROUGH 1998-

      (1) DEFINITION- For the purpose of this subsection, the term ‘cash award’ means any cash award, performance award, rank, or other form of recognition entitling the recipient to any monetary payment under subchapter I of chapter 45 of title 5, United States Code, or section 5384, 5406, or 5407 of such title.

      (2) RESTRICTION- Notwithstanding any other provision of law, no cash award may be awarded during the period beginning on October 1, 1993, and ending on September 30, 1998.

    (e) REDUCTION OF FEDERAL WORKFORCE BY 150,000-

      (1) DEFINITION- For the purpose of this subsection, the term ‘civilian employees in the executive branch’ means all civilian employees within the executive branch of the Government (other than in the United States Postal Service or the Postal Rate Commission).

      (2) LIMITATIONS- The average total number of civilian employees in the executive branch may not exceed--

        (A) 2,095,200 in fiscal year 1994;

        (B) 2,044,100 in fiscal year 1995;

        (C) 2,010,100 in fiscal year 1996;

        (D) 1,998,500 in fiscal year 1997; or

        (E) 1,996,700 in fiscal year 1998.

      (3) AVERAGING- The average total number of civilian employees in the executive branch in a fiscal year shall, for purposes of this subsection, be the average number in such fiscal year, as determined under regulations prescribed under paragraph (5). Any such average shall be determined on a ‘full-time equivalent’ basis.

      (4) VOLUNTARY MEASURES- To the extent practicable, any reductions necessary to achieve compliance with any limitation under paragraph (2) shall be effected through attrition or other voluntary measures.

      (5) REGULATIONS- The President shall prescribe regulations to carry out this subsection.

    (f) PAY-LIMITATION PROVISIONS MADE APPLICABLE TO CERTAIN EMPLOYEES IN THE JUDICIAL BRANCH- The Director of the Administrative Office of the United States Courts shall take such measures as may be necessary to ensure that the purposes of subsections (a) and (b) of section 10003 and subsections (a)(1) (if applicable) and (b) of this section are carried out with respect to employees who are subject to the personnel management system established by the Director under section 3 of Public Law 101-474 (28 U.S.C. 602 note).

SEC. 10005. APPLICATION OF MEDICARE PART B LIMITS TO PHYSICIANS’ SERVICES FURNISHED TO FEDERAL EMPLOYEE HEALTH BENEFITS ENROLLEES AGE 65 OR OLDER.

    (a) IN GENERAL- Section 8904(b) of title 5, United States Code, is amended--

      (1) in paragraph (1) by inserting ‘(A)’ after ‘(b)(1)’ and by adding at the end the following:

    ‘(B)(i) A plan, other than a prepayment plan described in section 8903(4), may not provide benefits, in the case of any retired enrolled individual who is age 65 or older and is not entitled to Medicare supplementary medical insurance benefits under part B of title XVIII of the Social Security Act (42 U.S.C. 1395j et seq.), to pay a charge imposed for physicians’ services (as defined in section 1848(j) of such Act, 42 U.S.C. 1395w-4(j)) which are covered for purposes of benefit payments under this chapter and under such part, to the extent that such charge exceeds the fee schedule amount under section 1848(a) of such Act (42 U.S.C. 1395w-4(a)).

    ‘(ii) Physicians and suppliers who have in force participation agreements with the Secretary of Health and Human Services consistent with section 1842(h)(1) of such Act (42 U.S.C. 1395u(h)(1)), whereby the participating provider accepts Medicare benefits (including allowable deductible and coinsurance amounts) as full payment for covered items and services shall accept equivalent benefit and enrollee cost-sharing under this chapter as full payment for services described in clause (i). Physicians and suppliers who are nonparticipating physicians and suppliers for purposes of part B of title XVIII of such Act shall not impose charges that exceed the limiting charge under section 1848(g) of such Act (42 U.S.C. 1395w-4(g)) with respect to services described in clause (i) provided to enrollees described in such clause. The Office of Personnel Management shall notify a physician or supplier who is found to have violated this clause and inform them of the requirements of this clause and sanctions for such a violation. The Office of Personnel Management shall notify the Secretary of Health and Human Services if a physician or supplier is found to knowingly and willfully violate this clause on a repeated basis and the Secretary of Health and Human Services may invoke appropriate sanctions in accordance with sections 1128A(a) and section 1848(g)(1) of such Act (42 U.S.C. 1320a-7a(a), 1395w-4(g)(1)) and applicable regulations.

    ‘(C) If the Secretary of Health and Human Services determines that a violation of this subsection warrants excluding a provider from participation for a specified period under title XVIII of the Social Security Act, the Office shall enforce a corresponding exclusion of such provider for purposes of this chapter.’;

      (2) in paragraph (3)(B)--

        (A) by inserting ‘(i)’ after ‘includes’; and

        (B) by inserting before the period at the end the following: ‘, and (ii) the fee schedule amounts and limiting charges for physicians’ services established under section 1848 of such Act (42 U.S.C. 1395w-4) and the identity of participating physicians and suppliers who have in force agreements with such Secretary under section 1842(h) of such Act (42 U.S.C. 1395u(h))’; and

      (3) by adding at the end the following:

    ‘(4) The Director of the Office of Personnel Management shall certify, before the first day of the fifth month that begins before each contract year, that there is in effect an arrangement with the Secretary of Health and Human Services under which, before the beginning of the contract year--

      ‘(A) physicians and suppliers (whether or not participating) under the Medicare program will be notified of the requirements of paragraph (1)(B);

      ‘(B) enforcement procedures will be in place to carry out such paragraph (including enforcement of protections against overcharging of beneficiaries); and

      ‘(C) Medicare program information described in paragraph (3)(B)(ii) will be supplied to carriers under paragraph (3)(A).’.

    (b) EFFECTIVE DATE- The amendments made by subsection (a) shall apply with respect to contract years beginning on or after January 1, 1995.

SEC. 10006. TEMPORARY EXTENSION OF METHOD FOR DETERMINING GOVERNMENT CONTRIBUTIONS UNDER FEHBP IN THE ABSENCE OF A GOVERNMENT-WIDE INDEMNITY BENEFIT PLAN.

    (a) IN GENERAL- Public Law 101-76 (5 U.S.C. 8906 note) is amended in subsection (a)(1) by striking ‘1993’ and inserting ‘1998’.

    (b) SENSE OF CONGRESS- It is the sense of the Congress that nothing in this section should be considered to reflect any view on the appropriateness, merits, or timing, or any other aspect of any comprehensive health care reform legislation.

Subtitle B--Postal Service

SEC. 10101. PAYMENTS TO BE MADE BY THE UNITED STATES POSTAL SERVICE.

    (a) RELATING TO CORRECTED CALCULATIONS FOR PAST RETIREMENT COLAS- In addition to any other payments required under section 8348(m) of title 5, United States Code, or any other provision of law, the United States Postal Service shall pay into the Civil Service Retirement and Disability Fund a total of $693,000,000, of which--

      (1) at least one-third shall be paid not later than September 30, 1995;

      (2) at least two-thirds shall be paid not later than September 30, 1996; and

      (3) any remaining balance shall be paid not later than September 30, 1997.

    (b) RELATING TO CORRECTED CALCULATIONS FOR PAST HEALTH BENEFITS- In addition to any other payments required under section 8906(g)(2) of title 5, United States Code, or any other provision of law, the United States Postal Service shall pay into the Employees Health Benefits Fund a total of $348,000,000, of which--

      (1) at least one-third shall be paid not later than September 30, 1995;

      (2) at least two-thirds shall be paid not later than September 30, 1996; and

      (3) any remaining balance shall be paid not later than September 30, 1997.

Subtitle C--Revenue Forgone Reform

SEC. 10201. SHORT TITLE; TABLE OF CONTENTS.

    (a) SHORT TITLE- This subtitle may be cited as the ‘Revenue Forgone Reform Act’.

    (b) TABLE OF CONTENTS- The table of contents for this subtitle is as follows:

      Sec. 10201. Short title; table of contents.

      Sec. 10202. References.

      Sec. 10203. Repeal of authorization of appropriations for mail sent at reduced rates of postage.

      Sec. 10204. Establishing reduced rates of postage.

      Sec. 10205. Eligibility of certain mailings for reduced rates of postage.

      Sec. 10206. Provisions relating to rates for books and certain other materials.

      Sec. 10207. Sense of Congress.

      Sec. 10208. Technical corrections.

SEC. 10202. REFERENCES.

    Except as otherwise expressly provided, whenever in this subtitle an amendment or repeal is expressed in terms of an amendment to, or a repeal of, a section or other provision, the reference shall be considered to be made to a section or other provision of title 39, United States Code.

SEC. 10203. REPEAL OF AUTHORIZATION OF APPROPRIATIONS FOR MAIL SENT AT REDUCED RATES OF POSTAGE.

    (a) IN GENERAL- Section 2401(c) is amended--

      (1) in the first sentence--

        (A) by striking ‘if sections’ through ‘had not been enacted’ and inserting ‘if sections 3217 and 3403-3406 had not been enacted’; and

        (B) by striking ‘such sections and Acts.’ and inserting ‘such sections.’; and

      (2) in the second sentence--

        (A) by striking ‘(i)’; and

        (B) by striking ‘volume;’ through ‘schedules.’ and inserting ‘volume.’.

    (b) APPLICABILITY- The amendments made by subsection (a) shall apply with respect to appropriations for fiscal years beginning after September 30, 1993.

SEC. 10204. ESTABLISHING REDUCED RATES OF POSTAGE.

    (a) RATES-

      (1) IN GENERAL- Section 3626(a) is amended to read as follows:

    ‘(a)(1) For the purpose of this subsection--

      ‘(A) the term ‘costs attributable’, as used with respect to a class of mail or kind of mailer, means the direct and indirect postal costs attributable to such class of mail or kind of mailer (excluding any other costs of the Postal Service);

      ‘(B) the term ‘regular-rate category’ means any class of mail or kind of mailer, other than a class or kind referred to in paragraph (2)(A) or section 2401(c); and

      ‘(C) the term ‘institutional-costs contribution’, as used with respect to a class of mail or kind of mailer, means that portion of the estimated revenues to the Postal Service from such class of mail or kind of mailer which remains after subtracting an amount equal to the estimated costs attributable to such class of mail or kind of mailer.

    ‘(2)(A) Except as provided in paragraph (3) or (4), rates of postage for a class of mail or kind of mailer under former section 4358, 4452(b), 4452(c), 4554(b), or 4554(c) of this title shall be established in a manner such that the estimated revenues to be received by the Postal Service from such class of mail or kind of mailer shall be equal to the sum of--

      ‘(i) the estimated costs attributable to such class of mail or kind of mailer; and

      ‘(ii) the product derived by multiplying the estimated costs referred to in clause (i) by the applicable percentage under subparagraph (B).

    ‘(B) The applicable percentage for any class of mail or kind of mailer referred to in subparagraph (A) shall be the product derived by multiplying--

      ‘(i) the percentage which, for the most closely corresponding regular-rate category, the institutional-costs contribution for such category represents relative to the estimated costs attributable to such category of mail, times

      ‘(ii)(I) one-twelfth, for fiscal year 1994;

      ‘(II) one-sixth, for fiscal year 1995;

      ‘(III) one-fourth, for fiscal year 1996;

      ‘(IV) one-third, for fiscal year 1997;

      ‘(V) five-twelfths, for fiscal year 1998; and

      ‘(VI) one-half, for any fiscal year after fiscal year 1998.

    ‘(C) For temporary special authority to permit the timely implementation of the preceding provisions of this paragraph, see section 3642.

    ‘(D) For purposes of establishing rates of postage under this subchapter for any of the classes of mail or kinds of mailers referred to in subparagraph (A), subclauses (I) through (V) of subparagraph (B)(ii) shall be deemed amended by striking the fraction specified in each such subclause and inserting ‘one-half’.

