[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5252 Enrolled Bill (ENR)]

        H.R.5252

                       One Hundred Third Congress

                                 of the

                        United States of America


                          AT THE SECOND SESSION

          Begun and held at the City of Washington on Tuesday,
 the twenty-fifth day of January, one thousand nine hundred and ninety-
                                  four


                                 An Act

  
 
  To amend the Social Security Act and related Acts to make 
miscellaneous and technical amendments, and for other purposes.

    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 ``Social Security Act Amendments of 
1994''.

SEC. 2. REFERENCES IN ACT; TABLE OF CONTENTS.

    (a) Amendments to Social Security Act.--Except as otherwise 
specifically provided, whenever in this Act 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 Act, the terms ``OBRA-1986'', 
``OBRA-1987'', ``OBRA-1989'', ``OBRA-1990'', and ``OBRA-1993'' 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), the 
Omnibus Budget Reconciliation Act of 1990 (Public Law 101-508), and the 
Omnibus Budget Reconciliation Act of 1993 (Public Law 103-66), 
respectively.
    (c) Table of Contents.--The table of contents is as follows:

Sec. 1. Short title.
Sec. 2. References in Act; table of contents.

                      TITLE I--MEDICARE PROVISIONS

                Subtitle A--Provisions Relating to Part A

Sec. 101. Provisions relating to adjustments to standardized amounts for 
          wages and wage-related costs.
Sec. 102. Essential access community hospital (EACH) amendments.
Sec. 103. Provisions relating to rural health transition grant program.
Sec. 104. Psychology services in hospitals.
Sec. 105. Medicare-dependent, small rural hospitals and sole community 
          hospitals.
Sec. 106. Skilled nursing facilities.
Sec. 107. Notification of availability of hospice benefit.
Sec. 108. Clarifying expertise of individuals to serve on the 
          Prospective Payment Assessment Commission.
Sec. 109. Authority for budget neutral adjustments for changes in 
          payment amounts for transfer cases.
Sec. 110. Clarification of DRG payment window expansion; miscellaneous 
          and technical corrections.

                Subtitle B--Provisions Relating to Part B
                      Part I--Physicians' Services
Sec. 121. Development and implementation of resource-based methodology 
          for practice expenses.
Sec. 122. Geographic cost of practice index refinements.
Sec. 123. Extra-billing limits.
Sec. 124. Relative values for pediatric services.
Sec. 125. Administration of claims relating to physicians' services.
Sec. 126. Miscellaneous and technical corrections.
                   Part II--Durable Medical Equipment
Sec. 131. Certification of suppliers.
Sec. 132. Restrictions on certain marketing and sales activities.
Sec. 133. Beneficiary liability for noncovered services.
Sec. 134. Adjustments for inherent reasonableness.
Sec. 135. Miscellaneous and technical corrections.
                   Part III--Other Items and Services
Sec. 141. Ambulatory surgical center services.
Sec. 142. Study of medicare coverage of patient care costs associated 
          with clinical trials of new cancer therapies.
Sec. 143. Study of annual cap on amount of medicare payment for 
          outpatient physical therapy and occupational therapy services.
Sec. 144. Payment of part B premium late enrollment penalties by States.
Sec. 145. Application of mammography certification requirements.
Sec. 146. Coverage of services of speech-language pathologists and 
          audiologists.
Sec. 147. Miscellaneous and technical corrections.
            Subtitle C--Provisions Relating to Parts A and B
Sec. 151. Medicare secondary payer reforms.
Sec. 152. Physician ownership and referral.
Sec. 153. Definition of FMGEMS examination for payment of direct 
          graduate medical education.
Sec. 154. Qualified medicare beneficiary outreach.
Sec. 155. Hospital agreements with organ procurement organizations.
Sec. 156. Peer review organizations.
Sec. 157. Health maintenance organizations.
Sec. 158. Home health agencies.
Sec. 159. Permanent extension of authority to contract with fiscal 
          intermediaries and carriers on other than a cost basis.
Sec. 160. Miscellaneous and technical corrections.
   Subtitle D--Provisions Relating to Medicare Supplemental Insurance 
                                Policies
Sec. 171. Standards for medicare supplemental insurance policies.
Sec. 172. 6-month extension of period for issuance of medicare select 
          policies.
TITLE II--MATERNAL AND CHILD HEALTH SERVICES BLOCK GRANT PROGRAM, INCOME 
             SECURITY, HUMAN RESOURCES, AND RELATED PROGRAMS
Sec. 201. Increase in authorization of appropriations for the Maternal 
          and Child Health Services Block Grant Program.
            Subtitle A--Child Welfare, Foster Care, Adoption
Sec. 202. Required protections for foster children.
Sec. 203. Conformity reviews.
Sec. 204. States required to report on measures taken to comply with the 
          Indian Child Welfare Act.
Sec. 205. Child welfare traineeships.
Sec. 206. Dispositional hearing.
Sec. 207. Elimination of foster care ceilings and of authority to 
          transfer unused foster care funds to child welfare services 
          programs.
Sec. 208. Demonstration projects.
Sec. 209. Placement accountability.
Sec. 210. Payments of State claims for foster care and adoption 
          assistance.
Sec. 211. Effect of failure to carry out State plan.
                  Subtitle B--Child Support Enforcement
Sec. 212. Reports to credit bureaus on persons delinquent in child 
          support payments.
Sec. 213. Technical amendments to provision on State paternity 
          establishment programs.
Sec. 214. Agreement to assist in locating missing children under the 
          parent locator service.

                Subtitle C--Supplemental Security Income

Sec. 221. Definition of disability for children under age 18 applied to 
          all individuals under age 18.

           Subtitle D--Aid to Families With Dependent Children

Sec. 231. Simplification of income and eligibility verification system.
Sec. 232. Measurement and reporting of welfare receipt.
Sec. 233. New Hope demonstration project.
Sec. 234. Delay in requirement that outlying areas operate an AFDC-UP 
          Program.
Sec. 235. State option to use retrospective budgeting without monthly 
          reporting.

                        Subtitle E--JOBS Program

Sec. 241. Expansion of coverage for Indian tribes.
Sec. 242. Report to the Congress with respect to performance standards 
          in the JOBS program.

                      Subtitle F--Other Provisions

Sec. 261. Extension of demonstration to expand job opportunities.
Sec. 262. Early childhood development projects.
Sec. 263. Reallocation of funds under title XX for empowerment and 
          enterprise grants.
Sec. 264. Corrections related to the income security and human resources 
          provisions of OBRA-1990.
Sec. 265. Technical corrections related to the human resource and income 
          security provisions of OBRA-1989.
Sec. 266. Technical correction related to the human resource and income 
          security provisions of OBRA-1993.
Sec. 267. Elimination of obsolete provisions relating to treatment of 
          the earned income tax credit.
Sec. 268. Redesignation of certain provisions.

                      TITLE I--MEDICARE PROVISIONS
               Subtitle A--Provisions Relating to Part A

    SEC. 101. PROVISIONS RELATING TO ADJUSTMENTS TO STANDARDIZED 
      AMOUNTS FOR WAGES AND WAGE-RELATED COSTS.
    (a) Use of Occupational Mix in Guidelines for Determination of Area 
Wage Index.--
        (1) In general.--Section 1886(d)(10)(D)(i)(I) (42 U.S.C. 
    1395ww(d)(10)(D)(i)(I)) is amended by inserting ``(to the extent 
    the Secretary determines appropriate)'' after ``taking into 
    account''.
        (2) Effective date.--The amendment made by paragraph (1) shall 
    take effect as if included in the enactment of OBRA-1989.
    (b) Conforming Amendments Relating to Geographic Area Used To 
Determine Wage Index Applicable to Hospital.--(1) Section 1886(d)(8)(C) 
(42 U.S.C. 1395ww(d)(8)(C)), as amended by section 13501(b)(1) of OBRA-
1993, is amended--
        (A) in clause (iv), by striking ``paragraph (1)'' and inserting 
    ``paragraph (10)''; and
        (B) by adding at the end the following new clause:
    ``(v) This subparagraph shall apply with respect to discharges 
occurring in a fiscal year only if the Secretary uses a method for 
making adjustments to the DRG prospective payment rate for area 
differences in hospital wage levels under paragraph (3)(E) for the 
fiscal year that is based on the use of Metropolitan Statistical Area 
classifications.''.
    (2) Section 1886(d)(10) (42 U.S.C. 1395ww(d)(10)) is amended--
        (A) in subparagraph (C)(i)(II), by striking ``the area wage 
    index applicable'' and inserting ``the factor used to adjust the 
    DRG prospective payment rate for area differences in hospital wage 
    levels that applies''; and
        (B) in subparagraph (D)--
            (i) by redesignating clause (ii) as clause (iii), and
            (ii) by inserting after clause (i) the following new 
        clause:
    ``(ii) Notwithstanding clause (i), if the Secretary uses a method 
for making adjustments to the DRG prospective payment rate for area 
differences in hospital wage levels under paragraph (3)(E) that is not 
based on the use of Metropolitan Statistical Area classifications, the 
Secretary may revise the guidelines published under clause (i) to the 
extent such guidelines are used to determine the appropriateness of the 
geographic area in which the hospital is determined to be located for 
purposes of making such adjustments.''.
    (c) Adjustment of Labor and Non-Labor Portions of Standardized 
Amounts.--Section 1886(d)(3)(A)(iii) (42 U.S.C. 1395ww(d)(3)(A)(iii)) 
is amended by adding at the end the following: ``For discharges 
occurring on or after October 1, 1994, the Secretary shall adjust the 
ratio of the labor portion to non-labor portion of each average 
standardized amount to equal such ratio for the national average of all 
standardized amounts.''.
    SEC. 102. ESSENTIAL ACCESS COMMUNITY HOSPITAL (EACH) AMENDMENTS.
    (a) Treatment of Inpatient Hospital Services Provided in Rural 
Primary Care Hospitals.--
        (1) In general.--Section 1820(f)(1)(F) (42 U.S.C. 1395i-
    4(f)(1)(F)) is amended to read as follows:
            ``(F) subject to paragraph (4), provides not more than 6 
        inpatient beds (meeting such conditions as the Secretary may 
        establish) for providing inpatient care to patients requiring 
        stabilization before discharge or transfer to a hospital, 
        except that the facility may not provide any inpatient hospital 
        services--
                ``(i) to any patient whose attending physician does not 
            certify that the patient may reasonably be expected to be 
            discharged or transferred to a hospital within 72 hours of 
            admission to the facility; or
                ``(ii) consisting of surgery or any other service 
            requiring the use of general anesthesia (other than 
            surgical procedures specified by the Secretary under 
            section 1833(i)(1)(A)), unless the attending physician 
            certifies that the risk associated with transferring the 
            patient to a hospital for such services outweighs the 
            benefits of transferring the patient to a hospital for such 
            services.''.
        (2) Limitation on average length of stay.--Section 1820(f) (42 
    U.S.C. 1395i-4(f)) is amended by adding at the end the following 
    new paragraph:
        ``(4) Limitation on average length of inpatient stays.--The 
    Secretary may terminate a designation of a rural primary care 
    hospital under paragraph (1) if the Secretary finds that the 
    average length of stay for inpatients at the facility during the 
    previous year in which the designation was in effect exceeded 72 
    hours. In determining the compliance of a facility with the 
    requirement of the previous sentence, there shall not be taken into 
    account periods of stay of inpatients in excess of 72 hours to the 
    extent such periods exceed 72 hours because transfer to a hospital 
    is precluded because of inclement weather or other emergency 
    conditions.''.
        (3) Conforming amendment.--Section 1814(a)(8) (42 U.S.C. 
    1395f(a)(8)) is amended by striking ``such services'' and all that 
    follows and inserting ``the individual may reasonably be expected 
    to be discharged or transferred to a hospital within 72 hours after 
    admission to the rural primary care hospital.''.
        (4) GAO reports.--Not later than 2 years after the date of the 
    enactment of this Act, the Comptroller General shall submit reports 
    to Congress on--
            (A) the application of the requirements under section 
        1820(f) of the Social Security Act (as amended by this 
        subsection) that rural primary care hospitals provide inpatient 
        care only to those individuals whose attending physicians 
        certify may reasonably be expected to be discharged within 72 
        hours after admission and maintain an average length of 
        inpatient stay during a year that does not exceed 72 hours; and
            (B) the extent to which such requirements have resulted in 
        such hospitals providing inpatient care beyond their 
        capabilities or have limited the ability of such hospitals to 
        provide needed services.
    (b) Designation of Hospitals.--
        (1) Permitting designation of hospitals located in urban 
    areas.--
            (A) In general.--Section 1820 (42 U.S.C. 1395i-4) is 
        amended--
                (i) by striking paragraph (1) of subsection (e) and 
            redesignating paragraphs (2) through (6) as paragraphs (1) 
            through (5);
                (ii) in subsection (e)(1)(A) (as redesignated by 
            subparagraph (A))--

                    (I) by striking ``is located'' and inserting 
                ``except in the case of a hospital located in an urban 
                area, is located'',
                    (II) by striking ``, (ii)'' and inserting ``or 
                (ii)'', and
                    (III) by striking ``or (iii)'' and all that follows 
                through ``section,''; and