    ‘(3) The rates for the advertising portion of any mail matter under former section 4358(d) or 4358(e) of this title shall be equal to the rates for the advertising portion of the most closely corresponding regular-rate category of mail, except that if the advertising portion does not exceed 10 percent of the issue of the publication involved, the advertising portion shall be subject to the same rates as apply to the nonadvertising portion.

    ‘(4) The rates for any advertising under former section 4358(f) of this title shall be equal to 75 percent of the rates for advertising contained in the most closely corresponding regular-rate category of mail.’.

      (2) SPECIAL AUTHORITY- Subchapter III of chapter 36 is amended by adding at the end the following:

‘Sec. 3642. Special authority relating to reduced-rate categories of mail

    ‘(a) In order to permit the timely implementation of section 3626(a)(2), the Postal Service may establish temporary rates of postage for any class of mail or kind of mailer referred to in section 3626(a)(2)(A).

    ‘(b) Any exercise of authority under this section shall be in conformance with the requirements of section 3626(a), subject to the following:

      ‘(1) All ‘attributable costs’ and ‘institutional-costs contributions’ assumed shall be the same as those which were assumed for purposes of the then most recent proceedings under subchapter II pursuant to which rates of postage for the class of mail or kind of mailer involved were last adjusted.

      ‘(2) Any temporary rate established under this section shall take effect upon such date as the Postal Service may determine, except that--

        ‘(A) such a rate may take effect only after 10 days’ notice in the Federal Register; and

        ‘(B) no such rate may take effect after September 30, 1998.

      ‘(3) A temporary rate under this section may remain in effect no longer than the last day of the fiscal year in which it first takes effect.

      ‘(4) Authority under this section may not be exercised in a manner that would result in more than 1 change taking effect under this section, during the same fiscal year, in the rates of postage for a particular class of mail or kind of mailer, except as provided in paragraph (5).

      ‘(5) Nothing in paragraph (4) shall prevent an adjustment under this section in rates for a class of mail or kind of mailer with respect to which any rates took effect under this section earlier in the same fiscal year if--

        ‘(A) the rates established for such class of mail or kind of mailer by the earlier adjustment are superseded by new rates established under subchapter II; and

        ‘(B) authority under this paragraph has not previously been exercised with respect to such class of mail or kind of mailer based on the new rates referred to in subparagraph (A).

    ‘(c) The Postal Service may prescribe any regulations which may be necessary to carry out this section, including provisions governing the coordination of adjustments under this section with any other adjustments under this title.’.

      (3) TECHNICAL AND CONFORMING AMENDMENTS-

        (A) SECTION 3626- Section 3626(i) is repealed.

        (B) SECTION 3627-

          (i) IN GENERAL- Section 3627 is amended--

            (I) by striking ‘sent at a free or reduced rate under section 3217, 3403-3406, or 3626 of this title,’ and inserting ‘sent free of postage under section 3217 or 3403-3406’; and

            (II) in the section heading by striking ‘and reduced’.

          (ii) TABLE OF CONTENTS- The table of contents for chapter 36 is amended--

            (I) by striking the item relating to section 3627 and inserting the following:

      ‘3627. Adjusting free rates.’;

            and

            (II) by inserting after the item relating to section 3641 the following:

      ‘3642. Special authority relating to reduced-rate categories of mail.’.

    (b) AUTHORIZATION-

      (1) IN GENERAL- Section 2401 is amended--

        (A) by striking subsections (d) through (f);

        (B) by redesignating subsections (g) through (i) as subsections (e) through (g), respectively;

        (C) in subsection (f) (as so redesignated by subparagraph (B)) by striking the second sentence;

        (D) in subsection (g) (as so redesignated by subparagraph (B)) by striking ‘subsections (b) and (d) of this section’ and inserting ‘subsection (b)’; and

        (E) by inserting after subsection (c) the following:

    ‘(d) As reimbursement to the Postal Service for losses which it incurred as a result of insufficient amounts appropriated under section 2401(c) for fiscal years 1991 through 1993, and to compensate for the additional revenues it is estimated the Postal Service would have received under the provisions of section 3626(a), for the period beginning on October 1, 1993, and ending on September 30, 1998, if the fraction specified in subclause (VI) of section 3626(a)(2)(B)(ii) were applied with respect to such period (instead of the respective fractions specified in subclauses (I) through (V) thereof), there are authorized to be appropriated to the Postal Service $29,000,000 for each of fiscal years 1994 through 2035.’.

      (2) RATEMAKING LIMITATIONS-

        (A) IN GENERAL- Except as provided in subparagraph (B), rates of postage may not be established, under subchapter II of chapter 36 of title 39, United States Code, in a manner designed to allow the United States Postal Service to receive through revenues any portion of the additional revenues (referred to in section 2401(d) of such title, as amended by paragraph (1)(E)) for which amounts are authorized to be appropriated under such section 2401(d).

        (B) EXCEPTION- If Congress fails to appropriate an amount authorized under section 2401(d) of title 39, United States Code (as amended by paragraph (1)(E)), rates for the various classes of mail may be adjusted in accordance with the provisions of subchapter II of chapter 36 of such title (excluding section 3627 thereof) such that the resulting increase in revenues will equal the amount that Congress so failed to appropriate.

    (c) APPLICABILITY-

      (1) RATES- The amendments made by subsection (a) shall apply with respect to rates for mail sent after September 30, 1993.

      (2) AUTHORIZATION- The amendments made by subsection (b) shall apply with respect to appropriations for fiscal years beginning after September 30, 1993.

SEC. 10205. ELIGIBILITY OF CERTAIN MAILINGS FOR REDUCED RATES OF POSTAGE.

    (a) ADVERTISING- Section 3626(j)(1) is amended--

      (1) in subparagraph (B) by striking ‘or’ after the semicolon;

      (2) in subparagraph (C) by striking the period and inserting ‘; or’; and

      (3) by adding at the end the following:

      ‘(D) any product or service (other than any to which subparagraph (A), (B), or (C) relates), if--

        ‘(i) the sale of such product or the providing of such service is not substantially related (aside from the need, on the part of the organization promoting such product or service, for income or funds or the use it makes of the profits derived) to the exercise or performance by the organization of one or more of the purposes constituting the basis for the organization’s authorization to mail at such rates; or

        ‘(ii) the mail matter involved is part of a cooperative mailing (as defined under regulations of the Postal Service) with any person or organization not authorized to mail at the rates for mail under former section 4452(b) or 4452(c) of this title;

      except that--

        ‘(I) any determination under clause (i) that a product or service is not substantially related to a particular purpose shall be made under regulations which shall be prescribed by the Postal Service based on subsections (a) and (c) of section 513 of the Internal Revenue Code of 1986; and

        ‘(II) clause (i) shall not apply if the product involved is a periodical publication described in subsection (m)(2) (including a subscription to receive any such publication).’.

    (b) PRODUCTS- Section 3626 is amended by adding at the end the following:

    ‘(m)(1) In the administration of this section, the rates for mail under former section 4452(b) or 4452(c) of this title shall not apply to mail consisting of products, unless such products--

      ‘(A) were received by the organization as gifts or contributions; or

      ‘(B) are low cost articles (as defined by section 513(h)(2) of the Internal Revenue Code of 1986).

    ‘(2) Paragraph (1) shall not apply with respect to a periodical publication of a qualified nonprofit organization.’.

    (c) CERTIFICATION; VERIFICATION- Section 3626(j)(3) is amended--

      (1) by striking ‘(3)’ and inserting ‘(3)(A)’; and

      (2) by adding at the end the following:

    ‘(B) The Postal Service shall establish procedures to carry out this paragraph, including procedures for mailer certification of compliance with the conditions specified in paragraph (1)(D) or subsection (m), as applicable, and verification of such compliance.’.

    (d) APPLICABILITY- The amendments made by this section shall apply with respect to mail sent, and the rates for mail sent, after September 30, 1993.

SEC. 10206. PROVISIONS RELATING TO RATES FOR BOOKS AND CERTAIN OTHER MATERIALS.

    (a) IN GENERAL- Section 3683(b) is amended to read as follows:

    ‘(b) The rates of postage under former section 4554(b)(1) of this title shall not be effective except with respect to mailings which--

      ‘(1) constitute materials specified in former section 4554(b)(2) of this title; and

      ‘(2) are sent between--

        ‘(A) an institution, organization, or association listed in subparagraph (A) or (B) of such former section 4554(b)(1) and any other such institution, organization, or association;

        ‘(B) an institution, organization, or association referred to in subparagraph (A) and any individual (other than an individual having a financial interest in the sale, promotion, or distribution of the materials involved); or

        ‘(C) an institution, organization, or association referred to in subparagraph (A) and a qualified nonprofit organization (as defined in former section 4452(d) of this title) that is not such an institution, organization, or association.’.

    (b) APPLICABILITY- The amendment made by subsection (a) shall apply with respect to mail sent after September 30, 1993.

SEC. 10207. SENSE OF CONGRESS.

    It is the sense of the Congress that any legislation, enacted after September 30, 1994, which would have the effect of expanding the classes of mail or kinds of mailers eligible for reduced rates of postage should provide for sufficient funding to ensure that neither any losses to the United States Postal Service nor any increase in the rates of postage for any of the other classes of mail or kinds of mailers will result.

SEC. 10208. TECHNICAL CORRECTIONS.

    (a) SECTION 410- Section 410(b) is amended--

      (1) in paragraph (8) by striking ‘and’ after the semicolon;

      (2) in the first paragraph (9) by striking ‘Chapter’ and inserting ‘chapter’, and by striking the period and inserting ‘; and’; and

      (3) by designating the second paragraph (9) as paragraph (10).

    (b) SECTION 3202- Section 3202(a) is amended--

      (1) in paragraph (3) by adding ‘and’ after the semicolon; and

      (2) in paragraph (4) by striking ‘; and’ and inserting a period.

    (c) SECTION 3210- The provisions of section 318(3) of Public Law 101-163 (103 Stat. 1068), which amended section 3210 of title 39, United States Code, shall be treated as if, as enacted, the reference in such provisions to ‘subparagraph (c)’ had instead read ‘subparagraph (C)’.

    (d) SECTION 3601- Section 3601(a) is amended by striking ‘concent’ and inserting ‘consent’.

    (e) SECTION 3625- Section 3625(d) is amended by striking ‘section 3268’ and inserting ‘section 3628’.

    (f) SECTION 3626- Section 3626 is amended by redesignating the second subsection (k) as subsection (l).

TITLE XI--COMMITTEE ON PUBLIC WORKS AND TRANSPORTATION

SEC. 11001. AVIATION FEES FOR SERVICES.

    (a) IN GENERAL- Section 313(f) of the Federal Aviation Act of 1958 (49 U.S.C. App. 1354(f)) is amended to read as follows:

    ‘(f) FEES FOR SERVICES-

      ‘(1) IMPOSITION AND COLLECTION- The following fees are imposed and shall be collected for services rendered:

        ‘(A) AIRCRAFT REGISTRATION FEES-

          ‘(i) GENERAL RULE- For registration of an aircraft, the fee to be collected from the owner of the aircraft in each fiscal year beginning after September 30, 1993, shall be determined under the following table:

If the maximum certificated

--

gross weight of

--Amount of

the aircraft is:

--fee is:

Not over 3,500 pounds

-- $40.00

Over 3,500 lbs. but not over 6,500 lbs.

-- $175.00

Over 6,500 lbs. but not over 10,000 lbs.

-- $500.00

Over 10,000 lbs. but not over 100,000 lbs.

-- $1,000.00

Over 100,000 lbs.

-- $2,000.00.

        If the ownership of the aircraft is also transferred in such fiscal year, the fee to be collected for registration of the aircraft in such fiscal year under this subparagraph, as determined from the table, shall be increased by such amount as the Administrator shall determine so that the average amount of the increase for all aircraft collected under this sentence in such fiscal year will be approximately $200.00.