                (iii) in subsection (i)(1)(B), by striking ``paragraph 
            (3)'' and inserting ``paragraph (2)''.
            (B) No change in medicare prospective payment.--Section 
        1886(d)(5)(D) (42 U.S.C. 1395ww(d)(5)(D)) is amended--
                (i) in clause (iii)(III), by inserting ``located in a 
            rural area and'' after ``that is'', and
                (ii) in clause (v), by inserting ``located in a rural 
            area and'' after ``in the case of a hospital''.
        (2) Permitting hospitals located in adjoining states to 
    participate in state program.--
            (A) In general.--Section 1820 (42 U.S.C. 1395i-4) is 
        amended--
                (i) by redesignating subsection (k) as subsection (l); 
            and
                (ii) by inserting after subsection (j) the following 
            new subsection:
    ``(k) Eligibility of Hospitals Not Located in Participating 
States.--Notwithstanding any other provision of this section--
        ``(1) for purposes of including a hospital or facility as a 
    member institution of a rural health network, a State may designate 
    a hospital or facility that is not located in the State as an 
    essential access community hospital or a rural primary care 
    hospital if the hospital or facility is located in an adjoining 
    State and is otherwise eligible for designation as such a hospital;
        ``(2) the Secretary may designate a hospital or facility that 
    is not located in a State receiving a grant under subsection (a)(1) 
    as an essential access community hospital or a rural primary care 
    hospital if the hospital or facility is a member institution of a 
    rural health network of a State receiving a grant under such 
    subsection; and
        ``(3) a hospital or facility designated pursuant to this 
    subsection shall be eligible to receive a grant under subsection 
    (a)(2).''.
            (B) Conforming amendments.--(i) Section 1820(c)(1) (42 
        U.S.C. 1395i-4(c)(1)) is amended by striking ``paragraph (3)'' 
        and inserting ``paragraph (3) or subsection (k)''.
            (ii) Paragraphs (1)(A) and (2)(A) of section 1820(i) (42 
        U.S.C. 1395i-4(i)) are each amended--
                (I) in clause (i), by striking ``(a)(1)'' and inserting 
            ``(a)(1) (except as provided in subsection (k))'', and
                (II) in clause (ii), by striking ``subparagraph (B)'' 
            and inserting ``subparagraph (B) or subsection (k)''.
    (c) Skilled Nursing Services in Rural Primary Care Hospitals.--
Section 1820(f)(3) (42 U.S.C. 1395i-4(f)(3)) is amended by striking 
``because the facility'' and all that follows and inserting the 
following: ``because, at the time the facility applies to the State for 
designation as a rural primary care hospital, there is in effect an 
agreement between the facility and the Secretary under section 1883 
under which the facility's inpatient hospital facilities are used for 
the furnishing of extended care services, except that the number of 
beds used for the furnishing of such services may not exceed the total 
number of licensed inpatient beds at the time the facility applies to 
the State for such designation (minus the number of inpatient beds used 
for providing inpatient care pursuant to paragraph (1)(F)). For 
purposes of the previous sentence, the number of beds of the facility 
used for the furnishing of extended care services shall not include any 
beds of a unit of the facility that is licensed as a distinct-part 
skilled nursing facility at the time the facility applies to the State 
for designation as a rural primary care hospital.''.
    (d) Deadline for Development of Prospective Payment System for 
Inpatient Rural Primary Care Hospital Services.--Section 1814(l)(2) (42 
U.S.C. 1395f(l)(2)) is amended by striking ``January 1, 1993'' and 
inserting ``January 1, 1996''.
    (e) Payment for Outpatient Rural Primary Care Hospital Services.--
        (1) Implementation of prospective payment system.--Section 
    1834(g) (42 U.S.C. 1395m(g)) is amended--
            (A) in paragraph (1), by striking ``during a year before 
        1993'' and inserting ``during a year before the prospective 
        payment system described in paragraph (2) is in effect''; and
            (B) in paragraph (2), by striking ``January 1, 1993,'' and 
        inserting ``January 1, 1996,''.
        (2) No use of customary charge in determining payment.--Section 
    1834(g)(1) (42 U.S.C. 1395m(g)(1)) is amended by adding at the end 
    the following new flush sentence:
    ``The amount of payment shall be determined under either method 
    without regard to the amount of the customary or other charge.''.
    (f) Clarification of Physician Staffing Requirement for Rural 
Primary Care Hospitals.--Section 1820(f)(1)(H) (42 U.S.C. 1395i-
4(f)(1)(H)) is amended by striking the period and inserting the 
following: ``, except that in determining whether a facility meets the 
requirements of this subparagraph, subparagraphs (E) and (F) of that 
paragraph shall be applied as if any reference to a `physician' is a 
reference to a physician as defined in section 1861(r)(1).''.
    (g) Technical Amendments Relating to Part A Deductible, 
Coinsurance, and Spell of Illness.--(1) Section 1812(a)(1) (42 U.S.C. 
1395d(a)(1)) is amended--
        (A) by striking ``inpatient hospital services'' the first place 
    it appears and inserting ``inpatient hospital services or inpatient 
    rural primary care hospital services'';
        (B) by striking ``inpatient hospital services'' the second 
    place it appears and inserting ``such services''; and
        (C) by striking ``and inpatient rural primary care hospital 
    services''.
    (2) Sections 1813(a) and 1813(b)(3)(A) (42 U.S.C. 1395e(a), 
1395e(b)(3)(A)) are each amended by striking ``inpatient hospital 
services'' each place it appears and inserting ``inpatient hospital 
services or inpatient rural primary care hospital services''.
    (3) Section 1813(b)(3)(B) (42 U.S.C. 1395e(b)(3)(B)) is amended by 
striking ``inpatient hospital services'' and inserting ``inpatient 
hospital services, inpatient rural primary care hospital services''.
    (4) Section 1861(a) (42 U.S.C. 1395x(a)) is amended--
        (A) in paragraph (1), by striking ``inpatient hospital 
    services'' and inserting ``inpatient hospital services, inpatient 
    rural primary care hospital services''; and
        (B) in paragraph (2), by striking ``hospital'' and inserting 
    ``hospital or rural primary care hospital''.
    (h) Authorization of Appropriations.--Section 1820(l) (42 U.S.C. 
1395i-4(l)), as redesignated by subsection (b)(2)(A), is amended by 
striking ``1990, 1991, and 1992'' and inserting ``1990 through 1997''.
    (i) Effective Date.--The amendments made by this section shall take 
effect on the date of the enactment of this Act.
    SEC. 103. PROVISIONS RELATING TO RURAL HEALTH TRANSITION GRANT 
      PROGRAM.
    (a) Eligibility of Rural Primary Care Hospitals for Grants.--
        (1) In general.--Section 4005(e)(2) of OBRA-1987 is amended in 
    the matter preceding subparagraph (A) by inserting ``any rural 
    primary care hospital designated by the Secretary under section 
    1820(i)(2) of the Social Security Act, or'' after ``means''.
        (2) Effective date.--The amendment made by paragraph (1) shall 
    apply to grants made on or after October 1, 1994.
    (b) Extension of Authorization of Appropriations.--Section 
4005(e)(9) of OBRA-1987 is amended--
        (1) by striking ``1989 and'' and inserting ``1989,''; and
        (2) by striking ``1992'' and inserting ``1992 and $30,000,000 
    for each of fiscal years 1993 through 1997''.
    (c) Frequency of Required Reports.--Section 4008(e)(8)(B) of OBRA-
1987 is amended by striking ``every 6 months'' and inserting ``every 12 
months''.

SEC. 104. PSYCHOLOGY SERVICES IN HOSPITALS.

    Section 1861(e)(4) (42 U.S.C. 1395x(e)(4)) is amended by striking 
``physician;'' and inserting ``physician, except that a patient 
receiving qualified psychologist services (as defined in subsection 
(ii)) may be under the care of a clinical psychologist with respect to 
such services to the extent permitted under State law;''.
    SEC. 105. MEDICARE-DEPENDENT, SMALL RURAL HOSPITALS AND SOLE 
      COMMUNITY HOSPITALS.
    (a) Medicare Dependent, Small Rural Hospitals.--
        (1) Clarification of additional payment.--Section 
    1886(d)(5)(G)(ii)(I) (42 U.S.C. 1395ww(d)(5)(G)(ii)(I)), as amended 
    by section 13501(e)(1) of OBRA-1993, is amended by striking ``the 
    first 3 12-month cost reporting periods that begin'' and inserting 
    ``the 36-month period beginning with the first day of the cost 
    reporting period that begins''.
        (2) Conforming target amounts to extension of additional 
    payments.--Section 1886(b)(3)(D) (42 U.S.C. 1395ww(b)(3)(D)) is 
    amended in the matter preceding clause (i) by striking ``March 31, 
    1993'' and inserting ``September 30, 1994''.
    (b) Clarification of Updates.--Section 1886(b)(3)(B)(iv)(II) (42 
U.S.C. 1395ww(b)(3)(B)(iv)(II)), as added by section 13501(a)(2) of 
OBRA-1993, is amended by striking ``(taking into account'' and all that 
follows through ``1994)'' and inserting ``(adjusted to exclude any 
portion of a cost reporting period beginning during fiscal year 1993 
for which the applicable percentage increase is determined under 
subparagraph (I))''.

SEC. 106. SKILLED NURSING FACILITIES.

    (a) Construction of Wage Index.--Not later than 1 year after the 
date of the enactment of this Act, the Secretary of Health and Human 
Services shall begin to collect data on employee compensation and paid 
hours of employment in skilled nursing facilities for the purpose of 
constructing a skilled nursing facility wage index adjustment to the 
routine service cost limits required under section 1888(a)(4) of the 
Social Security Act.
    (b) Clarification of Repeal of Utilization Review Requirements.--
        (1) In general.--(A) Section 1814(a)(5) (42 U.S.C. 1395f(a)(5)) 
    is amended--
            (i) by striking ``and with respect'' and all that follows 
        through ``regulations'';
            (ii) by striking ``or skilled nursing facility, as the case 
        may be''; and
            (iii) by striking ``or facility''.
        (B) Section 1866(d) (42 U.S.C. 1395cc(d)) is amended--
            (i) by striking ``or skilled nursing facility'';
            (ii) by striking ``or facility'' each place it appears;
            (iii) by striking ``or for post-hospital'' and all that 
        follows through ``the case may be''; and
            (iv) by striking ``, or (in the case of'' and all that 
        follows through ``transfer agreement,''.
         (2) Effective date.--The amendments made by paragraph (1) 
    shall take effect as if included in the enactment of OBRA-1987.
    (c) Conforming Amendments to Nursing Home Reform.--
        (1) Suspension of decertification of nurses aide training and 
    competency evaluation programs based on extended surveys.--
            (A) In general.--Section 1819(f)(2)(B)(iii)(I)(b) (42 
        U.S.C. 1395i-3(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;''.
            (B) Effective date.--The amendment made by subparagraph (A) 
        shall take effect as if included in the enactment of OBRA-1990.
        (2) Requirements for consultants conducting reviews on use of 
    drugs.--
            (A) In general.--Section 1819(c)(1)(D) (42 U.S.C. 1395i-
        3(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 preceding 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.''.
            (B) Effective date.--The amendment made by subparagraph (A) 
        shall take effect as if included in the enactment of OBRA-1987.
        (3) Increase in minimum amount required for separate deposit of 
    personal funds.--
            (A) In general.--Section 1819(c)(6)(B)(i) (42 U.S.C. 1395i-
        3(c)(6)(B)(i)) is amended by striking ``$50'' and inserting 
        ``$100''.
            (B) Effective date.--The amendment made by subparagraph (A) 
        shall take effect January 1, 1995.
        (4) Due process protections for nurses aides.--
            (A) Prohibiting state from including undocumented 
        allegations in nurses aide registry.--Section 1819(e)(2)(B) (42 
        U.S.C. 1395i-3(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.''.
            (B) Due process requirements for rebutting allegations.--
        Section 1819(g)(1)(C) (42 U.S.C. 1395i-3(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.''.
            (C) Effective date.--The amendments made by this paragraph 
        shall take effect January 1, 1995.
    (d) Corrections Relating to Section 4008.--
        (1) Section 1819(b)(5)(D) (42 U.S.C. 1395i-3(b)(5)(D)), as 
    amended by section 4008(h)(1)(D) of OBRA-1990, is amended by 
    striking the comma before ``or a new competency evaluation 
    program.''.
        (2) Section 1819(b)(5)(G) (42 U.S.C. 1395i-3(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''.
        (3) Section 1819(f)(2)(B)(i) (42 U.S.C. 1395i-3(f)(2)(B)(i)) is 
    amended by striking ``facilities,'' and inserting ``facilities 
    (subject to clause (iii)),''.
        (4) Section 1819(f)(2)(B)(iii)(I)(c) (42 U.S.C. 1395i-
    3(f)(2)(B)(iii)(I)(c)) is amended by striking ``clauses'' each 
    place it appears and inserting ``clause''.
        (5) Section 1819(g)(5)(B) (42 U.S.C. 1395i-3(g)(5)(B)) is 
    amended by striking ``paragraphs'' and inserting ``paragraph''.
        (6) Section 4008(h)(1)(F)(ii) of OBRA-1990 is amended--
            (A) by striking ``The amendments'' and inserting ``(I) The 
        amendments'';
            (B) by striking ``nursing facility'' each place it appears 
        and inserting ``skilled nursing facility'';
            (C) by redesignating subclauses (I) through (V) as items 
        (aa) through (ee); and
            (D) by adding at the end the following new subclause:
                ``(II) Notwithstanding subclause (I) and subject to 
            section 1819(f)(2)(B)(iii)(I) of the Social Security Act 
            (as amended by clause (i)), a State may approve a training 
            and competency evaluation program or a competency 
            evaluation program offered by or in a skilled nursing 
            facility described in subclause (I) if, during the previous 
            2 years, item (aa), (bb), (cc), (dd), or (ee) of subclause 
            (I) did not apply to the facility.''.
        (7) Effective date.--The amendments made by this subsection 
    shall take effect as if included in the enactment of OBRA-1990.
    SEC. 107. NOTIFICATION OF AVAILABILITY OF HOSPICE BENEFIT.
    (a) In General.--Section 1861(ee)(2)(D) (42 U.S.C. 1395x(ee)(2)(D)) 
is amended by inserting ``, including hospice services,'' after ``post-
hospital services''.
    (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. 108. CLARIFYING EXPERTISE OF INDIVIDUALS TO SERVE ON THE 
      PROSPECTIVE PAYMENT ASSESSMENT COMMISSION.
    Section 1886(e)(6)(B) (42 U.S.C. 1395ww(e)(6)(B)) is amended by 
striking ``hospital reimbursement, hospital financial management'' and 
inserting ``health facility management, reimbursement of health 
facilities or other providers of services which reflect the scope of 
the Commission's responsibilities''.
    SEC. 109. AUTHORITY FOR BUDGET NEUTRAL ADJUSTMENTS FOR CHANGES IN 
      PAYMENT AMOUNTS FOR TRANSFER CASES.
    Section 1886(d)(5)(I) (42 U.S.C. 1395ww(d)(5)) is amended--
        (1) by inserting ``(i)'' after ``(I)''; and
        (2) by adding at the end the following new clause:
    ``(ii) In making adjustments under clause (i) for transfer cases 
(as defined by the Secretary) in a fiscal year, the Secretary may make 
adjustments to each of the average standardized amounts determined 
under paragraph (3) to assure that the aggregate payments made under 
this subsection for such fiscal year are not greater or lesser than 
those that would have otherwise been made in such fiscal year.''.
    SEC. 110. CLARIFICATION OF DRG PAYMENT WINDOW EXPANSION; 
      MISCELLANEOUS AND TECHNICAL CORRECTIONS.
    (a) Clarification of DRG Payment Window Expansion.--The first 
sentence of section 1886(a)(4) (42 U.S.C. 1395ww(a)(4)) is amended by 
inserting ``(or, in the case of a hospital that is not a subsection (d) 
hospital, during the 1 day)'' after ``3 days''.
    (b) Technical Correction Relating to Resident Assessment in Nursing 
Homes.--Section 1819(b)(3)(C)(i)(I) (42 U.S.C. 1395i-3(b)(3)(C)(i)(I)) 
is amended by striking ``not later than'' before ``14 days''.
    (c) Technical Correction Relating to Applicable Adjustment Factor 
for Indirect Medical Education Adjustment.--Section 1886(d)(5)(B)(ii) 
(42 U.S.C. 1395ww(d)(5)(B)(ii)) is amended by striking ``May 1, 1986,'' 
and inserting ``October 1, 1988,''.
    (d) Clerical Corrections.--(1) Section 1814(i)(1)(C)(i) (42 U.S.C. 
1395f(i)(1)(C)(i)) is amended by striking ``September 30, 1990,,'' and 
inserting ``September 30, 1990,''.
    (2) Section 1816(f)(2)(A)(ii) (42 U.S.C. 1396h(f)(2)(A)(ii)) is 
amended by striking ``such agency'' and inserting ``such agency's''.