        ‘(ii) EXEMPTIONS- No fee shall be collected under this subparagraph for registration of an aircraft in a fiscal year if the aircraft--

          ‘(I) is owned or operated by an air carrier exclusively to provide air transportation;

          ‘(II) is owned by, or operated exclusively by or for, the United States Government;

          ‘(III) is registered under a dealer’s aircraft registration certificate issued under section 505 of this Act;

          ‘(IV) is not originally certificated with an engine driven electrical system or has not subsequently been certified by the Administrator with such a system installed; or

          ‘(V) is a balloon or glider.

        ‘(B) DESIGNATION AS AVIATION MEDICAL EXAMINERS- For designation of a person as an aviation medical examiner, the fee to be collected from such person in each fiscal year beginning after September 30, 1993, shall be $500.

        ‘(C) ISSUANCE OF CERTIFICATES TO PILOTS- After September 30, 1993, the fee to be collected for issuance or renewal of an airman’s certificate to a pilot shall be $12. The fee shall be collected from each pilot at least once every 3 fiscal years.

      ‘(2) CONTINUATION OF FEE FOR PROCESSING OF FORMS FOR MAJOR FUEL TANK ALTERATIONS-

        ‘(A) ESTABLISHMENT AND COLLECTION- The Administrator may establish such fees as may be necessary to cover the costs associated with processing of forms for major repairs and alterations of fuel tanks and fuel systems of aircraft.

        ‘(B) MAXIMUM AMOUNT- The amount of any fee under this subsection with respect to processing of a form for a major repair or alternation of a fuel tank or fuel system of an aircraft may not exceed $7.50. Such maximum amount shall be adjusted annually by the Administrator for changes in the Consumer Price Index of All Urban Consumers published by the Bureau of Labor Statistics of the Department of Labor.

      ‘(3) COLLECTION AND DEPOSIT IN TRUST FUND- The amounts of all fees established by or under this subsection shall be collected by the Administrator, or the Secretary of the Treasury for the Administrator, and shall be deposited in the Airport and Airway Trust Fund.’.

    (b) CONFORMING AMENDMENT- The portion of the table of contents contained in the first section of such Act relating to section 313 is amended by striking

‘(f) Processing fees.’.

    and inserting

‘(f) Fees for services.’.

SEC. 11002. RECREATIONAL USER FEES.

    (a) IN GENERAL- Section 210 of the Flood Control Act of 1968 (16 U.S.C. 460d-3) is amended--

      (1) by striking ‘SEC. 210. No entrance’ and inserting the following:

‘SEC. 210. RECREATIONAL USER FEES.

    ‘(a) PROHIBITION ON ADMISSIONS FEES- No entrance’;

      (2) by striking the second sentence; and

      (3) by adding at the end the following new subsection:

    ‘(b) FEES FOR USE OF DEVELOPED RECREATION SITES AND FACILITIES-

      ‘(1) ESTABLISHMENT AND COLLECTION- Notwithstanding section 4(b) of the Land and Water Conservation Fund Act of 1965 (16 U.S.C. 460l-6a(b)), the Secretary of the Army is authorized, subject to paragraphs (2) and (3), to establish and collect fees for the use of developed recreation sites and facilities, including campsites, swimming beaches, and boat launching ramps.

      ‘(2) EXEMPTION OF CERTAIN FACILITIES- The Secretary shall not establish or collect fees under this subsection for the use or provision of drinking water, wayside exhibits, general purpose roads, overlook sites, picnic tables, toilet facilities, surface water areas, undeveloped or lightly developed shoreland, or general visitor information.

      ‘(3) PER VEHICLE LIMIT- The fee under this subsection for use of a site or facility (other than an overnight camping site or facility or any other site or facility at which a fee is charged for use of the site or facility as of the date of the enactment of this paragraph) for persons entering the site or facility by private, noncommercial vehicle shall not exceed $3 per day per vehicle. Such maximum amount may be adjusted annually by the Secretary for changes in the Consumer Price Index of All Urban Consumers published by the Bureau of Labor Statistics of the Department of Labor.

      ‘(4) DEPOSIT INTO TREASURY ACCOUNT- All fees collected under this subsection shall be deposited into the Treasury account for the Corps of Engineers established by section 4(i) of the Land and Water Conservation Fund Act of 1965 (16 U.S.C. 460l-6a(i)).’.

    (b) CONFORMING AMENDMENT FOR CAMPSITES- Section 4(b) of the Land and Water Conservation Fund Act of 1965 (16 U.S.C. 460l-6a(b)) is amended by striking the next to the last sentence.

TITLE XII--COMMITTEE ON VETERANS AFFAIRS

SEC. 12001. SHORT TITLE.

    This title may be cited as the ‘Veterans Reconciliation Act of 1993’.

SEC. 12002. EXTENSION OF AUTHORITY TO REQUIRE THAT CERTAIN VETERANS AGREE TO MAKE COPAYMENTS IN EXCHANGE FOR RECEIVING HEALTH-CARE BENEFITS.

    (a) HOSPITAL AND MEDICAL CARE- Section 8013(e) of the Omnibus Budget Reconciliation Act of 1990 (Public Law 101-508; 38 U.S.C. 1710 note) is amended--

      (1) by striking out ‘September 30, 1992’ in the first sentence and inserting in lieu thereof ‘September 30, 1998’; and

      (2) by striking out the second sentence.

    (b) OUTPATIENT MEDICATIONS- Section 1722A(c) of title 38, United States Code, is amended--

      (1) by striking out ‘September 30, 1992’ in the first sentence and inserting in lieu thereof ‘September 30, 1998’; and

      (2) by striking out the second sentence.

SEC. 12003. EXTENSION OF AUTHORITY FOR MEDICAL CARE COST RECOVERY.

    (a) IN GENERAL- Section 1729(a) of title 38, United States Code, is amended--

      (1) in paragraph (1), by striking out ‘non-service-connected’; and

      (2) in paragraph (2)--

        (A) by inserting ‘disability and, during the period before October 1, 1998, to a service-connected’ after ‘non-service-connected’ in the matter preceding subparagraph (A); and

        (B) by striking out ‘before August 1, 1994,’ in subparagraph (E) and inserting in lieu thereof ‘before October 1, 1998,’.

    (b) EFFECTIVE DATE- The amendments made by subsection (a) shall apply with respect to care and services furnished under chapter 17 of title 38, United States Code, after September 30, 1993.

SEC. 12004. EXTENSION OF AUTHORITY FOR CERTAIN INCOME VERIFICATION PROVISIONS UNDER THE OMNIBUS BUDGET RECONCILIATION ACT OF 1990.

    (a) AUTHORITY FOR SECRETARY OF VETERANS AFFAIRS TO OBTAIN INFORMATION- Section 5317(g) of title 38, United States Code, is amended by striking out ‘September 30, 1997’ and inserting in lieu thereof ‘September 30, 1998’.

    (b) AUTHORITY FOR SECRETARY OF TREASURY TO PROVIDE INFORMATION- Subparagraph (D) of section 6103(l)(7) of the Internal Revenue Code of 1986 is amended by striking out ‘September 30, 1997’ in the last sentence and inserting in lieu thereof ‘September 30, 1998’.

SEC. 12005. EXTENSION OF LIMITATION ON PENSION FOR CERTAIN RECIPIENTS OF MEDICAID-COVERED NURSING HOME CARE.

    Section 5503(f)(7) of title 38, United States Code, is amended by striking out ‘September 30, 1997’ and inserting in lieu thereof ‘September 30, 1998’.

SEC. 12006. DENIAL OF FISCAL YEAR 1994 COST-OF-LIVING ADJUSTMENT FOR CERTAIN DIC RECIPIENTS.

    During fiscal year 1994, no increase may be provided in the rates of dependency and indemnity compensation in effect under section 1311(a)(3) of title 38, United States Code.

SEC. 12007. EXTENSION OF PROCEDURES APPLICABLE TO LIQUIDATION SALES ON DEFAULTED HOME LOANS GUARANTEED BY THE DEPARTMENT OF VETERANS AFFAIRS.

    (a) INCLUSION OF LOSSES- Section 3732(c) of title 38, United States Code, is amended--

      (1) in paragraph (1)(C), by striking out ‘resale,’ and inserting in lieu thereof ‘resale (including losses sustained on the resale of the property),’; and

      (2) in paragraph (11), by striking out ‘December 31, 1992’ and inserting in lieu thereof ‘September 30, 1998’.

    (b) EFFECTIVE DATE- The amendment made by subsection (a)(1) shall apply to all liquidation sales occurring on or after October 1, 1993.

SEC. 12008. INCREASE IN HOME LOAN FEES.

    Paragraph (6) of section 3729(a) of title 38, United States Code, is amended to read as follows:

    ‘(6) With respect to a loan closed after September 30, 1993, and before October 1, 1998, for which a fee is collected under paragraph (1), the amount of such fee, as computed under paragraph (2), shall be increased by 0.75 percent of the total loan amount other than in the case of a loan described in subparagraph (A), (D)(ii), or (E) of paragraph (2).’.

SEC. 12009. REDUCTION OF FISCAL YEAR 1994 COST-OF-LIVING ADJUSTMENT FOR MONTGOMERY GI BILL BENEFITS.

    (a) BENEFITS PAYABLE UNDER CHAPTER 30- Section 3015(g)(1) of title 38, United States Code, is amended by inserting ‘less one percentage point’ after ‘June 30, 1993,’.

    (b) BENEFITS PAYABLE UNDER SELECTED RESERVE PROGRAM- Section 2131(b)(2)(A) of title 10, United States Code, is amended by inserting ‘less one percentage point’ after ‘June 30, 1993,’.

    (c) TECHNICAL AMENDMENTS- (1) Section 301(c) of Public Law 102-568 (106 Stat. 4326) is amended by striking out ‘Section 3015(f)’ and inserting in lieu thereof ‘Section 3015(g) (as redesignated by section 307(a)(1))’.

    (2) Section 307(a) of such Public Law (106 Stat. 4328) is amended by striking out ‘(as amended by section 301)’.

    (3) The amendments made by paragraphs (1) and (2) shall apply as if included in the enactment of Public Law 102-568.

SEC. 12010. LIMITATION ON CHILDREN ELIGIBLE FOR SURVIVORS’ AND DEPENDENTS’ EDUCATIONAL ASSISTANCE.

    (a) REVISION IN DEFINITION OF CHILDREN ELIGIBLE- Section 3501(a)(2) of title 38, United States Code, is amended by inserting ‘, but does not include an individual who is not the natural or legally adopted child of the parent from whom eligibility under this chapter is derived’ before the period at the end.

    (b) EFFECTIVE DATE- The amendment made by subsection (a) does not apply with respect to any individual who, before October 1, 1993, files an original application for educational assistance under chapter 35 of title 38, United States Code.

TITLE XIII--COMMITTEE ON WAYS AND MEANS--SAVINGS

Subtitle A--Old-Age, Survivors, and Disability Insurance Program

TABLE OF CONTENTS OF SUBTITLE

      Sec. 13001. Explicit requirements for maintenance of telephone access to local offices of the Social Security Administration.

      Sec. 13002. Expansion of State option to exclude service of election officials or election workers from coverage.

      Sec. 13003. Use of social security numbers by States and local governments and Federal district courts for jury selection purposes.

      Sec. 13004. Authorization for all States to extend coverage to State and local policemen and firemen under existing coverage agreements.

      Sec. 13005. Limited exemption for Canadian ministers from certain self-employment tax liability.

      Sec. 13006. Exclusion of totalization benefits from the application of the windfall elimination provision.

      Sec. 13007. Exclusion of military reservists from application of the government pension offset and windfall elimination provisions.

      Sec. 13008. Repeal of the facility-of-payment provision.

      Sec. 13009. Maximum family benefits in guarantee cases.

      Sec. 13010. Authorization for disclosure by the Secretary of Health and Human Services of information for purposes of public or private epidemiological and similar research.

      Sec. 13011. Improvement and clarification of provisions prohibiting misuse of symbols, emblems, or names in reference to social security programs and agencies.

      Sec. 13012. Increased penalties for unauthorized disclosure of social security information.

      Sec. 13013. Simplification of employment taxes on domestic services.

      Sec. 13014. Increase in authorized period for extension of time to file annual earnings report.

      Sec. 13015. Allocations to Federal Disability Insurance Trust Fund.

      Sec. 13016. Extension of disability insurance program demonstration project authority.

      Sec. 13017. Technical and clerical amendments.

      Sec. 13018. Cross-matching of social security account number information and employer identification number information maintained by the Department of Agriculture.

      Sec. 13019. Prohibition of misuse of Department of the Treasury names, symbols, etc.

      Sec. 13020. Availability and use of death information under the old-age, survivors, and disability insurance program.

SEC. 13001. EXPLICIT REQUIREMENTS FOR MAINTENANCE OF TELEPHONE ACCESS TO LOCAL OFFICES OF THE SOCIAL SECURITY ADMINISTRATION.

    (a) MAINTENANCE OF SERVICE TO LOCAL OFFICES-

      (1) IN GENERAL- Section 5110(a) of the Omnibus Budget Reconciliation Act of 1990 (104 Stat. 1388-272) is amended by adding at the end the following new sentence: ‘In carrying out the requirements of the preceding sentence, the Secretary shall reestablish and maintain in service at least the same number of telephone lines to each such local office as was in place as of such date, including telephone sets for connections to such lines.’.

      (2) EFFECTIVE DATE- The Secretary of Health and Human Services shall ensure that the requirements of the amendment made by paragraph (1) are carried out no later than 90 days after the date of the enactment of this Act.

      (3) GAO REPORT- The Comptroller General of the United States shall make an independent determination of the number of telephone lines to each local office of the Social Security Administration which are in place as of 90 days after the enactment of this Act and shall report his findings to the Committee on Ways and Means of the House of Representatives and the Committee on Finance of the Senate no later than 150 days after the date of the enactment of this Act.

    (b) MAINTENANCE OF TOLL-FREE TELEPHONE NUMBER SERVICE- The Secretary of Health and Human Services shall ensure that toll-free telephone service provided by the Social Security Administration is maintained at a level which is at least equal to that in effect on the date of the enactment of this Act.

SEC. 13002. EXPANSION OF STATE OPTION TO EXCLUDE SERVICE OF ELECTION OFFICIALS OR ELECTION WORKERS FROM COVERAGE.

    (a) Limitation on Mandatory Coverage of State Election Officials and Election Workers Without State Retirement System-

      (1) AMENDMENT TO SOCIAL SECURITY ACT- Section 210(a)(7)(F)(iv) of the Social Security Act (42 U.S.C. 410(a)(7)(F)(iv)) (as amended by section 11332(a) of the Omnibus Budget Reconciliation Act of 1990) is amended by striking ‘$100’ and inserting ‘$1,000 with respect to service performed during 1994, and the adjusted amount determined under section 218(c)(8)(B) for any subsequent year with respect to service performed during such subsequent year’.

      (2) AMENDMENT TO FICA- Section 3121(b)(7)(F)(iv) of the Internal Revenue Code of 1986 (as amended by section 11332(b) of the Omnibus Budget Reconciliation Act of 1990) is amended by striking ‘$100’ and inserting ‘$1,000 with respect to service performed during 1994, and the adjusted amount determined under section 218(c)(8)(B) of the Social Security Act for any subsequent year with respect to service performed during such subsequent year’.

    (b) Conforming Amendments Relating to Medicare Qualified Government Employment-

      (1) AMENDMENT TO SOCIAL SECURITY ACT- Section 210(p)(2)(E) of the Social Security Act (42 U.S.C. 410(p)(2)(E)) is amended by striking ‘$100’ and inserting ‘$1,000 with respect to service performed during 1994, and the adjusted amount determined under section 218(c)(8)(B) for any subsequent year with respect to service performed during such subsequent year’.

      (2) AMENDMENT TO FICA- Section 3121(u)(2)(B)(ii)(V) of the Internal Revenue Code of 1986 is amended by striking ‘$100’ and inserting ‘$1,000 with respect to service performed during 1994, and the adjusted amount determined under section 218(c)(8)(B) of the Social Security Act for any subsequent year with respect to service performed during such subsequent year’.

    (c) AUTHORITY FOR STATES TO MODIFY COVERAGE AGREEMENTS WITH RESPECT TO ELECTION OFFICIALS AND ELECTION WORKERS- Section 218(c)(8) of the Social Security Act (42 U.S.C. 418(c)(8)) is amended--

      (1) by striking ‘on or after January 1, 1968,’ and inserting ‘at any time’;

      (2) by striking ‘$100’ and inserting ‘$1,000 with respect to service performed during 1994, and the adjusted amount determined under subparagraph (B) for any subsequent year with respect to service performed during such subsequent year’; and

      (3) by striking the last sentence and inserting the following new sentence: ‘Any modification of an agreement pursuant to this paragraph shall be effective with respect to services performed in and after the calendar year in which the modification is mailed or delivered by other means to the Secretary.’.

    (d) INDEXATION OF EXEMPT AMOUNT- Section 218(c)(8) of such Act (as amended by subsection (c)) is further amended--

      (1) by inserting ‘(A)’ after ‘(8)’; and

      (2) by adding at the end the following new subparagraph:

    ‘(B) For each year after 1994, the Secretary shall adjust the amount referred to in subparagraph (A) at the same time and in the same manner as is provided under section 215(a)(1)(B)(ii) with respect to the amounts referred to in section 215(a)(1)(B)(i), except that--

      ‘(i) for purposes of this subparagraph, 1992 shall be substituted for the calendar year referred to in section 215(a)(1)(B)(ii)(II), and

      ‘(ii) such amount as so adjusted, if not a multiple of $100, shall be rounded to the next higher multiple of $100 where such amount is a multiple of $50 and to the nearest multiple of $100 in any other case.

    The Secretary shall determine and publish in the Federal Register each adjusted amount determined under this subparagraph not later than November 1 preceding the year for which the adjustment is made.’.

    (e) EFFECTIVE DATE- The amendments made by subsections (a), (b), and (c) shall apply with respect to service performed on or after January 1, 1994.

SEC. 13003. USE OF SOCIAL SECURITY NUMBERS BY STATES AND LOCAL GOVERNMENTS AND FEDERAL DISTRICT COURTS FOR JURY SELECTION PURPOSES.

    (a) IN GENERAL- Section 205(c)(2) of the Social Security Act (42 U.S.C. 405(c)(2)) is amended--

      (1) in subparagraph (B)(i), by striking ‘(E)’ in the matter preceding subclause (I) and inserting ‘(F)’;

      (2) by redesignating subparagraphs (E) and (F) as subparagraphs (F) and (G), respectively; and

      (3) by inserting after subparagraph (D) the following:

    ‘(E)(i) It is the policy of the United States that--

      ‘(I) any State (or any political subdivision of a State) may utilize the social security account numbers issued by the Secretary for the additional purposes described in clause (ii) if such numbers have been collected and are otherwise utilized by such State (or political subdivision) in accordance with applicable law, and

      ‘(II) any district court of the United States may use, for such additional purposes, any such social security account numbers which have been so collected and are so utilized by any State.

    ‘(ii) The additional purposes described in this clause are the following:

      ‘(I) identifying duplicate names of individuals on master lists used for jury selection purposes, and

      ‘(II) identifying on such master lists those individuals who are ineligible to serve on a jury by reason of their conviction of a felony.

    ‘(iii) To the extent that any provision of Federal law enacted before the date of the enactment of this subparagraph is inconsistent with the policy set forth in clause (i), such provision shall, on and after that date, be null, void, and of no effect.

    ‘(iv) For purposes of this subparagraph, the term ‘State’ has the meaning such term has in subparagraph (D).’.

    (b) EFFECTIVE DATE- The amendments made by subsection (a) shall take effect on the date of the enactment of this Act.

SEC. 13004. AUTHORIZATION FOR ALL STATES TO EXTEND COVERAGE TO STATE AND LOCAL POLICEMEN AND FIREMEN UNDER EXISTING COVERAGE AGREEMENTS.

    (a) IN GENERAL- Section 218(l) of the Social Security Act (42 U.S.C. 418(l)) is amended--

      (1) in paragraph (1), by striking ‘(1)’ after ‘(l)’, and by striking ‘the State of’ and all that follows through ‘prior to the date of enactment of this subsection’ and inserting ‘a State entered into pursuant to this section’; and

      (2) by striking paragraph (2).

    (b) CONFORMING AMENDMENT- Section 218(d)(8)(D) of such Act (42 U.S.C. 418(d)(8)(D)) is amended by striking ‘agreements with the States named in’ and inserting ‘State agreements modified as provided in’.

    (c) EFFECTIVE DATE- The amendments made by this section shall apply with respect to modifications filed by States after the date of the enactment of this Act.

SEC. 13005. LIMITED EXEMPTION FOR CANADIAN MINISTERS FROM CERTAIN SELF-EMPLOYMENT TAX LIABILITY.

    (a) IN GENERAL- Notwithstanding any other provision of law, if--

      (1) an individual performed services described in section 1402(c)(4) of the Internal Revenue Code of 1986 which are subject to tax under section 1401 of such Code,

      (2) such services were performed in Canada at a time when no agreement between the United States and Canada pursuant to section 233 of the Social Security Act was in effect, and

      (3) such individual was required to pay contributions on the earnings from such services under the social insurance system of Canada,

    then such individual may file a certificate under this section in such form and manner, and with such official, as may be prescribed in regulations issued under chapter 2 of such Code. Upon the filing of such certificate, notwithstanding any judgment which has been entered to the contrary, such individual shall be exempt from payment of such tax with respect to services described in paragraphs (1) and (2) and from any penalties or interest for failure to pay such tax or to file a self-employment tax return as required under section 6017 of such Code.

    (b) PERIOD FOR FILING- A certificate referred to in subsection (a) may be filed only during the 180-day period commencing with the date on which the regulations referred to in subsection (a) are issued.

    (c) TAXABLE YEARS AFFECTED BY CERTIFICATE- A certificate referred to in subsection (a) shall be effective for taxable years ending after December 31, 1978, and before January 1, 1985.

    (d) RESTRICTION ON CREDITING OF EXEMPT SELF-EMPLOYMENT INCOME- In any case in which an individual is exempt under this section from paying a tax imposed under section 1401 of the Internal Revenue Code of 1986, any income on which such tax would have been imposed but for such exemption shall not constitute self-employment income under section 211(b) of the Social Security Act (42 U.S.C. 411(b)), and, if such individual’s primary insurance amount has been determined under section 215 of such Act (42 U.S.C. 415), notwithstanding section 215(f)(1) of such Act, the Secretary of Health and Human Services shall recompute such primary insurance amount so as to take into account the provisions of this subsection. The recomputation under this subsection shall be effective with respect to benefits for months following approval of the certificate of exemption.

SEC. 13006. EXCLUSION OF TOTALIZATION BENEFITS FROM THE APPLICATION OF THE WINDFALL ELIMINATION PROVISION.

    (a) IN GENERAL- Section 215(a)(7) of the Social Security Act (42 U.S.C. 415(a)(7)) is amended--

      (1) in subparagraph (A), by striking ‘but excluding’ and all that follows through ‘1937’ and inserting ‘but excluding (I) a payment under the Railroad Retirement Act of 1974 or 1937, and (II) a payment by a social security system of a foreign country based on an agreement concluded between the United States and such foreign country pursuant to section 233’; and

      (2) in subparagraph (E), by inserting after ‘in the case of an individual’ the following: ‘whose eligibility for old-age or disability insurance benefits is based on an agreement concluded pursuant to section 233 or an individual’.