               Subtitle B--Provisions Relating to Part B

                      PART I--PHYSICIANS' SERVICES

    SEC. 121. DEVELOPMENT AND IMPLEMENTATION OF RESOURCE-BASED 
      METHODOLOGY FOR PRACTICE EXPENSES.
    (a) Development.--
        (1) In general.--The Secretary of Health and Human Services 
    shall develop a methodology for implementing in 1998 a resource-
    based system for determining practice expense relative value units 
    for each physicians' service. The methodology utilized shall 
    recognize the staff, equipment, and supplies used in the provision 
    of various medical and surgical services in various settings.
        (2) Report.--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.
    (b) Implementation.--
        (1) In general.--Section 1848(c)(2)(C)(ii) (42 U.S.C. 1395w-
    4(c)(2)(C)(ii)) is amended--
            (A) by inserting ``for the service for years before 1998'' 
        before ``equal to'',
            (B) by striking the period at the end of subclause (II) and 
        inserting a comma, and
            (C) by adding after and below subclause (II) the following:
            ``and for years beginning with 1998 based on the relative 
            practice expense resources involved in furnishing the 
            service.''.
        (2) Conforming amendment.--Section 1848(c)(3)(C)(ii) (42 U.S.C. 
    1395w-4(c)(3)(C)(ii)) is amended by striking ``The practice'' and 
    inserting ``For years before 1998, the practice''.
        (3) Application of certain provisions.--In implementing the 
    amendment made by paragraph (1)(C), the provisions of clauses 
    (ii)(II) and (iii) of section 1848(c)(2)(B) of the Social Security 
    Act shall apply in the same manner as they apply to adjustments 
    under clause (ii)(I) of such section.
    SEC. 122. GEOGRAPHIC COST OF PRACTICE INDEX REFINEMENTS.
    (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) 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. 123. EXTRA-BILLING LIMITS.

    (a) Enforcement of Limits.--Section 1848(g) (42 U.S.C. 1395w-4(g)), 
as amended by section 13517(a) of OBRA-1993, is amended--
        (1) by amending paragraph (1) 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).''; and
        (2) in paragraph (3)(B)--
            (A) 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
            (B) in the last sentence, by striking ``previous sentence'' 
        and inserting ``first sentence''.
    (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 126(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 subsection (j)(2) in the same manner as such section applies with 
respect to a physician. Paragraph (4) of subsection (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 
``information on the extent to which actual charges exceed limiting 
charges, the number and types of services involved, and the average 
amount of excess charges and information'' after ``report to the 
Congress''.
    (e) Miscellaneous and Technical Amendments.--Section 1833(h)(5)(D) 
(42 U.S.C. 1395l(h)(5)(D)) is amended--
        (1) by striking ``paragraphs (2) and (3)'' and by inserting 
    ``paragraph (2)''; and
        (2) 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; 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, 1995.
        (2) Practitioners.--The amendments made by subsection (b) shall 
    apply to services furnished on or after January 1, 1995.
        (3) EOMBs.--The amendments made by subsection (c)(1) shall 
    apply to explanations of benefits provided on or after July 1, 
    1995.
        (4) Carrier determinations.--The amendments made by subsection 
    (c)(2) shall apply to contracts as of January 1, 1995.
        (5) Report.--The amendment made by subsection (d) shall apply 
    to reports for years beginning with 1995.

SEC. 124. RELATIVE VALUES FOR PEDIATRIC SERVICES.

    (a) In General.--The Secretary of Health and Human Services shall 
fully develop, by not later than July 1, 1995, 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, 1995, 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. 125. 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 subparagraph 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. 126. MISCELLANEOUS AND TECHNICAL CORRECTIONS.

    (a) Overvalued Procedures.--(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.--(1) Section 1834(b)(4) (42 U.S.C. 
1395m(b)(4)) is amended by redesignating the subparagraphs (E) and (F) 
redesignated by section 4102(a)(1) of OBRA-1990 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.--(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.--(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 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 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) 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 4106(c) of OBRA-1990 is amended by inserting ``of the 
Social Security Act'' after ``1848(d)(1)(B)''.
    (4) Section 4114 of OBRA-1990 is amended by striking ``patients'' 
the second place it appears.
    (5) Section 1848(e)(1)(C) (42 U.S.C. 1395w-4(e)(1)(C)) is amended 
by inserting ``date of the'' after ``since the''.
    (6) Section 4118(f)(1)(D) of OBRA-1990 is amended by striking ``is 
amended''.
    (7) Section 4118(f)(1)(N)(ii) of OBRA-1990 is amended by striking 
``subsection (f)(5)(A)'' and inserting ``subsection (f)(5)(A))''.
    (8) 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).
    (9) Section 4118(j)(2) of OBRA-1990 is amended by striking ``In 
section'' and inserting ``Section''.
    (10)(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--
        (i) by striking ``apply to'' and inserting ``would otherwise 
    apply to'', and
        (ii) by inserting before the period at the end ``but for the 
    application of section 1848(i)(3)''.
    (h) 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).
    (i) Effective Date.--Except as provided in subsection (h), the 
amendments made by this section and the provisions of this section 
shall take effect as if included in the enactment of OBRA-1990.

                   PART II--DURABLE MEDICAL EQUIPMENT

SEC. 131. CERTIFICATION OF SUPPLIERS.

    (a) Requirements.--
        (1) In general.--Section 1834 (42 U.S.C. 1395m), as amended by 
    section 13544(b)(1) of OBRA-1993, is amended by adding at the end 
    the following new subsection:
    ``(j) 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 the date of the 
        enactment of the Social Security Act Amendments of 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 the date of the enactment of the Social Security 
            Act Amendments of 1994 and before January 1, 1996, the 
            supplier meets standards prescribed by the Secretary in 
            regulations issued on June 18, 1992; 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 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) Limitation on information provided by suppliers on 
        certificates of medical necessity.--
                ``(i) In general.--Effective 60 days after the date of 
            the enactment of the Social Security Act Amendments of 
            1994, a supplier of medical equipment and supplies may 
            distribute to physicians, or to individuals entitled to 
            benefits under this part, a certificate of medical 
            necessity for commercial purposes which contains no more 
            than the following information completed by the supplier:

                    ``(I) An identification of the supplier and the 
                beneficiary to whom such medical equipment and supplies 
                are furnished.
                    ``(II) A description of such medical equipment and 
                supplies.
                    ``(III) Any product code identifying such medical 
                equipment and supplies.
                    ``(IV) Any other administrative information (other 
                than information relating to the beneficiary's medical 
                condition) identified by the Secretary.

                ``(ii) Information on payment amount and charges.--If a 
            supplier distributes a certificate of medical necessity 
            containing any of the information permitted to be supplied 
            under clause (i), the supplier shall also list on the 
            certificate of medical necessity 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) 
            or fails to provide the information required under clause 
            (ii) 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).
            ``(B) Definition.--For purposes of this paragraph, the term 
        `certificate of medical necessity' means a form or other 
        document containing information required by the carrier to be 
        submitted to show that an 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.--The Secretary shall 
    annually review the coverage and utilization of items of medical 
    equipment and supplies to determine whether such items should be 
    made subject to coverage and utilization review criteria, and if 
    appropriate, shall develop and apply such criteria to such 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)),
                ``(ii) immunosuppressive drugs (as described in section 
            1861(s)(2)(J)),
                ``(iii) therapeutic shoes for diabetics (as described 
            in section 1861(s)(12)),
                ``(iv) oral drugs prescribed for use as an anticancer 
            therapeutic agent (as described in section 1861(s)(2)(Q)), 
            and
                ``(v) self-administered erythropoetin (as described in 
            section 1861(s)(2)(P)).''.
        (2) Conforming amendment.--Effective 60 days after the date of 
    enactment of the Social Security Act Amendments of 1994, paragraph 
    (16) of section 1834(a) (42 U.S.C. 1395m(a)) is repealed.
    (b) 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.
    (c) Criteria for Treatment of Items as Prosthetic 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. 132. 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 unless 1 of the following applies:
                ``(i) The individual has given written permission to 
            the supplier to make contact by telephone regarding the 
            furnishing of a covered item.
                ``(ii) The supplier has furnished a covered item to the 
            individual and the supplier is contacting the individual 
            only regarding the furnishing of such covered item.
                ``(iii) If the contact is regarding the furnishing of a 
            covered item other than a covered item already furnished to 
            the individual, the supplier has furnished at least 1 
            covered item to the individual during the 15-month period 
            preceding the date on which the supplier makes such 
            contact.
            ``(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. 133. BENEFICIARY LIABILITY FOR NONCOVERED SERVICES.
    (a) Unassigned Claims.--
        (1) In general.--Section 1834(j) (42 U.S.C. 1395m(i)), as added 
    by section 131(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 134(a), is amended by 
    striking ``1834(j)(4)'' and inserting ``1834(j)(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(j)(5))--
        ``(1) furnishes an item or service to a beneficiary for which 
    no payment may be made by reason of section 1834(j)(1);
        ``(2) furnishes an item or service to a beneficiary for which 
    payment is denied in advance under section 1834(a)(15); or
        ``(3) furnishes an item or service to a beneficiary for which 
    no payment may be made by reason of section 1834(a)(17)(B),
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 January 1, 1995.
    SEC. 134. 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. 135. MISCELLANEOUS AND TECHNICAL CORRECTIONS.

    (a) Updates to Payment Amounts.--(1) 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''.
    (2) The amendment made by paragraph (1) shall be effective on the 
date of the enactment of this Act.
    (b) Advance 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) Advance determinations of coverage for certain items.--
            ``(A) Development of lists of items by secretary.--The 
        Secretary may develop and periodically update a list of items 
        for which payment may be made under this subsection that the 
        Secretary determines, on the basis of prior payment experience, 
        are frequently subject to unnecessary utilization throughout a 
        carrier's entire service area or a portion of such area.
            ``(B) Development of lists of suppliers by secretary.--The 
        Secretary may develop and periodically update a list of 
        suppliers of items for which payment may be made under this 
        subsection with respect to whom--
                ``(i) the Secretary has found that a substantial number 
            of claims for payment under this part for items furnished 
            by the supplier have been denied on the basis of the 
            application of section 1862(a)(1); or
                ``(ii) the Secretary has identified a pattern of 
            overutilization resulting from the business practice of the 
            supplier.
            ``(C) Determinations of coverage in advance.--A carrier 
        shall determine in advance of delivery of an item whether 
        payment for the item may not be made because the item is not 
        covered or because of the application of section 1862(a)(1) 
        if--
                ``(i) the item is included on the list developed by the 
            Secretary under subparagraph (A);
                ``(ii) the item is furnished by a supplier included on 
            the list developed by the Secretary under subparagraph (B); 
            or
                ``(iii) the item is a customized item (other than 
            inexpensive items specified by the Secretary) and the 
            patient to whom the item is to be furnished or the supplier 
            requests that such advance determination be made.''.
    (2) 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 125(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)(15)(C).''.
    (3) Effective on the date of the enactment of this Act, section 
1834(h)(3) (42 U.S.C. 1395m(h)(3)), as amended by section 133(b), is 
amended by striking ``(12) and (17)'' and inserting ``(12), (15), and 
(17)''.
    (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 July 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.--(1) Section 1834(a)(5)(E) (42 U.S.C. 
1395m(a)(5)(E)) is amended by striking ``55'' and inserting ``56''.
    (2) The amendment made by paragraph (1) shall be effective on the 
date of the enactment of this Act.
    (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) The amendments made by this subsection shall take effect as if 
included in the enactment of OBRA-1990.

                   PART III--OTHER ITEMS AND SERVICES

SEC. 141. AMBULATORY SURGICAL CENTER SERVICES.