    (b) CONFORMING AMENDMENT RELATING TO BENEFITS UNDER 1939 ACT- Section 215(d)(3) of such Act (42 U.S.C. 415(d)(3)) is amended by striking ‘but excluding’ and all that follows through ‘1937’ and inserting ‘but excluding (I) a payment under the Railroad Retirement Act of 1974 or 1937, and (II) a payment by a social security system of a foreign country based on an agreement concluded between the United States and such foreign country pursuant to section 233’.

    (c) EFFECTIVE DATE- The amendments made by this section shall apply (notwithstanding section 215(f)(1) of the Social Security Act (42 U.S.C. 415(f)(1))) with respect to benefits payable for months after October 1993.

SEC. 13007. EXCLUSION OF MILITARY RESERVISTS FROM APPLICATION OF THE GOVERNMENT PENSION OFFSET AND WINDFALL ELIMINATION PROVISIONS.

    (a) EXCLUSION FROM GOVERNMENT PENSION OFFSET PROVISIONS- Subsections (b)(4), (c)(2), (e)(7), (f)(2), and (g)(4) of section 202 of the Social Security Act (42 U.S.C. 402 (b)(4), (c)(2), (e)(7), (f)(2), and (g)(4)) are each amended--

      (1) in subparagraph (A)(ii), by striking ‘unless subparagraph (B) applies.’;

      (2) in subparagraph (A), by striking ‘The’ in the matter following clause (ii) and inserting ‘unless subparagraph (B) applies. The’; and

      (3) in subparagraph (B), by redesignating the existing matter as clause (ii), and by inserting before such clause (ii) (as so redesignated) the following:

    ‘(B)(i) Subparagraph (A)(i) shall not apply with respect to monthly periodic benefits based wholly on service as a member of a uniformed service (as defined in section 210(m)).’.

    (b) EXCLUSION FROM WINDFALL ELIMINATION PROVISIONS- Section 215(a)(7)(A) of such Act (as amended by section 13006(a) of this Act) and section 215(d)(3) of such Act (as amended by section 13006(b) of this Act) are each further amended--

      (1) by striking ‘and’ before ‘(II)’; and

      (2) by striking ‘section 233’ and inserting ‘section 233, and (III) a payment based wholly on service as a member of a uniformed service (as defined in section 210(m))’.

    (c) EFFECTIVE DATE- The amendments made by this section shall apply (notwithstanding section 215(f) of the Social Security Act) with respect to benefits payable for months after October 1993.

SEC. 13008. REPEAL OF THE FACILITY-OF-PAYMENT PROVISION.

    (a) REPEAL OF RULE PRECLUDING REDISTRIBUTION UNDER FAMILY MAXIMUM- Section 203(i) of the Social Security Act (42 U.S.C. 403(i)) is repealed.

    (b) COORDINATION UNDER FAMILY MAXIMUM OF REDUCTION IN BENEFICIARY’S AUXILIARY BENEFITS WITH SUSPENSION OF AUXILIARY BENEFITS OF OTHER BENEFICIARY UNDER EARNINGS TEST- Section 203(a)(4) of such Act (42 U.S.C. 403(a)(4)) is amended by striking ‘section 222(b). Whenever’ and inserting the following: ‘section 222(b). Notwithstanding the preceding sentence, any reduction under this subsection in the case of an individual who is entitled to a benefit under subsection (b), (c), (d), (e), (f), (g), or (h) of section 202 for any month on the basis of the same wages and self-employment income as another person--

      ‘(A) who also is entitled to a benefit under subsection (b), (c), (d), (e), (f), (g), or (h) of section 202 for such month,

      ‘(B) who does not live in the same household as such individual, and

      ‘(C) whose benefit for such month is suspended (in whole or in part) pursuant to subsection (h)(3) of this section,

    shall be made before the suspension under subsection (h)(3). Whenever’.

    (c) CONFORMING AMENDMENT APPLYING EARNINGS REPORTING REQUIREMENT DESPITE SUSPENSION OF BENEFITS- The third sentence of section 203(h)(1)(A) of such Act (42 U.S.C. 403(h)(1)(A)) is amended by striking ‘Such report need not be made’ and all that follows through ‘The Secretary may grant’ and inserting the following: ‘Such report need not be made for any taxable year--

      ‘(i) beginning with or after the month in which such individual attained age 70, or

      ‘(ii) if benefit payments for all months (in such taxable year) in which such individual is under age 70 have been suspended under the provisions of the first sentence of paragraph (3) of this subsection, unless--

        ‘(I) such individual is entitled to benefits under subsection (b), (c), (d), (e), (f), (g), or (h) of section 202,

        ‘(II) such benefits are reduced under subsection (a) of this section for any month in such taxable year, and

        ‘(III) in any such month there is another person who also is entitled to benefits under subsection (b), (c), (d), (e), (f), (g), or (h) of section 202 on the basis of the same wages and self-employment income and who does not live in the same household as such individual.

    The Secretary may grant’.

    (d) CONFORMING AMENDMENT DELETING SPECIAL INCOME TAX TREATMENT OF BENEFITS NO LONGER REQUIRED BY REASON OF REPEAL- Section 86(d)(1) of the Internal Revenue Code of 1986 (relating to income tax on social security benefits) is amended by striking the last sentence.

    (e) EFFECTIVE DATES-

      (1) The amendments made by subsections (a), (b), and (c) shall apply with respect to benefits payable for months after December 1994.

      (2) The amendment made by subsection (d) shall apply with respect to benefits received after December 31, 1994, in taxable years ending after such date.

SEC. 13009. MAXIMUM FAMILY BENEFITS IN GUARANTEE CASES.

    (a) IN GENERAL- Section 203(a) of the Social Security Act (42 U.S.C. 403(a)) is amended by adding at the end the following new paragraph:

    ‘(10)(A) Subject to subparagraphs (B) and (C)--

      ‘(i) the total monthly benefits to which beneficiaries may be entitled under sections 202 and 223 for a month on the basis of the wages and self- employment income of an individual whose primary insurance amount is computed under section 215(a)(2)(B)(i) shall equal the total monthly benefits which were authorized by this section with respect to such individual’s primary insurance amount for the last month of his prior entitlement to disability insurance benefits, increased for this purpose by the general benefit increases and other increases under section 215(i) that would have applied to such total monthly benefits had the individual remained entitled to disability insurance benefits until the month in which he became entitled to old-age insurance benefits or reentitled to disability insurance benefits or died, and

      ‘(ii) the total monthly benefits to which beneficiaries may be entitled under sections 202 and 223 for a month on the basis of the wages and self- employment income of an individual whose primary insurance amount is computed under section 215(a)(2)(C) shall equal the total monthly benefits which were authorized by this section with respect to such individual’s primary insurance amount for the last month of his prior entitlement to disability insurance benefits.

    ‘(B) In any case in which--

      ‘(i) the total monthly benefits with respect to such individual’s primary insurance amount for the last month of his prior entitlement to disability insurance benefits was computed under paragraph (6), and

      ‘(ii) the individual’s primary insurance amount is computed under subparagraph (B)(i) or (C) of section 215(a)(2) by reason of the individual’s entitlement to old-age insurance benefits or death,

    the total monthly benefits shall equal the total monthly benefits that would have been authorized with respect to the primary insurance amount for the last month of his prior entitlement to disability insurance benefits if such total monthly benefits had been computed without regard to paragraph (6).

    ‘(C) This paragraph shall apply before the application of paragraph (3)(A), and before the application of section 203(a)(1) of this Act as in effect in December 1978.’.

    (b) CONFORMING AMENDMENT- Section 203(a)(8) of such Act (42 U.S.C. 403(a)(8)) is amended by striking ‘Subject to paragraph (7),’ and inserting ‘Subject to paragraph (7) and except as otherwise provided in paragraph (10)(C),’.

    (c) EFFECTIVE DATE- The amendments made by this section shall apply for the purpose of determining the total monthly benefits to which beneficiaries may be entitled under sections 202 and 223 of the Social Security Act based on the wages and self-employment income of an individual who--

      (1) becomes entitled to an old-age insurance benefit under section 202(a) of such Act,

      (2) becomes reentitled to a disability insurance benefit under section 223 of such Act, or

      (3) dies,

    after October 1993.

SEC. 13010. AUTHORIZATION FOR DISCLOSURE BY THE SECRETARY OF HEALTH AND HUMAN SERVICES OF INFORMATION FOR PURPOSES OF PUBLIC OR PRIVATE EPIDEMIOLOGICAL AND SIMILAR RESEARCH.

    (a) IN GENERAL- Section 1106 of the Social Security Act (42 U.S.C. 1306) is amended--

      (1) by redesignating subsections (d) and (e) as subsections (e) and (f), respectively;

      (2) in subsection (f) (as so redesignated), by striking ‘subsection (d)’ and inserting ‘subsection (e)’; and

      (3) by inserting after subsection (c) the following new subsection:

    ‘(d) Notwithstanding any other provision of this section, in any case in which--

      ‘(1) information regarding whether an individual is shown on the records of the Secretary as being alive or deceased is requested from the Secretary for purposes of epidemiological or similar research which the Secretary finds may reasonably be expected to contribute to a national health interest, and

      ‘(2) the requester agrees to reimburse the Secretary for providing such information and to comply with limitations on safeguarding and rerelease or redisclosure of such information as may be specified by the Secretary,

    the Secretary shall comply with such request, except to the extent that compliance with such request would constitute a violation of the terms of any contract entered into under section 205(r).’.

    (b) AVAILABILITY OF INFORMATION RETURNS REGARDING WAGES PAID EMPLOYEES- Section 6103(l)(5) of the Internal Revenue Code of 1986 (relating to disclosure of returns and return information to the Department of Health and Human Services for purposes other than tax administration) is amended--

      (1) by striking ‘for the purpose of’ and inserting ‘for the purpose of--’;

      (2) by striking ‘carrying out, in accordance with an agreement’ and inserting the following:

        ‘(A) carrying out, in accordance with an agreement’;

      (3) by striking ‘program.’ and inserting ‘program; or’; and

      (4) by adding at the end the following new subparagraph:

        ‘(B) providing information regarding the mortality status of individuals for epidemiological and similar research in accordance with section 1106(d) of the Social Security Act.’.

    (c) EFFECTIVE DATE- The amendments made by this section shall apply with respect to requests for information made after the date of the enactment of this Act.

SEC. 13011. IMPROVEMENT AND CLARIFICATION OF PROVISIONS PROHIBITING MISUSE OF SYMBOLS, EMBLEMS, OR NAMES IN REFERENCE TO SOCIAL SECURITY PROGRAMS AND AGENCIES.

    (a) PROHIBITION OF UNAUTHORIZED REPRODUCTION, REPRINTING, OR DISTRIBUTION FOR FEE OF CERTAIN OFFICIAL PUBLICATIONS- Section 1140(a) of the Social Security Act (42 U.S.C. 1320b-10(a)) is amended--

      (1) by redesignating paragraphs (1) and (2) as subparagraphs (A) and (B), respectively;

      (2) by inserting ‘(1)’ after ‘(a)’; and

      (3) by adding at the end the following new paragraph:

    ‘(2) No person may, for a fee, reproduce, reprint, or distribute any item consisting of a form, application, or other publication of the Social Security Administration unless such person has obtained specific, written authorization for such activity in accordance with regulations which the Secretary shall prescribe.’.