    (a) Payment Amounts for Services Furnished in Ambulatory Surgical 
Centers.--
        (1) Use of survey to determine incurred costs.--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,''.
        (2) Automatic application of inflation adjustment.--Section 
    1833(i)(2) (42 U.S.C. 1395l(i)(2)) is amended--
            (A) 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
            (B) 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 year involved.''.
        (3) Consultation requirement.--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.''.
    (b) Adjustments to Payment Amounts for New Technology Intraocular 
Lenses.--
        (1) Establishment of process for review of amounts.--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) Factors considered.--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) Notice and comment.--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 the Secretary's determinations with respect to 
    intraocular lenses listed in the notice within 90 days after the 
    close of the comment period.
        (4) Effective date of adjustment.--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).
    (c) Technical Correction Relating to Blend Amounts for Ambulatory 
Surgical Center Payments.--
        (1) In general.--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''.
        (2) Effective date.--The amendments made by paragraph (1) shall 
    take effect as if included in the enactment of OBRA-1990.
    (d) Technical Correction Related to Cataract Surgery.--Effective as 
if included in the enactment of OBRA-1990, section 4151(c)(3) of such 
Act is amended by striking ``for the insertion of an intraocular lens'' 
and inserting ``for an intraocular lens inserted''.
    SEC. 142. STUDY OF MEDICARE COVERAGE OF PATIENT CARE COSTS 
      ASSOCIATED WITH CLINICAL TRIALS OF NEW CANCER THERAPIES.
    (a) Study.--The Secretary of Health and Human Services shall 
conduct a study of the effects of expressly covering under the medicare 
program the patient care costs for beneficiaries enrolled in clinical 
trials of new cancer therapies, where the protocol for the trial has 
been approved by the National Cancer Institute or meets similar 
scientific and ethical standards, including approval by an 
institutional review board. The study shall include--
        (1) an estimate of the cost of such coverage, taking into 
    account the extent to which medicare currently pays for such 
    patient care costs in practice;
        (2) an assessment of the extent to which such clinical trials 
    represent the best available treatment for the patients involved 
    and of the effects of participation in the trials on the health of 
    such patients;
        (3) an assessment of whether progress in developing new 
    anticancer therapies would be assisted by medicare coverage of such 
    patient care costs; and
        (4) an evaluation of whether there should be special criteria 
    for the admission of medicare beneficiaries (on account of their 
    age or physical condition) to clinical trials for which medicare 
    would pay the patient care costs.
    (b) Report.--Not later than 2 years after the date of the enactment 
of this Act, the Secretary of Health and Human Services shall submit a 
report on the study conducted under subsection (a) 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. Such report 
shall include recommendations as to the coverage under the medicare 
program of patient care costs of beneficiaries enrolled in clinical 
trials of new cancer therapies.
    SEC. 143. STUDY OF ANNUAL CAP ON AMOUNT OF MEDICARE PAYMENT FOR 
      OUTPATIENT PHYSICAL THERAPY AND OCCUPATIONAL THERAPY SERVICES.
    (a) Study.--The Secretary of Health and Human Services 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.
    (b) Report.--By not later than January 1, 1996, the Secretary 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 subsection (a). Such report shall 
include such recommendations for changes in such annual limitation as 
the Secretary finds appropriate.
    SEC. 144. PAYMENT OF PART B PREMIUM LATE ENROLLMENT PENALTIES BY 
      STATES.
    Section 1839 (42 U.S.C. 1395r) is amended by adding at the end the 
following new subsection:
    ``(g)(1) Upon the request of a State, the Secretary may enter into 
an agreement with the State under which the State agrees to pay on a 
quarterly or other periodic basis to the Secretary (to be deposited in 
the Treasury to the credit of the Federal Supplementary Medical 
Insurance Trust Fund) an amount equal to the amount of the part B late 
enrollment premium increases with respect to the premiums for eligible 
individuals (as defined in paragraph (3)(A)).
    ``(2) No part B late enrollment premium increase shall apply to an 
eligible individual for premiums for months for which the amount of 
such an increase is payable under an agreement under paragraph (1).
    ``(3) In this subsection:
        ``(A) The term `eligible individual' means an individual who is 
    enrolled under this part B and who is within a class of individuals 
    specified in the agreement under paragraph (1).
        ``(B) The term `part B late enrollment premium increase' means 
    any increase in a premium as a result of the application of 
    subsection (b).''.
    SEC. 145. 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. 146. COVERAGE OF SERVICES OF SPEECH-LANGUAGE PATHOLOGISTS AND 
      AUDIOLOGISTS.
    (a) Services Defined.--Section 1861 (42 U.S.C. 1395x), as amended 
by section 148(f)(6)(E), is amended by inserting after subsection (kk) 
the following new subsection:

        ``Speech-Language Pathology Services; Audiology Services

    ``(ll)(1) The term `speech-language pathology services' means such 
speech, language, and related function assessment and rehabilitation 
services furnished by a qualified speech-language pathologist as the 
speech-language pathologist is legally authorized to perform under 
State law (or the State regulatory mechanism provided by State law) as 
would otherwise be covered if furnished by a physician.
    ``(2) The term `audiology services' means such hearing and balance 
assessment services furnished by a qualified audiologist as the 
audiologist is legally authorized to perform under State law (or the 
State regulatory mechanism provided by State law), as would otherwise 
be covered if furnished by a physician.
    ``(3) In this subsection:
        ``(A) The term `qualified speech-language pathologist' means an 
    individual with a master's or doctoral degree in speech-language 
    pathology who--
            ``(i) is licensed as a speech-language pathologist by the 
        State in which the individual furnishes such services, or
            ``(ii) in the case of an individual who furnishes services 
        in a State which does not license speech-language pathologists, 
        has successfully completed 350 clock hours of supervised 
        clinical practicum (or is in the process of accumulating such 
        supervised clinical experience), performed not less than 9 
        months of supervised full-time speech-language pathology 
        services after obtaining a master's or doctoral degree in 
        speech-language pathology or a related field, and successfully 
        completed a national examination in speech-language pathology 
        approved by the Secretary.
        ``(B) The term `qualified audiologist' means an individual with 
    a master's or doctoral degree in audiology who--
            ``(i) is licensed as an audiologist by the State in which 
        the individual furnishes such services, or
            ``(ii) in the case of an individual who furnishes services 
        in a State which does not license audiologists, has 
        successfully completed 350 clock hours of supervised clinical 
        practicum (or is in the process of accumulating such supervised 
        clinical experience), performed not less than 9 months of 
        supervised full-time audiology services after obtaining a 
        master's or doctoral degree in audiology or a related field, 
        and successfully completed a national examination in audiology 
        approved by the Secretary.''.
    (b) Conforming Amendments Relating to Medicare Treatment of Speech 
and Language Services.--
        (1) Extended care services.--Section 1861(h)(3) (42 U.S.C. 
    1395x(h)(3)) is amended by striking ``, occupational, or speech 
    therapy'' and inserting ``or occupational therapy or speech-
    language pathology services''.
        (2) Home health services.--Section 1861(m)(2) (42 U.S.C. 
    1395x(m)(2)) is amended by striking ``, occupational, or speech 
    therapy'' and inserting ``or occupational therapy or speech-
    language pathology services''.
        (3) Outpatient physical therapy services.--The fourth sentence 
    of section 1861(p) (42 U.S.C. 1395x(p)) is amended by striking 
    ``speech pathology services'' and inserting ``speech-language 
    pathology services''.
        (4) Comprehensive outpatient rehabilitation facility 
    services.--Section 1861(cc)(1)(B) (42 U.S.C. 1395x(cc)(1)(B)) is 
    amended by striking ``speech pathology services'' and inserting 
    ``speech-language pathology services''.
        (5) Hospice care.--Section 1861(dd)(1)(B) (42 U.S.C. 
    1395x(dd)(1)(B)) is amended by striking ``therapy or speech-
    language pathology'' and inserting ``therapy, or speech-language 
    pathology services''.
    (c) Effective Date.--The amendments made by this section shall take 
effect on January 1, 1995.

SEC. 147. 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, 1989'' and inserting ``April 1, 1989''.
    (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(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''.
    (3) 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)''.
    (4) 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)''.
    (5) Section 1861(aa)(5) (42 U.S.C. 1395x(aa)(5)) is amended by 
striking ``this Act'' and inserting ``this title''.
    (6) 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)''.
    (7) 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) Clinical diagnostic laboratory tests.--Section 4154(e)(5) 
    of OBRA-1990 is amended by striking ``(1)(A)'' and inserting 
    ``(1)(A),''.
        (3) Separate payment under part b for certain services.--
    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''.
        (4) Community health centers and rural health clinics.--(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''.
        (5) Screening mammography.--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''.
        (6) 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 a 
            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 of 
            subparagraph (E) and inserting ``; and''; and
                (iv) by adding at the end the following new 
            subparagraph:
            ``(F) with respect to a 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 a 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''.
        (7) Other miscellaneous and technical corrections.--
            (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.

            Subtitle C--Provisions Relating to Parts A and B

SEC. 151. MEDICARE SECONDARY PAYER REFORMS.

    (a) 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 60 days after the date 
        of the enactment of the Social Security Act Amendments of 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 the expiration of the 120-day period beginning on the 
        date of the enactment of this Act.
    (b) Improvements in Recovery of Payments From Primary Payers.--
        (1) Submission of reports on efforts to recover erroneous 
    payments.--
            (A) Fiscal intermediaries under part a.--Section 1816 (42 
        U.S.C. 1396h) is amended by adding at the end the following new 
        subsection:
    ``(k) An agreement with an agency or organization under this 
section shall require that such agency or organization submit an annual 
report to the Secretary describing the steps taken to recover payments 
made 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)).''.
            (B) Carriers under part b.--Section 1842(b)(3) (42 U.S.C. 
        1395u(b)(3)) is amended--
                (i) by striking ``and'' at the end of subparagraph (G);
                (ii) by striking ``and'' at the end of subparagraph 
            (H); and
                (iii) 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)); and''.
        (2) Requirements under carrier performance evaluation 
    program.--
            (A) Fiscal intermediaries under part a.--Section 
        1816(f)(1)(A) (42 U.S.C. 1396h(f)(1)(A)) is amended by striking 
        ``processing'' and inserting ``processing (including the 
        agency's or organization's success in recovering payments made 
        under this title for services for which payment has been or 
        could be made under a primary plan (as defined in section 
        1862(b)(2)(A)))''.
            (B) Carriers under part b.--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 carrier shall be 
subject to 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 contract 
    years beginning with 1995.
    (c) Miscellaneous and Technical Corrections.--
        (1) Effective as if included in the enactment of OBRA-1993, 
    section 1862(b)(1)(A) (42 U.S.C. 1395y(b)(1)(A)), as amended by 
    section 13561(e)(1) of OBRA-1993, is amended--
            (A) in clause (i)(II), by striking ``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'' and inserting ``older (and the spouse age 65 
        or older of any individual) who has current employment status 
        with an employer''; and
            (B) in clause (ii), by striking ``or employee organization 
        that has 20 or more individuals in current employment status'' 
        and inserting ``that has 20 or more employees''.
        (2) Effective as if included in the enactment of OBRA-1993, 
    section 1837(i) (42 U.S.C. 1395p(i)) is amended--
            (A) by striking ``as an active individual (as those terms 
        are defined in section 1862(b)(1)(B)(iv))'' each place it 
        appears in the second sentence of paragraph (1), and the second 
        sentence of paragraph (2) and inserting ``(as that term is 
        defined in section 1862(b)(1)(B)(iv)) by reason of the 
        individual's current employment status (or the current 
        employment status of a family member of the individual)'';
            (B) in paragraph (3)(B), by striking ``as an active 
        individual in a large group health plan (as such terms are 
        defined in section 1862(b)(1)(B)(iv))'' and inserting ``in a 
        large group health plan (as that term is defined in section 
        1862(b)(1)(B)(iv)) by reason of the individual's current 
        employment status (or the current employment status of a family 
        member of the individual)'';
            (C) in the second sentence of paragraph (2) (as amended by 
        subparagraph (A)), by striking ``as an active individual'' and 
        inserting ``by reason of the individual's current employment 
        status (or the current employment status of a family member of 
        the individual)''; and
            (D) by inserting ``status'' after ``current employment'' 
        each place it appears in paragraphs (1)(A), (2)(B), (2)(C), and 
        (3)(A).
        (3) Effective as if included in the enactment of OBRA-1993, the 
    second sentence of section 1839(b) (42 U.S.C. 1395r(b)) is 
    amended--
            (A) by inserting ``status'' after ``current employment'', 
        and
            (B) by striking ``as an active individual (as those terms 
        are defined in section 1862(b)(1)(B)(iv))'' and inserting ``(as 
        that term is defined in section 1862(b)(1)(B)(iv)) by reason of 
        the individual's current employment status (or the current 
        employment status of a family member of the individual)''.
        (4) Effective as if included in the enactment of OBRA-1990, 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''.
        (5) Effective as if included in the enactment of OBRA-1989, 
    section 1862(b)(1)(C) is amended in the matter after clause (ii), 
    by striking ``taking into account that'' and inserting ``paying 
    benefits secondary to this title when''.
        (6) Effective as if included in the enactment of OBRA-1989, 
    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)''.
        (7) Effective as if included in the enactment of OBRA-1990, 
    section 4203(c)(2) of such Act 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.''.
        (8) Effective as if included in the enactment of OBRA-1990, 
    section 4203(d) of OBRA-1990 is amended by striking ``this 
    subsection'' and inserting ``this section''.
        (9) Effective as if included in the enactment of OBRA-1993, 
    section 13561(e)(1)(D) of OBRA-1993 is amended--
            (A) by inserting ``effective as if included in the 
        enactment of OBRA-1989,'' after ``(D)'', and
            (B) by striking ``of each subparagraph''.
        (10) The amendment made by section 13561(e)(1)(G) of OBRA-1993, 
    to the extent it relates to the definition of large group health 
    plan, shall be effective as if included in the enactment of OBRA-
    1989.

SEC. 152. PHYSICIAN OWNERSHIP AND REFERRAL.

    (a) In General.--Section 1877(f) (42 U.S.C. 1395nn) is amended--
        (1) in the matter before paragraph (1), by inserting ``, 
    investment, and compensation'' after ``ownership'';
        (2) in paragraph (2), by inserting ``, or with a compensation 
    arrangement (as described in subsection (a)(2)(B)),'' after 
    ``investment interest (as described in subsection (a)(2)(A))'';
        (3) in paragraph (2), by inserting ``interest or who have such 
    a compensation relationship with the entity'' before the period at 
    the end;
        (4) in the fourth sentence, by striking ``covered items and'' 
    and inserting ``designated health''; and
        (5) by striking the third and fifth sentences.
    (b) Radiology Services.--Section 1877(h)(6) (42 U.S.C. 
1395nn(h)(6)), as amended by section 13562(a)(2) of OBRA-1993, is 
amended--
        (1) in subparagraph (D), by striking ``or other diagnostic 
    services'' and inserting ``services, including magnetic resonance 
    imaging, computerized axial tomography scans, and ultrasound 
    services''; and
        (2) in subparagraphs (E), (F), and (H), by inserting ``and 
    supplies'' before the period at the end.
    (c) Revision of Effective Date Exception Provision.--Section 
13562(b)(2) of OBRA-1993 is amended by striking subparagraphs (A) and 
(B) and inserting the following:
            ``(A) the second sentence of subsection (a)(2), and 
        subsections (b)(2)(B) and (d)(2), of section 1877 of the Social 
        Security Act (as in effect on the day before the date of the 
        enactment of this Act) shall apply instead of the corresponding 
        provisions in section 1877 (as amended by this Act);
            ``(B) section 1877(b)(4) of the Social Security Act (as in 
        effect on the day before the date of the enactment of this Act) 
        shall apply;
            ``(C) the requirements of section 1877(c)(2) of the Social 
        Security Act (as amended by this Act) shall not apply to any 
        securities of a corporation that meets the requirements of 
        section 1877(c)(2) of the Social Security Act (as in effect on 
        the day before the date of the enactment of this Act);
            ``(D) section 1877(e)(3) of the Social Security Act (as 
        amended by this Act) shall apply, except that it shall not 
        apply to any arrangement that meets the requirements of 
        subsection (e)(2) or subsection (e)(3) of section 1877 of the 
        Social Security Act (as in effect on the day before the date of 
        the enactment of this Act);
            ``(E) the requirements of clauses (iv) and (v) of section 
        1877(h)(4)(A), and of clause (i) of section 1877(h)(4)(B), of 
        the Social Security Act (as amended by this Act) shall not 
        apply; and
            ``(F) section 1877(h)(4)(B) of the Social Security Act (as 
        in effect on the day before the date of the enactment of this 
        Act) shall apply instead of section 1877(h)(4)(A)(ii) of such 
        Act (as amended by this Act).''.
    (d) Effective Dates.--
        (1) The amendments made by subsections (a) and (b) shall apply 
    to referrals made on or after January 1, 1995.
        (2) The amendment made by subsection (c) shall apply as if 
    included in the enactment of OBRA-1993.
    SEC. 153. DEFINITION OF FMGEMS EXAMINATION FOR PAYMENT OF DIRECT 
      GRADUATE MEDICAL EDUCATION.
    (a) In General.--Section 1886(h)(5)(E) (42 U.S.C. 1395ww(h)(5)(E)) 
is amended by inserting ``or any successor examination'' after 
``Medical Sciences''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply as if included in the enactment of the Consolidated Omnibus 
Budget Reconciliation Act of 1985 (Public Law 99-272).

SEC. 154. QUALIFIED MEDICARE BENEFICIARY OUTREACH.

    Not later than 1 year after the date of the enactment of this Act, 
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. 155. HOSPITAL AGREEMENTS WITH ORGAN PROCUREMENT ORGANIZATIONS.
    (a) Hospital Agreements.--
        (1) In general.--
            (A) Identification of organ donors.--Section 
        1138(a)(1)(A)(iii) (42 U.S.C. 1320b-8(a)(1)(A)(iii)) is amended 
        to read as follows:
            ``(iii) require that such hospital's designated organ 
        procurement agency (as defined in paragraph (3)(B)) is notified 
        of potential organ donors;''.
            (B) Agreements with designated organ procurement 
        agencies.--Section 1138(a)(1) (42 U.S.C. 1320b-8(a)(1)) is 
        amended--
                (i) by striking the period at the end of subparagraph 
            (B) and inserting ``; and''; and
                (ii) by adding at the end the following new 
            subparagraph:
        ``(C) the hospital or rural primary care hospital has an 
    agreement (as defined in paragraph (3)(A)) only with such 
    hospital's designated organ procurement agency.''.
            (C) Waiver of requirements related to agreements.--Section 
        1138(a) (42 U.S.C. 1320b-8(a)) is amended--
                (i) by redesignating paragraph (2) as paragraph (3); 
            and
                (ii) by inserting after paragraph (1) the following new 
            paragraph:
    ``(2)(A) The Secretary shall grant a waiver of the requirements 
under subparagraphs (A)(iii) and (C) of paragraph (1) to a hospital or 
rural primary care hospital desiring to enter into an agreement with an 
organ procurement agency other than such hospital's designated organ 
procurement agency if the Secretary determines that--
        ``(i) the waiver is expected to increase organ donation; and
        ``(ii) the waiver will assure equitable treatment of patients 
    referred for transplants within the service area served by such 
    hospital's designated organ procurement agency and within the 
    service area served by the organ procurement agency with which the 
    hospital seeks to enter into an agreement under the waiver.
    ``(B) In making a determination under subparagraph (A), the 
Secretary may consider factors that would include, but not be limited 
to--
        ``(i) cost effectiveness;
        ``(ii) improvements in quality;
        ``(iii) whether there has been any change in a hospital's 
    designated organ procurement agency due to a change made on or 
    after December 28, 1992, in the definitions for metropolitan 
    statistical areas (as established by the Office of Management and 
    Budget); and
        ``(iv) the length and continuity of a hospital's relationship 
    with an organ procurement agency other than the hospital's 
    designated organ procurement agency;
except that nothing in this subparagraph shall be construed to permit 
the Secretary to grant a waiver that does not meet the requirements of 
subparagraph (A).
    ``(C) Any hospital or rural primary care hospital seeking a waiver 
under subparagraph (A) shall submit an application to the Secretary 
containing such information as the Secretary determines appropriate.
    ``(D) The Secretary shall--
        ``(i) publish a public notice of any waiver application 
    received from a hospital or rural primary care hospital under this 
    paragraph within 30 days of receiving such application; and
        ``(ii) prior to making a final determination on such 
    application under subparagraph (A), offer interested parties the 
    opportunity to submit written comments to the Secretary during the 
    60-day period beginning on the date such notice is published.''.
            (D) Definitions.--Section 1138(a)(3) (42 U.S.C. 1320b-
        8(a)(3)), as redesignated by subparagraph (C), is amended to 
        read as follows:
    ``(3) For purposes of this subsection--
        ``(A) the term `agreement' means an agreement described in 
    section 371(b)(3)(A) of the Public Health Service Act;
        ``(B) the term `designated organ procurement agency' means, 
    with respect to a hospital or rural primary care hospital, the 
    organ procurement agency designated pursuant to subsection (b) for 
    the service area in which such hospital is located; and
        ``(C) the term `organ' means a human kidney, liver, heart, 
    lung, pancreas, and any other human organ or tissue specified by 
    the Secretary for purposes of this subsection.''.
        (2) Existing agreements.--Any hospital or rural primary care 
    hospital which has an agreement (as defined in section 
    1138(a)(3)(A) of the Social Security Act) with an organ procurement 
    agency other than such hospital's designated organ procurement 
    agency (as defined in section 1138(a)(3)(B) of such Act) on the 
    date of the enactment of this section shall, if such hospital 
    desires to continue such agreement on and after the effective date 
    of the amendments made by paragraph (1), submit an application to 
    the Secretary for a waiver under section 1138(a)(2) of such Act not 
    later than January 1, 1996, and such agreement may continue in 
    effect pending the Secretary's determination with respect to such 
    application.
        (3) Effective date.--The amendments made by paragraph (1) shall 
    apply to hospitals and rural primary care hospitals participating 
    in the programs under titles XVIII and XIX of the Social Security 
    Act beginning January 1, 1996.
    (b) Study on Hospital Agreements with Organ Procurement Agencies.--
        (1) In general.--The Office of Technology Assessment (referred 
    to in this section as the ``OTA'') shall, pursuant to the approval 
    of the Technology Assessment Board of the OTA, conduct a study to 
    determine the efficacy and fairness of requiring a hospital to 
    enter into an agreement under section 371(b)(3)(A) of the Public 
    Health Service Act with the organ procurement agency designated 
    pursuant to section 1138(b) of the Social Security Act for the 
    service area in which such hospital is located and the impact of 
    such requirement on the efficacy and fairness of organ procurement 
    and distribution.
        (2) Report.--Not later than 2 years after the date of the 
    enactment of this Act, the OTA shall complete the study required 
    under paragraph (1) and prepare and submit to the Committee on 
    Finance and the Committee on Labor and Human Resources of the 
    Senate and the Committee on Ways and Means and the Committee on 
    Energy and Commerce of the House of Representatives a report 
    containing the findings of such study and the implications of such 
    findings with respect to policies affecting organ procurement and 
    distribution.

SEC. 156. 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 subparagraph 
            (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 ``basis,'' and inserting ``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) Section 1154(a)(9)(B) (42 U.S.C. 1320c-3(a)(9)(B)) is 
amended to read as follows:
        ``(B) If the organization finds, after reasonable notice to and 
    opportunity for discussion with the physician or practitioner 
    concerned, that the physician or practitioner has furnished 
    services in violation of section 1156(a) and the organization 
    determines that the physician or practitioner should enter into a 
    corrective action plan under section 1156(b)(1), 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. 157. HEALTH MAINTENANCE ORGANIZATIONS.

    (a) 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 October 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 1997 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 under paragraph (1), the Comptroller General shall review the 
proposal and shall report to Congress on the appropriateness of the 
proposed modifications.''.
    (b) 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. 158. HOME HEALTH AGENCIES.

    (a) Use of Most Current Data in Determining Wage Index.--
        (1) In general.--Section 1861(v)(1)(L)(iii) (42 U.S.C. 
    1395x(v)(1)(L)(iii)) is amended by striking ``as of such date to'' 
    and inserting ``and determined using the survey of the most recent 
    available wages and wage-related costs of''.
        (2) Effective date.--The amendment made by paragraph (1) shall 
    apply with respect to cost reporting periods beginning on or after 
    July 1, 1996.
    (b) Clarification of Extension of Waiver of Liability.--
        (1) In general.--The second sentence of section 9205 of the 
    Consolidated Omnibus Budget Reconciliation Act of 1985 is amended 
    by striking ``November 1, 1990'' and inserting ``December 31, 
    1995''.
        (2) Effective date.--The amendment made by paragraph (1) shall 
    take effect as if included in the enactment of OBRA-1990.
    SEC. 159. PERMANENT EXTENSION OF AUTHORITY TO CONTRACT WITH FISCAL 
      INTERMEDIARIES AND CARRIERS ON OTHER THAN A COST BASIS.
    (a) In General.--Section 2326(a) of the Deficit Reduction Act of 
1984, as amended by section 6215 of OBRA-1989, is amended in the third 
sentence by striking ``during such period'' and inserting ``beginning 
with fiscal year 1990 and any subsequent fiscal year''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply beginning with fiscal year 1994.

SEC. 160. 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) Home Dialysis Demonstration Technical Corrections.--Section 
4202 of OBRA-1990 is amended--
        (1) in subsection (b)(1)(A), by striking ``home hemodialysis 
    staff assistant'' and inserting ``qualified home hemodialysis staff 
    assistant (as described in subsection (d))'';
        (2) in subsection (b)(2)(B)(ii)(I), by striking ``(as adjusted 
    to reflect differences in area wage levels)'';
        (3) in subsection (c)(1)(A), by striking ``skilled''; and
        (4) in subsection (c)(1)(E), by striking ``(b)(4)'' and 
    inserting ``(b)(2)''.
    (c) Technical Correction to Revisions of Coverage for 
Immunosuppressive Drug Therapy.--The Secretary of Health and Human 
Services may administer section 1861(s)(2)(J) of the Social Security 
Act (42 U.S.C. 1395x(s)(2)(J)) in a manner such that the months of 
coverage of drugs described in such section are provided consecutively, 
so long as the total number of months of coverage provided is the same 
as the number of months described in such section.
    (d) 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 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.
    (4) 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.
    (5)(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)''.
    (6) 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''.
    (7) Section 4207(b)(4)(B)(iii)(III) of OBRA-1990 is amended by 
striking the period at the end and inserting a semicolon.
    (8) 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)''.
    (9) 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''.
    (10) Section 4207(d) of OBRA-1990 is amended by redesignating the 
second paragraph (3) (relating to effective date) as paragraph (4).
    (11) 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''.
    (12) Section 4207(j) of OBRA-1990 is amended by striking ``title'' 
each place it appears and inserting ``subtitle''.

  Subtitle D--Provisions Relating to Medicare Supplemental Insurance 
                                Policies

    SEC. 171. 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 
(aa) a State medicaid plan under such title pays the premiums for the 
policy, (bb) in the case of a qualified medicare beneficiary described 
in section 1905(p)(1), the policy provides for coverage of outpatient 
prescription drugs, or (cc) the only medical assistance to which the 
individual is entitled under the State plan is medicare cost sharing 
described in section 1905(p)(3)(A)(ii).''.
        (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, 
    but not limited to, as separate types of policies, policies paying 
    directly to the beneficiary fixed, cash benefits, and policies that 
    limit benefit payments to specific diseases) which are sold or 
    issued 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, but not limited to, as separate types of policies, 
policies paying directly to the beneficiary fixed, cash benefits, and 
policies that limit benefit payments to specific diseases) which are 
sold or issued 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 
    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) 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 171(m)(4) of the Social Security Act 
        Amendments of 1994.'';
            (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 
        171(m)(4) of the Social Security Act Amendments of 1994.'';
            (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 the Social Security 
    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, 1995, 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) in the second subsection (f) (relating to authorization of 
    appropriations for grants)--
            (A) by striking ``and 1993'' and inserting ``1993, 1994, 
        1995, and 1996''; and
            (B) by redesignating such subsection 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 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, 1995, 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, 1995, and who were not covered under such 
    section before January 1, 1995, the 6-month period specified in 
    that section shall begin January 1, 1995).
    (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 
    revised regulation incorporating the modifications shall be 
    considered to be the 1991 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 revised regulation incorporating the modifications shall 
    be considered to be the 1991 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 1996 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, 1996. 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. 172. 6-MONTH EXTENSION OF PERIOD FOR ISSUANCE OF MEDICARE 
      SELECT POLICIES.
    (a) In General.--Section 4358(c) of the Omnibus Budget 
Reconciliation Act of 1990 (42 U.S.C. 1320c-3 note) is amended by 
striking ``3-year'' and inserting ``3\1/2\-year''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect as if included in the enactment of the Omnibus Budget 
Reconciliation Act of 1990.

   TITLE II--MATERNAL AND CHILD HEALTH SERVICES BLOCK GRANT PROGRAM, 
         INCOME SECURITY, HUMAN RESOURCES, AND RELATED PROGRAMS

    SEC. 201. 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''.