    (b) ADDITION TO PROHIBITED WORDS, LETTERS, SYMBOLS, AND EMBLEMS- Paragraph (1) of section 1140(a) of such Act (as redesignated by subsection (a)) is further amended--

      (1) in subparagraph (A) (as redesignated), by striking ‘Administration’, the letters ‘SSA’ or ‘HCFA’,’ and inserting ‘Administration’, ‘Department of Health and Human Services’, ‘Health and Human Services’, ‘Supplemental Security Income Program’, or ‘Medicaid’, the letters ‘SSA’, ‘HCFA’, ‘DHHS’, ‘HHS’, or ‘SSI’,’; and

      (2) in subparagraph (B) (as redesignated), by striking ‘Social Security Administration’ each place it appears and inserting ‘Social Security Administration, Health Care Financing Administration, or Department of Health and Human Services’, and by striking ‘or of the Health Care Financing Administration’.

    (c) EXEMPTION FOR USE OF WORDS, LETTERS, SYMBOLS, AND EMBLEMS OF STATE AND LOCAL GOVERNMENT AGENCIES BY SUCH AGENCIES- Paragraph (1) of section 1140(a) of such Act (as redesignated by subsection (a)) is further amended by adding at the end the following new sentence: ‘The preceding provisions of this subsection shall not apply with respect to the use by any agency or instrumentality of a State or political subdivision of a State of any words or letters which identify an agency or instrumentality of such State or of a political subdivision of such State or the use by any such agency or instrumentality of any symbol or emblem of an agency or instrumentality of such State or a political subdivision of such State.’.

    (d) INCLUSION OF REASONABLENESS STANDARD- Section 1140(a)(1) of such Act (as amended by the preceding provisions of this section) is further amended, in the matter following subparagraph (B) (as redesignated), by striking ‘convey’ and inserting ‘convey, or in a manner which reasonably could be interpreted or construed as conveying,’.

    (e) INEFFECTIVENESS OF DISCLAIMERS- Subsection (a) of section 1140 of such Act (as amended by the preceding provisions of this section) is further amended by adding at the end the following new paragraph:

    ‘(3) Any determination of whether the use of one or more words, letters, symbols, or emblems (or any combination or variation thereof) in connection with an item described in paragraph (1) or the reproduction, reprinting, or distribution of an item described in paragraph (2) is a violation of this subsection shall be made without regard to any inclusion in such item (or any so reproduced, reprinted, or distributed copy thereof) of a disclaimer of affiliation with the United States Government or any particular agency or instrumentality thereof.’.

    (f) VIOLATIONS WITH RESPECT TO INDIVIDUAL ITEMS- Section 1140(b)(1) of such Act (42 U.S.C. 1320b-10(b)(1)) is amended by adding at the end the following new sentence: ‘In the case of any items referred to in subsection (a)(1) consisting of pieces of mail, each such piece of mail which contains one or more words, letters, symbols, or emblems in violation of subsection (a) shall represent a separate violation. In the case of any item referred to in subsection (a)(2), the reproduction, reprinting, or distribution of such item shall be treated as a separate violation with respect to each copy thereof so reproduced, reprinted, or distributed.’.

    (g) ELIMINATION OF CAP ON AGGREGATE LIABILITY AMOUNT-

      (1) REPEAL- Paragraph (2) of section 1140(b) of such Act (42 U.S.C. 1320b-10(b)(2)) is repealed.

      (2) CONFORMING AMENDMENTS- Section 1140(b) of such Act is further amended--

        (A) by striking ‘(1) Subject to paragraph (2), the’ and inserting ‘The’;

        (B) by redesignating subparagraphs (A) and (B) as paragraphs (1) and (2), respectively; and

        (C) in paragraph (1) (as redesignated), by striking ‘subparagraph (B)’ and inserting ‘paragraph (2)’.

    (h) REMOVAL OF FORMAL DECLINATION REQUIREMENT- Section 1140(c)(1) of such Act (42 U.S.C. 1320b-10(c)(1)) is amended by inserting ‘and the first sentence of subsection (c)’ after ‘and (i)’.

    (i) PENALTIES RELATING TO SOCIAL SECURITY ADMINISTRATION DEPOSITED IN OASI TRUST FUND- Section 1140(c)(2) of such Act (42 U.S.C. 1320b-10(c)(2)) is amended in the second sentence by striking ‘United States.’ and inserting ‘United States, except that, to the extent that such amounts are recovered under this section as penalties imposed for misuse of words, letters, symbols, or emblems relating to the Social Security Administration, such amounts shall be deposited into the Federal Old-Age and Survivor’s Insurance Trust Fund.’.

    (j) ENFORCEMENT- Section 1140 of such Act (42 U.S.C. 1320b-10) is amended by adding at the end the following new subsection:

    ‘(d) The preceding provisions of this section shall be enforced through the Office of Inspector General of the Department of Health and Human Services.’.

    (k) ANNUAL REPORTS- Section 1140 of such Act (as amended by the preceding provisions of this section) is further amended by adding at the end the following new subsection:

    ‘(e) The Secretary shall include in the annual report submitted pursuant to section 704 a report on the operation of this section during the year covered by such annual report. Such report shall specify--

      ‘(1) the number of complaints of violations of this section received by the Social Security Administration during the year,

      ‘(2) the number of cases in which a notice of violation of this section was sent by the Social Security Administration during the year requesting that an individual cease activities in violation of this section,

      ‘(3) the number of complaints of violations of this section referred by the Social Security Administration to the Inspector General in the Department of Health and Human Services during the year,

      ‘(4) the number of investigations of violations of this section undertaken by the Inspector General during the year,

      ‘(5) the number of cases in which a demand letter was sent during the year assessing a civil money penalty under this section,

      ‘(6) the total amount of civil money penalties assessed under this section during the year,

      ‘(7) the number of requests for hearings filed during the year pursuant to subsection (c)(1) of this section and section 1128A(c)(2),

      ‘(8) the disposition during such year of hearings filed pursuant to sections 1140(c)(1) and 1128A(c)(2), and

      ‘(9) the total amount of civil money penalties under this section deposited into the Federal Old-Age and Survivors Insurance Trust Fund during the year.’.

    (l) EFFECTIVE DATE- The amendments made by this section shall apply with respect to violations occurring after the date of the enactment of this Act.

SEC. 13012. INCREASED PENALTIES FOR UNAUTHORIZED DISCLOSURE OF SOCIAL SECURITY INFORMATION.

    (a) UNAUTHORIZED DISCLOSURE- Section 1106(a) of the Social Security Act (42 U.S.C. 1306(a)) is amended--

      (1) by striking ‘misdemeanor’ and inserting ‘felony’;

      (2) by striking ‘$1,000’ and inserting ‘$10,000 for each occurrence of a violation’; and

      (3) by striking ‘one year’ and inserting ‘5 years’.

    (b) UNAUTHORIZED DISCLOSURE BY FRAUD- Section 1107(b) of such Act (42 U.S.C. 1307(b)) is amended--

      (1) by inserting ‘social security account number,’ after ‘information as to the’;

      (2) by striking ‘misdemeanor’ and inserting ‘felony’;

      (3) by striking ‘$1,000’ and inserting ‘$10,000 for each occurrence of a violation’; and

      (4) by striking ‘one year’ and inserting ‘5 years’.

    (c) EFFECTIVE DATE- The amendments made by this section shall apply to violations occurring on or after the date of the enactment of this Act.

SEC. 13013. SIMPLIFICATION OF EMPLOYMENT TAXES ON DOMESTIC SERVICES.

    (a) COORDINATION OF COLLECTION OF DOMESTIC SERVICE EMPLOYMENT WITH COLLECTION OF INCOME TAXES-

      (1) IN GENERAL- Chapter 25 of the Internal Revenue Code of 1986 (relating to general provisions relating to employment taxes) is amended by adding at the end thereof the following new section:

‘SEC. 3510. COORDINATION OF COLLECTION OF DOMESTIC SERVICE EMPLOYMENT TAXES WITH COLLECTION OF INCOME TAXES.

    ‘(a) GENERAL RULE- Except as otherwise provided in this section--

      ‘(1) returns with respect to domestic service employment taxes shall be made on a calendar year basis,

      ‘(2) any such return for any calendar year shall be filed on or before the 15th day of the fourth month following the close of the employer’s taxable year which begins in such calendar year, and

      ‘(3) no requirement to make deposits (or to pay installments under section 6157) shall apply with respect to such taxes.

    ‘(b) DOMESTIC SERVICE EMPLOYMENT TAXES SUBJECT TO ESTIMATED TAX PROVISIONS-

      ‘(1) IN GENERAL- Solely for purposes of section 6654, domestic service employment taxes imposed with respect to any calendar year shall be treated as a tax imposed by chapter 2 for the taxable year of the employer which begins in such calendar year.

      ‘(2) ANNUALIZATION- Under regulations prescribed by the Secretary, appropriate adjustments shall be made in the application of section 6654(d)(2) in respect of the amount treated as tax under paragraph (1).

      ‘(3) TRANSITIONAL RULE- For purposes of applying section 6654 to a taxable year beginning in 1993, the amount referred to in clause (ii) of section 6654(d)(1)(B) shall be increased by 90 percent of the amount treated as tax under paragraph (1) for such taxable year.

    ‘(c) DOMESTIC SERVICE EMPLOYMENT TAXES- For purposes of this section, the term ‘domestic service employment taxes’ means--

      ‘(1) any taxes imposed by chapter 21 or 23 on remuneration paid for domestic service in a private home of the employer, and

      ‘(2) any amount withheld from such remuneration pursuant to an agreement under section 3402(p).

    For purposes of this subsection, the term ‘domestic service in a private home of the employer’ does not include service described in section 3121(g)(5).

    ‘(d) EXCEPTION WHERE EMPLOYER LIABLE FOR OTHER EMPLOYMENT TAXES- To the extent provided in regulations prescribed by the Secretary, this section shall not apply to any employer for any calendar year if such employer is liable for any tax under this subtitle with respect to remuneration for services other than domestic service in a private home of the employer.

    ‘(e) GENERAL REGULATORY AUTHORITY- The Secretary shall prescribe such regulations as may be necessary or appropriate to carry out the purposes of this section. Such regulations may treat domestic service employment taxes as taxes imposed by chapter 1 for purposes of coordinating the assessment and collection of such employment taxes with the assessment and collection of domestic employers’ income taxes.

    ‘(f) AUTHORITY TO ENTER INTO AGREEMENTS TO COLLECT STATE UNEMPLOYMENT TAXES-

      ‘(1) IN GENERAL- The Secretary is hereby authorized to enter into an agreement with any State to collect, as the agent of such State, such State’s unemployment taxes imposed on remuneration paid for domestic service in a private home of the employer. Any taxes to be collected by the Secretary pursuant to such an agreement shall be treated as domestic service employment taxes for purposes of this section.

      ‘(2) TRANSFERS TO STATE ACCOUNT- Any amount collected under an agreement referred to in paragraph (1) shall be transferred by the Secretary to the account of the State in the Unemployment Trust Fund.

      ‘(3) SUBTITLE F MADE APPLICABLE- For purposes of subtitle F, any amount required to be collected under an agreement under paragraph (1) shall be treated as a tax imposed by chapter 23.

      ‘(4) STATE- For purposes of this subsection, the term ‘State’ has the meaning given such term by section 3306(j)(1).’

      (2) CLERICAL AMENDMENT- The table of sections for chapter 25 of such Code is amended by adding at the end thereof the following:

‘Sec. 3510. Coordination of collection of domestic service employment taxes with collection of income taxes.’

      (3) EFFECTIVE DATE- The amendments made by this subsection shall apply to remuneration paid in calendar years beginning after December 31, 1993.

      (4) EXPANDED INFORMATION TO EMPLOYERS- The Secretary of the Treasury or his delegate shall prepare and make available information on the Federal tax obligations of employers with respect to employees performing domestic service in a private home of the employer. Such information shall also include a statement that such employers may have obligations with respect to such employees under State laws relating to unemployment insurance and workers compensation.