            Subtitle A--Child Welfare, Foster Care, Adoption

    SEC. 202. REQUIRED PROTECTIONS FOR FOSTER CHILDREN.
    (a) In General.--Section 422(b) (42 U.S.C. 622(b)) is amended--
        (1) by striking ``and'' at the end of paragraph (7);
        (2) by striking the period at the end of paragraph (8) and 
    inserting ``; and''; and
        (3) by adding at the end the following:
        ``(9) provide assurances that the State--
            ``(A) since June 17, 1980, has completed an inventory of 
        all children who, before the inventory, had been in foster care 
        under the responsibility of the State for 6 months or more, 
        which determined--
                ``(i) the appropriateness of, and necessity for, the 
            foster care placement;
                ``(ii) whether the child could or should be returned to 
            the parents of the child or should be freed for adoption or 
            other permanent placement; and
                ``(iii) the services necessary to facilitate the return 
            of the child or the placement of the child for adoption or 
            legal guardianship;
            ``(B) is operating, to the satisfaction of the Secretary--
                ``(i) a statewide information system from which can be 
            readily determined the status, demographic characteristics, 
            location, and goals for the placement of every child who is 
            (or, within the immediately preceding 12 months, has been) 
            in foster care;
                ``(ii) a case review system (as defined in section 
            475(5)) for each child receiving foster care under the 
            supervision of the State;
                ``(iii) a service program designed to help children--

                    ``(I) where appropriate, return to families from 
                which they have been removed; or
                    ``(II) be placed for adoption, with a legal 
                guardian, or, if adoption or legal guardianship is 
                determined not to be appropriate for a child, in some 
                other planned, permanent living arrangement; and

                ``(iv) a preplacement preventive services program 
            designed to help children at risk of foster care placement 
            remain with their families; and
            ``(C)(i) has reviewed (or within 12 months after the date 
        of the enactment of this paragraph will review) State policies 
        and administrative and judicial procedures in effect for 
        children abandoned at or shortly after birth (including 
        policies and procedures providing for legal representation of 
        such children); and
            ``(ii) is implementing (or within 24 months after the date 
        of the enactment of this paragraph will implement) such 
        policies and procedures as the State determines, on the basis 
        of the review described in clause (i), to be necessary to 
        enable permanent decisions to be made expeditiously with 
        respect to the placement of such children.''.
    (b) Restriction on Reallotment.--Section 424 (42 U.S.C. 624) is 
amended--
        (1) in the first sentence, by striking ``The amount'' and 
    inserting the following:
    ``(a) In General.--Subject to subsection (b), the amount''; and
        (2) by adding at the end the following:
    ``(b) Exception Relating to Foster Child Protections.--The 
Secretary shall not reallot under subsection (a) of this section any 
amount that is withheld or recovered from a State due to the failure of 
the State to meet the requirements of section 422(b)(9).''.
    (c) Repeal.--Section 427 (42 U.S.C. 627) is hereby repealed.
    (d) Conforming Amendments.--
        (1) Section 423(a) (42 U.S.C. 623(a)) is amended by striking 
    ``and in section 427''.
        (2) Section 425(a)(2) (42 U.S.C. 625(a)(2)) is amended by 
    striking ``the statistical report required by section'' and 
    inserting ``section 422(b)(9) or''.
        (3) Section 472(d) (42 U.S.C. 672(d)) is amended by striking 
    ``427(b)'' and inserting ``422(b)(9)''.
    (e) Effective Date.--The amendments and repeal made by this section 
shall be effective with respect to fiscal years beginning on or after 
April 1, 1996.

SEC. 203. CONFORMITY REVIEWS.

    (a) In General.--Part A of title XI (42 U.S.C. 1301-1320b-13) is 
amended by inserting after section 1122 the following:


   ``REVIEWS OF CHILD AND FAMILY SERVICES PROGRAMS, AND OF FOSTER CARE 
   AND ADOPTION ASSISTANCE PROGRAMS, FOR CONFORMITY WITH STATE PLAN 
                              REQUIREMENTS

    ``Sec. 1123. (a) In General.--The Secretary, in consultation with 
the State agencies administering the State programs under parts B and E 
of title IV, shall promulgate regulations for the review of such 
programs to determine whether such programs are in substantial 
conformity with--
        ``(1) State plan requirements under such parts B and E,
        ``(2) implementing regulations promulgated by the Secretary, 
    and
        ``(3) the relevant approved State plans.
    ``(b) Elements of Review System.--The regulations referred to in 
subsection (a) shall--
        ``(1) specify the timetable for conformity reviews of State 
    programs, including--
            ``(A) an initial review of each State program;
            ``(B) a timely review of a State program following a review 
        in which such program was found not to be in substantial 
        conformity; and
            ``(C) less frequent reviews of State programs which have 
        been found to be in substantial conformity, but such 
        regulations shall permit the Secretary to reinstate more 
        frequent reviews based on information which indicates that a 
        State program may not be in conformity;
        ``(2) specify the requirements subject to review, and the 
    criteria to be used to measure conformity with such requirements 
    and to determine whether there is a substantial failure to so 
    conform;
        ``(3) specify the method to be used to determine the amount of 
    any Federal matching funds to be withheld (subject to paragraph 
    (4)) due to the State program's failure to so conform, which 
    ensures that--
            ``(A) such funds will not be withheld with respect to a 
        program, unless it is determined that the program fails 
        substantially to so conform;
            ``(B) such funds will not be withheld for a failure to so 
        conform resulting from the State's reliance upon and correct 
        use of formal written statements of Federal law or policy 
        provided to the State by the Secretary; and
            ``(C) the amount of such funds withheld is related to the 
        extent of the failure to so conform; and
        ``(4) require the Secretary, with respect to any State program 
    found to have failed substantially to so conform--
            ``(A) to afford the State an opportunity to adopt and 
        implement a corrective action plan, approved by the Secretary, 
        designed to end the failure to so conform;
            ``(B) to make technical assistance available to the State 
        to the extent feasible to enable the State to develop and 
        implement such a corrective action plan;
            ``(C) to suspend the withholding of any Federal matching 
        funds under this section while such a corrective action plan is 
        in effect; and
            ``(D) to rescind any such withholding if the failure to so 
        conform is ended by successful completion of such a corrective 
        action plan.
    ``(c) Provisions for Administrative and Judicial Review.--The 
regulations referred to in subsection (a) shall--
        ``(1) require the Secretary, not later than 10 days after a 
    final determination that a program of the State is not in 
    conformity, to notify the State of--
            ``(A) the basis for the determination; and
            ``(B) the amount of the Federal matching funds (if any) to 
        be withheld from the State;
        ``(2) afford the State an opportunity to appeal the 
    determination to the Departmental Appeals Board within 60 days 
    after receipt of the notice described in paragraph (1) (or, if 
    later, after failure to continue or to complete a corrective action 
    plan); and
        ``(3) afford the State an opportunity to obtain judicial review 
    of an adverse decision of the Board, within 60 days after the State 
    receives notice of the decision of the Board, by appeal to the 
    district court of the United States for the judicial district in 
    which the principal or headquarters office of the agency 
    responsible for administering the program is located.''.
    (b) Conforming Amendment.--Section 471(b) (42 U.S.C. 671(b)) is 
amended by striking all that follows the first sentence.
    (c) Effective Dates.--
        (1) In general.--The amendment made by subsection (a) shall 
    take effect on the date of the enactment of this Act.
        (2) Conforming amendment.--The amendment made by subsection (b) 
    shall take effect on October 1, 1995.
        (3) Regulations.--The Secretary shall promulgate the 
    regulations referred to in section 1123(a) of the Social Security 
    Act (as added by this section) not later than July 1, 1995, to take 
    effect on April 1, 1996.
    SEC. 204. STATES REQUIRED TO REPORT ON MEASURES TAKEN TO COMPLY 
      WITH THE INDIAN CHILD WELFARE ACT.
    (a) State Plan Requirement.--Section 422(b) (42 U.S.C. 622(b)), as 
amended by section 202(a), is amended--
        (1) by striking ``and'' at the end of paragraph (8);
        (2) by striking the period at the end of paragraph (9) and 
    inserting ``; and''; and
        (3) by adding at the end the following:
        ``(10) contain a description, developed after consultation with 
    tribal organizations (as defined in section 4 of the Indian Self-
    Determination and Education Assistance Act) in the State, of the 
    specific measures taken by the State to comply with the Indian 
    Child Welfare Act.''.
    (b) Effective Date.--The amendments made by subsection (a) shall be 
effective with respect to fiscal years beginning on or after October 1, 
1995.

SEC. 205. CHILD WELFARE TRAINEESHIPS.

    (a) In General.--Subpart 1 of part B of title IV (42 U.S.C. 620-
628) is amended by inserting after section 428 the following:


                       ``CHILD WELFARE TRAINEESHIPS

    ``Sec. 429. The Secretary may approve an application for a grant to 
a public or nonprofit institution for higher learning to provide 
traineeships with stipends under section 426(a)(1)(C) only if the 
application--
        ``(1) provides assurances that each individual who receives a 
    stipend with such traineeship (in this section referred to as a 
    `recipient') will enter into an agreement with the institution 
    under which the recipient agrees--
            ``(A) to participate in training at a public or private 
        nonprofit child welfare agency on a regular basis (as 
        determined by the Secretary) for the period of the traineeship;
            ``(B) to be employed for a period of years equivalent to 
        the period of the traineeship, in a public or private nonprofit 
        child welfare agency in any State, within a period of time 
        (determined by the Secretary in accordance with regulations) 
        after completing the postsecondary education for which the 
        traineeship was awarded;
            ``(C) to furnish to the institution and the Secretary 
        evidence of compliance with subparagraphs (A) and (B); and
            ``(D) if the recipient fails to comply with subparagraph 
        (A) or (B) and does not qualify for any exception to this 
        subparagraph which the Secretary may prescribe in regulations, 
        to repay to the Secretary all (or an appropriately prorated 
        part) of the amount of the stipend, plus interest, and, if 
        applicable, reasonable collection fees (in accordance with 
        regulations promulgated by the Secretary);
        ``(2) provides assurances that the institution will--
            ``(A) enter into agreements with child welfare agencies for 
        onsite training of recipients;
            ``(B) permit an individual who is employed in the field of 
        child welfare services to apply for a traineeship with a 
        stipend if the traineeship furthers the progress of the 
        individual toward the completion of degree requirements; and
            ``(C) develop and implement a system that, for the 3-year 
        period that begins on the date any recipient completes a child 
        welfare services program of study, tracks the employment record 
        of the recipient, for the purpose of determining the percentage 
        of recipients who secure employment in the field of child 
        welfare services and remain employed in the field.''.
    (b) Conforming Amendment.--Section 426(a)(1)(C) (42 U.S.C. 
626(a)(1)(C)) is amended by inserting ``described in section 429'' 
after ``including traineeships''.
    (c) Applicability.--The amendments made by this section shall apply 
to grants awarded on or after October 1, 1995.

SEC. 206. DISPOSITIONAL HEARING.

    (a) Most Appropriate Setting.--Section 475(5)(A) (42 U.S.C. 
675(5)(A)) is amended by inserting ``and most appropriate'' after 
``(most family like)''.
    (b) Timing of Subsequent Review.--Section 475(5)(C) (42 U.S.C. 
675(5)(C)) is amended by striking ``periodically'' and inserting ``not 
less frequently than every 12 months''.
    (c) Effective Date.--The amendments made by this section shall take 
effect on October 1, 1995.
    SEC. 207. ELIMINATION OF FOSTER CARE CEILINGS AND OF AUTHORITY TO 
      TRANSFER UNUSED FOSTER CARE FUNDS TO CHILD WELFARE SERVICES 
      PROGRAMS.
    (a) Repeal.--Subsections (b) and (c) of section 474 (42 U.S.C. 674 
(b) and (c)) are hereby repealed.
    (b) Conforming Amendments.--Section 474 (42 U.S.C. 674) is 
amended--
        (1) in subsection (d)(1)--
            (A) by striking ``subsections (a), (b), and (c)'' and 
        inserting ``subsection (a)''; and
            (B) by striking ``the provisions of such subsections'' and 
        inserting ``subsection (a)''; and
        (2) by redesignating subsections (d) and (e) as subsections (b) 
    and (c), respectively.
    (c) Effective Date.--The amendments and repeals made by this 
section shall apply to payments for calendar quarters beginning on or 
after October 1, 1993.

SEC. 208. DEMONSTRATION PROJECTS.

    Part A of title XI (42 U.S.C. 1301-1320b-13) is amended by 
inserting after section 1129 the following:


                         ``DEMONSTRATION PROJECTS

    ``Sec. 1130. (a) In General.--The Secretary may authorize not more 
than 10 States to conduct demonstration projects pursuant to this 
section which the Secretary finds are likely to promote the objectives 
of part B or E of title IV.
    ``(b) Waiver Authority.--The Secretary may waive compliance with 
any requirement of part B or E of title IV which (if applied) would 
prevent a State from carrying out a demonstration project under this 
section or prevent the State from effectively achieving the purpose of 
such a project, except that the Secretary may not waive--
        ``(1) any provision of section 427 (as in effect before April 
    1, 1996), section 422(b)(9) (as in effect after such date), or 
    section 479; or
        ``(2) any provision of such part E, to the extent that the 
    waiver would impair the entitlement of any qualified child or 
    family to benefits under a State plan approved under such part E.
    ``(c) Treatment as Program Expenditures.--For purposes of parts B 
and E of title IV, the Secretary shall consider the expenditures of any 
State to conduct a demonstration project under this section to be 
expenditures under subpart 1 or 2 of such part B, or under such part E, 
as the State may elect.
    ``(d) Duration of Demonstration.--A demonstration project under 
this section may be conducted for not more than 5 years.
    ``(e) Application.--Any State seeking to conduct a demonstration 
project under this section shall submit to the Secretary an 
application, in such form as the Secretary may require, which 
includes--
        ``(1) a description of the proposed project, the geographic 
    area in which the proposed project would be conducted, the children 
    or families who would be served by the proposed project, and the 
    services which would be provided by the proposed project (which 
    shall provide, where appropriate, for random assignment of children 
    and families to groups served under the project and to control 
    groups);
        ``(2) a statement of the period during which the proposed 
    project would be conducted;
        ``(3) a discussion of the benefits that are expected from the 
    proposed project (compared to a continuation of activities under 
    the approved plan or plans of the State);
        ``(4) an estimate of the costs or savings of the proposed 
    project;
        ``(5) a statement of program requirements for which waivers 
    would be needed to permit the proposed project to be conducted;
        ``(6) a description of the proposed evaluation design; and
        ``(7) such additional information as the Secretary may require.
    ``(f) Evaluations; Report.--Each State authorized to conduct a 
demonstration project under this section shall--
        ``(1) obtain an evaluation by an independent contractor of the 
    effectiveness of the project, using an evaluation design approved 
    by the Secretary which provides for--
            ``(A) comparison of methods of service delivery under the 
        project, and such methods under a State plan or plans, with 
        respect to efficiency, economy, and any other appropriate 
        measures of program management;
            ``(B) comparison of outcomes for children and families (and 
        groups of children and families) under the project, and such 
        outcomes under a State plan or plans, for purposes of assessing 
        the effectiveness of the project in achieving program goals; 
        and
            ``(C) any other information that the Secretary may require; 
        and
        ``(2) provide interim and final evaluation reports to the 
    Secretary, at such times and in such manner as the Secretary may 
    require.
    ``(g) Cost Neutrality.--The Secretary may not authorize a State to 
conduct a demonstration project under this section unless the Secretary 
determines that the total amount of Federal funds that will be expended 
under (or by reason of) the project over its approved term (or such 
portion thereof or other period as the Secretary may find appropriate) 
will not exceed the amount of such funds that would be expended by the 
State under the State plans approved under parts B and E of title IV if 
the project were not conducted.''.

SEC. 209. PLACEMENT ACCOUNTABILITY.

    (a) Case Plan Requirements.--Section 475(5)(A) (42 U.S.C. 
675(5)(A)) is amended by adding at the end the following: ``which--
                ``(i) if the child has been placed in a foster family 
            home or child-care institution a substantial distance from 
            the home of the parents of the child, or in a State 
            different from the State in which such home is located, 
            sets forth the reasons why such placement is in the best 
            interests of the child, and
                ``(ii) if the child has been placed in foster care 
            outside the State in which the home of the parents of the 
            child is located, requires that, periodically, but not less 
            frequently than every 12 months, a caseworker on the staff 
            of the State agency of the State in which the home of the 
            parents of the child is located, or of the State in which 
            the child has been placed, visit such child in such home or 
            institution and submit a report on such visit to the State 
            agency of the State in which the home of the parents of the 
            child is located,''.
    (b) Dispositional Hearing.--Section 475(5)(C) (42 U.S.C. 675(5)(C)) 
is amended by inserting ``and, in the case of a child described in 
subparagraph (A)(ii), whether the out-of-State placement continues to 
be appropriate and in the best interests of the child,'' after ``long-
term basis)''.
    (c) Data Collection.--Section 479(c)(3)(C) (42 U.S.C. 679(c)(3)(C)) 
is amended--
        (1) by striking ``and'' at the end of clause (i); and
        (2) by adding at the end the following:
                ``(iii) children placed in foster care outside the 
            State which has placement and care responsibility, and''.
    (d) Effective Date.--The amendments made by this section shall be 
effective with respect to fiscal years beginning on or after October 1, 
1995.
    SEC. 210. PAYMENTS OF STATE CLAIMS FOR FOSTER CARE AND ADOPTION 
      ASSISTANCE.
    (a) In General.--Section 474(b) (42 U.S.C. 674(b)), as redesignated 
by section 207(b)(2), is amended by adding at the end the following:
    ``(4)(A) Within 60 days after receipt of a State claim for 
expenditures pursuant to subsection (a), the Secretary shall allow, 
disallow, or defer such claim.
    ``(B) Within 15 days after a decision to defer such a State claim, 
the Secretary shall notify the State of the reasons for the deferral 
and of the additional information necessary to determine the 
allowability of the claim.
    ``(C) Within 90 days after receiving such necessary information (in 
readily reviewable form), the Secretary shall--
        ``(i) disallow the claim, if able to complete the review and 
    determine that the claim is not allowable, or
        ``(ii) in any other case, allow the claim, subject to 
    disallowance (as necessary)--
            ``(I) upon completion of the review, if it is determined 
        that the claim is not allowable; or
            ``(II) on the basis of findings of an audit or financial 
        management review.''.
    (b) Effective Date.--The amendment made by subsection (a) shall be 
effective with respect to claims made on or after the date of the 
enactment of this Act.

SEC. 211. EFFECT OF FAILURE TO CARRY OUT STATE PLAN.

    (a) In General.--Part A of title XI (42 U.S.C. 1301-1320b-13), as 
amended by section 208, is amended by inserting after section 1130 the 
following:


               ``EFFECT OF FAILURE TO CARRY OUT STATE PLAN

    ``Sec. 1130A. In an action brought to enforce a provision of the 
Social Security Act, such provision is not to be deemed unenforceable 
because of its inclusion in a section of the Act requiring a State plan 
or specifying the required contents of a State plan. This section is 
not intended to limit or expand the grounds for determining the 
availability of private actions to enforce State plan requirements 
other than by overturning any such grounds applied in Suter v. Artist 
M., 112 S. Ct. 1360 (1992), but not applied in prior Supreme Court 
decisions respecting such enforceability: Provided, however, That this 
section is not intended to alter the holding in Suter v. Artist M. that 
section 471(a)(15) of the Act is not enforceable in a private right of 
action.''.
    (b) Applicability.--The amendment made by subsection (a) shall 
apply to actions pending on the date of the enactment of this Act and 
to actions brought on or after such date of enactment.

                 Subtitle B--Child Support Enforcement

    SEC. 212. REPORTS TO CREDIT BUREAUS ON PERSONS DELINQUENT IN CHILD 
      SUPPORT PAYMENTS.
    (a) In General.--Section 466(a)(7) (42 U.S.C. 666(a)(7)) is 
amended--
        (1) by striking ``Procedures'' and all that follows through 
    ``request of such agency'' and inserting ``Procedures which require 
    the State to periodically report to consumer reporting agencies (as 
    defined in section 603(f) of the Fair Credit Reporting Act (15 
    U.S.C. 1681a(f))) the name of any parent who owes overdue support 
    and is at least 2 months delinquent in the payment of such support 
    and the amount of such delinquency''; and
        (2) by striking ``(C) a fee'' and all that follows through ``by 
    the State'' and inserting ``(C) such information shall not be made 
    available to (i) a consumer reporting agency which the State 
    determines does not have sufficient capability to systematically 
    and timely make accurate use of such information, or (ii) an entity 
    which has not furnished evidence satisfactory to the State that the 
    entity is a consumer reporting agency''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
take effect on October 1, 1995.
    SEC. 213. TECHNICAL AMENDMENTS TO PROVISION ON STATE PATERNITY 
      ESTABLISHMENT PROGRAMS.
    Section 452(g)(2)(A) (42 U.S.C. 652(g)(2)(A)), as amended by 
section 13721(a) of OBRA-1993, is amended--
        (1) in clause (i), by striking ``during the fiscal year'';
        (2) in subclause (I) of clause (ii), by striking ``as of the 
    end of the fiscal year'' and inserting ``in the fiscal year or, at 
    the option of the State, as of the end of such year'';
        (3) in subclause (II) of clause (ii), by striking ``or E as of 
    the end of the fiscal year'' and inserting ``in the fiscal year or, 
    at the option of the State, as of the end of such year'';
        (4) in clause (iii), by striking ``during the fiscal year''; 
    and
        (5) in the matter following clause (iii)--
            (A) by striking ``who were born out of wedlock during the 
        immediately preceding fiscal year'' and inserting ``born out of 
        wedlock'';
            (B) by striking ``such preceding fiscal year'' both places 
        it appears and inserting ``the preceding fiscal year''; and
            (C) by striking ``or E'' the second place it appears.
    SEC. 214. AGREEMENT TO ASSIST IN LOCATING MISSING CHILDREN UNDER 
      THE PARENT LOCATOR SERVICE.
    (a) In General.--Section 463 (42 U.S.C. 663) is amended by adding 
at the end the following new subsection:
    ``(f) The Secretary shall enter into an agreement with the Attorney 
General of the United States, under which the services of the Parent 
Locator Service established under section 453 shall be made available 
to the Office of Juvenile Justice and Delinquency Prevention upon its 
request to locate any parent or child on behalf of such Office for the 
purpose of--
        ``(1) enforcing any State or Federal law with respect to the 
    unlawful taking or restraint of a child, or
        ``(2) making or enforcing a child custody determination.
The Parent Locator Service shall charge no fees for services requested 
pursuant to this subsection.''.
    (b) Conforming Amendment.--Section 463(c) (42 U.S.C. 663(c)) is 
amended by striking ``(a), (b), or (e)'' and inserting ``(a), (b), (e), 
or (f)''.
    (c) Effective Date.--The amendments made by this section shall take 
effect on October 1, 1995.

                Subtitle C--Supplemental Security Income

    SEC. 221. DEFINITION OF DISABILITY FOR CHILDREN UNDER AGE 18 
      APPLIED TO ALL INDIVIDUALS UNDER AGE 18.
    (a) In General.--Section 1614(a)(3) (42 U.S.C. 1382c(a)(3)) is 
amended--
        (1) in subparagraphs (A) and (H), by striking ``a child'' each 
    place it appears and inserting ``an individual''; and
        (2) in subparagraph (H), by striking ``child'' the second and 
    third place it appears and inserting ``individual''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply to determinations made on or after the date of the enactment of 
this Act.

          Subtitle D--Aid to Families With Dependent Children

    SEC. 231. SIMPLIFICATION OF INCOME AND ELIGIBILITY VERIFICATION 
      SYSTEM.
    Paragraph (1)(A) of section 1137(d) (42 U.S.C. 1320b-7(d)) is 
amended to read as follows:
        ``(1)(A) The State shall require, as a condition of an 
    individual's eligibility for benefits under a program listed in 
    subsection (b), a declaration in writing, under penalty of 
    perjury--
            ``(i) by the individual,
            ``(ii) in the case in which eligibility for program 
        benefits is determined on a family or household basis, by any 
        adult member of such individual's family or household (as 
        applicable), or
            ``(iii) in the case of an individual born into a family or 
        household receiving benefits under such program, by any adult 
        member of such family or household no later than the next 
        redetermination of eligibility of such family or household 
        following the birth of such individual,
    stating whether the individual is a citizen or national of the 
    United States, and, if that individual is not a citizen or national 
    of the United States, that the individual is in a satisfactory 
    immigration status.''.
    SEC. 232. MEASUREMENT AND REPORTING OF WELFARE RECEIPT.
    (a) Congressional Policy.--The Congress hereby declares that--
        (1) it is the policy and responsibility of the Federal 
    Government to reduce the rate at which and the degree to which 
    families depend on income from welfare programs and the duration of 
    welfare receipt, consistent with other essential national goals;
        (2) it is the policy of the United States to strengthen 
    families, to ensure that children grow up in families that are 
    economically self-sufficient and that the life prospects of 
    children are improved, and to underscore the responsibility of 
    parents to support their children;
        (3) the Federal Government should help welfare recipients as 
    well as individuals at risk of welfare receipt to improve their 
    education and job skills, to obtain child care and other necessary 
    support services, and to take such other steps as may be necessary 
    to assist them to become financially independent; and
        (4) it is the purpose of this section to provide the public 
    with generally accepted measures of welfare receipt so that it can 
    track such receipt over time and determine whether progress is 
    being made in reducing the rate at which and, to the extent 
    feasible, the degree to which, families depend on income from 
    welfare programs and the duration of welfare receipt.
    (b) Development of Welfare Indicators and Predictors.--The 
Secretary of Health and Human Services (in this section referred to as 
the ``Secretary'') in consultation with the Secretary of Agriculture 
shall--
        (1) develop--
            (A) indicators of the rate at which and, to the extent 
        feasible, the degree to which, families depend on income from 
        welfare programs and the duration of welfare receipt; and
            (B) predictors of welfare receipt;
        (2) assess the data needed to report annually on the indicators 
    and predictors, including the ability of existing data collection 
    efforts to provide such data and any additional data collection 
    needs; and
        (3) not later than 2 years after the date of the enactment of 
    this section, provide an interim report containing conclusions 
    resulting from the development and assessment described in 
    paragraphs (1) and (2), to--
            (A) the Committee on Ways and Means of the House of 
        Representatives;
            (B) the Committee on Education and Labor of the House of 
        Representatives;
            (C) the Committee on Agriculture of the House of 
        Representatives;
            (D) the Committee on Energy and Commerce of the House of 
        Representatives;
            (E) the Committee on Finance of the Senate;
            (F) the Committee on Labor and Human Resources of the 
        Senate; and
            (G) the Committee on Agriculture, Nutrition, and Forestry 
        of the Senate.
    (c) Advisory Board on Welfare Indicators.--
        (1) Establishment.--There is established an Advisory Board on 
    Welfare Indicators (in this subsection referred to as the 
    ``Board'').
        (2) Composition.--The Board shall be composed of 12 members 
    with equal numbers to be appointed by the House of Representatives, 
    the Senate, and the President. The Board shall be composed of 
    experts in the fields of welfare research and welfare statistical 
    methodology, representatives of State and local welfare agencies, 
    and organizations concerned with welfare issues.
        (3) Vacancies.--Any vacancy occurring in the membership of the 
    Board shall be filled in the same manner as the original 
    appointment for the position being vacated. The vacancy shall not 
    affect the power of the remaining members to execute the duties of 
    the Board.
        (4) Duties.--Duties of the Board shall include--
            (A) providing advice and recommendations to the Secretary 
        on the development of indicators of the rate at which and, to 
        the extent feasible, the degree to which, families depend on 
        income from welfare programs and the duration of welfare 
        receipt; and
            (B) providing advice on the development and presentation of 
        annual reports required under subsection (d).
        (5) Travel expenses.--Members of the Board shall not be 
    compensated, but shall receive travel expenses, including per diem 
    in lieu of subsistence, at rates authorized for employees of 
    agencies under subchapter I of chapter 57 of title 5, United States 
    Code, for each day the member is engaged in the performance of 
    duties away from the home or regular place of business of the 
    member.
        (6) Detail of federal employees.--The Secretary shall detail, 
    without reimbursement, any of the personnel of the Department of 
    Health and Human Services to the Board to assist the Board in 
    carrying out its duties. Any detail shall not interrupt or 
    otherwise affect the civil service status or privileges of the 
    Federal employee.
        (7) Voluntary service.--Notwithstanding section 1342 of title 
    31, United States Code, the Board may accept the voluntary services 
    provided by a member of the Board.
        (8) Termination of board.--The Board shall be terminated at 
    such time as the Secretary determines the duties described in 
    paragraph (4) have been completed, but in any case prior to the 
    submission of the first report required under subsection (d).
    (d) Annual Welfare Indicators Report.--
        (1) Preparation.--The Secretary shall prepare annual reports on 
    welfare receipt in the United States.
        (2) Coverage.--The report shall include analysis of families 
    and individuals receiving assistance under means-tested benefit 
    programs, including the program of aid to families with dependent 
    children under part A of title IV of the Social Security Act (42 
    U.S.C. 601 et seq.), the food stamp program under the Food Stamp 
    Act of 1977 (7 U.S.C. 2011 et seq.), and the Supplemental Security 
    Income program under title XVI of the Social Security Act (42 
    U.S.C. 1381 et seq.), or as general assistance under programs 
    administered by State and local governments.
        (3) Contents.--Each report shall set forth for each of the 
    means-tested benefit programs described in paragraph (2)--
            (A) indicators of--
                (i) the rate at which and, to the extent feasible, the 
            degree to which, families depend on income from welfare 
            programs, and
                (ii) the duration of welfare receipt;
            (B) trends in indicators;
            (C) predictors of welfare receipt;
            (D) the causes of welfare receipt;
            (E) patterns of multiple program receipt;
            (F) such other information as the Secretary deems relevant; 
        and
            (G) such recommendations for legislation, which shall not 
        include proposals to reduce eligibility levels or impose 
        barriers to program access, as the Secretary may determine to 
        be necessary or desirable to reduce--
                (i) the rate at which and the degree to which families 
            depend on income from welfare programs, and
                (ii) the duration of welfare receipt.
        (4) Submission.--The Secretary shall submit such a report not 
    later than 3 years after the date of the enactment of this section 
    and annually thereafter, to the committees specified in subsection 
    (b)(3)(C). Each such report shall be transmitted during the first 
    60 days of each regular session of Congress.
    (e) Short Title.--This section may be cited as the ``Welfare 
Indicators Act of 1994''.