    (b) THRESHOLD REQUIREMENT FOR SOCIAL SECURITY TAXES-

      (1) AMENDMENTS OF INTERNAL REVENUE CODE-

        (A) Subparagraph (B) of section 3121(a)(7) of the Internal Revenue Code of 1986 (defining wages) is amended to read as follows:

        ‘(B) cash remuneration paid by an employer in any calendar year to an employee for domestic service in a private home of the employer (within the meaning of subsection (y)), if the cash remuneration paid in such year by the employer to the employee for such service is less than the applicable dollar threshold (as defined in subsection (y)) for such year;’.

        (B) Section 3121 of such Code is amended by adding at the end thereof the following new subsection:

    ‘(y) DOMESTIC SERVICE IN A PRIVATE HOME- For purposes of subsection (a)(7)(B)--

      ‘(1) EXCLUSION FOR CERTAIN FARM SERVICE- The term ‘domestic service in a private home of the employer’ does not include service described in subsection (g)(5).

      ‘(2) APPLICABLE DOLLAR THRESHOLD- The term ‘applicable dollar threshold’ means $1,800. In the case of calendar years after 1994, the Secretary of Health and Human Services shall adjust such $1,800 amount at the same time and in the same manner as under section 215(a)(1)(B)(ii) of the Social Security Act with respect to the amounts referred to in section 215(a)(1)(B)(i) of such Act, except that, for purposes of this subparagraph, 1992 shall be substituted for the calendar year referred to in section 215(a)(1)(B)(ii)(II) of such Act. If the amount determined under the preceding sentence is not a multiple of $50, such amount shall be rounded to the nearest multiple of $50.’

        (C) The second sentence of section 3102(a) of such Code is amended--

          (i) by striking ‘calendar quarter’ each place it appears and inserting ‘calendar year’, and

          (ii) by striking ‘$50’ and inserting ‘the applicable dollar threshold (as defined in section 3121(y)(2)) for such year’.

      (2) AMENDMENT OF SOCIAL SECURITY ACT- Subparagraph (B) of section 209(a)(6) of the Social Security Act (42 U.S.C. 409(a)(6)(B)) is amended to read as follows:

      ‘(B) Cash remuneration paid by an employer in any calendar year to an employee for domestic service in a private home of the employer, if the cash remuneration paid in such year by the employer to the employee for such service is less than the applicable dollar threshold (as defined in section 3121(y)(2) of the Internal Revenue Code of 1986) for such year. As used in this subparagraph, the term ‘domestic service in a private home of the employer’ does not include service described in section 210(f)(5).’

      (3) EFFECTIVE DATE- The amendments made by this subsection shall apply to remuneration paid in calendar years beginning after December 31, 1993.

      (4) RELIEF FROM LIABILITY FOR CERTAIN UNDERPAYMENT AMOUNTS-

        (A) IN GENERAL- On and after the date of the enactment of this Act, an underpayment to which this paragraph applies (and any penalty, addition to tax, and interest with respect to such underpayment) shall not be assessed (or, if assessed, shall not be collected).

        (B) UNDERPAYMENTS TO WHICH PARAGRAPH APPLIES- This paragraph shall apply to an underpayment to the extent of the amount thereof which would not be an underpayment if--

          (i) the amendments made by paragraph (1) had applied to all calendar years after 1950 and before 1994, and

          (ii) the applicable dollar threshold for any such calendar year were the amount determined under the following table:

In the case of

--The applicable

calendar year:

--dollar threshold is:

1951, 1952, or 1953

--$ 200

1954, 1955, 1956, or 1957

-- 250

1958, 1959, 1960, 1961, or 1962

-- 300

1963, 1964, 1965, or 1966

-- 350

1967, 1968, 1969

-- 400

1970

-- 450

1971, 1972, or 1973

-- 500

1974 or 1975

-- 600

1976

-- 650

1977

-- 700

1978

-- 750

1979

-- 800

1980

-- 850

1981

-- 900

1982

-- 1,000

1983

-- 1,100

1984

-- 1,200

1985

-- 1,250

1986

-- 1,300

1987

-- 1,350

1988

-- 1,400

1989

-- 1,500

1990

-- 1,550

1991

-- 1,600

1992

-- 1,700

1993

-- 1,750

SEC. 13014. INCREASE IN AUTHORIZED PERIOD FOR EXTENSION OF TIME TO FILE ANNUAL EARNINGS REPORT.

    (a) IN GENERAL- Section 203(h)(1)(A) of the Social Security Act (42 U.S.C. 403(h)(1)(A)) is amended in the last sentence by striking ‘three months’ and inserting ‘four months’.

    (b) EFFECTIVE DATE- The amendment made by subsection (a) shall apply with respect to reports of earnings for taxable years ending on or after December 31, 1993.

SEC. 13015. ALLOCATIONS TO FEDERAL DISABILITY INSURANCE TRUST FUND.

    (a) ALLOCATION WITH RESPECT TO WAGES- Section 201(b)(1) of the Social Security Act (42 U.S.C. 401(b)(1)) is amended to read as follows:

      ‘(1) 1.75 percent of the wages (as defined in section 3121 of the Internal Revenue Code of 1986) paid after December 31, 1992, and reported to the Secretary of the Treasury or his delegate pursuant to subtitle F of the Internal Revenue Code of 1986, which wages shall be certified by the Secretary of Health and Human Services on the basis of the records of wages established and maintained by such Secretary in accordance with such reports; and’.

    (b) ALLOCATION WITH RESPECT TO SELF-EMPLOYMENT INCOME- Section 201(b)(2) of such Act (42 U.S.C. 401(b)(2)) is amended to read as follows:

      ‘(2) 1.75 percent of the self-employment income (as defined in section 1402 of the Internal Revenue Code of 1986) reported to the Secretary of the Treasury or his delegate on tax returns under subtitle F of the Internal Revenue Code of 1986 for any taxable year beginning after December 31, 1992, which self-employment income shall be certified by the Secretary of Health and Human Services on the basis of the records of self-employment income established and maintained by the Secretary of Health and Human Services in accordance with such returns.’.

    (c) EFFECTIVE DATE- The amendments made by this section shall apply with respect to wages paid after December 31, 1992, and self-employment income for taxable years beginning after such date.

    (d) STUDY ON RISING COSTS OF DISABILITY BENEFITS-

      (1) IN GENERAL- As soon as practicable after the date of the enactment of this Act, the Secretary of Health and Human Services shall conduct a comprehensive study of the reasons for rising costs payable from the Federal Disability Insurance Trust Fund.

      (2) MATTERS TO BE INCLUDED IN STUDY- In conducting the study under this subsection, the Secretary shall--

        (A) determine the relative importance of the following factors in increasing the costs payable from the Trust Fund:

          (i) increased numbers of applications for benefits;

          (ii) higher rates of benefit allowances; and

          (iii) decreased rates of benefit terminations; and

        (B) identify, to the extent possible, underlying social, economic, demographic, programmatic, and other trends responsible for changes in disability benefit applications, allowances, and terminations.

      (3) REPORT- Not later than December 31, 1995, the Secretary shall transmit a report to the Committee on Ways and Means of the House of Representatives and the Committee on Finance of the Senate setting forth the results of the study conducted under this subsection, together with any recommendations for legislative changes which the Secretary determines appropriate.

SEC. 13016. EXTENSION OF DISABILITY INSURANCE PROGRAM DEMONSTRATION PROJECT AUTHORITY.

    (a) IN GENERAL- Section 505 of the Social Security Disability Amendments of 1980 (Public Law 96-265), as amended by section 12101 of the Consolidated Omnibus Budget Reconciliation Act of 1985 (Public Law 99-272), section 10103 of the Omnibus Budget Reconciliation Act of 1989 (Public Law 101-239), and section 5120 of the Omnibus Budget Reconciliation Act of 1990 (Public Law 101-508) is further amended--

      (1) in paragraph (3) of subsection (a), by striking ‘June 10, 1993’ and inserting ‘June 10, 1996’;

      (2) in paragraph (4) of subsection (a), by striking ‘1992’ and inserting ‘1995’; and

      (3) in subsection (c), by striking ‘October 1, 1993’ and inserting ‘June 9, 1996’.

    (b) EFFECTIVE DATE- The amendments made by this section shall take effect on the date of the enactment of this Act.

SEC. 13017. TECHNICAL AND CLERICAL AMENDMENTS.

    (a) AMENDMENTS TO TITLE II OF THE SOCIAL SECURITY ACT-

      (1) Section 201(a) of the Social Security Act (42 U.S.C. 401(a)) is amended, in the matter following clause (4), by striking ‘and and’ and inserting ‘and’.

      (2) Section 202(d)(8)(D)(ii) of such Act (42 U.S.C. 402(d)(8)(D)(ii)) is amended by adding a period at the end and by adjusting the left hand margination thereof so as to align with section 202(d)(8)(D)(i) of such Act.

      (3) Section 202(q)(1)(A) of such Act (42 U.S.C. 402(q)(1)(A)) is amended by striking the dash at the end.

      (4) Section 202(q)(9) of such Act (42 U.S.C. 402(q)(9)) is amended, in the matter preceding subparagraph (A), by striking ‘parargaph’ and inserting ‘paragraph’.

      (5) Section 202(t)(4)(D) of such Act (42 U.S.C. 402(t)(4)(D)) is amended by inserting ‘if the’ before ‘Secretary’ the second and third places it appears.

      (6) Clauses (i) and (ii) of section 203(f)(5)(C) of such Act (42 U.S.C. 403(f)(5)(C)) are amended by adjusting the left-hand margination thereof so as to align with clauses (i) and (ii) of section 203(f)(5)(B) of such Act.

      (7) Paragraph (3)(A) and paragraph (3)(B) of section 205(b) of such Act (42 U.S.C. 405(b)) are amended by adjusting the left-hand margination thereof so as to align with the matter following section 205(b)(2)(C) of such Act.

      (8) Section 205(c)(2)(B)(iii) of such Act (42 U.S.C. 405(c)(2)(B)(iii)) is amended by striking ‘non-public’ and inserting ‘nonpublic’.

      (9) Section 205(c)(2)(C) of such Act (42 U.S.C. 405(c)(2)(C)) is amended--

        (A) by striking the clause (vii) added by section 2201(c) of Public Law 101-624; and

        (B) by redesignating the clause (iii) added by section 2201(b)(3) of Public Law 101-624, clause (iv), clause (v), clause (vi), and the clause (vii) added by section 1735(b) of Public Law 101-624 as clause (iv), clause (v), clause (vi), clause (vii), and clause (viii), respectively;

        (C) in clause (v) (as redesignated), by striking ‘subclause (I) of’, and by striking ‘subclause (II) of clause (i)’ and inserting ‘clause (ii)’; and

        (D) in clause (viii)(IV) (as redesignated), by inserting ‘a social security account number or’ before ‘a request for’.

      (10) The heading for section 205(j) of such Act (42 U.S.C. 405(j)) is amended to read as follows:

‘Representative Payees’.

      (11) The heading for section 205(s) of such Act (42 U.S.C. 405(s)) is amended to read as follows:

‘Notice Requirements’.

      (12) Section 208(c) of such Act (42 U.S.C. 408(c)) is amended by striking ‘subsection (g)’ and inserting ‘subsection (a)(7)’.

      (13) Section 210(a)(5)(B)(i)(V) of such Act (42 U.S.C. 410(a)(5)(B)(i)(V)) is amended by striking ‘section 105(e)(2)’ and inserting ‘section 104(e)(2)’.

      (14) Section 211(a) of such Act (42 U.S.C. 411(a)) is amended--

        (A) in paragraph (13), by striking ‘and’ at the end; and

        (B) in paragraph (14), by striking the period and inserting ‘; and’.

      (15) Section 213(c) of such Act (42 U.S.C. 413(c)) is amended by striking ‘section’ the first place it appears and inserting ‘sections’.