SEC. 233. NEW HOPE DEMONSTRATION PROJECT.

    (a) In General.--The Secretary of Health and Human Services (in 
this section referred to as the ``Secretary'') shall provide for a 
demonstration project for a qualified program to be conducted in 
Milwaukee, Wisconsin, in accordance with this section.
    (b) Payments.--For each calendar quarter in which there is a 
qualified program approved under this subsection, the Secretary shall 
pay to the operator of the qualified program, for no more than 20 
calendar quarters, an amount equal to the aggregate amount that would 
otherwise have been payable to the State with respect to participants 
in the program for such calendar quarter, in the absence of the 
program, for cash assistance and child care under part A of title IV of 
the Social Security Act, for medical assistance under title XIX of such 
Act, and for administrative expenses related to such assistance. The 
amount payable to the operator of the program under this section shall 
not include the costs of evaluating the effects of the program.
    (c) Demonstration Project Described.--For purposes of this section, 
the term ``qualified program'' means a program operated--
        (1) by The New Hope Project, Inc., a private, not-for-profit 
    corporation incorporated under the laws of the State of Wisconsin 
    (in this section referred to as the ``operator''), which offers 
    low-income residents of Milwaukee, Wisconsin, employment, wage 
    supplements, child care, health care, and counseling and training 
    for job retention or advancement; and
        (2) in accordance with an application submitted by the operator 
    of the program and approved by the Secretary based on the 
    Secretary's determination that the application satisfies the 
    requirements of subsection (d).
    (d) Contents of Application.--The operator of the qualified program 
shall provide, in its application to conduct a demonstration project 
for the program, that the following terms and conditions will be met:
        (1) The operator will develop and implement an evaluation plan 
    designed to provide valid and reliable information on the impact 
    and implementation of the program. The evaluation plan will include 
    adequately sized groups of project participants and control groups 
    assigned at random.
        (2) The operator will develop and implement a plan addressing 
    the services and assistance to be provided by the program, the 
    timing and determination of payments from the Secretary to the 
    operator of the program, and the roles and responsibilities of the 
    Secretary and the operator with respect to meeting the requirements 
    of this paragraph.
        (3) The operator will specify a reliable methodology for 
    determining expenditures to be paid to the operator by the 
    Secretary, with assistance from the Secretary in calculating the 
    amount that would otherwise have been payable to the State in the 
    absence of the program, pursuant to subsection (b).
        (4) The operator will issue an interim and final report on the 
    results of the evaluation described in paragraph (1) to the 
    Secretary at such times as required by the Secretary.
    (e) Effective Date.--This section shall take effect on the first 
day of the first calendar quarter that begins after the date of the 
enactment of this Act.
    SEC. 234. DELAY IN REQUIREMENT THAT OUTLYING AREAS OPERATE AN AFDC-
      UP PROGRAM.
    (a) In General.--Section 401(g)(2) of the Family Support Act of 
1988 (42 U.S.C. 602 note; 102 Stat. 2396) is amended by striking 
``October 1, 1992'' and inserting ``the date of the repeal of the 
limitations contained in section 1108(a) of the Social Security Act on 
payments to such jurisdictions for purposes of making maintenance 
payments under parts A and E of title IV of such Act''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect as if included in the provision of the Family Support Act 
of 1988 to which the amendment relates at the time such provision 
became law.
    SEC. 235. STATE OPTION TO USE RETROSPECTIVE BUDGETING WITHOUT 
      MONTHLY REPORTING.
    (a) In General.--Section 402(a)(13) (42 U.S.C. 602(a)(13)) is 
amended--
        (1) by striking all that precedes subparagraph (A) and 
    inserting the following:
        ``(13) provide, at the option of the State and with respect to 
    such category or categories as the State may select and identify in 
    the State plan, that--''; and
        (2) in each of subparagraphs (A) and (B), by striking ``, in 
    the case of families who are required to report monthly to the 
    State agency pursuant to paragraph (14)''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect on October 1, 1994, and shall apply to payments under part 
A of title IV of the Social Security Act for fiscal year 1994 and such 
payments for succeeding fiscal years.

                        Subtitle E--JOBS Program

SEC. 241. EXPANSION OF COVERAGE FOR INDIAN TRIBES.

    (a) In General.--Section 482(i)(2)(A) (42 U.S.C. 682(i)(2)(A)) is 
amended by striking ``members of such Indian tribe receiving aid to 
families with dependent children'' and inserting ``Indians receiving 
aid to families with dependent children who reside on the reservation 
or within the designated service area''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect on October 1, 1995.
    SEC. 242. REPORT TO THE CONGRESS WITH RESPECT TO PERFORMANCE 
      STANDARDS IN THE JOBS PROGRAM.
    Section 487(a) (42 U.S.C. 687(a)) is amended--
        (1) by striking ``3'' and inserting ``4'';
        (2) in paragraph (1), by inserting ``criteria for'' after 
    ``develop'';
        (3) in paragraph (2), by striking ``for'' and inserting ``with 
    respect to''; and
        (4) in the second sentence, by striking ``under this 
    subsection'' and inserting ``with respect to the program under this 
    part''.

                      Subtitle F--Other Provisions

    SEC. 261. EXTENSION OF DEMONSTRATION TO EXPAND JOB OPPORTUNITIES.
    (a) In General.--Section 505 of the Family Support Act of 1988 (42 
U.S.C. 1315 note; 102 Stat. 2404) is amended--
        (1) in subsection (e), by striking ``3-year period'' and 
    inserting ``6-year period'',
        (2) in subsection (f)(2), by striking ``January 1, 1993'' and 
    inserting ``January 1, 1995'', and
        (3) in subsection (g), by striking ``1991, and 1992'' and 
    inserting ``1991, 1992, 1993, 1994, 1995, and 1996''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
take effect on October 1, 1993.

SEC. 262. EARLY CHILDHOOD DEVELOPMENT PROJECTS.

    Section 501(a) of the Family Support Act of 1988 (42 U.S.C. 1315 
note; 102 Stat. 2400) is amended by adding at the end the following:
    ``(4) For grants to States to conduct demonstration projects under 
this subsection, there are authorized to be appropriated not to exceed 
$3,000,000 for each of the fiscal years 1995 through 1999.''.
    SEC. 263. REALLOCATION OF FUNDS UNDER TITLE XX FOR EMPOWERMENT AND 
      ENTERPRISE GRANTS.
    Section 2007 (42 U.S.C. 1397f), as added by section 13761 of OBRA-
1993, is amended--
        (1) by redesignating subsection (e) as subsection (f); and
        (2) by inserting after subsection (d) the following new 
    subsection:
    ``(e) Reallocation of Remaining Funds.--
        ``(1) Remitted amounts.--The amount specified in section 
    2003(c) for any fiscal year is hereby increased by the total of the 
    amounts remitted during the fiscal year pursuant to subsection (d) 
    of this section.
        ``(2) Amounts not paid to the states.--The amount specified in 
    section 2003(c) for fiscal year 1998 is hereby increased by the 
    amount made available for grants under this section that has not 
    been paid to any State by the end of fiscal year 1997.''.
    SEC. 264. CORRECTIONS RELATED TO THE INCOME SECURITY AND HUMAN 
      RESOURCES PROVISIONS OF OBRA-1990.
    (a) Amendment Related to Section 5035(a)(2).--Section 5035(a)(2) of 
OBRA-1990 is amended by striking ``a semicolon'' and inserting ```; 
and'''.
    (b) Amendment Related to Section 5040.--Section 1631(n) (42 U.S.C. 
1383(n)) is amended by striking ``subsection'' and inserting 
``section''.
    (c) Amendment Related to Section 5051(a).--Section 402(a)(14) (42 
U.S.C. 602(a)(14)) is amended to read as follows:
        ``(14) at the option of the State and with respect to such 
    category or categories as the State may select and identify in the 
    plan, provide that--
            ``(A) the State agency will require each family to which 
        the State provides (or, but for paragraph (22) or (32), would 
        provide) aid to families with dependent children, as a 
        condition to the continued receipt of such aid (or to 
        continuing to be deemed to be a recipient of such aid), to 
        report to the State agency monthly (or less frequently in the 
        case of such categories of recipients as the State may select) 
        on--
                ``(i) the income of the family, the composition of the 
            family, and other relevant circumstances during the prior 
            month; and
                ``(ii) the income and resources the family expects to 
            receive, or any changes in circumstances affecting 
            continued eligibility for, or amount of benefits, the 
            family expects to occur, in that month or in future months; 
            and
            ``(B) in addition to any action that may be appropriate 
        based on other reports or information received by the State 
        agency, the State agency will--
                ``(i) take prompt action to adjust the amount of 
            assistance payable, as may be appropriate, on the basis of 
            the information contained in the report (or upon the 
            failure of the family to submit a timely report); and
                ``(ii) give the family an appropriate explanatory 
            notice concurrent with any action taken under clause 
            (i);''.
    (d) Repeal of Provision Inadvertently Included.--Section 5057 of 
OBRA-1990, and the amendment made by such section, are hereby repealed, 
and section 1139(d) of the Social Security Act shall be applied and 
administered as if such section 5057 had never been enacted.
    (e) Amendment Related to Section 5105(a)(1)(B).--The second 
paragraph of section 1631(a) (42 U.S.C. 1383(a)) is amended by striking 
``(A)(i) Payments'' and inserting ``(2)(A)(i) Payments''.
    (f) Amendments Related to Section 5105(b).--Section 1631(a)(2)(C) 
(42 U.S.C. 1383(a)(2)(C)) is amended--
        (1) in clause (i), by striking ``to representative'' and 
    inserting ``to a representative'';
        (2) by striking clause (ii);
        (3) by redesignating clauses (iii), (iv), and (v) as clauses 
    (ii), (iii), and (iv), respectively; and
        (4) in clause (iv) (as so redesignated), by striking ``(iii), 
    and (iv)'' and inserting ``and (iii)''.
    (g) Amendments Related to Section 5107(a)(2)(B).--Section 
1631(c)(1)(B) (42 U.S.C. 1383(c)(1)(B)) is amended by striking 
``paragraph (1)'' each place such term appears and inserting 
``subparagraph (A)''.
    (h) Effective Date.--Each amendment made by this section shall take 
effect as if included in the provision of OBRA-1990 to which the 
amendment relates at the time such provision became law.
    SEC. 265. TECHNICAL CORRECTIONS RELATED TO THE HUMAN RESOURCE AND 
      INCOME SECURITY PROVISIONS OF OBRA-1989.
    (a) Amendment Relating to Section 8004(a).--Section 408(m)(2)(A) 
(42 U.S.C. 608(m)(2)(A)) is amended by striking ``a fiscal'' and 
inserting ``the fiscal''.
    (b) Amendment Relating to Section 8006(a).--Section 473(a)(6)(B) 
(42 U.S.C. 673(a)(6)(B)) is amended by striking ``474(a)(3)(B)'' and 
inserting ``474(a)(3)(C)''.
    (c) Amendment Relating to Section 8007(b)(3).--Subparagraph (D) of 
section 475(5) (42 U.S.C. 675(5)(D)) is amended by moving such 
subparagraph 2 ems to the right so that the left margin of such 
subparagraph is aligned with the left margin of subparagraph (C) of 
such section.
    (d) Effective Date.--Each amendment made by this section shall take 
effect as if the amendment had been included in the provision of OBRA-
1989 to which the amendment relates, at the time the provision became 
law.
    SEC. 266. TECHNICAL CORRECTION RELATED TO THE HUMAN RESOURCE AND 
      INCOME SECURITY PROVISIONS OF OBRA-1993.
    (a) Amendment Relating to Section 13713(a).--Section 473(a)(6)(B) 
(42 U.S.C. 673(a)(6)(B)) is amended by striking ``474(a)(3)(C)'' and 
inserting ``474(a)(3)(E)''.
    (b) Effective Date.--The amendment made by this section shall take 
effect as if the amendment had been included in the provision of OBRA-
1993 to which the amendment relates, at the time the provision became 
law.
    SEC. 267. ELIMINATION OF OBSOLETE PROVISIONS RELATING TO TREATMENT 
      OF THE EARNED INCOME TAX CREDIT.
    (a) Treatment of EITC as Earned Income.--Section 1612(a)(1) (42 
U.S.C. 1382a(a)(1)) is amended by striking subparagraph (C) and by 
redesignating subparagraphs (D) and (E) as subparagraphs (C) and (D), 
respectively.
    (b) Adjustment of Benefits Due to Treatment of EITC as Earned 
Income.--Section 1631(b) (42 U.S.C. 1383(b)) is amended by striking 
paragraph (3) and by redesignating paragraphs (4) and (5) as paragraphs 
(3) and (4), respectively.

SEC. 268. REDESIGNATION OF CERTAIN PROVISIONS.

    The first paragraph 6 of section 1631(e) (42 U.S.C. 1383(e)(6)) is 
amended by redesignating subparagraphs (1) and (2) as subparagraphs (A) 
and (B), respectively.







                               Speaker of the House of Representatives.







                            Vice President of the United States and    
                                               President of the Senate.