      (16) Section 215(a)(5)(B)(i) of such Act (42 U.S.C. 415(a)(5)(B)(i)) is amended by striking ‘subsection’ the second place it appears and inserting ‘subsections’.

      (17) Section 215(f)(7) of such Act (42 U.S.C. 415(f)(7)) is amended by inserting a period after ‘1990’.

      (18) Subparagraph (F) of section 218(c)(6) of such Act (42 U.S.C. 418(c)(6)) is amended by adjusting the left-hand margination thereof so as to align with section 218(c)(6)(E) of such Act.

      (19) Section 223(i) of such Act (42 U.S.C. 423(i)) is amended by adding at the beginning the following heading:

‘Limitation on Payments to Prisoners’.

    (b) RELATED AMENDMENTS-

      (1) Section 603(b)(5)(A) of Public Law 101-649 (amending section 202(n)(1) of the Social Security Act) (104 Stat. 5085) is amended by inserting ‘under’ before ‘paragraph (1),’ and by striking ‘(17), or (18)’ and inserting ‘(17), (18), or (19)’, effective as if this paragraph were included in such section 603(b)(5)(A).

      (2) Section 10208(b)(1) of Public Law 101-239 (amending section 230(b)(2)(A) of the Social Security Act) (103 Stat. 2477) is amended by striking ‘230(b)(2)(A)’ and ‘430(b)(2)(A)’ and inserting ‘230(b)(2)’ and ‘430(b)(2)’, respectively, effective as if this paragraph were included in such section 10208(b)(1).

    (c) CONFORMING, CLERICAL AMENDMENTS UPDATING, WITHOUT SUBSTANTIVE CHANGE, REFERENCES IN TITLE II OF THE SOCIAL SECURITY ACT TO THE INTERNAL REVENUE CODE-

      (1)(A) Section 201(a) of such Act (42 U.S.C. 401(a)) is amended--

        (i) by striking clauses (1) and (2);

        (ii) in clause (3), by striking ‘(3) the taxes imposed’ and all that follows through ‘December 31, 1954,’ and inserting ‘(1) the taxes imposed by chapter 21 (other than sections 3101(b) and 3111(b)) of the Internal Revenue Code of 1986 with respect to wages (as defined in section 3121 of such Code) reported to the Secretary of the Treasury or his delegate pursuant to subtitle F of such Code,’, and by striking ‘subchapter or’;

        (iii) in clause (4), by striking ‘(4) the taxes imposed’ and all that follows through ‘such Code,’ and inserting ‘(2) the taxes imposed by chapter 2 (other than section 1401(b)) of the Internal Revenue Code of 1986 with respect to self-employment income (as defined in section 1402 of such Code) reported to the Secretary of the Treasury or his delegate on tax returns under subtitle F of such Code,’, and by striking ‘subchapter or chapter’ and inserting ‘chapter’; and

        (iv) in the matter following the clauses amended by this subparagraph, by striking ‘clauses (3) and (4)’ each place it appears and inserting ‘clauses (1) and (2)’.

      (B) The amendments made by subparagraph (A) shall apply only with respect to taxes imposed with respect to wages paid on or after January 1, 1993, or with respect to self-employment income for taxable years beginning on or after such date.

      (2)(A)(i) Section 201(g)(1) of such Act (42 U.S.C. 401(g)(1)) is amended--

        (I) in subparagraph (A)(i), by striking ‘and subchapter E’ and all that follows through ‘1954’ and inserting ‘and chapters 2 and 21 of the Internal Revenue Code of 1986’;

        (II) in subparagraph (A)(ii), by striking ‘1954’ and inserting ‘1986’;

        (III) in the matter in subparagraph (A) following clause (ii), by striking ‘subchapter E’ and all that follows through ‘1954.’ and inserting ‘chapters 2 and 21 of the Internal Revenue Code of 1986.’, and by striking ‘1954 other’ and inserting ‘1986 other’; and

        (IV) in subparagraph (B), by striking ‘1954’ each place it appears and inserting ‘1986’.

      (ii) The amendments made by clause (i) shall apply only with respect to periods beginning on or after the date of the enactment of this Act.

      (B)(i) Section 201(g)(2) of such Act (42 U.S.C. 401(g)(2)) is amended by striking ‘section 3101(a)’ and all that follows through ‘1950.’ and inserting ‘section 3101(a) of the Internal Revenue Code of 1986 which are subject to refund under section 6413(c) of such Code with respect to wages (as defined in section 3121 of such Code).’, and by striking ‘wages reported’ and all that follows through ‘1954,’ and inserting ‘wages reported to the Secretary of the Treasury or his delegate pursuant to subtitle F of such Code,’.

      (ii) The amendments made by clause (i) shall apply only with respect to wages paid on or after January 1, 1993.

      (C) Section 201(g)(4) of such Act (42 U.S.C. 401(g)(4)) is amended--

        (i) by striking ‘The Board of Trustees shall prescribe before January 1, 1981, the method’ and inserting ‘If at any time or times the Boards of Trustees of such Trust Funds deem such action advisable, they may modify the method prescribed by such Boards’;

        (ii) by striking ‘1954’ and inserting ‘1986’; and

        (iii) by striking the last sentence.

      (3) Section 202(v) of such Act (42 U.S.C. 402(v)) is amended--

        (A) in paragraph (1), by striking ‘1954’ and inserting ‘1986’; and

        (B) in paragraph (3)(A), by inserting ‘of the Internal Revenue Code of 1986’ after ‘3127’.

      (4) Section 205(c)(5)(F)(i) of such Act (42 U.S.C. 405(c)(5)(F)(i)) is amended by inserting ‘or the Internal Revenue Code of 1986’ after ‘1954’.

      (5)(A) Section 208(a)(1) of such Act (42 U.S.C. 408(a)(1)) is amended--

        (i) in the matter preceding subparagraph (A), by striking ‘subchapter E’ and all that follows through ‘1954’ and inserting ‘chapter 2 or 21 or subtitle F of the Internal Revenue Code of 1986’;

        (ii) in subparagraph (A), by inserting ‘of 1986’ after ‘Internal Revenue Code’; and

        (iii) in subparagraph (B), by inserting ‘of 1986’ after ‘Internal Revenue Code’.

      (B) The amendments made by subparagraph (A) shall apply only with respect to violations occurring on or after the date of the enactment of this Act.

      (6)(A) Section 209(a)(4)(A) of such Act (42 U.S.C. 409(a)(4)(A)) is amended by inserting ‘or the Internal Revenue Code of 1986’ after ‘Internal Revenue Code of 1954’.

      (B) Section 209(a) of such Act (42 U.S.C. 409(a)) is amended--

        (i) in subparagraphs (C) and (E) of paragraph (4),

        (ii) in paragraph (5)(A),

        (iii) in subparagraphs (A) and (B) of paragraph (14),

        (iv) in paragraph (15),

        (v) in paragraph (16), and

        (vi) in paragraph (17),

      by striking ‘1954’ each place it appears and inserting ‘1986’.

      (C) Subsections (b), (f), (g), (i)(1), and (j) of section 209 of such Act (42 U.S.C. 409) are amended by striking ‘1954’ each place it appears and inserting ‘1986’.

      (7) Section 211(a)(15) of such Act (42 U.S.C. 411(a)(15)) is amended by inserting ‘of the Internal Revenue Code of 1986’ after ‘section 162(m)’.

      (8) Title II of such Act is further amended--

        (A) in subsections (f)(5)(B)(ii) and (k) of section 203 (42 U.S.C. 403),

        (B) in section 205(c)(1)(D)(i) (42 U.S.C. 405(c)(1)(D)(i)),

        (C) in the matter in section 210(a) (42 U.S.C. 410(a)) preceding paragraph (1) and in paragraphs (8), (9), and (10) of section 210(a),

        (D) in subsections (p)(4) and (q) of section 210 (42 U.S.C. 410),

        (E) in the matter in section 211(a) (42 U.S.C. 411(a)) preceding paragraph (1) and in paragraphs (3), (4), (6), (10), (11), and (12) and clauses (iii) and (iv) of section 211(a),

        (F) in the matter in section 211(c) (42 U.S.C. 411(c)) preceding paragraph (1), in paragraphs (3) and (6) of section 211(c), and in the matter following paragraph (6) of section 211(c),

        (G) in subsections (d), (e), and (h)(1)(B) of section 211 (42 U.S.C. 411),

        (H) in section 216(j) (42 U.S.C. 416(j)),

        (I) in section 218(e)(3) (42 U.S.C. 418(e)(3)),

        (J) in section 229(b) (42 U.S.C. 429(b)),

        (K) in section 230(c) (42 U.S.C. 430(c)), and

        (L) in section 232 (42 U.S.C. 432),

      by striking ‘1954’ each place it appears and inserting ‘1986’.

    (d) RULES OF CONSTRUCTION-

      (1) The preceding provisions of this section shall be construed only as technical and clerical corrections and as reflecting the original intent of the provisions amended thereby.

      (2) Any reference in title II of the Social Security Act to the Internal Revenue Code of 1986 shall be construed to include a reference to the Internal Revenue Code of 1954 to the extent necessary to carry out the provisions of paragraph (1).

    (e) UTILIZATION OF NATIONAL AVERAGE WAGE INDEX FOR WAGE-BASED ADJUSTMENTS-

      (1) DEFINITION OF NATIONAL AVERAGE WAGE INDEX- Section 209(k) of the Social Security Act (42 U.S.C. 409(k)) is amended--

        (A) by redesignating paragraph (2) as paragraph (3);

        (B) in paragraph (3) (as redesignated), by striking ‘paragraph (1)’ and inserting ‘this subsection’; and

        (C) by striking paragraph (1) and inserting the following new paragraphs:

    ‘(k)(1) For purposes of sections 203(f)(8)(B)(ii), 213(d)(2)(B), 215(a)(1)(B)(ii), 215(a)(1)(C)(ii), 215(a)(1)(D), 215(b)(3)(A)(ii), 215(i)(1)(E), 215(i)(2)(C)(ii), 224(f)(2)(B), and 230(b)(2) (and 230(b)(2) as in effect immediately prior to the enactment of the Social Security Amendments of 1977), the term ‘national average wage index’ for any particular calendar year means, subject to regulations of the Secretary under paragraph (2), the average of the total wages for such particular calendar year.

    ‘(2) The Secretary shall prescribe regulations under which the national average wage index for any calendar year shall be computed--

      ‘(A) on the basis of amounts reported to the Secretary of the Treasury or his delegate for such year,

      ‘(B) by disregarding the limitation on wages specified in subsection (a)(1),

      ‘(C) with respect to calendar years after 1990, by incorporating deferred compensation amounts and factoring in for such years the rate of change from year to year in such amounts, in a manner consistent with the requirements of section 10208 of the Omnibus Budget Reconciliation Act of 1989, and

      ‘(D) with respect to calendar years before 1978, in a manner consistent with the manner in which the average of the total wages for each of such calendar years was determined as provided by applicable law as in effect for such years.’.

      (2) CONFORMING AMENDMENTS-

        (A) Section 203(f)(8)(B)(ii) of such Act (42 U.S.C. 403(f)(8)(B)(ii)) is amended by striking ‘deemed average total wages’ each place it appears and inserting ‘national average wage index’.

        (B) Section 213(d)(2)(B) of such Act (42 U.S.C. 413(d)(2)(B)) is amended by striking ‘deemed average total wages’ and inserting ‘national average wage index’, and by striking ‘the average of the total wages’ and all that follows and inserting ‘the national average wage index (as so defined) for 1976,’.

        (C) Section 215(a)(1)(B)(ii) of such Act (42 U.S.C. 415(a)(1)(B)(ii)) is amended--

          (i) in subclause (I), by striking ‘deemed average total wages’ and inserting ‘national average wage index’; and

          (ii) in subclause (II), by striking ‘the average